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Year 2 - LCRS - Anatomy of the Head, Neck and Spine > Session 2: Spinal Cord > Flashcards

Session 2: Spinal Cord Flashcards

15.10.2019

1
Q

What are the functions of the vertebral column?

A

Support and Protection

  • Body weight
  • Transmits forces
  • Supports the head
  • Supports the upper limbs (and aid movements)
  • Spinal cord

Movement

  • upper limbs + ribs (extrinsic muscles)
  • postural control and movement (intrinsic muscles)
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2
Q

What are the regions. of the vertebral column?

A 
C1-C7
T1-T12
L1-L5
S1-S5 (sacrum)
Coccyx
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3
Q

What are the curvatures of the spine?

A

There are 4:

  • cervical (secondary)
  • thoracic (primary)
  • lumbar (secondary)
  • sacral (primary)
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4
Q

What are primary and secondary curvatures?

A

Primary: same as in the foetus with the concavity facing anteriorly

Secondary: concavity facing posterior, develops with upright stance

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5
Q

How does posture change in pregnancy?

A

As the baby grows, women start to lean back to counteract the weight of the baby anteriorly.

=> also applies to obese people. (secondary curvature to make the center of weight correct)

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6
Q

Where is the lordotic curvature in humans?

A

in the lumbar spine

the curvature is extensive in four legged animals when mating

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7
Q

Does lordosis, mean there is something wrong with them?

A

No, only if the lordosis is exaggerated.

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8
Q

What is a potential cause of scoliosis?

A
  • hormonal influence

- e.g. females during puberty

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9
Q

What are the problems associated with scoliosis?

A
  • aesthetics
  • organs in the chest/abdomen can be compressed with extensive curvature
  • severe, chronic pain
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10
Q

How can severe scoliosis be treated?

A
  • surgery which involves screws in the vertebral column

- adjusting the screws and rods so that the column becomes upright

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11
Q

How can less severe scoliosis be treated?

A
  • brace
  • corsett

-> helps straighten the vertebral column

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12
Q

What are the bones of the back?

A

33 vertebrae

  • 7 cervical
  • 12 thoracic
  • 5 lumbar
  • 5 sacral (fused)
  • 3-4 coccygeal (fused)
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13
Q

What allows flexibility of the back?

A
  • the stacking of units

- each vertebrae by itself is not flexible, only when they are stacked

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14
Q

What percentage of people is hypermobile?

A

~ 20%

=> means you can bend joints more than others and are flexible

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15
Q

What are the main components of a vertebra?

A
  • vertebral body (weight bearing part)
  • vertebral arch (spinal cord passes in the middle)
  • pedicles (anchor the body to the arch)
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16
Q

What determines how a spine fragment can move?

A
  • appreciate that the orientation of the facets determines how you can move the spine:
    • vertical: difficult to move sideways, forwards + backwards works well
    • horizontal: more rotation is possible
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17
Q

Vertebral arch

A
  • Forms roof of vertebral canal
  • Has projections for attachment of muscles and ligaments
  • Has sites of articulation for adjacent vertebrae
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18
Q

Vertebral body

A
  • weight bearing part of the vertebrae
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19
Q

Pedicles

A
  • Anchor the vertebral arch to the vertebral body
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20
Q

Intervertebral disks

A
  • are situated in between vertebrae
  • water filled structures that have some cartilage collagen rings in the middle with a gel nucleus
  • help transmit forces
  • throughout the day the disks become dehydrated -> shorter
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21
Q

What is the issue with degenerative disease of the intervertebral disks?

A
  • if the gaps between vertebrae become smaller they can impinge on nerves
  • intervertebral foramina may become smaller and cause problems like pain due to pressing on nerves
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22
Q

Which vertebrae are atypical?

A

C1 and C2

-> allow for movement of head and neck, great deal of flexibility

23
Q

When are injuries to C1 and C2 common?

A
  • in car accidents, the seatbelts do not protect the head and these vertebrae
  • this area is put under extreme stress
  • damage can cause paralysis from neck down or death
24
Q

What is special about the C1 vertebra?

A
  • “atlas”
  • the vertebral body is not connected, it is connected to the vertebrae beneath
  • holds the head
  • if the neck undergoes extreme flexion or extension, odontoid peg can break loose and crush the spinal cord or lower part of medulla -> instant death (hanging)
25
Q

What causes fast death in high speed collisions or in hanging?

A

if the neck undergoes extreme flexion or extension, odontoid peg can break loose and crush the spinal cord or lower part of medulla -> instant death

26
Q

Why do only cervical vertebrae have transverse foramina?

