Ligamentum Flavum - Strongest or weakest? - Where is it thin and thick at? - How thick at L2-L3? - Join the _____ through vertical extensions from adjacent lamina - Paired flat ligaments between each lamina and overlap - Creates appearance of a

- Strongest - Thin on lateral edge, thick midline, like a V - Can be 3-5 mm thick at L2-3 - Join the Vertebral arches through vertical extensions from adjacent lamina - Paired flat ligaments between each lamina and overlap - Creates appearance of a contiguous ligament

Spinal Anatomy Flashcards by Kelsey Fuller

The spine has ___ vertebrae separated by intervertebral discs

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The vertebral body is ____ and ____

Solid and cylinderical

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2 pedicles join with 2 lamina to complete and arch known as

(oval shape) vertebral foramen

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What is the purpose of the vertebral foramen?

Allows for passage and protection of spinal cord

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What process is on each side laterally?

What process is posteriorly?

laterally - transverse process

posteriorly - spinous process

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When feeling for a a spinal or epidural placement, what are we feeling for?

The spinous process

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Why do the spinous process overlap?

To protect the spinal cord

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There are lateral notches superiorly and inferiorly (larger), it creates a space known as ______, and allows for passage of _____.

intervertebral body

nerves

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If the discs in-between the intervertebral lamina become damaged, pressure on the nerves can result in what?

pain and paresthesias

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Pedicles have superior and inferior articular surfaces and lateral notches
When vertebrae are stacked the notches and surfaces form the ____

facet joint

guides and restricts the movement of the vertebral column

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Cervical and Thoracic
Spinous processes are more ____
Require more ____ angle for needle

angled

cephalad

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Lumbar
The vertebra are ____
Less overlap =
Allows for easier

Larger
Larger gaps
needle placement

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Sacrum

This part of the vertebra is ____

Fused

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Sacrum

Lamina of last vertebra is incomplete and bridged only by ligaments, what is this known as

Sacral hiatus

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What is the bony process used to ID the sacral hiatus?

What is this good for?

Sacral Cornu

Caudal block

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How many
Cervical:
Thoracic:
Vertebral:
Sacral:
Coccygeal:

Cervical: 7
Thoracic: 12
Vertebral: 5 
Sacral: 5 fused
Coccygeal: 4 fused

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Scoliosis –
Kyphosis –
Lordosis –

Scoliosis – lateral curvature
Kyphosis – posterior curvature
Lordosis – Anterior curvature

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Is the interlaminar foramen always directly anterior to the spinous process

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What are the 3 ligaments that connect the spinous process (in order of how you hit them with a needle)

Supraspinous
Intraspinous
Ligamentum Flavum

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Supraspinous Ligament
Weak or strong?
What does it connect?
Where is this a major ligament at?

Strong cord like ligament
Connects apices of spinous processes
Major ligament of cervical & upper thoracic regions

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Intraspinous ligament 
Thin or thick?
Where is it located?
What is it like in the cervical region?
What is it like in the lumbar region?

Thin
Runs between adjacent spinous processes
Absent or poor quality in cervical region
Can be extremely thin in Lumbar

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Ligamentum Flavum

Strongest or weakest?
Where is it thin and thick at?
How thick at L2-L3?
Join the _____ through vertical extensions from adjacent lamina
Paired flat ligaments between each lamina and overlap
Creates appearance of a

Strongest
Thin on lateral edge, thick midline, like a V
Can be 3-5 mm thick at L2-3
Join the Vertebral arches through vertical extensions from adjacent lamina
Paired flat ligaments between each lamina and overlap
Creates appearance of a contiguous ligament

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Where is the epidural space located?

Lies between ligamentum flavum and dura mater

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Where does the epidural space originate and end?

Contiguous from base of cranium to sacral sulcus

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What is the distance of the epidural space from the skin?

Varies with level and loosely correlated with weight (heavier they are, the deeper it is) Midline Lumbar approach 2.5-8 cm, average 5 cm

What are the contents of the epidural space?

veins, fat, lymphatics, segmental arteries, and nerve roots

Epidural veins are _____, form a plexus being most predominantly _____, become engorged during ____&_____

valveless Lateral Pregnancy & obesity

What is the depth of the epidural space at Cervical: Thoracic: Lumbar:

Cervical: 1.5-2mm Thoracic: 3-5mm Lumbar: 5-6mm

The spinal cord extends from the medulla oblongata to where in adults vs Peds?

Adults: L2 Peds: L3

The spinal cord has 3 layers of meninges, what are they in order from posterior to anterior

Dura Mater Arachnoid Mater Pia Mater

Which meningeal layer holds the CSF?

Arachnoid Mater

``` The spinal cord has ___ pairs of spinal nerves Cervical: Thoracic: Lumbar: Sacral: Coccygeal: ```

``` 31 pairs Cervical: 8 Thoracic: 12 Lumbar: 5 Sacral: 5 Coccygeal: 1 ```

Thoracic nerves run along what margin of the rib? Where would you want to place a chest tube?

Inferior Superior aspect of the rib

The level of spinal nerve does not always correlate with vertebra. Where does the 1st nerve exit? Where does C8 exit? Cervical correlate with vertebrae ___, after T1 correlates with vertebrae ____.

Base of skull and atlas Between C7 and T1 below above

The spinal cord is approx _____ shorter than the vertebral canal

25 cm

Where is the spinal cord enlarged at?

