Session 2: Vertebral Column and Spinal Cord

Question 1

Which part is the lamina of the vertebra?

Answer 1

Between the spinous process + transverse process

Question 2

What are the 3 main features of a typical vertebrae? What are the functions of each?

Answer 2

Vertebral body (weight bearing)
Vertebral arch ("roof" of vertebral canal, projections for attachment of muscles + ligaments, has sites of articulation for adjacent vertebrae)
Pedicles (anchor vertebral arch to vertebral body)

Question 3

Describe 5 distinctive features of cervical vertebrae.

Answer 3

Triangular vertebral foramen
Rectangular vertebral body
Transverse foramina in the transverse processes
Bifid spine (except C1 + C7)
Atlas + axis (C1 + C2) are specialized for movement

Question 4

Describe 5 distinctive features of thoracic vertebrae.

Answer 4

Bigger than cervical vertebrae
Circular vertebral foramen
Heart shaped vertebral body
Spinous process pointing sharply downwards
Transverse costal facets (for rib articulation)

Question 5

Describe 5 distinctive features of lumbar vertebrae.

Answer 5

LARGE
Articular facets are angled to limit movement
Thin, long transverse processes (except L5)
Triangular vertebral foramen
“Kidney shaped” vertebral body

Question 6

How many bones fuse to form the sacrum?

Answer 6

5

Question 7

Describe the structure of the sacrum.

Answer 7

Concave anterior surface
Triangular in shape
L shaped articular facets (for articulation with pelvic bones)

Question 8

How many bones fuse to form the coccyx?

Answer 8

3-4

Vertebral arches + canal are absent

Question 9

Between which vertebrae do you find intervertebral discs?

Answer 9

C2-S1

Question 10

What are the 2 parts of the intervertebral disc?

Answer 10

Nucleus pulposus

Anulus fibrosus

Question 11

Describe how problems with the intervertebral disc can lead to potential clinical problems.

Answer 11

Degenerative changes in the anulus fibrosus can lead to herniation of the nucleus pulposus, which can then impinge on spinal nerves or the spinal cord (causing pain, weakness + changes in sensation)

Question 12

Name the 2 ligaments that rung along the length of the vertebral bodies from the skull to the sacrum.

Answer 12

Anterior + Posterior Longitudinal Ligaments

Question 13

Which ligament is typically damaged in whiplash?

Answer 13

Anterior Longitudinal Ligament

Question 14

What is the name given to the upper part of the posterior longitudinal ligament going from C2 to the skull?

Answer 14

Tectorial Membrane

Question 15

Which ligament is found between the laminae of adjacent vertebrae? When is this pierced?

Answer 15

Ligamentum flavum

Pierced in a lumbar puncture

Question 16

Which ligament runs all the way down the back of the spinous processes, connecting them

Answer 16

Supraspinous ligament

Question 17

Which ligament lies between adjacent spinous processes?

Answer 17

Interspinous ligament

Question 18

What determines the degree of movement in each spinal cord segment?

Answer 18

Angles of articular facets
Presence of ribs
Presence of muscles

Question 19

What is the purpose of spinous ligaments?

Answer 19

Provide stability

Allow movement, but limit excessive movement

Question 20

Describe the shape of the atlas (C1).

Answer 20

NO vertebral body

Consists of 2 lateral masses with an anterior + posterior arch

Question 21

Describe the articulations of the atlas.

Answer 21

The 2 lateral masses articulate superiorly with the occipital condyles + inferiorly with the superior articular surfaces of C2

Question 22

Describe the structure of the axis (C2).

Answer 22

A typical cervical vertebra with the body extended upwards to form the dens (odontoid process)

Question 23

Which ligaments are attached to the dens?

Answer 23

Alar ligaments are attached to the superiolateral surfaces of the dens + the medial occipital condyles. Prevent excessive rotation of head.
Longitudinal fascicles of the cruciform ligament (crosses over the transverse ligament of the atlas to form the cruciate ligament)

Question 24

How many vertebrae are there in total?

Answer 24

30-33 depending on number of coccygeal vertebrae

Question 25

Which layer of cranial dura mater is the spinal dura mater continuous with?

Answer 25

Meningeal layer of the cranial dura

Question 26

At what vertebral level does the spinal cord (+ Pia) end?

Answer 26

L2

Question 27

What space is present in the vertebral column that you don’t find in the skull?

Answer 27

Epidural space

Question 28

What does the epidural space contain?

Answer 28

Connective tissue Fat Internal vertebral venous plexus

Question 29

At what vertebral level do the dura + arachnoid layers end?

Answer 29

S2

Question 30

What is the significance of the subarachnoid space between L2 and S2?

Answer 30

A needle can be inserted here to remove CSF or insert anaesthetic

Question 31

What is the difference between an epidural and a spinal block?

Answer 31

Epidural: Around dura (large volume can be infused over many hours) Spinal: In sub-arachnoid space (particular volume, lasts for a particular duration)

Question 32

How is the sacral hiatus formed? What is the significance of this space?

Answer 32

No lamina/ spinous process on last few sacral vertebrae | Can insert needle into sacral hiatus- possible to infiltrate very low region of epidural space with anaesthetic

Question 33

Where do the denticulate ligaments attach medially and laterally?

Answer 33

Medially – spinal cord | Laterally – form a series of triangular extensions that anchor through the arachnoid membrane to the dura mater

Question 34

Why would you perform a lumbar puncture?

Answer 34

To obtain CSF (e.g. to test for meningitis) | To inject spinal anaesthesia (into the subarachnoid space)

Question 35

At which level would you perform a lumbar puncture?

Answer 35

L3/L4 in an adult | 1 or 2 vertebral spaces lower in a child

Question 36

Which ligament is pierced in lumbar puncture?

