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Block 1 Week 3 > Spinal Cord and Spinal Nerves > Flashcards

Spinal Cord and Spinal Nerves Flashcards

1
Q

What are the anatomical components of a vertebra?

A
  1. Vertebral body
  2. Pedicles
  3. Transverse processes
  4. Lamina
  5. Spinous process
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2
Q

What is the collective name for the pedicles, transverse processes, lamina, and spinous process?

A

Neural arch

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3
Q

What can be found in the vertebral canal?

A

The spinal cord and its meningeal coverings.

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4
Q

What is in the centre of the vertebral body and neural arch?

A

Vertebral canal.

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5
Q

How are transverse processes of the vertebrae C1-C6 different anatomically different?

A

They have a hole in each transverse process.

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6
Q

What runs through the formanen of the transverse processes of the cervical vertebrae?

A

The vertebral artery.

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7
Q

How are the spinous processes of the cervical vertebrae different anatomically?

A

They are bifid - they split into two rather than coming to a singular point.

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8
Q

Why does the size of the vertebral bodies increase as you move down the spinal column?

A

Because the lower down they are, the more weight they will be carrying.

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9
Q

Which section of the vertebral column has the narrowest vertebral canal?

A

Thoracic.

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10
Q

Why are the vertebral canals of the cervical and lumbar regions wider than the thoracic?

A

To accommodate for the normal swelling of the spinal cord due to the extra traffic leaving and coming in from the upper and lower limbs in these regions.

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11
Q

How do the vertebrae join together?

A

A superior articular process joins onto the inferior articular process of the vertebra above it to form a joint.

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12
Q

What type of joint is formed between the superior and inferior articular processes of two adjacent vertebrae? What is the specific name given to this joint?

A

Synovial joint - called the zygapophyseal joint.

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13
Q

What is found between two adjacent vertebral bodies?

A

Intervertebral discs.

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14
Q

What is the name of the hole from which the spinal nerves enter and exit the vertebral canal?

A

The intervertebral foramen.

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15
Q

What are the borders of the intervertebral foramen?

A

2 pedicles, an intervertebral disc, and the zygapophyseal joint.

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16
Q

How many vertebrae are in the cervical segment?

A

7

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17
Q

How many vertebrae are in the thoracic segment?

A

12

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18
Q

How many vertebrae are in the lumbar segment?

A

5

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19
Q

How many vertebrae are in the sacral segment?

A

5

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20
Q

What bony feature is below the sacrum?

A

Coccyx

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21
Q

Do spinal nerves C1 - C7 exit above or below their corresponding numbered vertebrae? What about C8 spinal nerve? What about the rest of the spinal nerves after C8?

A

Above. C8, because there are only 7 cervical vertebrae, exits above T1. From T1 downwards all spinal nerves exit below their corresponding numbered vertebrae.

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22
Q

What is the outermost meningeal covering of the spinal cord?

A

Dura mater

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23
Q

When the dura mater continues along each spinal nerve, it blends into what?

A

The spinal nerve’s epineurium.

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24
Q

What is superficial to the dura mater in the spinal column and what is contained in this area?

A

Epidural space - filled with fat and veins.

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25
Q

What space is deep to the dura mater in the spinal column?

A

The subdural space.

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26
Q

What is deep to the subdural space in the spinal column?

A

Arachnoid mater

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27
Q

What space is deep to the arachnoid mater in the spinal column?

A

Subarachnoid space.

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28
Q

In the spinal column, what is the subarachnoid space filled with?

A

Cerebrospinal fluid (CSF).

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29
Q

What is deep to the subarachnoid space? What does this surround?

A

Pia mater - surrounds the spinal cord.

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30
Q

When viewing an axial section of the spinal cord, is it viewed from above or below?

A

Above.

31
Q

Describe the arrangement of white matter and grey matter in the spinal cord.

A

Grey matter is predominantly surrounded by white matter.

32
Q

In the spinal cord, what is the grey matter?

A

Cell bodies.

33
Q

In the spinal cord, what is the white matter?

A

Axons of neurons arranged in bundles of similar function.

34
Q

Which horns of the spinal cord are sensory and motor?

A

Sensory is the dorsal horn and motor is the ventral horn.

35
Q

What is in between the dorsal and ventral horns of the spinal cord? What does this contain?

A

The lateral horn, containing autonomic preganglionic sympathetic cell bodies.

36
Q

In which regions of the spinal column are the lateral horns of the spinal column present? Why?

A

T1 - L2, because this is where sympathetic autonomic nerve fibres can originate.

37
Q

In which 2 sections of spinal column does the spinal cord contain large grey horns? Why?

A

The Cervical and Lumbar, because there are many neurons required to innervate the upper and lower limbs respectively.

38
Q

List the blood supply of the spinal cord.

A
  • 2 posterior spinal arteries
  • 1 anterior spinal artery
  • Feeder arteries which enter the intervertebral foramen at every level, which arise from the vertebral arteries in the neck.
  • Posterior intercostal arteries
  • Lumbar arteries
39
Q

Which supplies more blood to the spinal cord, anterior spinal artery or posterior spinal arteries?

