MSCT Week 1: Back and Spinal Cord Flashcards
The vertebral column AKA
Spine
The Vertebral Column has how many vertebrae
33 Vertebrae
How many Cervical Vertebrae?
7
How many Thoracic Vertebrae?
12
How many Lumbar Vertebrae?
5
How many Sacral Vertebrae?
5
How many coccygeal Vertebrae?
3-5
Surface Landmarks of the back
3 Listed
- vertebrae prominens
- scapula
- iliac crests
Useful landmarks for a lumbar puncture?
A horizontal line between the Iliac Crests passes through the spinous process of L4 and the L4-L5 disc
Identify
Natural Curvatures of the Vertebral column
- Kyphotic curvatures
- Lordotic curvatures
Kyphotic Curvatures
- Thoracic
- Sacral
The primary curvatures
- Kyphotic Curvatures: thoracic and sacral regions
The secondary curvatures
- Lordotic curvatures: Lumbar and Cervical regions
which curvatures are postnatal?
secondary curvatures
Lordotic curvatures: cervical and lumbar
Which spinal curvatures are present from birth?
- Primary curvatures
- Thoracic and sacral Kyphotic curvatures
Kyphosis is?
excessive forward curvature (flexion) of the thoracic spine. It may be congenital or posture related but it is usually due to a collapse of the vertebral bodies
Lordosis is?
excessive inward curvature (extension) of the lumbar spine that can develop temporarily during pregnancy, pathology, or excess weight
Scoliosis is?
an abnormal lateral curvature of the thoracic or lumbar spine. it may be congenital, idiopathic or caused by diseases such as cerebral palsy and muscular dystrophy
Idiopathic definition
relating to or denoting any disease or condition that arises spontaneously or for which the cause is unknown.
Congenital definition
(especially of a disease or physical abnormality) present from birth.
Identify
Identify?
The secondary curvatures develop after _______ when …
- Birth
- infants learn to hold their head up and walk
spinal curvature that develops when infants learn to hold their head up?
Cervical Lordotic curvature
The spinal curvature that develops when infants learn to walk?
Lumbar lordotic curvature
The intrinsic muscles of the back do what?
Maintain posture and move the vertebral column
The extrinsic muscles of the back do what?
move the upper limbs and ribs
Movement patterns of the vertebral column?
- Extension
- Flexion
- Lateral Flexion
- Rotation
A vertebra consists of ____________, _______________, and ___________ for _________ attachment and ___________ with _________.
A vertebra consists of a vertebral body, a vertebral arch, and processes for muscle attachment and articulation with bones
The vertebral arch is formed by ________________ that attach to the ___________ and paired _____________ that join to form the spinous process.
The vertebral arch is formed by paired pedicles that attach to the vertebral body and paired laminae that join to form the spinous process.
Transverse processes project ______ from the __________.
Transverse processes project laterally from the vertebral arch
Superior and inferior processes articulate with vertebrae _________ and _________.
Superior and inferior processes articulate with vertebrae above and below.
Identify
Identify
Spinal nerves exit from?
Intervertebral foramina
Intervertebral joints and articular surfaces of vertebral bodies are?
Symphyses, Fibrocartilaginous joints that are only slightly mobile
Annulus Fibrosis
Fibrocartilage rings found in between vertebral body articular surfaces
Nucleus Pulposus
Gelatinous material surrounded by the annulus fibrosis
A Herniated Disc pathology?
Degeneration of the annulus fibrosis leads to herniation of the nucleus pulposus which can impinge on the spinal cord or spinal nerves
Zygapophyseal joints AKA
Facet Joints
Superior and inferior articular processes are?
Synovial joints called Zygapophyseal joints which contain fluid and allow for movement but are prone to arthritis
posterior herniation
+
Posterolateral herniation
Supraspinous and interspinous ligaments
attach the spines of adjacent vertebrae to each other
The interspinous and supraspinous ligaments continue superiorly to the neck as as the?
Nuchal ligament
Nuchal ligament
extension of the interspinous and supraspinous ligaments and attaches to the external occipital protuberance of the skull;
Nuchal ligament main function
Limits flexion of the cervical spine
Flavum means …
Yellow
Ligamentum flavum location
on the inner aspect of the vertebral arch
Identify
Identify
Anterior longitudinal ligament location
On the anterior surface of the vertebral bodies
Anterior longitudinal ligament main function
Limits hyperextension
Can reduce the dimensions of the vertebral canal, producing the syndrome of spinal stenosis
3 Listed
- Zygapophysial joint hypertrophy
- Ligamenta flava hypertrophy
- mild disc protrusion
The spinal cord is…
- A long tubular structure that extends from the end of the brain stem to the lumbar region of the vertebral column
it encloses the central canal that contains cerebral spinal fluid
Spinal cord
the central canal is located and contains what?
In the spinal cord and contains cerebral spinal fluid
The spinal cord consists of and does what?
nervous tissue that carries incoming and outgoing messages between the brain and the rest of the body
Organization of grey matter in the spinal cord and consists of?
