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Block 4 Week 1 Meg > Sievert: Back, Vertebral Column, and Spinal Cord > Flashcards

Sievert: Back, Vertebral Column, and Spinal Cord Flashcards

1
Q

T/F: Fractures may cause compression of nerve roots or spinal cord.

A

True

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2
Q

Spondylolisthesis can cause these things.

A

damage to the cord, roots, or exiting spinal nerves.

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3
Q

This can put pressure on exiting nerve roots.

A

Herniating discs

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4
Q

T/F: osteophytes may impinge on the exiting spinal nerve.

A

True

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5
Q

Components of the axial skeleton - is the pelvis included?

A 
Skull
Vertebral column
Ribs
Sternum
No pelvis!
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6
Q

How many cervical vertebrae are there? Thoracic? Lumbar? Sacral? Coccygeal?

A

7; 12; 5; 5; 4

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7
Q

How many vertebrae are there?

A

33, but it can vary from 32-34

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8
Q

Which sections of the vertebral column contains primary curvatures? Secondary curvatures?

A

thoracic and sacral; cervical and lumbar

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9
Q

What is C1 called? What is C2 called?

A

atlas; axis

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10
Q

T/F: abnormal curves may be exaggerated normal curves or simply curves that don’t belong.

A

True

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11
Q

Three components of the vertebral foramen of the spinal cord.

A

body, pedicle, and lamina

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12
Q

What are the three processes that protrude from the vertebra?

A

transverse processes
spinous process
articular processes (superior and inferior)

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13
Q

What two components make up the intervertebral foramen?

A

inferior and superior vertebral notches.

*note: the inferior vertebral notch forms most of the foramen and is actually up top!

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14
Q

These structures are found on the lateral surface of each superior articular facet for muscle attachment

A

mammillary processes

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15
Q

What are two specific features of the sacrum?

A

anterior and posterior foramina

sacral hiatus

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16
Q

What two spinal nerves exit out of the sacral hiatus?

A

S5 and the spinal nerve of the coccyx

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17
Q

How can you distinguish a cervical vertebra?

A

spinous process is bifid

transverse foramen for the passage of the vertebral artery as it courses toward the brain

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18
Q

What way are the articular facets pointing in a cervical vertebra?

A

inferior and superior

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19
Q

How can you distinguish a thoracic vertebra?

A

larger vertebral body
has articular facets for the ribs
has spinous process that points inferiorly

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20
Q

How can you distinguish a lumbar vertebra?

A

largest body
massive neural arch
large squarish spinous process
articular facets are facing medially and laterally

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21
Q

Which vertebral region has the most “degrees of freedom?” Which has the least?

A

cervical has the most; lumbar has the least

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22
Q

This vertebral body has an anterior and a posterior arch to hold the dens in place, a transverse foramen, and a superior and inferior articular fovea

A

atlas C1

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23
Q

This vertebral body has a dens

A

axis C2

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24
Q

Which vertebral body does the head “spin” on? Which does it “rock” on?

A

spins on the atlas; rocks on the axis

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25
Q

Along which axis does flexion/extension occur?

A

transverse axis

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26
Q

Along which axis does lateral bending occur?

A

anteroposterior

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27
Q

Along which axis does rotation occur?

A

vertical

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28
Q

What four factors can allow or restrict movement of the trunk?

A
  1. the thickness of the intervertebral discs
  2. the orientation of the articular facets
  3. the attachment of ribs
  4. the size, elasticity and orientation of the muscles of the back, and abdominal wall
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29
Q

Which region of the vertebral column is the most mobile?

A

cervical region

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30
Q

Which region of the vertebral column is least mobile? Why?

A

thoracic region; ribs and thin discs

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31
Q

Which region of the vertebral column allows for considerable flexion and extension?

A

lumbar

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32
Q

Stress fracture of pars interarticularis

A

spondylolysis

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33
Q

Where is the pars interarticularis located?

A

in between the superior and inferior articular facets

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34
Q

What is a characteristic sign of spondylolysis (fracture of pars interarticularis) on an xray?

A

Scotty dog sign in posterolateral oblique view – a “collar” on the neck

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35
Q

Fracture of pars interarticularis, portion forming dog’s neck where collar belongs

A

Scotty dog

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36
Q

Repeated stress to the spine can cause this

A

spondylolysis

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37
Q

What can bilateral spondylolysis cause?

A

spondylolithesis

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38
Q

What is spondylolithesis?

A

“slipping” of one vertebra relative to the others

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39
Q

List the three vertebral ligaments

A

anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum

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40
Q

What does the anterior longitudinal ligament do? Where is it located?

A

limits extension; anterior half of the vertebral body

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41
Q

What does the posterior longitudinal ligament do? Where is it located?

A

limits flexion; posterior side of vertebra, beneath the lamina

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42
Q

What does the ligamentum flavum do? Is it continuous between each vertebra?

