L5 - MSK Back Angiology and Neurology Flashcards
Vertebral A.
travels superiorly in the Transverse Foramina of the Cervical Vertebrae C6-1,
exits the Transverse Foramen of the Atlas, crosses over the Posterior Arch of the Atlas, where it is visible in the floor of the Suboccipital Triangle,
sends a branch anteriorly to meet with a similar contralateral branch to form the Anterior Spinal A. and a branch posteriorly, the Posterior Spinal A.,
the Vertebral A. then enters the Posterior Cranial Fossa through the Foramen Magnum and meets up with the contralateral Vertebral A. to form the Basilar A. Produces Paraspinal As.
Subclavian A.
- Inferior Thyroid A.
- Vertebral A.
- Thyrocervical Trunck
- Internal Thoracic A.
- Ascending Cervical A.
- Transverse Cerical A.
- Supra-scapular A.
- Dorsal Scapula A.
Brachiocephalic Trunk
a.
b.
a. Right Subclavian A. (see Left Subclavian A.)
b. Right Common Carotid A.
Anterior Spinal A.
formed by two branches from each Vertebral A. that unite in the midline, travels inferiorly in the Anterior Median Fissure, produces Sulcal As., and is additionally supplied by Anterior Segmental Medullary As. along the length of the Spinal Cord
Posterior Spinal A.
*paired arteries from the Vertebral A.
Travel inferiorly along the Spinal Cord, may arise from the Posterior Inferior Cerebellar A.,
The Posterior Spinal As. are additionally supplied by Posterior Segmental Medullary As. along the length of the Spinal Cord
Transverse Cervical A.
travels posteriorly across the Neck
where it variably branches into a Deep and Superficial Branch
if no branching occurs it travels to the deep surface of the Trapezius M.
* Subclavian A.
Dorsal Scapular A.
Variably arises from the 3rd part of the Subclavian A.
Travels superior to the Scapula then along the medial Border of the Scapula supplying the Levator Scapulae and Rhomboid Ms.
If this vessel arises from the Transverse Cervical A. it is known as the Deep Branch of the Transverse Cervical A.
Subscapular A.
* Largest, yet shortest branch of the Axillary A.
After its origin is quickly terminates into its two terminal branches:
- Circumflex Scapular A.
(see Upper Extremity)
- Thoracodorsal A.
(continues in the direction of the Subscapular A., supplies the Latissimus Dorsi M.)
Thoracodorsal A.
continues in the direction of the Subscapular A., supplies the Latissimus Dorsi M.
Thoracic Descending Aorta
- Posterior Intercostal A.
- Subcostal A.
Abdominal Descending Aorta
- Common Iliac A.
- Lumbar A.
Posterior Spinal A.
paired arteries from the Vertebral A., travel inferiorly along the Spinal Cord, may arise from the Posterior Inferior Cerebellar A., the Posterior Spinal As. are additionally supplied by Posterior Segmental Medullary As. along the length of the Spinal Cord)
Dorsal Branch
travels with the Posterior Ramus of the Spinal Nerve, supplies the Spinous Processes with Periosteal and Nutrient branches
Posterior Segmental Medullary A.
occur sporadically near the Cervical and Lumbosacral Enlargements of the Spinal Cord in place of Radicular As., feed directly into the Posterior Spinal As.
Anterior Segmental Medullary A.
occur sporadically near the Cervical and Lumbosacral Enlargements of the Spinal Cord in place of Radicular As.
feed directly into the Anterior Spinal A.
Spinal Branch
Occur at every Thoracic level of the Vertebral Column
Travel through the Intervertebral Foramen and produce Anterior and Posterior Vertebral Canal Branches
Also produce Anterior and Posterior Radicular As. or Anterior and Posterior Segmental Medullary As.
Anterior Spinal A.
Formed by two branches from each Vertebral A. that unite in the midline
Travels inferiorly in the Anterior Median Fissure, produces Sulcal As.,
The Anterior Spinal A. is additionally supplied by Anterior Segmental Medullary As. along the length of the Spinal Cord
Periosteal Branch
occur at every level of the Vertebral Column, supply the Periostium of the Vertebrae
Equitorial Branch
occur at every level of the Vertebral Column, supply the Vertebrae
Anterior Vertebral Canal Branch
Produce ascending and descending branches that communicate with other Anterior Vertebral Canal Branches, also produce Nutrient As.
Anterior Radicular A.
Occur at every level a Spinal Branch exists
Unless replaced by a larger Anterior Segmental Medullary A.
Supplies the Ventral Roots of the Spinal Nerves
Posterior Radicular A.