C5-C7 and L2-L3 C4-T1 – brachial plexus L2-S3 – lumbar and sacral plexus

What is the Cuada Equine? | Where does it extend?

Long roots of lumbar and sacral nerves | Extends from L1-S5

Dorsal root contains _____ fibers | Ventral root contains _____ fibers

Sensory (dorsal entering sensory) | Motor (ventral outgoing motor)

The spinal cord contains ___ shaped central grey region. What does it contain?

H-shaped | Neuronal cell bodies and unmyelinated fibers

The spinal cord is surrounded by ____ matter. What does it contain?

white matter | Fiber tract

Grey matter is subdivided into: | What are the afferent and efferent tracts?

12 Laminae of Rexed Afferent I-VI (receives sensory information from the periphery) Efferent VII-IX (Ventral tracts - motor neurons)

In the grey matter, the _____ is very important to anesthesia. What is it called?

Laminae II | Substanca Gelatinosa

What is dorsal white matter?

Almost exclusively ascending sensory fiber tracts

What are lateral and ventral white matter?

Descending motor tracts Can do two things: Ascend to the brain Association tract originate and terminate entirely within the spinal cord (reflexes)

What do sensory (afferent/ascending) transmit?

Transmit pain, temp, pressure, touch, vibratory sense, and proprioception

Where are sensory afferent receptors located?

Epidermis & Dermis = pain and temp | Dermis = Pressure, touch, vibration, proprioception

What are 2 classifiactions of sensory receptors?

Extroceptors --> near surface of skin and oral mucosa (why kids put things in their mouth) Proprioceptors --> Deeper skin layers, joint capsules, ligaments, tendons, muscles, and periostium

There are 2 main sensory tracts, what is the Dorsal Column-Medial Lemniscus Carries signals ______ in dorsal column tract Cross over at _____ Carried through ___ in medial lemniscus tract To area of brain to ____

upwards towards the medulla medulla brainstem to thalamus interpret (look at slide 29)

There are 2 main sensory tracts, what is the Anterolateral Pathway Originate in dorsal horn to ____ where they synapse ____ cross over in anterior commissure to anterior and lateral white columns Ascend to brain through associated tract Anterior spinothalmic or lateral spinothalmic Go to brainstem or thalmus To area of brain to interpret

Laminae I, IV, V, VI Immediately (look at slide 31)

Where do IV and Neuraxial opioids work?

Substancia Gelatinosa

``` Dorsal Column-Medial Lemniscus: Fibers: Conduction Speed: Spatial Orientation: Types of mechanoreceptive sensations: ```

Fibers: Large/mylinated Conduction Speed: 30-110 m/sec (fast) Spatial Orientation: high respect to organ Types of mechanoreceptive sensations: discrete

``` Anterolateral System: Fibers: Conduction Speed: Spatial Orientation: Types of mechanoreceptive sensations: ```

Fibers: smaller/mylinated Conduction Speed: Few – 40 m/sec (slow) Spatial Orientation: low respect to origin Types of mechanoreceptive sensations: broad

What sensations does the anterolateral sensation transmit?

``` Pain Thermal (hot and cold) Crude touch and pressure Tickle and itch sensation Sexual sensation ```

``` Sympathetic Nervous System ______ neurons What type of fibers? Where does it originate? Where does it exit the spinal cord? ``` Series of _____ segmental paravertebral ganglia form sympathetic trunks

Preganglionic Neurons Small B fibers Originate in the intermediolateral gray horn between? T1-L2/L3 Exit the spinal cord via the ventral nerve root (White rami communicans) Paired

What is the cervical ganglia divided into?

superior, medial, and inferior ganglia

What does stimulation of the SNS in the superior ganglia cause?

Mydriasis (contraction of the radial muscle of the iris) Relaxation of the ciliary muscle of the eye Constriction of the blood vessels of the head

Damage to the superior cervical ganglia causes:

Miosis (small pupil) Ptosis (drooping eyelid) Anhydrosis (lack of sweating) HORNERS SYNDROME

The inferior cervical ganglia fuses with first thoracic to form what?

Stellate Ganglia | C5-C6

What are the 4 stages of pain transmission?

Transduction Transmission Modulation Perception

Pain and temp pathway

need to read book to understand this...

Spinal reflex arc

need to read book to understand this...

Dematomes: T4 T6/T7 T10

T4 - nipple line T6/T7 - Xiphoid process T10 - Belly Button

Dermatomes: Hand C6 C7 C8

C6 - thumb C7 - index/middle finger C8 - ring/pinky finge

Motor pathways: | Motor/Efferent (Exit) transmits info from brain to...

voluntary muscles, smooth and cardiac muscles and some glands

Motor pathways: | Corticospinal tract supplies the...

voluntary muscles of the trunk and extremities

Where does the corticospinal tract originate?

Originates in large, upper motor neurons locate in the precentral gyrus

Corticospinal tract: | Damage can cause lower motor neurons to..

Overfire – Hyperreflexia | Fire simultaneously – spasticity

Corticospinal tract: | With upper motor neuron paralysis..

Reflexes intact Suppressor fibers impeded Hyperreflexia occurs

Corticospinal tract: | Damage to lower motor neurons produce..

flaccid type paralysis

What disease effect the corticospinal tract?

Cerebal Palsy and ALS