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Year 2 LCRS > HNS Anatomy 2 - Spinal Cord > Flashcards

HNS Anatomy 2 - Spinal Cord Flashcards

1
Q

List the functions of the vertebral column

A

Support and protection

  • Body weight
  • Transmits forces
  • Supports the head
  • Supports the upper limbs (and aids movement)
  • Spinal cord (protective role)

Movement

  • Upper limbs and ribs (extrinsic muscles, which go outside of the vertebral column)
  • Postural control and movement (intrinsic muscles which remain inside the vertebral column)
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2
Q

List the curvatures of the vertebral column present in a normal adult

A
  • Cervical (secondary)
  • Thoracic (primary)
  • Lumbar (secondary)
  • Sacral (primary)
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3
Q

What is the function of the vertebral body?

A

It is the major weight bearing part

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4
Q

List the functions of the vertebral arch

A
  • Forms the roof of the vertebral canal
  • Has projections for attachment of muscles and ligaments
  • Has sites of articulation for adjacent vertebrae
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5
Q

What is the function of the pedicles?

A

Anchor the vertebral arch to the vertebral body

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6
Q

List the typical features of cervical vertebrae

A
  • Vertebral body (bean shape) is short in height and square shaped when viewed from above, with a concave superior surface and convex inferior surface
  • Each transverse process is trough shaped perforated by a round foramen transversarium
  • Short and bifid spinous process with a triangular vertebral foramen
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7
Q

List the typical features of the axis and atlas

A
  • No intervertebral disc between the two - as the vertebral body of C1 forms the dens of C2
  • C1 lacks a vertebral body
  • Atlas is ring shaped with two lateral masses interconnected by an anterior and posterior arch
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8
Q

List the typical features of the thoracic vertebrae

A
  • Characterised by their articulation with ribs, typically 2 partial facets (superior and inferior) on each side of the vertebral body.
  • Superior costal facet is much larger than inferior
  • Transverse processes have facets for articulation with the tubercle of each rib
  • Vertebral body is heart shaped
  • Vertebral foramen is circular
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9
Q

List the characteristics of lumbar vertebrae

A
  • Large size
  • Lack facets for rib articulation
  • Long and thin transverse processes (except L5 which are massive and cone shaped)
  • Vertebral body is cylindrical (kidney shaped)
  • Vertebral foramen is triangular, larger than thoracic
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10
Q

List the characteristics of the sacrum

A
  • Triangluar shape, apex inferiorly projecting
  • Curved with a concave anterior surface
  • Articulates with L5 and the coccyx
  • Two large L shaped facets for articulation with the pelvic bones
  • 4 pairs of sacral foramina on the anterior surface and posterior surface
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11
Q

List the characteristics of the coccyx

A
  • Small triangular bone, represents 3-4 fused coccygeal vertebrae
  • Small size and absence of vertebral arches and therefore vertebral canal
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12
Q

Describe the structure of intervertebral discs

A
  • Anulus fibrosis outside

- Nucleus pulposis inside

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13
Q

List the movements of the spine and the muscles involved

A
  • Extension (lean back - erector spinae)
  • Flexion (rectus abdominis/psoas major)
  • Lateral flexion (leaning side to side - oblique muscles, rhomboid, serratus anterior)
  • Rotation - oblique muscles, sternocleidomastoid, erector spinae
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14
Q

List the common spinal pathologies

A
  • Low back pain
  • Prolapsed intervertebral disc (sciatica)
  • Spondolysis (degeneration)
  • Spondylolysis (stress fracture of pars interarticularis)
  • Spondylolisthesis (forward displacement of vertebra)
  • Spondylitis (inflammation of vertebrae)
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15
Q

List the abnormal curvatures of the spine

A
  • Excessive kyposis, often seen in older people - can be normal (cervical curve)
  • Excessive lordosis - can be normal or exaggerated (lumbar curve)
  • Scoliosis, more common in females during puberty (lateral curve)
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16
Q

Describe the development of the curvatures

A
  • Primary curvatures have concave side facing anteriorly (these are the same as in a foetus)
  • Secondary curvatures have a convex side facing posteriorly (develop through age)
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17
Q

When is the lumbar curvature enhanced?

A
  • In obesity
  • In pregnancy
  • To move the centre of gravity backwards
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18
Q

Why are the intervertebral discs important?

A
  • They help to bear weight

- They allow rotation of the spine

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19
Q

Where are the alar ligaments?

A

From the skull to the odontoid peg

20
Q

Why is the atlantooccipital joint called the yes joint?

A

Because this joint allows us to nod our heads (flexion and extension)

21
Q

Why is the atlantoaxial joint called the no joint?

A

This joint allows us to shake our head (rotation)

22
Q

What is an important risk of the intervertebral discs reducing in height?

A
  • The intervertebral foramen becoming smaller

- This crushes the nerves emerging from the foramen, and can result in pain

23
Q

What is the cauda equina?

A
  • The bundle of nerves making their way down from the spinal cord, which ends at L2, to the lower vertebrae.
  • Here injections are placed for anaesthetic/epidural
24
Q

What is a prolapsed intervertebral disc?