Occur at every level a Spinal Branch exists
Unless replaced by a larger Posterior Segmental Medullary A.
Supplies the Dorsal Roots of Spinal N.
Posterior Vertebral Canal Branch
Supply the Vertebral Arch
Paraspinal Arterial Source (8)
- Vertebral Artery
- Ascending Cervical A.
- Deep Cervical A.
- Posterior Intercostal A.
- Subcostal A.
- Lumbar A.
- Iliolumbar A.
- Lateral Sacral A.
of Cervical Spinal Nerves
8
even though only have 7 cervical vertebrae
In what area(s) are the spinal nerves larger and why?
In the cervical and lumbar regions
So can operate limbs (arms and legs)
What is in the Subarachnoid Space?
Cerebral Spinal Fluid (CSF)
What is the Denticulate L. made out of?
Pia Mater
What space in the Spinal Meninges do you want to be minimal / not a real space?
Dura-Arachnoid Interface
- Do not want is to be an actual space
- When it is = bad
What is the tapered end of the spinal cord called?
Medullary Cone
What are the (non-nerve) Pia Mater strings that come down from the spinal cord called?
Filum Terminale Internum
What changes at the end of the Lumbar Cistern?
What is the new name?
A layer of Dura Mater is added
Filum Terminale Internum becomes Filum Terminale Externum
What are the nerve rootlets called at the end of the spinal cord?
Cauda Equina
What is the area between the dura mater and the vertebral wall, and what occupies it?
Epidural Space
Occupied by:
- Internal Vertebral Venous Plexus
- Epidural Fat
What is the outermost tough covering of the Spinal Cord and Spinal Roots?
Spinal Dura Mater
What is the potential space, with no natural space, that is often erroneously called the Subdural Space?
Dura-Arachnoid Interface
What is the laterally tapering extension of Spinal Dura Mater that surround the Anterior and Posterior Roots?
Dural Root Sheath
What is the long tube-shaped sheath surrounding the Spinal Cord lining the Vertebral Canal?
Spinal Dural Sac
What is the thin membranous intermediate layer that lines the Spinal Dural Sac and what holds it in place?
The Spinal Arachnoid Mater, which is held firmly to the Dural Sac by pressure of the cerebrospinal fluid which circulates in the Subarachnoid Space.
What is the cerebrospinal fluid filled space between the arachnoid and pia mater?
Subarchnoid Space
What is the enlargement of the Subarachnoid Space inferior to the Conus Medullaris and what does it contain?
The Lumbar Cistern, and it contains the Cauda Equina.
What is the thinnest innermost covering of the spinal cord?
Does it follow the entire surface of the spinal cord? and Spinal roots?
Pia Mater
Yes, Yes
What is the lateral extension of fibrous Pia Mater at regular intervels between the Spinal Roots?
What do they attach to?
What do they suspend?
Denticulate L.
Attach to the Dural Sac
To suspend the Spinal Cord in the Dural Sac
What is the inferior continuation of Pia Mater inferior to the Conus Medullaris?
Where does it pick up a layer of Dura Mater?
What does it become then?
Filum Terminale Internum
Picks up Dura Mater inferior to the Dural Sac
Becomes Filum Terminale Externum
Spinal Cord Injury
What occurs when Complete Transection of the Spinal Cord occurs?
What occurs with each level?
C1-C3:
C4-C5:
C6-C8:
T1-T9:
T10-L1:
L2-3:
CN: Spinal Cord injury can be the result of a number of disease states and traumas.
Complete transection of the Spinal Cord results in a loss of sensation and motor function below the lesion. Transection at different levels will result in different loss of function:
C1-C3 (no function below the Head, respirator necessary for life),
C4-5 (no function of Limbs, respiration capable),
C6-C8 (loss of hand and variable upper limb function,. May be able to propel a wheelchair),
T1-9 (paralysis of both lower limbs),
T10-L1 (some thigh muscle function, may allow walking with long leg braces),
L2-3 (most lower limb functions present, may be able to walk with short leg braces).
What area of the Vertebral Canal does the Spinal Cord occupy?
From what to what?
The upper 2/3 of the V. Canal
From Medulla Oblongata to Conus Medullaris
Where is a lumbar puncture inserted?
Why?
What layer “pops”?
CN: Lumbar Puncture: A lumbar puncture or spinal tap is an important diagnostic procedure for evaluating a variety of central nervous system disorders.
A needle is inserted between either the L3/L4 vertebrae or L4/L5 vertebrae at the level of the iliac crests.
This level is typically chosen to avoid the needle injuring the spinal cord. Spinal cord tapers off here.