A

It is where the vertebral arteries pass, therefore only needed there.

27
Q

What lies on the body of C2?

A
  • the odontoid peg
  • it is the body of C1 which is joined to C2
  • allows for rotation of C1 and C2 -> specific range of motion
28
Q

How can you distinguish cervical vertebrae?

A
  • they have transverse foramina
29
Q

How can you distinguish thoracic vertebrae?

A
  • they have heart shaped bodies

- ribs attach to them

30
Q

How can you distinguish lumbar vertebrae?

A
  • they have kidney shaped bodies
31
Q

What are the alar ligaments

A
  • come from the underside of the skull

- cross to the odontoid peg.

32
Q

What is the cruciate ligament?

A
  • collective term for ligaments from skull to C2

- cruciate = cross

33
Q

Atlanto-axial joint

A
  • between C1 and C2
  • NO joint (allows rotation)
  • principal joint that allows rotation
34
Q

Atlanto-occipital joint

A
  • between skull and C1
  • YES joint (allows nodding of head)
  • skull can rock backwards and forwards on this joint
  • principal joint that allows flexion and extension
35
Q

What are the tough ligaments that run along the vertebral column called?

A

anterior and posterior longitudinal ligaments

36
Q

Ligamenta flava

A
  • found between adjacent laminae
37
Q

Interspinous ligaments

A
  • between spinous processes (?)
38
Q

Which ligaments should you know?

A
  • longitudinal ligaments (A and P)
  • supraspinous ligament (tough)
  • interspinous ligaments (limit how much you can bend down towards the floor
  • ligamentum flavus (yellow ligament; between laminae)

=> huge stability + allow for movement

39
Q

Where do spinal nerves emerge from?

A

Intervertebral foramina

40
Q

Where do spinal nerves emerge from in relation to the vertebrae? (height)

A
  • C1-C7 emerge above the vertebrae
  • C8-coccygeal emerge below the vertebrae

=> because we have a C8 nerve but no C8 vertebrae

41
Q

Below which level is there no more spinal cord present?

A

below L2

42
Q

Corda equina

A
  • “horses tail”
  • bundle of nerves where the spinal cord has finished
  • where injections are given like spinal anaesthetic
  • where CSF can be take taken in an LP
43
Q

Prolapsed intervertebral disk

A
  • ruptured disk, contents emerge into the space that is occupied by the nerves or the spinal cord
  • jelly like substance takes the path of least resistance out
  • pain, parasthesia, weakness
44
Q

What is parasthesia?

A

is an abnormal dermal sensation (e.g., a tingling, pricking, chilling, burning, or numb sensation on the skin) with no apparent physical cause

45
Q

What part of the spine do disk herniations usually occur at?

A
  • lower spine

- reason: the lower spine has to bear more weight

46
Q

What can the oblique muscles facilitate?

A
  • help with side bending and rotation
47
Q

What can the erector spinae muscles do?

A
  • make the spine straight

- very complicated intrinsic muscles of the spine

48
Q

What are intrinsic and extrinsic muscles of the spine?

A

Intrinsic: the deep muscles develop embryologically in the back

Exrtinsic: The superficial and intermediate muscles do not develop in the back

49
Q

What meningeal layer is not present in the spine?

A
  • the periosteal dura reflects back at the foramen magnum

- there is an epidural space in the vertebral column but not in the brain

50
Q

sacral hiatus

A
  • hole at the end of the spine
51
Q

Common spinal pathology

A
  • Low back pain
  • Prolapsed intervertebral disc - sciatica
  • Spondolysis (degeneration)
  • Spondylolysis (stress fracture of pars interarticularis)
  • Spondylolisthesis (forward displacement of vertebra)
  • Spondylitis (inflammation of vertebrae)
52
Q

What is the difference between spinal and epidural anaesthesia?

A

Spinal:

  • e.g. C-section or hip replacement if patient is not fit for GA -> known length of procedure, limited space for drug.
  • inside subarachnoid space

Epidural:

  • e.g. duration of about (unknown), can be infused, large convenient space
  • around the dura
53
Q

Spinal injuries

A
  • Spinal cord injury paralyses over 6 people every day
    NHS Specialised Spinal Cord Injury Services Annual Statement - in 2017/18, 2429 new patients were referred to the eight specialist centres in England.
  • This adds to the 50,000 living here that are already paralysed.
  • Most common causes of spinal cord injury is a broken neck or back as a result of road traffic accidents, accidents during sports or recreation or falls (in older people).
  • Currently no cure – yet!

Year 2 - LCRS - Anatomy of the Head, Neck and Spine (6 decks)

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