Session 2: Vertebral Column and Spinal Cord Flashcards
Which part is the lamina of the vertebra?
Between the spinous process and the transverse process
Where is the pedicle
Between the transverse process and the vertebral body
What name is giving to the joints between the articular facets ofadjacent vertebrae?
Zygapophysial joints
Describe some distinctive features of cervical vertebrae.
Triangular vertebral foramen Short, square vertebral body Transverse foramina in the transverse processes Bifid spine (except C1 and C7) Atlas and axis (C1 and C2) are specialized for movement
Describe some distinctive features of thoracic vertebrae.
Bigger than cervical vertebrae Circular vertebral foramen Heart shaped vertebral body Spinous process pointing sharply downwards Transverse costal facets (for rib articulation)
Describe some distinctive features of lumbar vertebrae.
LARGE Articular facets are angled to limit movement Thin, long transverse processes (except L5) Triangular vertebral foramen Cylindrical vertebral body
How many bones fuse to form the sacrum?
5
Describe the structure of the sacrum.
Concave anterior surface Triangular in shape L shaped articular facets (for articulation with pelvic bones)
How many bones fuse to form the coccyx?
3-4 Vertebral arches and canal are absent
What two types of joint are found between vertebrae?
Symphyses – between adjacent vertebral bodies Synovial Joints – between articular processes
How many joints are there between two typical vertebrae?
6 2 symphyses (above and below) 4 synovial joints (2 superior and 2 inferior)
Between which vertebrae do you find intervertebral discs?
C2-S1 There is no intervertebral disc between C1 and C2 (you instead get atlanto-axial joint capsules)
What are the two parts of the intervertebral disc?
Nucleus pulposus Annulus fibrosus
Describe how problems with the intervertebral disc can lead to potential clinical problems.
Degenerative changes in the annulus fibrosus can lead to herniation of the nucleus pulposus, which can then impinge on spinal nerves or thespinal cord
Name the two ligaments that rung along the length of the vertebral bodies from the skull to the sacrum.
Anterior and Posterior Longitudinal Ligaments
Which ligament is typically damaged in whiplash?
Anterior Longitudinal Ligament
What is the name given to the upper art of the posterior longitudinal ligament going from C2 to the skull?
Tectorial Membrane
Which ligament is pierced in lumbar puncture and where is it positioned relative to the vertebral bodies?
Ligamentum flavum – found between the laminae of adjacent vertebrae
Name the triangular sheet-like structure found in the upper vertebral column. Where is it attached?
Ligamentum nuchae – attached from C7 to the occipital bone
What it continuous with the ligamentum nuchae and which part of the vertebrae is this attached to?
Supraspinous ligament It is connects to the spinous processes from C7 to the sacrum
Which ligament lies between adjacent spinous processes?
Interspinous ligament
What are the three categories of muscles in the back and which muscles fall into each of these categories?
Superficial: Trapezius Latissimus dorsi Levator scapulae Rhomboid minor Rhomboid major Intermediate: Serratus posterior superior Serratus posterior inferior Deep Spinotransversales Erector spinae Transversospinales Interspinales Intertransversarii
State the origin, insertion and function of: a. Trapezius b. Latissimus Dorsi c. Levator Scapulae d. Rhomboid Minor e. Rhomboid Major
a. Trapezius Origin – external occipital protuberance, cervical and thoracic spine Insertion – clavicle and scapula Function – elevate and rotate the scapula when the humerus is abducted b. Latissimus Dorsi Origin – T7 to sacrum + thoracolumbar fasica + posterior 1/3 of iliac crest Insertion – intertubercular sulcus of the humerus Function – extends, adducts and medially rotates the humerus c. Levator Scapulae Origin – transverse processes of C1-C4 Insertion – upper medial scapula Function – elevates the scapula d. Rhomboid Minor Origin – spinous processes of C7-T1 Insertion – medial border of scapula Function – adduct and elevate scapula e. Rhomboid Major Origin – spinous processes of T2-T5 Insertion – medial border of scapula Function – adduct and elevate scapula
State the origin, insertion and function of: a. Serratus Posterior Superior b. Serratus Posterior Inferior
a. Serratus Posterior Superior Origin –C7-T3 Insertion – upper border of ribs 2-5 Function – elevates ribs 2-5 b. Serratus Posterior Inferior Origin – T11-L3 Insertion – lateral inferior margins of ribs 9-12 Function – depresses ribs 9-12 and prevents lower limbs from elevating when the diaphragm contracts
State the location and function of: a. Spinotransversales b. Erector Spinae and Transversospinales c. Interspinales and Intertransversarii
a. Spinotransversales Extensors and rotators of the head and neck The two spinotransversales muscles run from the spinous processes up to T6 and ligamentum nuchae, running superiorly and laterally b. Erector Spinae and Transversospinales Extensors and rotators of the vertebral column Erector spinae lie posterolaterally to the vertebral column between the spinous processes medially and the angles of the ribs laterally Transversospinales run obliquely upward and medially from the transverse process to the spinous process c. Interspinales and Intertransversarii These are short segmental muscles that are the stabilisers of the vertebral column Interspinales – pass between adjacent spinous processes Intertransversarii – pass between adjacent transverse processes
Describe the flexibility of the cervical spine in terms of flexion/extension, lateral flexion and rotation.