Answer 36

Ligamentum flavum

Question 37

Why would you never do a lumbar puncture in the case of raised intracranial pressure?

Answer 37

It will cause a sudden relieving of pressure, which could cause brainstem herniation and death.

Question 38

List 6 common spinal pathologies

Answer 38

Low back pain Prolapsed intervertebral disc (Sciatica) Spondolysis (degeneration) Spondololysis (stress fracture of pars interrticularis) Spondylolistesis (forward displacement of vertebra) Spondylitis (inflammation of vertebrae)

Question 39

What are 2 common spinal injuries seen in car crashes?

Answer 39

Ligaments snap | Small parts of bone break off

Question 40

State 3 common deviations in spinal curvature.

Answer 40

``` Scoliosis = abnormal lateral curvatures Kyphosis = excessive thoracic curvature Lordosis = excessive lumbar curvature ```

Question 41

Name 7 functions of the vertebral column

Answer 41

Hold body weight Transmit forces Support the head Support the upper limbs Protect the spinal cord Movement of upper limbs + ribs (extrinsic muscles) Postural control + movement (intrinsic muscles)

Question 42

What characterises primary curvatures? Which curvatures in an adult are primary?

Answer 42

They are in the direction that you would expect to see in the foetal position (concave side facing anteriorly) Thoracic Sacral

Question 43

What characterises secondary curvatures? Which curvatures in an adult are secondary?

Answer 43

Concave surface faces posteriorly Cervical Lumbar

Question 44

List 2 functions of intervertebral discs

Answer 44

Help with transmitting forces | Allow flexibility between vertebrae

Question 45

What is the name of the joint between the skull and C1? What does this allow?

Answer 45

Atlanto-occipital joint Facets allow skull to rock back + forth (flexion + extension) "Yes joint"

Question 46

What is the name of the joint between the C1 and C2? What does this allow?

Answer 46

Atlanto-axial joint Allows rotation "No joint"

Question 47

Where do the spinal nerves emerge?

Answer 47

C1-C7 nerves emerge from above their respective vertebrae | C8- Coccygeal nerves emerge below their respective vertebrae

Question 48

What is the result of the vertebral column developing at a greater rate than the spinal cord?

Answer 48

The point at which nerves emerge from the spine get progressively further away from where they emerge from the spinal cord

Question 49

Where is disc herniation more likely to occur? Why?

Answer 49

Lower spine | More weight is being transmitted by the discs (forces get greater)

Question 50

What are the 3 categories of muscles in the back and which muscles fall into each of these categories?

Answer 50

Superficial: Trapezius, Latissimus dorsi, Levator scapulae, Rhomboid minor, Rhomboid major Intermediate: Serratus posterior superior + inferior Deep: Spinotransversales, Erector spinae, Transversospinales, Interspinales, Intertransversarii

Question 51

State the origin, insertion and function of: a. Trapezius b. Latissimus Dorsi c. Levator Scapulae d. Rhomboid Minor e. Rhomboid Major

Answer 51

``` Trapezius O: external occipital protuberance, cervical + thoracic spine I: clavicle + scapula F: elevate + rotate scapula when humerus is abducted b. Latissimus Dorsi O: T7 to sacrum + thoracolumbar fasica + posterior 1/3 of iliac crest I: intertubercular sulcus of the humerus F: extends, adducts + medially rotates humerus c. Levator Scapulae O: transverse processes of C1-C4 I: upper medial scapula F: elevates the scapula Rhomboid Minor O: spinous processes of C7-T1 I: medial border of scapula F: adduct + elevate scapula e. Rhomboid Major O: spinous processes of T2-T5 I: medial border of scapula F: adduct + elevate scapula ```

Question 52

State the origin, insertion and function of: a. Serratus Posterior Superior b. Serratus Posterior Inferior

Answer 52

``` Serratus Posterior Superior O: C7-T3 I: upper border of ribs 2-5 F: elevates ribs 2-5 Serratus Posterior Inferior O: T11-L3 I: lateral inferior margins of ribs 9-12 F: depresses ribs 9-12 + prevents lower limbs from elevating when diaphragm contracts ```

Question 53

State the location and function of: a. Spinotransversales b. Erector Spinae and Transversospinales c. Interspinales and Intertransversarii

Answer 53

Spinotransversales Extensors + rotators of head + neck The 2 spinotransversales muscles run from the spinous processes up to T6 + ligamentum nuchae, running superiorly + laterally Erector Spinae + Transversospinales Extensors + rotators of vertebral column Erector spinae lie posterolaterally to the vertebral column between the spinous processes medially + the angles of the ribs laterally Transversospinales run obliquely upward + medially from the transverse process to the spinous process Interspinales + Intertransversarii Short segmental muscles, stabilisers of the vertebral column Interspinales: pass between adjacent spinous processes Intertransversarii: pass between adjacent transverse processes

Question 54

Describe the flexibility of the cervical spine in terms of flexion/extension, lateral flexion and rotation.

Answer 54

Can comfortably flex, extend, laterally flex + rotate. Articular surfaces between vertebrae are almost horizontal, so all these movements are possible. Neck has less surrounding tissue than other parts of spine

Question 55

Describe the flexibility of the upper thoracic spine (T1-T6).

Answer 55

NO flexion/extension Some lateral flexion Some rotation Articular surfaces are almost vertical, which doesn’t allow for flexion/extension.

Question 56

Describe the flexibility of the lower thoracic spine (T7-T12).

Answer 56

Some flexion/extension Good lateral flexion Good rotation

Question 57

Describe the flexibility of the lumbar spine (L1-sacrum).

Answer 57

NO rotation Good flexion/extension Good lateral flexion Articular surfaces curled around articular surfaces of the adjacent superior vertebrae, ensuring no rotation.