As the needle passes through the ligamentum flavum it “pops” and passes into the lumbar cistern deep to the spinal dura and arachnoid mater. Cerebrospinal fluid can then be draw out and evaluated.
What is Cervical Enlargement and where does it occur?
Swelling of the Spinal Cord that corresponds with the Brachial Plexus and Upper Extremity
C4-T1
What is Lumbosacral Enlargement and where does it occur?
Swelling of the Spinal Cord that corresponds with the Lumbar and Sacral Plexuses and Lower Extremity
T11 - S1
What part of the spinal cord produces Spinal Rootlets?
Spinal Cord Segment
What are the central projections from neuronal cell bodies in the Anterior Horn of the Spinal Cord?
What do they converge with?
What do they form?
Where are they located?
Anterior Root
Converge with Posterior Root
Form Spinal Nerve
At each Spinal Cord Segment
What are the small fibers originating from the Spinal Cord?
What do they converge to form?
Where are they located?
Anterior and Posterior Rootlets
Converge to form a single Anterior/Posterior Root
At each Spinal Cord Segment
What are the central projectiong from neuronal cell bodies in the Spinal Ganglion?
What to they converge to form?
Where are they located?
Posterior Root
Converge with Anterior Root
Form Spinal Nerve
At each Spinal Cord Segment
What is a collection of Sensory nerve cell bodies associated with the Posterior Root?
Spinal Ganglion
How are there 8 cervical spinal nerves but only 7 cervical vertebrae?
The C1 Spinal Nerve exits the Vertebral Column above C1.
Then C2 Spinal nerve exits below C1 (between C1 and C2), and so on.
What allows for the union of Anterior and Posterior Roots and very quickly branches into Anterior and Posterior Rami?
Roots –> ? –> Rami
Spinal Nerves
*VERY short
What is the second most common reason people visit a physician?
What five categories of structures?
What are they innervated by?
What is the most common?
And what are the most common a result of?
CN: Back pain is the second most common reason people visit a physician, unfortunately the anatomical basis for this pain is rarely described.
There are five categories of structures innervated by the Recurrent Meningeal N. and Posterior Rami of Spinal Nerves:
Fibroskeletal Structures (Periostium and Ligaments) and Meninges innervated by Recurrent Meningeal Ns.
Synovial Joints, Intrinsic Back Muscles and Spinal Nerves and Nerve Roots innervated by the Posterior Rami.
Of these five the most common are muscular, joint and Fibroskeletal pain.
- Muscular pain is often the result of spasm in muscular tissue producing ischemia.
- Joint pain is usually the result of osteoarthritis or disease arthritis
- Fibroskeletal pain is usually a result of fractures and dislocation of ligamentous structures.
What are the Anterior Rami of the Cervical Spinal Nerves? And what region do they run?
1.
2.
3.
- Cervical Plexus (C1 - 4)
- Brachial Plexus (C5-T1)
- Recurrent Meningeal Branch (sensory and Sympathetic fivers to the Dura Mater)
What are the Posterior Rami of the Cervical Spine?
1.
2.
3.
4.
a.
b.
- Suboccipital N.
- Greater Occipital N.
- Least Occipital N.
- C4-C8: cutaneous and muscular innervation
- Medial Branch: muscular, articular, cutaneous branches
- Lateral Branch: muscular, cutaneous branches
What is the Posterior Ramus of C1?
What does it innervate?
Where does it travel?
Suboccipital N.
Innervated Suboccipital musculature
Travels through Suboccipital Triangle
What is the Posterior Ramus of C2?
Where does it run?
Where does it appear?
Great Occipital N.
Cutaneous to posterior Scalp
Appears below the Suboccipital Triangle traveling superiorly
What is the Posterior Ramus of C3?
What does it innervate?
Least Occipital N.
Cutaneous and Muscular Innervation
What goes to Transversospinalis muscles? And what part of the Cervical Posterior Rami is it a part of?
Muscular Branches
Part of Medial Branch
C4-C8
What do the Articular Branches of the Medial Branch of Cervical Posterior Rami go to?
Zygopophyseal Joints
What Posterior Rami innervate Skin of Dermatome?
Cutaneous Branches of Medial Branch and Lateral Branch of Cervical Posterior Rami
C4-C8
What Cervical Posterior Rami innervate the Erector Spinae and Splenius muscles?
Muscular branches of Lateral Branch of C4-C8
What is the distal cone shaped terminal end of the Spinal Cord?
When does it begin and end?