A

Anterior spinal artery - supplies about 3/4 of the spinal cord.

40
Q

Why might a blockage of the segmental arteries in the more inferiorly located area of the cord result in ischaemic damage to the spinal cord?

A

Because the vertebral arteries are less able to supply the more inferior segments of the spinal cord, so the segments may be left without blood supply in the case of a blockage in a segmental artery.

41
Q

How are the veins of the vertebral venous plexus anatomically different from most veins in the body?

A

They are valveless.

42
Q

What is the benefit of the veins of the spinal cord being valveless?

A

In any position venous blood can freely drain out of the spinal cord, so that there’s rarely ever venous congestion in this area.

43
Q

Why might someone with prostate cancer have backache?

A

Because the pelvic veins communicate with the vertebral venous plexuses and forms a route for cancer to spread into the vertebral bodies.

44
Q

Which vertebrae have holes in the transverse processes?

A

C1 - C6.

45
Q

Which segments of the vertebral column do the sympathetic and parasympathetic nerves arise?

A

Sympathetic - T1 - L2.

Parasympathetic - S2 - S4.

46
Q

What type of fibres are coming into the spinal column from the dorsal roots?

A

Sensory afferent (somatic or visceral).

47
Q

What type of fibres are going out of the spinal column from the ventral roots?

A

Motor efferent (somatic or autonomic).

48
Q

What is radiculopathy?

A

Damage to a nerve root.

49
Q

What can cause radiculopathy and what might the patients symptoms be?

A

Narrowing of the space where the nerve roots are trying to exit the spinal column or cord. This could be caused by stenosis of vertebral canal or intervertebral foramen, or disc herniation. Patients may describe sharp shooting pains in dermatomal distribution of the damaged spinal nerve.

50
Q

What vertebral level is the common level of adult spinal cord termination?

A

L1.

51
Q

What vertebral level is the common level of dural sac/ subarachnoid space termination?

A

S1/2.

52
Q

What tethers the end of the dural sac to the coccyx? What is the name given to this structure?

A

A final cord-like extension of pia mater, called the filum terminale.

53
Q

What is the Cauda Equina? What do they innervate?

A

A collection of lumbar and sacral spinal nerves which supply the lower limbs, pelvic floor, urinary and sphincters.

54
Q

What lies between the intervertebral discs and vertebral bodies?

A

Hyaline cartilage.

55
Q

What are the 2 major parts of intervertebral discs?

A
  1. An outer annulus fibrosus

2. An inner nuclear pulposus

56
Q

The annulus fibrosus has an outer ring of what?

A

Collagen.

57
Q

What is the nucleus pulposus made from?

A

A jelly-like material that consists mainly of water, as well as a loose network of collagen fibres.

58
Q

On T1 and T2 - weighted MRI’s, which tissues show up distinctive in each?

A
  1. T1-weighted shows only fat.

2. T2-weighted shows fat and water.

59
Q

IV disc prolapse is common in which region? Which specific disc is most commonly affected and which direction does it prolapse?

A

Lumbar region. Disc L4/L5 projects posteriorly and laterally.

60
Q

A lateral L4/L5 disc prolapse will affect which spinal nerve(s)?

A

L5 only.

61
Q

What is Cauda Equina syndrome and what is the treatment?

A

A rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed. Treatment is lumbar decompression surgery, ideally within 48 hours.

62
Q

What are some causes of Cauda Equina Syndrome?

A
  1. Herniated disc
  2. Tumour
  3. Infection
  4. Fracture
63
Q

What are some symptoms of Cauda Equina Syndrome?

A
  1. ‘Saddle anaesthesia’
  2. Urinary and/or faecal incontinence.
  3. Pain in the back and/or legs (sciatica)
  4. Sexual dysfunction.
64
Q

In Cauda Equina syndrome, which reflex will the patient be missing? What is this reflex?

A

The anal wink reflex.

It is the reflexive contraction of the external anal sphincter upon stroking of the skin around the anus.

65
Q

What vertebral levels is a lumbar puncture most commonly performed?

A

Either between L3-L4 or L4-L5.

66
Q

In a lumbar puncture, what angle should the needle be at?

A

15 degrees towards the head.

67
Q

List the structures which would be penetrated in a lumbar puncture.

A 
Skin
Subcutaneous fat
Supraspinous ligament 
Interspinous ligament
Ligamentum flavum
Epidural space
Dura mater
Arachnoid mater
68
Q

In an epidural, how can you tell when the needle has reached the epidural space?

A

By sensing a loss of resistance when the needle passes through the ligamentum flavum.

69
Q

The caudal epidural space can be accessed for anaesthetic administration using what? Is this procedure common?

A

The sacral hiatus.

No, it’s not common.

70
Q

Where is the sacral hiatus located?

A

At the inferior apex of an equilateral triangle measured between the posterior superior iliac spines.

71
Q

The line joining the PSIS passes through or just above which spinous process?

A

S2.

72
Q

Where does a spinal insert anaesthesia into?

A

Subarachnoid space.

73
Q

Why might someone receive spinal anaesthesia rather than epidural?

A

Spinal is much faster acting.

Block 1 Week 3 (9 decks)

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