Neuro 1.2 Flashcards
What are the spinal meninges?
Three layers than surround the spinal cord
What do the meninges form distally?
form a strand of fibrous tissue, the filum terminale
What does the filum terminale do?
- attaches to the vertebral bodies of the coccyx
- acts as an anchor for the spinal cord and meninges
Where does the spinal dura mater extend?
- from the foramen magnum to the filum terminal
2. separated from the walls of the vertebral canal by the epidural space
What does the epidural space contain?
- some loose connective tissue
2. the internal vertebral venous plexus
How is the epineurium formed?
- As the spinal nerves exit the vertebral canal
- they pierce the dura mater
- temporarily passing in the epidural space
- In doing so, the dura mater surrounds the nerve root
- and fuses with the outer connective tissue covering of the nerve, the epineurium
What does the subarachnoid space have in it?
CSF
What happens to the subarachnoid space distal to the conus medullaris?
subarachnoid space expands, forming the lumbar cistern
What is the lumbar cistern used for?
- accessed during a lumbar puncture (to obtain CSF fluid)
- spinal anaesthesia
What does the spinal pia mater fuse with inferiorly?
filum terminale
What does the pia mater do between the nerve roots?
pia mater thickens to form the denticulate ligaments
What do the denticulate ligaments do?
attach to the dura mater – suspending the spinal cord in the vertebral canal
When would you use spinal anaesthetic?
in order to carry out procedures such as caesarean section or hip replacement in the elderly so any patients in which general anaesthetics are maybe contra indicated for safety reasons
Where would the lumbar spinal puncture be for spinal anaesthesia?
sub-archanoid space
Where would the lumbar injection be for epidural anaesthesia?
epidural space
What is in the lumbar cistern?
- CSF
- Nerve roots of cauda equina
When is epidural given?
childbirth (normal childbirth)
When is spinal anaesthetic given?
might be given for delivery of a baby via caesarian section
Why is there ready access to the sacral region?
no spinous process
What is the theca sac?
dural sac that surrounds spinal cord and cauda equina (contains CSF)
What happens if you insert a needle below S2?
- Ready access to the epidural space
- Nerves in this region that are on their way to emerge between vertebrae so infiltration of this lower caudal region of the verbal column epidural space is often used to provide pain relief for severe back pain and sciatica pain
- Caudal epidural or sacral epidural injection as opposed to a lumbar epidural injection which is into the same space but at a different vertebral level
What is spondylosis?
degeneration
What is spondylolysis?
stress fracture of pars interarticularis
What is spondylolisthesis?
forward displacement of vertebra
What is spondylitis?
inflammation of vertebrae
What are examples of some spinal pathology?
- Fractures of vertebral column
- Prolapsed intervertebral disc - sciatica
- Spondylosis
- Spondylolysis
- Spondylolisthesis
- Spondylitis
- Spinal cord injury
What happens in spondylolysis?
- Fracture of pars interarticularis which is part of the vertebral column between the articular facet
- Breaking of the part of vertebal column between the superior articular facet the inferior articular facet
- can result in slippage of the vertebrae with respect to either the sacrum below or just between adjacent vertebrae
What is prolapsed intervertebral disc?
Contents of the disc being able to be spilled out of the protective fibrous outer layer
When do you have more severe symptoms with a prolapsed intervertebral disc?
- So the extent to which this internal substance impinges on the nerves in the space here with determine the extent of the symptoms of the person that has the slipped disc
- The more nerves that are impinged upon by this disc the greater the symptoms or the greater the amount of body that would be affected by the injury, so the more nerves will give a greater area of symptoms
What are factors affecting the severity of the spinal lesion?
- Loss of neural tissue
- Vertical level
- Transverse plane
How is the loss of neural tissue affect a spinal lesion?
•Usually small if due to trauma but can be more extensive (e.g. metastases, degenerative disease)
How does vertical level affect a spinal lesion?
•Higher the lesion, greater the disability
What else determines the severity of symptoms/disability?
not just the level, but also how many tracts are involved in the lesion or how many tracts affected by the lesions are involved will determine the resulting symptoms/disability (brown sequard)
What are the most common causes of spinal cord injury?
broken neck or back as a result of road traffic accidents, accidents during sports or recreation or falls (in older people)