Cervical spine can comfortably flex, extend, laterally flex and rotate. The articular surfaces between vertebrae are almost horizontal, so all these movement are possible. Also the neck has less surrounding tissue than other parts of the spine
Describe the flexibility of the upper thoracic spine (T1-T6).
NO flexion/extension Some lateral flexion Some rotation The articular surfaces are almost vertical, which doesn’t allow for flexion/extension.
Describe the flexibility of the lower thoracic spine (T7-T12).
Some flexion/extension Good lateral flexion Good rotation
Describe the flexibility of the lumbar spine (L1-sacrum).
NO rotation Good flexion/extension Good lateral flexion Their articular surfaces are curled around the articular surfaces of the adjacent superior vertebrae, ensuring no rotation.
Describe the shape of the atlas (C1).
It has NO vertebral body It consists of two lateral masses with an anterior and posterior arch
Describe the superior articulations of the atlas.
Articulate with condyles of occipital bone
State 5 important vertebral landmarks and how you would identify them on an individual.
C7 – vertebra prominens T3 – level of the medial end of the scapular spine T7 – level of the inferior angle of the scapula L2 – level of the lowest rib L4 – level with the iliac crest
How many sacral vertebrae are there?
5 (fused)
How many coccygeal vertebrae are there?
1-4 (fused)
How many vertebrae are there in total?
30-33 depending on how many coccygeal vertebrae there are
Which layer of cranial dura mater is the spinal dura mater continuous with?
Meningeal layer of the cranial dura
At what level does the dural sac narrow around the filum terminale?
S2
What space is present in the vertebral column that you don’t find in the skull?
Epidural space
What does this space contain?
Connective tissue Fat Internal vertebral venous plexus
What is the arachnoid membrane and where does it end?
It is a thin, delicate membrane that is against but not adherent to the deep surface of the dura mater. It ends at S2
What thin structures interconnect the arachnoid and pia mater?
Arachnoid trabeculae – these also suspend vessels in the subarachnoid space
Where does the subarachnoid space end?
S2
What is the spinal pia mater?
A vascular membrane that firmly adheres to the surface of the spinal cord
What are the longitudinally oriented sheets of pia mater that youfind on either side of the spinal cord?
Denticulate ligaments
Where do these denticulate ligaments attach medially and laterally?
Medially – to the spinal cord Laterally – form a series of triangular extensions that anchor through the arachnoid membrane to the dura mater
Why would you perform a lumbar puncture?
To obtain some CSF (e.g. to test for meningitis) To inject spinal anaesthesia (into the epidural space)
At which level would you perform a lumbar puncture?
L3/L4 in an adult 1 or 2 vertebral spaces lower in a child
Which ligament is pierced in lumbar puncture?
Ligamentum flavum
Why would you never do a lumbar puncture in the case of raised intracranial pressure?
It will cause a sudden relieving of pressure, which could have brainstem herniation and death.
State some signs of cervical spine injury.
Low blood pressure + high pulse Large erection (Custer’s last stand) Flaccid paralysis Large bladder and inability to micturate
Degrees of spinal curvatures for each region
Cervical Convex Thoracic Concave Lumbar Convex Sacral Concave
Lordosis
Excessive concave bending of spine
Kyphosis
Excessive convex bending of spine
Atypical cervical vertebrae
C1 and 2
Name for C1
Atlas
Name for C2
Axis
Inferior articulations of atlas
Superior articular surface of C2
What joint is Atlanta-occipital
Synovial
Describe the Atlantoaxial joint
Dens of axis goes through foramen of dens anterior to transverse ligament of atlas and articulates with facet for dens on atlas
Role of alar ligaments
Prevent excessive rotation of the head
Where do alar ligaments attach
Medial occipital condyles and superiolateral surface of dens
What makes up cruciate ligament
Superior longitudinal band Transverse ligament of atlas Inferior longitudinal band
Where does superior longitudinal band attach
Occipital bone
Where does inferior longitudinal band attach
Body of dens
Most common spinal pathology
Low back pain Prolapsed intervertebral disc Spondolysis Spondylolysis Spondylolisthesis Spondylitis
What happens in prolapsed disc
Herniation of nucleus pulposus in front of posterior longitudinal ligament that has potential to compress a spinal nerve or part of the chord
What is spondolysis
Degeneration of spinal skeleton
What is spondylolysis
Stress fracture of pars interarticularis
What is spondylolisthesis
Forward displacement of vertebra
What is spondylitis
Inflammation of vertebra
Scoliosis
Lateral curvature of spine
Blood supply to spine main sources
Anterior and posterior spinal arteries Posterior branches of posterior intercostal arteries
What does segmental spinal artery become after branching off posterior branch of posterior intercostal artery
Anterior and posterior radicular artery
What drains spines blood
Internal and external vertebral sinuses
Describe the structure of the axis (C2).
It is a typical cervical vertebra with the body extended upwards to form the dens (odontoid process)
