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M1 Gross Anatomy > Spinal Cord > Flashcards

Spinal Cord Flashcards

1
Q

Where does the spinal cord lie?

A

The upper 2/3 of the vertebral canal

Begins at the medulla of the brain and extends to the verebral levels LV1-LV2

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2
Q

What envelopes the spinal cord?

A

Three meninges - pia mater, arachnoid mater, and the dura mater

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3
Q

What is the significance at the C4-T1 level?

A

Cervical enlargement - nerve supply to the upper limbs; enlargement because of extensive input from limbs and fine motor control

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4
Q

What is the significance at the T11-L1 level?

A

Lumbar enlargement - nerve supply to lower limbs; enlargement becuase of extensive input from limbs and fine motor control

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5
Q

What are the two types of tissue within the spinal cord?

A

White matter - outer - myelinated axons

Grey matter - inner - nonmyelinated nerve cell bodies

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6
Q

Where does the spinal cord receive its blood supply?

A

Anterior spinal artery - from vertebral arteries

Two posterior spinal arteries - from vertebral or posterior cerebellar arteries

Branches of the vertebral, cervical, posterior intercostal and lumbar arteries - segmental medullary and radicular arteries

Artery of Adamkiewicz/Great segmental artery - largest segmental artery - usually from left lower intercostal or upper lumbar artery

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7
Q

Compared to the vertebral column, describe the rate of growth of the spinal cord:

A

The spinal cord grows slower than the vertebral column during fetal development (the spinal cord terminates at LV3 in the newborn and LV1-2 in adults)

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8
Q

What are spinal segments?

A

Parts of the spinal cord that contribute to a spinal nerve

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9
Q

What comprises a single spinal nerve?

A

Dorsal and ventral roots arise from the spinal segment to create a single spinal nerve

Spinal nerves are formed within the intervertebral foramen by the union of the ventral and dorsal roots

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10
Q

List the number of each class of spinal nerve:

A

There are 31 pairs of spinal nerves:

8 cervical
12 thoracic
5 lumbar
1 coccygeal

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11
Q

Shortly after a spinal nerve exits the intervertebral foramen, in branches into the ________ .

A

Dorsal ramus, ventral ramus, and ramus communicans

Each carry both sensory and motor information

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12
Q

What aspect of the spinal nerves contains cell bodies of sensory neurons?

A

The dorsal root ganglion

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13
Q

Ventral Rami

A

Supply the antero-lateral parts of the trunk, and the limbs; they are form the most part larger than the posterior divisions

In the thoracic regions they remain distinct from each other and each innervates a narrow strip of muscle and skin along the sides, chest, ribs, and abdominal wall. These rami are called the intercostal nerves. In regions other than the thoracic ventral rami converge with each other to form networks of nerves called nerve plexuses. Within each plexus, fibers from the various ventral rami branch and become redistributed so that each nerve exiting the plexus has fibers from several different spinal nerves.

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14
Q

What does the rami comminicans connect?

A

The spinal nerves with the sympathetic chain

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15
Q

Dorsal Rami

A

Innervates skin and deep muscles of the back

Divide into medial and lateral branches to supply the muscles and skin of the posterior part of the trunk

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16
Q

What is one advantage of the plexus?

A

Damage to a single spinal nerve will not completely paralyze a limb.

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17
Q

What are the four main plexuses formed by the ventral rami?

A

Cervical plexus

Brachial plexus

Lumbar plexus

Sacral plexus

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18
Q

Cervical plexus

A

contains ventral rami from spinal nerves C1-C5.

Branches of the cervical plexus, which include the phrenic nerve, innervate muscles of the neck,. the diaphragm, and the skin of the neck and upper chest.