5 listed
- shaped like a butterfly
- consists of cell bodies of interneurons
- motor neurons
- as well as glial cells (support cells)
- unmyelinated axons
Are grey matter neurons myelinated or unmyelinated?
Grey matter is unmyelinated
Nerve cell processes AKA
Nerve fibers
Nerve fibers AKA
Nerve cell processes
Spinal Cord White matter organization
Surrounds the grey matter
Spinal cord white matter consists of?
2 Listed
- Myelinated axons
- glial cells
What is myelin?
2 listed
- a lipid-rich substance that encases axons and protects them
- also increases conduction speed
Conus medullaris
the spinal cords cone-shaped end between L1 and L2
Filum Terminale
continues from the apex of the conus medullaris as a fine filament of connective tissue anchoring the spinal cord to the coccyx
filum terminale main function
To anchor the spinal cord to the coccyx
How many pairs of spinal nerves are there?
31 pairs
How many cervical spinal nerves are there?
8 cervical spinal nerves
How many Thoracic spinal nerves are there?
12 Thoracic spinal nerves
How many lumbar spinal nerves are there?
5 lumbar spinal nerves
How many sacral spinal nerves are there?
5 sacral spinal nerves
How many coccygeal spinal nerves are there?
1 coccygeal spinal nerves
How many enlargements are associated with the spinal cord?
2 enlargements
what are the spinal cord enlargements called?
2 listed
- The cervical enlargement
- The lumbosacral or lumbar enlargement
The cervical enlargement encludes these nerves
C5-T1 spinal nerves
The lumbosacral enlargement includes these nerves
L1-S3 spinal nerves
What is the Cauda Equina?
Inferior to the conus medullaris is the lumbar and sacral spinal nerves form a loose collection of ventral and dorsal roots called cauda equina
What does Cauda Equina mean?
The horses tail
Identify
Identify
What membranes cover and protect the spinal cord?
Three membranes referred to as the meninges
What are the names of the Meninges
3 Listed
- Dura mater
- Arachnoid mater
- pia mater
The meninges covering the spinal cord are __________ with the meninges covering the brain
Continuous
Pia mater location
lies directly on the spinal cord
Arachnoid mater location and description
is the middle layer and is fine and delicate, similar to a spiders web
Dura Mater location and description
is the external layer and is a thick, strong membrane
Epidural space
- superficial to the dura mater and contains fat and blood vessels
subdural space
the dura is usually attached to the arachnoid mater but illness or injury can create a subdural space between them
Subarachnoid space
deep to the arachnoid mater and contains CSF produced by the ventricles of the brain
What produces CSF?
The ventricles of the brain produces CSF
Identify
Identify
Lumbar cistern
The subarachnoid space below the conus medullaris where the CSF is often sampled
CSF samples are taken from?
inserting a needle between L3/L4 or L4/L5 below the conus medullaris in the lumbar cistern
Lumbar puncture
L3/L4 or L4/L5 in the subarachnoid space in the lumbar cistern
Epidural anesthesia is given by?
placing a catheter in the epidural space or inserting a needle through the sacral hiatus into the epidural space
or
by inserting a needle through the sacral hiatus into the epidural space
Spinal nerves are _________ nerves
Mixed nerves
Mixed nerves are?
contain sensory and motor nerve fibers
Afferent nerves are?
Sensory nerves that carry information towards the CNS
Efferent Nerves are?
carry information away from the CNS
Each spinal nerve attaches to the spinal cord by?
Posterior and Anterior roots
AKA
Dorsal and Ventral Roots
The cell bodies of the sensory neurons are in?
a spinal or dorsal root ganglion
Dorsal root ganglion nerves synapse with?
sensory neurons in the posterior or dorsal horn of the grey matter of the spinal cord
The anterior or ventral root contains?
motor nerve fibers which carry signals away from the CNS
The cell bodies of the primary motor neurons are in?
Anterior region of the gray matter of the spinal cord (The anterior or ventral horn)
After exiting the vertebral canal…
each spinal nerve branches into a posterior or dorsal ramus that innervates only the intrinsic back muscles and the skin and back overlying them
or
an anterior or ventral ramus that innervates other skeletal muscles and remaining areas of the skin
The dorsal and anterior rami are ___________ nerves
mixed
Identify
Identify
Cervical spinal nerves pass where?
superior to their associated vertebrae
C8 and down spinal nerves pass where
inferior to their associated vertebrae
All spinal nerves
Dermatome
an area of skin innervated by one spinal cord level, or on one side, by a single spinal nerve
Dermatome testing
testing touch on the skin can localize lesions to a specific spinal nerve or to a specific level in the spinal cord
Myotome
is a portion of skeletal muscle innervated by a single spinal cord level
Most individual muscles are innervated by __________ spinal level
more than one
Myotome testing
since most individual muscles are innervated by more than one spinal level, myotomes are evaluated by testing movements of joints or muscle groups
A knowledge of _______ and _________ is essential for completing a neurological exam
- dermatomes
- myotomes
Identify
