Joints and ligaments of the spine

Question 1

Type of joint formed by the intervertebral discs

Answer 1

Secondary cartilaginous

Question 2

Annulus fibrosis

Answer 2

Formed from layers of fibrocartilage. The posterior aspect is weak and poorly organised and hence prolapse is more likely to occur in this direction (into the vertebral foramen)

Question 3

Nucleus pulposus

Answer 3

Compression resistant. Keeps the annulus under constant pressure. Gel-like
GAG side chains of proteosulcans. Contains type II collagen and has a high water content.

Question 4

Change in the vertebral column from superior to inferior

Answer 4

1. Increase in size: Greater forces upon them. Provides greater stability
2. The intervertebral foramen increase in size inferiorly
3. Facet joints move from a horizontal to a vertical position - decreases range of movement but increases stabilty

Question 5

Intervertebral disc pathology: Degeneration

Answer 5

The nucleus pulposus becomes desiccated (less gel-like).
Annulus fibrosis becomes disorganised.
Disc height decreases

Question 6

Intervertebral disc pathology: Hernination/prolapse

Answer 6

The nucleus pulposus begins to push through the annulus fibrosus.

Question 7

Intervertebral disc pathology: Extrusion

Answer 7

The nucleus pulposus extrudes through the annulus fibrosis. The disc may then compress nerves within the vertebral foramen e.g. sciatic nerve L4-S3

Question 8

Facet/Zygapophyseal joints

Answer 8

Formed by the fusion of superior and inferior articular processes of adjacent vertebrae.
Innervated by branches of the dorsal (posterior) rami of spinal nerves.

Question 9

Ligaments of the vertebral column

Answer 9

Posterior and anterior longitudinal ligaments.
Supra- and Inter- spinous ligaments: Limit flexion, supraspinous also involved in multifidus muscle reflex arc.
Ligamentum Flavum: Assists in extension, resists separation during flexion

Question 10

Ligamentum nuchae

Answer 10

Supports the head. Resists flexion and aids return to the anatomical position.

Question 11

Exit of nerve roots: General rule

Answer 11

Nerve roots < C8 exit above the associated vertebra e.g. C3 nerve root exits between C2-C3.
Below C8 nerve roots exits below, e.g. T3 nerve roots exits between T3-T4. This is due to there being 8 cervical nerve roots but only 7 vertebra

Question 12

Number of vertebral bodies in the spinal column

Answer 12

33

Question 13

At what vertebral level does the spinal cord end in adults and children?

Answer 13

Adults: L1-L2
Children: L3

Question 14

Define Cauda Equina

Answer 14

Formed from ventral and dorsal rootlets.
Filum Terminale ‘tethers’ fibres to the coccyx
**Cauda Equina Syndrome results from compression. Saddle paraesthesia and incontinence = red flags

Question 15

What is the Conus medullaris?

Answer 15

It marks the end of the spinal cord

Question 16

What structures form the intervertebral foramen?

Answer 16

Superior and inferior vertebral notches of adjacent vertebrae.

Question 17

Name the layers of the meninges and their order

Answer 17

Pia, Arachnoid (avascular), Dura Mater(interior to exterior)

Question 18

Name the spaces between the layers of the meninges

Answer 18

Pia –> Arachnoid: Subarachnoid space (contains CSF)

Arachnoid –> Dura: Subdural space

Question 19

Describe the surface markings used to perform a Lumbar puncture

Answer 19

Patient position: Patient on side with knees raised to chest, allowing full spinal flexion.
Surface markings: Posterior iliac crest marks L4 spinous process.
Performed between L3-L4 or L4-L5

Question 20

Name the structures passed through during lumbar puncture.

Answer 20

Skin, fascia, muscles of the back, supraspinous ligament, interspinous ligament, ligamentum flavum, Dura mater, arachnoid mater, subarachnoid space ***here is CSF for sampling