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19
Q

Brachial plexus

A

Contains ventral rami from spinal nerves C5-T1

This plexus innervates the pectoral girdle and upper limb

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20
Q

Lumbar plexus

A

Contains ventral rami from spinal nerves L1-L4

The lumbar and sacral plexuses innervate the pelvic girdle and lower limbs

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21
Q

Sacral plexus

A

Contains ventral rami from spinal nerves L4-S4

The lumbar and sacral plexuses innervate the pelvic girdle and lower limbs

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22
Q

Where does SN C8 exit?

A

Below CV7 and above TV1

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23
Q

Where do SN C1-C7 exit?

A

They exit the intervertebral foramen avove the corresponding vertebrae

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24
Q

From TV1, inferiorly, where do the corresponding spinal nerves exit?

A

Below the corresponding vertebrae

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25
Q

What nerve root is affected by a CV3-CV4 disk protrusion?

A

C4

26
Q

What nerve root is affected by a TV6-TV7 disk protrusion?

A

T6

27
Q

What nerve root is affected by a LV4-LV5 disk protrusion?

A

L5

28
Q

Would L4 exit above or below a disk protrusion?

A

above, however the spinal roots of L5 will be compressed as they descend past the protruding disk on their course to the intervertebral formen between LV5 and SV1.

29
Q

Pia mater

A

The innermost layer, closely applied to the spinal cord (cannot be dissected from it)

  • Dentibulate ligaments - lateral extentions of pia mater between the dorsal
    and ventral roots of spinal nerves
  • Filum terminale - inferior extension of pia mater
30
Q

Arachnoid mater

A

Middle layer of the meninges

Forms the subarachnoid space that is filled with CSF

Lumbar cistern - enlarged subarachnoid space between LV1-SV2

31
Q

Dura mater

A

Tough, fibrous, outermost layer of meninges

Subdural space - potential space between arachnoidand dura; extends inferiorly to SV2

Epidural space - exxternal to dura mater and contains the internal vertebral venous plexus and epidural fat

32
Q

Cauda equina

A

“Horses tail” - L2-Co1 -Dorsal and ventral roots of the lumbar and sacra spinal nerves that surround the filum terminale

Located within the subarachnoid space/lumbar cistern below the level of the conus medullaris

Floats freely in the CSF and not damaged during lumbar puncture

33
Q

Denticulate ligaments

A

21 pair of lateral extension of pia that help hold the spinal cord in position inthe subarachnoid space

34
Q

Filum terminale

A

Inferior prolongation of pia from the conus medullaris at LV2 to SV2

Blends with the dura and continues downward to attach to the dorsum of the coccyx as the coccygeal ligament

35
Q

CSF

A

Contained in the subarachnoid space

Made in the choroid plexuses in the ventricles

Circulates through the ventricles, enters the subarachnoid space and filters into the venous system through arachnoid ville in the dural venous sinuses

36
Q

Dermatome

A

Area of skin innervated by sensory fivers from a particular spinal nerve or segment of the spinal cord. Useful clinically to prudce a region of anesthesia or determine which nerve has been damaged

37
Q

Myotome

A

Group of muscles innervated by motor fibers derived from a single spinal nerve segment

38
Q

Sclerotome

A

Area of bone innervated from a single spinal segment

39
Q

Herpes zoster

A

Shingles - Virus remains latent in the dorsal root ganglia of spinal nerves. Activation of the virus produces neuralgic pain, eruption of vesicles or a rash in the dermatome of the nerve affected.

40
Q

Radiculopathy

A

Results from compression of the nerve root in the intervertebral formina or vertebral canal. Produces pain and paresthesias. The pain may radiate over the dermatomal disctribution of the affected nerve root. May also have weakness of skeletal muscles in myotomes supplied gby the affected nerve root. Usually caused by osteoarthritis and herniated disks.

41
Q

Herniated nucleus pulposus

A

Protrude poster-lateral part of the annulus fibrosus. Can result in compressuion of a nerve root. Most location in the lower cervical and lower lumbar regions.