A

limits flexion; no, does not run the whole length of the vertebral column

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43
Q

If a herniated disc came out of place, which direction would it move in?

A

postero-lateral

44
Q

Two other important ligaments of the spinal column

A

interspinous ligament

supraspinous ligament

45
Q

What ligament attaches the dens of the atlas to the occipital bone? What do these ligaments do?

A

alar ligaments on either side; limit rotation

46
Q

This feature of the atlanto-occipital joint adds strength

A

capsule

47
Q

How many components does the cruciate ligament have? What are they?

A

3 components; strong transverse component and two weaker superior and inferior parts

48
Q

What covers all three portions of the cruciate ligament posteriorly?

A

tectorial membrane (a continuation of the posterior longitudinal ligament)

49
Q

Two important components of the intervertebral discs

A

annulus fibrosis

nucleus pulposis

50
Q

peripheral ring of fibrocartilage around each intervertebral disc

A

annulus fibrosis

51
Q

Is the annulus fibrosis thinner anteriorly or posteriorly?

A

posteriorly

52
Q

gelatinous core of the intervertebral disc

A

nucleus pulposis

*think pulp = juicy

53
Q

In what direction do herniated discs usually occur?

A

posterolateral

54
Q

In what region are herniated discs most common?

A

L5-S1 and second L4-5 levels

55
Q

When a disc herniates, which nerve roots are affected?

A

the herniated disc will push on the nerve root of the level below
ex: L4 herniated disc will compress L5 nerve root

56
Q

What is different between the way spinal nerves exit in the cervical region vs the lumbar, thoracic and sacral levels?

A

Spinal nerves in the cervical region exit ABOVE the vertebra with the same number, while spinal nerves in the lumbar, thoracic and sacral levels exit BELOW the vertebra with the same number

57
Q

Herniating discs most frequently impinge the root (blank) the herniating level

A

BELOW

58
Q

Spinal nerves in the cervical region exit (blank) the vertebra with the same number. Spinal nerves in the thoracic, lumbar and sacral levels exit (blank) the vertebra with the same number.

A

ABOVE; BELOW

59
Q

How can exiting nerve fibers avoid the herniation?

A

rather large opening created by the inferior intervertebral notch

60
Q

Spinal meninges: list the layers from the spinal cord out

A 
spinal cord
pia mater
subarachnoid space
arachnoid
subdural space (potential space)
dura mater
epidural space (fatty)
vertebra
61
Q

What’s contained in the subarachnoid space?

A

CSF

62
Q

What does the pia mater form in order to stabilize the spinal cord within the column?

A

denticulate ligaments

63
Q

Portions of the pia mater that poke out and project through the arachnoid to attach to the dura.

A

denticulate ligaments

64
Q

Is the “H shaped” center of the spinal cord gray or white matter? What’s unique about the white matter?

A

gray matter; there are ascending and descending fibers in the white matter. Some go up, some go down. If you cut these fibers, you will lose signal from the brain to everything below the cut. If you cut a tract that is going up to the brain (ex: L4), you will deprive that person of all sensory information below the site of the cut

65
Q

What kind of neurons leave via the lateral horn?

A

autonomic preganglionic neurons (T1-L2: sympathetic, sacral S2-4: parasympathetic)

66
Q

If someone sustains a spinal cord injury, they can experience a level loss or a segmental loss. What’s the difference?

A

Ex of level loss: if you cut L1, everything motor and sensory will be lost below the cut. Generally have to cut white matter.

If you damage the gray matter (like a tumor growing in there), this would cause a segmental loss. Segmental loss is like loss in sensation in a particular dermitome.

Level loss: generally have to “cut” white matter.
Segmental loss: have to “cut” the gray matter.

67
Q

Put these in order: dura mater, pia mater, arachnoid

A

pia mater closest to spinal cord, then arachnoid, then dura mater

68
Q

In which regions of the spinal column are there enlargements? Why?

A

cervical and lumbosacral regions, because C5-8 and T1 must give rise to ALL neurons of the upper limbs and carry lots of fine motor information. This is different from regions of the spinal cord that innervate large motor units, like the glutes.

69
Q

At what vertebral level does the spinal cord end?

A

L2

70
Q

The inferior, tapered end of the spinal cord

A

conus medullaris

71
Q

How many cervical nerves are there? Thoracic? Lumbar? Sacral? Coccygeal?

A

8 pairs, 12 pairs, 5 pairs, 5 pairs, 1 pair

72
Q

As you move down the spinal cord towards the cauda equina each successive nerve root must get (blank) to reach its appropriate intervertebral foramen

A

longer and longer

73
Q

Where does the dural sac end? What significance does this have for injecting anesthesia?

A

ends at S2 vertebral level; can inject anesthesia outside of the dural sac to bathe the most caudal spinal nerves –> epidural block

74
Q

Because the spinal cord ends at vertebral level L2, the dorsal and ventral roots for more caudal spinal nerves must descend within the vertebral canal before exiting through the correct intervertebral foramina. What are these nerve roots collectively called?

