Netter's spine Flashcards
what is a hip pointer
contusion of iliac crest
common site for autologous bone graft harvest
iliac crest
what part of the atlas (C1) is the attachment site for the ALL
anterior tubercle
What part of the atlas (C1) is the attachment site of ligamentum nuchae?
posterior tubercle
what is the primary horizontal stabilizer of the Axis (C2)
odontoid process (dens)
What part of cervical vertebrae have foramen for vertebral artery except C7
transverse processes
What part of cervical vertebrae can accept screws if angled laterally
lateral masses . . . artery at risk in foramen
site of sponsylolysis fx
pars intercularis . .area between facets
avulsion fracture can occur where on lumbar vertebrae
transverse process
in the lumbar spine, failure of fusion of two neural arches (pedicle/lamina) ossification centers results in what?
spina bifida
what is the first x ray in all trauma cases
lateral cross table of cervical spine
In spinal cord trauma, what given within 8 hrs of injury may improved functional level?
IV methylprednisolone
#1 type of spinal cord injury? give mechanism and details
- central cord
- hyperextension
- seen in elderly with cervical spondylosis
What is the primary stabilizer of the occipitoatlantal joint?
Tectorial membrane
The tectorial membrane is a continuation of what?
it limits what movement?
- PLL
- extension
strongest AA ligament that holds that odontoid to the atlas
Transverse atlantal
This is part of the intervertebral disc that attaches to adjacent vertebral bodies and gives strong conncection b/t adjacent bodies
Annulus
This is a strong, thick ligament that attaches to adjacent anterior vertebral bodies and resists hyperextension
ALL
This ligament is weak, limits hyperflexion and the disc herniates around it
PLL
This is a strong, NOT continuous ligament that may hypertrophy and contribute to nerve root impingement
Ligamentum flavum
This ligament goes from L5 transverse process to the ilium and may avulse in pelvic fracture (eg, vertical shear fx)
iliolumbar
2 parts of the intervertebral disc
- outside: annulus fibrosus
- inside: nucleus pulposus
hypertrophic changes in the facet (zygapophyseal joint) in degenerative disease can cause/contribute to what?
nerve root impingement
What type of cartilage is outer annulus made of
dense (type 1 collagen)
what type of collagen is nucleus pulposus made of
type 2
what happened to nucleus pulposus with advancing age
water and proteoglycan content decrease
The nucleus pulposus can herniate out of the annulus and compress nerve root. . . what is #1 level
L4-5
This is the articulation in cervical spine b/t the uncinate process on the concave superior end plates of the inferior vertebral body and the articulating portion of the convex inferior end plate of the superior adjacent vertebral body
Joints of Luschka
Articular cartilage of the joints of Luschka can degenerate and contribute to what?
cervical spondylosis
Bowel/bladder symptoms are concerning for what spinal cord pathology
Cauda equina syndrome
C5 reflex?
biceps brachii
C6 reflex?
brachioradialis
C8 muscles
interossei
C6 muscle
biceps brachii
What reflexes in upper extremity are indicative of myelopathy (upper motor neuron lesion)?
- Inverted radial: tap BR tendon in distal forearm . . . hypoactive BR and hyperactive finger flexion
- Hoffman’s: flick MF DIPJ into flexion, pathologic if thumb IPJ flexes
What reflexes in lower extremity are indicative of myelopathy (upper motor neuron lesion)?
- Babinski
- Ankle clonus
Motor for L4
- Quads
- Tib ant
Motor for L5
EHL
what are the 3 erector spinae muscles from lateral to medial
- Iliocostalis
- Longissimus
- Spinalis
The spinal cord fruns from the brain stem to conus medullaris which terminates where
L1
Clavicle dermatome
C5
nipple dermatome
T4
umbilicus dermatome
T10
inguinal dermatome
L1
What is the most commonly compressed cervical nerve root
C6
Most commonly compressed lumbar nerve root
L5
What nerve roots are affected in cauda equina syndrome
S2-S4
This is the primary blood supply to the thoracolumbar cord and injury can cause cord ischemia/paralysis
Artery of Adamkiewicz: single medullary artery (usually left T10-T12) to ant. spinal artery
When assessing low back pain, what are Waddell signs?
- Presence indicates nonorganic pathology
1) Exaggerated response/overreaction
2) Pain to light touch
3) Nonanatomic pain localization
4) Negative flip sign with positive straight leg test
Myelodysplasia is incomplete spinal cord development (neural tube closure defect) . . it is associated with elevated maternal levels of what
AFP .. prenatal folic acid decreases incidence
Myelodysplasia is often associated with what allergy
latex
In myelodysplasia, symptoms/exam are based on lowest functional level . . intact what levels allows ambulation
L4
Types of scoliosis
- Congenital (abnormal vertebrae)
- Idiopathic: most common, often + fam hx
- Neuromuscular: associated with neuromuscular dz
Most common type of idiopathic scoliosis?
Give certain traits
- Adolescent
- F > M
- R > L
Curve progression in Scoliosis is evaluated by what?
- Curve magnitude: x-ray/Cobb angle
- Skeletal maturity: use Risser stage
Neurologic findings in scoliosis are rare but are increased with what side
Left sided
Anterior cervical spine approach accesses C3-T1. Most surgeons use which side and why
- Left
- Right recurrent laryngeal nerve is more susceptible to injury