Medullary Cone / Conus Medullaris
Begins tapering off at T12 and ends at L2
What is the bundle of Anterior and Posterior Roots from the Lumbosacral Enlargement and Medullary Cone?
What does it occupy?
Where does it begin?
Cauda Equina
Occupied Vertebral Canal inside Lumbar Cistern
From Medullary Cone inferiorly
What are the Anterior Rami of the Thoracic Spinal Nerves?
- a,b
2.
3.
4.
- Atypical Intercostal N.
(T1 and 2, 7 – 11)
a. T 1,2 : send branches to the Brachial Plexus
b. T7-11 : become Thoracoabdominal N. as they travel over the Abdomen
2. Typical Intercostal N.
(T3-6)
- Subcostal N.
(T12)
- Recurrent Meningeal Branches
Sensory and Sympathetic fibers to the Dura Mater
Posterior Rami of the Thoracic Spinal Nerves
- a,b,c
- a,b
- Medial Branch
A. Muscular Branch
(to transversospinalis muscles and Longissimus Thoracis muscle)
B. Articular branch
(to the Zygopophyseal Joint)
C. Cutaneous Branch
(to Skin of Dermatome)
- Lateral Branch
A. Muscular Branch
(to Erector Spinae muscles)
B. Cutaneous Branch
(to Skin of Dermatome)
Anterior Rami of Lumbar Spinal Nerves
Anterior Rami
i. Lumbar Plexus (L1-4)
ii. Lumbosacral Trunk (some of L4 and all of L5, travels inferiorly to join with the Sacral Plexus)
iii. Recurrent Meningeal Branches (sensory and Sympathetic fibers to the Dura Mater)
Posterior Rami of Lumbar Spinal Nerves
- Medial Branch
A. Muscular Branch (to Transversospinalis, Interspinalis and Intertransversarii muscles)
B. Articular branch (to the Zygopophyseal Joint)
C. Cutaneous Branch (to Skin of Dermatome)
- Lateral Branch
A. Muscular Branch (to Erector Spinae muscles)
B. Cutaneous Branch (to Skin of Dermatome)
C. Superior Cluneal N. (Lateral Branch of the Posterior Rami of L1-3)
Anterior Rami of Sacral Spinal Nerves
- Sacral Plexus (L4-S4)
- Coccygeal Plexus (some of S4 and all of S5)
- Recurrent Meningeal Branches (sensory and Sympathetic fibers to the Dura Mater)
Posterior Rami of Sacral Spinal Nerves
i. Medial Branch
ii. Lateral Branch
A. Middle Cluneal N. (Lateral Branch of Posterior Rami of S1-3)
- Epidural Space
- Dura Mater
- Dura-Arachnoid Interface
- Subarachnoid Space
- Denticulate L.
- Dural Root Sheath
- Arachnoid Mater
- Pia Mater
- Arachnoid Trabeculae
1?
Vertebral A.
2?
Ascending Cervical A.
3?
Deep Cervical A.
4?
Posterior Intercostal A.
5?
Subcostal A.
6?
Lumbar A.
7?
Iliolumbar A.
8?
Lateral Sacral A.
1?
2?
8?
- External Vertebral Venous Plexus
- Internal Vertebral Venous Plexus
- External Vertebral Plexus
3?
4?
- Posterior Radicular V.
- Posterior Medullary V.
5?
- Intervertebral V.
6?
7?
- Anterior Medullary V.
- Anterior Radicular V.
Spinal Dura Sac
1.
2.
3.
4.
5.
Spinal Meninges
- Medullary Cone
- Lumbar Cistern
- Filum Terminale Interum
- Filum Terminale Externum
- Cauda Equina
1
2
3
- Denticulate L.
- Dura Mater
- Pia Mater
4.
5.
6.
- Arachnoid Mater
- Dura Root Sheath
- Arachnoid Trabeculae
7.
8.
- Subarachnoid Space
- Epidural Space
1.
2.
7.
8.
- Posterior Rootlets
- Posterior Root
- Anterior Root
- Anterior Rootlets
3.
4.
5.
6.
- Spinal Ganglion
- Posterior Ramus
- Anterior Ramus
- Spinal Nerve
9.
10.
- Anterior Horn
- Posterior Horn
1.
2.
3.
4.
5.
1 & 4: Greater Occipital N. (C2)
2&5: Least Occipital N. (C3)
- Suboccipital N. (C1)
Posterior Rami of C1-3
- Suboccipital N. (C1)
- Greater Occipital N. (C2)
- Least Occipital N. (C3)
1-3
- Greater Occipital N. (C2)
- Suboccipital N. (C1)
- Least Occipital N. (C3)