A

the cauda equina

75
Q

What is the middle nerve at the caudal end referred to as?

A

filum terminale

76
Q

T/F: cauda equina is important for lumbar puncture and epidural anesthesia

A

True

77
Q

What is the first “thing” that gets pushed on if a disc is herniated? What can this cause?

A

ventral/motor nerve roots; this can lead to motor weakness or paralysis in the body part innervated by that nerve

78
Q

What dermatome is along the side of the foot? The butt hole? The umbilicus? The nipple? Back of head?

A

S1; S3-S5; T10; T4; C2

79
Q

The posterior intercostal arteries give rise to these branches

A

anterior medullary artery and posterior radicular artery

80
Q

The posterior radicular artery communicates with what artery? The anterior medullary artery communicates with what artery?

A

posterior spinal artery; anterior spinal artery

81
Q

This artery arises low in the brainstem and does not have enough blood flow to support the nervous system all the way down, so it gets tributaries from radicular branches

A

anterior spinal artery

82
Q

Anterior spinal artery doesn’t get enough flow to supply the entire length of the cord. Where does it get segmental contributions from to boost flow?

A

anterior segmental medullary arteries

83
Q

Blockage of the anterior spinal artery can cause anterior spinal artery syndrome. What region is the origin of the most important medullary artery (Adamkiewicz) due to prevalence of aortic aneurysm in the area?

A

T8-L2

84
Q

Does anterior spinal artery syndrome cause complete level loss for all different types of sensations?

A

No; it spares some types of sensations – level losses are not complete

85
Q

The internal vertebral venous plexus communicates with both the venous sinuses of the brain and a venous plexus associated with the pelvis (prostatic venous plexus). Why is this important?

A

It is possible for cancer of the prostate to metastasize to the CNS

86
Q

Loss of sensation or muscle strength in a specific location that correlates with either a dermatome or a myotome

A

segmental loss

87
Q

Loss of sensation or muscle strength that starts at the toes and ascends to a particular level

A

level loss

88
Q

First notable spinous process on the posterior surface of the back? What other processes are notable?

A

C7 spinous process; T1, T2, supraspinous ligament, and T4

89
Q

At what vertebral level are the iliac crests found?

A

L4/5

90
Q

At what vertebral level are the dimples of the back?

A

spine of S2

91
Q

List some extrinsic back muscles

A 
Levator scapulae
Trapezius
Rhomboids
Latissimus dorsi
Serratus posterior superior and inferior
92
Q

These two muscles are accessory respiratory muscles

A

serratus posterior superior and inferior

93
Q

3 layers of intrinsic back muscles

A

spinotransverse (superficial)
erector spinae (intermediate)
transversospinae (deep)

94
Q

Erector spinae muscles are (blank) oriented. There are 3 groups. (blank) – most medial, go from spine to spine. (blank) – more lateral, goes from spine to limbs. (blank) –most lateral, out to ribs from iliac crest. What do these do in terms of movement?

A

vertically; spinalis; longissimus; ileocostalis; Involved in bilateral movement and in flexion

95
Q

This muscle attaches the spinous processes to the skull or to the transverse processes of cervical vertebrae

A

splenius muscle

96
Q

Two components of the splenius muscle

A 
splenius capitis (head)
splenius cervicis (neck)
97
Q

Three erector spinae muscles. Which is most medial? Which is most lateral?

A

spinalis (medial)
longissimus
iliocostalis (lateral)

98
Q

What innervates the erector spinae muscles?

A

dorsal rami

99
Q

These muscles are oriented vertically along either side of the vertebral column and are powerful extenders

A

erector spinae

100
Q

These muscles are oriented from inferior transverse to superior spine; divided into four muscles

A

transversospinae muscles

101
Q

How many vertebrae do the long rotators span? How many do the short rotators span? How many do the semispinalis span? How about the multifidus?

A

2; 1; 6-8; 3-5

102
Q

What do the transversospinae muscles do? What’s an exception to this?

A

involved in rotation; the semispinalis capitis extends the head because of its attachment to skull instead of spinous process

103
Q

What three muscles of the back of the head make up the suboccipital triangle?

A

rectus capitis minor/major (medial), superior oblique (lateral), and inferior oblique

104
Q

C1 spine to occipital bone

C2 spine to occipital bone

A

rectus capitis minor

rectus capitis major

105
Q

C1 transverse to occipital bone

C2 spine to C1 transverse

A

superior oblique

inferior oblique

106
Q

This nerve is sensory to the back of the head, from the dorsal ramus of C2, nice landmark for inferior oblique muscle

A

greater occipital nerve

107
Q

T/F: Anterior spinal artery syndrome is characterized by loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord (pain and temperature), and preservation of sensations carried by the posterior columns (fine touch and proprioception).

A

True

Block 4 Week 1 Meg (13 decks)

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