42
Q

Meningitis

A

Inflammation of the menginges (bacterial or nonbacterial/aseptic). Fever, headache, stiff neck (meningismus), nausea, vomting, photophbia, mental status change

43
Q

Tethered cord

A

Congenital anomaly from defective closure of the neural tube. Abnormally low conus medullaris, which is tethered by a short thickened filum terminale. Causes progressive neurologic defects in the legfs and feet.

44
Q

Arnold chiari deformity

A

Cerebellum and medulla protrude down into the vertebral canal through the foramen magnum

45
Q

Spina bifida

A

Neural tube defect linkned to low folic acid ingestion during first trimester of pregnancy. The lamina of the vertebrae fail to fuse to form a spinous process. Most commonly at LV5 or SV1 levels. If the meninges and CSF protrude as a cyst, this is called a meningocele. If the meninges and the cord reside in the this is called a meningomyelocele.

46
Q

Ischemia of the spinal cord

A

Caused by aortic disease, surgery, regional anesthesia, or pain blocks

47
Q

Lumbar puncture

A

Usually performed between LV3-4 or LV4-5 lamina. Needle is inserted into subarachnoid space to withdrawal CSF for analysis/cultures. Can introduce anesthesia, drugs, and imaging contrast here.

The needle path: Skin -> superficial then deep fascia -> supraspinous then interspinous ligaments -> epidural space -> dura -> subdural space -> arachnoid mater -> subarachnoid space

48
Q

Epidrual anesthesia

A

Inject anesthetics to block the spinal nerves in the epidural space. Used for rectal, anal, and genital surgery.

49
Q

Spondylosis

A

Osteoarthritis of the joints of the verebrae

50
Q

Spinal stenosis

A

Narrowing of the spinal canal. Can results from spondylosis and herniated nucleus pulposus.

51
Q

A 45 y/o Pt presents w/ weakness in the UE’s and difficulty w/ fine motor control. Which spinal cord is likely affected?

A

Cervical enlargement

52
Q

A newborn has a suspected spinal condition and a termination of the spinal cord at LV3 is found during imaging. This is considered:

A

Normal

53
Q

A Pt with trauma to the lower back exhibits loss of motor and sensory Fx in the LE’s. Which part of the spinal cord is most likely injured?

A

Lumbar enlargement

54
Q

A Pt presents w/ a suspected herniated disc b/w LV2/LV3. Which nerve root is involved?

A

LV3

55
Q

A Pt has a herniated disk at CV5/CV6. Which spinal nerve is most likely affected?

A

C6

56
Q

A Pt w/ a congenital anomaly exhibits progressive neurologic deficits in the legs and feet. Imaging reveals a low conus medullaris connected by a short filum terminale. What is the diagnosis?

A

Tethered cord syndrome

57
Q

If the interior vertebral venous plexus is damaged, where would blood be found upon imaging?

A

The epidural space

The vertebral venous plexus is located in the epidural space (intervertebral foramen).

58
Q

Why is the lumbar spine a common site of metastisis for prostate cancer?

A

The vertebral venous plexus (hemotogenous metastisis)

The prosthetic venous plexus connects to the external venous plexus

59
Q

What is the difference between a medullary and radicular artery of the spinal cord?

A

The medullary arteries fuse with the spinal arteries, the radicular does not.

60
Q

Great medulary artery of Adamkiewicz

A

Major blood supply to lumbar and sacral portion of the spinal cord

Anterior spinal artery syndrome
Urinary and fecal incontinence
Impaired motor function of lower extremities
Sensory often preserved

Major blood supply to lumbar and sacral portion of the spinal cord

61
Q

What section of the spinal cord contains a lateral gray horn?

A

T1 - L2 (because they are the neuronal cell body’s of the sympathetic motor system)

62
Q

What section of the spinal cord contains a lateral gray horn?

A

T1 - L2 (because they are the neuronal cell body’s of the sympathetic motor system)

M1 Gross Anatomy (16 decks)

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