Session 2: Vertebral Column and Spinal Cord

Question 1

Which part is the lamina of the vertebra?

Answer 1

Between the spinous process and the transverse process

Question 2

Where is the pedicle

Answer 2

Between the transverse process and the vertebral body

Question 3

What name is giving to the joints between the articular facets ofadjacent vertebrae?

Answer 3

Zygapophysial joints

Question 4

Describe some distinctive features of cervical vertebrae.

Answer 4

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

Question 5

Describe some distinctive features of thoracic vertebrae.

Answer 5

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

Question 6

Describe some distinctive features of lumbar vertebrae.

Answer 6

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

Question 7

How many bones fuse to form the sacrum?

Answer 7

5

Question 8

Describe the structure of the sacrum.

Answer 8

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

Question 9

How many bones fuse to form the coccyx?

Answer 9

3-4 Vertebral arches and canal are absent

Question 10

What two types of joint are found between vertebrae?

Answer 10

Symphyses – between adjacent vertebral bodies Synovial Joints – between articular processes

Question 11

How many joints are there between two typical vertebrae?

Answer 11

6 2 symphyses (above and below) 4 synovial joints (2 superior and 2 inferior)

Question 12

Between which vertebrae do you find intervertebral discs?

Answer 12

C2-S1 There is no intervertebral disc between C1 and C2 (you instead get atlanto-axial joint capsules)

Question 13

What are the two parts of the intervertebral disc?

Answer 13

Nucleus pulposus Annulus fibrosus

Question 14

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

Answer 14

Degenerative changes in the annulus fibrosus can lead to herniation of the nucleus pulposus, which can then impinge on spinal nerves or thespinal cord

Question 15

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

Answer 15

Anterior and Posterior Longitudinal Ligaments

Question 16

Which ligament is typically damaged in whiplash?

Answer 16

Anterior Longitudinal Ligament

Question 17

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

Answer 17

Tectorial Membrane

Question 18

Which ligament is pierced in lumbar puncture and where is it positioned relative to the vertebral bodies?

Answer 18

Ligamentum flavum – found between the laminae of adjacent vertebrae

Question 19

Name the triangular sheet-like structure found in the upper vertebral column. Where is it attached?

Answer 19

Ligamentum nuchae – attached from C7 to the occipital bone

Question 20

What it continuous with the ligamentum nuchae and which part of the vertebrae is this attached to?

Answer 20

Supraspinous ligament It is connects to the spinous processes from C7 to the sacrum

Question 21

Which ligament lies between adjacent spinous processes?

Answer 21

Interspinous ligament

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

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

Answer 27

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

Question 28

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

Answer 28

Some flexion/extension Good lateral flexion Good rotation

Question 29

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

Answer 29

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.

Question 30

Describe the shape of the atlas (C1).

Answer 30

It has NO vertebral body It consists of two lateral masses with an anterior and posterior arch

Question 31

Describe the superior articulations of the atlas.

Answer 31

Articulate with condyles of occipital bone

Question 32

State 5 important vertebral landmarks and how you would identify them on an individual.

Answer 32

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

Question 33

How many sacral vertebrae are there?

Answer 33

5 (fused)

Question 34

How many coccygeal vertebrae are there?

Answer 34

1-4 (fused)

Question 35

How many vertebrae are there in total?

Answer 35

30-33 depending on how many coccygeal vertebrae there are

Question 36

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

Answer 36

Meningeal layer of the cranial dura

Question 37

At what level does the dural sac narrow around the filum terminale?

Answer 37

S2

Question 38

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

Answer 38

Epidural space

Question 39

What does this space contain?

Answer 39

Connective tissue Fat Internal vertebral venous plexus

Question 40

What is the arachnoid membrane and where does it end?

Answer 40

It is a thin, delicate membrane that is against but not adherent to the deep surface of the dura mater. It ends at S2

Question 41

What thin structures interconnect the arachnoid and pia mater?

Answer 41

Arachnoid trabeculae – these also suspend vessels in the subarachnoid space

Question 42

Where does the subarachnoid space end?

Answer 42

S2

Question 43

What is the spinal pia mater?

Answer 43

A vascular membrane that firmly adheres to the surface of the spinal cord

Question 44

What are the longitudinally oriented sheets of pia mater that youfind on either side of the spinal cord?

Answer 44

Denticulate ligaments

Question 45

Where do these denticulate ligaments attach medially and laterally?

Answer 45

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

Question 46

Why would you perform a lumbar puncture?

Answer 46

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

Question 47

At which level would you perform a lumbar puncture?

Answer 47

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

Question 48

Which ligament is pierced in lumbar puncture?

Answer 48

Ligamentum flavum

Question 49

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

Answer 49

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

Question 50

State some signs of cervical spine injury.

Answer 50

Low blood pressure + high pulse Large erection (Custer’s last stand) Flaccid paralysis Large bladder and inability to micturate

Question 51

Degrees of spinal curvatures for each region

Answer 51

Cervical Convex Thoracic Concave Lumbar Convex Sacral Concave

Question 52

Lordosis

Answer 52

Excessive concave bending of spine

Question 53

Kyphosis

Answer 53

Excessive convex bending of spine

Question 54

Atypical cervical vertebrae

Answer 54

C1 and 2

Question 55

Name for C1

Answer 55

Atlas

Question 56

Name for C2

Answer 56

Axis

Question 57

Inferior articulations of atlas

Answer 57

Superior articular surface of C2

Question 58

What joint is Atlanta-occipital

Answer 58

Synovial

Question 59

Describe the Atlantoaxial joint

Answer 59

Dens of axis goes through foramen of dens anterior to transverse ligament of atlas and articulates with facet for dens on atlas

Question 60

Role of alar ligaments

Answer 60

Prevent excessive rotation of the head

Question 61

Where do alar ligaments attach

Answer 61

Medial occipital condyles and superiolateral surface of dens

Question 62

What makes up cruciate ligament

Answer 62

Superior longitudinal band Transverse ligament of atlas Inferior longitudinal band

Question 63

Where does superior longitudinal band attach

Answer 63

Occipital bone

Question 64

Where does inferior longitudinal band attach

Answer 64

Body of dens

Question 65

Most common spinal pathology

Answer 65

Low back pain Prolapsed intervertebral disc Spondolysis Spondylolysis Spondylolisthesis Spondylitis

Question 66

What happens in prolapsed disc

Answer 66

Herniation of nucleus pulposus in front of posterior longitudinal ligament that has potential to compress a spinal nerve or part of the chord

Question 67

What is spondolysis

Answer 67

Degeneration of spinal skeleton

Question 68

What is spondylolysis

Answer 68

Stress fracture of pars interarticularis

Question 69

What is spondylolisthesis

Answer 69

Forward displacement of vertebra

Question 70

What is spondylitis

Answer 70

Inflammation of vertebra

Question 71

Scoliosis

Answer 71

Lateral curvature of spine

Question 72

Blood supply to spine main sources

Answer 72

Anterior and posterior spinal arteries Posterior branches of posterior intercostal arteries

Question 73

What does segmental spinal artery become after branching off posterior branch of posterior intercostal artery

Answer 73

Anterior and posterior radicular artery

Question 74

What drains spines blood

Answer 74

Internal and external vertebral sinuses

Question 75

Describe the structure of the axis (C2).

Answer 75

It is a typical cervical vertebra with the body extended upwards to form the dens (odontoid process)