A
  • The nucleus pulposis herniates into the vertebral canal, which results in nerve impingement, pain and sciatica (pain radiating down the leg)
  • More likely further down the spine as there is more weight being transmitted
25
Q

Describe the range of motion of the cervical spine

A
  • Rotation (L/R 80 degrees)
  • Extension and flexion (45 degrees)
  • Right and left lateral flexion (45 degrees)
26
Q

Describe the range of motion of the thoracolumbar spine

A
  • Extension (30 degrees)
  • Flexion (90 degrees)
  • Lateral flexion (30 degrees)
  • Rotation (L/R 30 degrees)
27
Q

Where do the different layers of the meninges end in the spinal cord?

A
  • Pia mater ends with the spinal cord (L2) at the filum terminale, which extends down from the base of the spinal cord alongside the cauda equina
  • Arachnoid and dura mater extend down to the level of S2 vertebra, so there is a large epidural space
28
Q

When are needles inserted to the epidural space via the sacral hiatus?

A
  • In patients with severe sciatica, anaesthetics and analgesics are administered.
  • This can reduce inflammation and reduce need for disc surgery.
29
Q

Compare the location of epidural and spinal anaesthetics

A
  • Epidural in the epidural space (used for the duration of labour, over many hours)
  • Spinal in the subarachnoid space (used for a procedure of known length, such as C-section/ hip replacement, if someone is not fit for general anaesthetic)
30
Q

What is the conus medullaris?

A

The tapered lower end of the spinal cord

31
Q

Where is the nuchal ligament?

A

At the back of the neck, continuous with the supraspinous ligament

32
Q

Which ligament is most likely to be damaged in whiplash?

A

Anterior longitudinal ligament

33
Q

List the functions of the trapezius muscle

A
  • Elevates and depresses the scapula
  • Rotates the arm
  • Retracts the scapula
34
Q

List the functions of the rhomboid major and minor muscles

A
  • Depress the scapula

- Retracts the scapula

35
Q

Where does prostate cancer commonly metastasise to?

A

The vertebral body, which can result in compressed spinal cord

36
Q

List the muscles making up the erector spinae

A
  • Illiocostalis
  • Longissimus
  • Spinalis
    (I like standing) - lateral to medial
37
Q

Compare the dura in the brain and in the spinal cord

A
  • In the brain, there are two layers - meningeal and periosteal
  • In the spinal cord there is only the meningeal layer
38
Q

Describe what is looked at initially in a spinal examination

A
  • Look at curvatures
  • Wide stance suggests stenosis
  • Look for asymmetry (shoulder blades and pelvis)
39
Q

Describe the assessment of the cervical spine

A
  • Split into two (upper and lower)
  • Look for musclar atrophy (or increased tone) or asymmetry in the shoulders and upper limbs
  • Look at movements - flexion (head moved forwards), extension (head moved backwards), lateral flexion, and rotation of the head
  • Protraction and retraction of the head can also be looked at
  • C7 is the first vertebra you can see and feel
  • C1 and 2 rotation is used and the transverse processes are held
  • Look for associated movement in the thoracic spine
40
Q

Describe the process of a thoracic spine examination

A
  • Patient sits down, places their hands on the opposite shoulder and moves forwards (flexion)
  • Extension - patients puts their hands on neck and leans backwards
  • Patient puts hands on the same shoulder and rotates either side
  • To look at pain, do a percussion test (palpate the spinous process and tap, see if the patient feels pain to detect a vertebral compression fracture)
41
Q

Describe the assessment of the lumbar spine

A
  • Look for lordosis
  • Flexion (run hands down thighs as far as you can), Extension (run hands down back of legs)
  • Look at where movement takes place
  • Latriflex their hand down the side of each leg
  • Palpation is used to identify pain (use iliac crest for L4 level) use a thumb and gentle compression
42
Q

Describe the assessment of the sacro-iliac joint

A
  • Compression test (hold and compress the iliac crest)
  • To compress the sacro-iliac joint push the iliac crests outwards
  • Gaenslen test - drop one leg off the table and then push the other knee towards the chest
  • Thigh thrust test - press down on the knee through the thigh
  • Roll onto their tummy and push the sacrum down
  • 3/5 tests increases likelihood of pain arising from sacro-iliac joint by 50%
43
Q

Describe the process of assessing spinal posture

A

Ask them to lift their chest and bring into a neutral posture

44
Q

Describe the neural assessment of the spine in the upper limbs

A
  • Reflexes (brachial, pectoralradialis, triceps, c7 (thumb flexion is hoffmans reflex)
  • Look at myotomes - pressure into your hand, shrug shouler, adduct the arm and maintain pressure, flex arm, bring their thumb up, extend the wrist, grip the hand
  • Sensation - light touch along the arm and pinprick
45
Q

When is neural assessment of the spine undertaken?

A
  • Spinal fracture
  • Cervical myelopathy
  • Assess the neural integrity - reflexes, myotomes and dermotomes
46
Q

Describe the neural assessment of the spinal cord in the legs

A
  • Reflexes - hyporeflexia/hyper (knee, ankle)
  • Push foot upwards, flex toes against opposing pressure
  • Up and down 3 times when standing on one foot
  • Sensation (sweep a hand along the dermatomes) and then pinprick
  • Look for fanning of the toes and big toe extension as well as beating on the foot
  • Straight leg raise and dorsiflex the foot.
  • Crossed over straight leg raise (when disc prolapse occurs)
  • Thrust test (flex head and straighten leg)

Year 2 LCRS (128 decks)

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