Spine

Question 1

Describe the articular facets of the first cervical vertebra

Answer 1

Superior facets are concave and kidney shapes

Inferior facets are circular and almost flat

Question 2

Which ligaments attach to the odontoid process?

Answer 2

Transverse atlantal ligament
Apical odontoid ligament
Alar ligament

Question 3

What type of joint is the atlanto axial joint?

Answer 3

Synovial pivot

Question 4

Name the ligaments between C1 and C2

Answer 4

Anterior atlanto axial ligament
Posterior atlanto axial ligament
Transverse ligament

Question 5

What is the first spinous process to be felt?

Answer 5

C7 - has a long spine or vertebral prominence

Question 6

Why can we not feel the spinous processes above C7?

Answer 6

The spinous processes are small, bifid and attached to the nuchal ligament

Question 7

Name the atypical cervical vertebrae and their atypical features

Answer 7

C1 (atlas) - no body and no spine
C2 (axis)- Body projects upwards in the form of the odontoid process, thick spine
C7 - very long spine, smaller foramen transversum

Question 8

How many vertebrae make up the spinal column and how many spinal nerves are there?

Answer 8

7 cervical vertebrae, 8 cervical nerves
12 thoracic vertebrae, 12 thoracic nerves
5 lumbar vertebrae, 5 lumbar nerves
5 fused sacral vertebrae, 5 sacral nerves
3 fused coccygeal vertebrae, 1 coccygeal nerve

Question 9

What are the characteristics of the lumbar vertebrae?

Answer 9

Very large bodies, kidney shaped

They lack transverse foramina, costal facets or bifid spinous processes

They have triangular- shaped vertebral foramina (like the cervical vertebrae)

Spinous processes are shorter than those of the thoracic vertebrae and do not extend inferiorly below the level of the vertebral body

Question 10

What structures pass through the intervertebral foramen?

Answer 10

Root of each spinal nerve
Dorsal root ganglion
Spinal artery of the segmental artery
Communicating veins between the internal and external plexuses
Recurrence meningeal nerves
Transforaminal ligaments

Question 11

At what level should a lumbar puncture be done?

Answer 11

L4/L5

Question 12

What layers are passed through when undertaking a lumber puncture?

Answer 12

Skin, subcutaneous fat and fascia
Supraspinous ligament
interspinous ligament
Ligamentum flavum
Epidural space
dura mater
Arachnoid mater
CSF

Question 13

What is the anatomy of the intervetebral discs?

Answer 13

INternal nucleus pulposus surrounded by fibrocartilagenous annulus fibrosus

Question 14

What type of joint is the intervetebral joint?

Answer 14

Secondary cartilaginous joint

Question 15

What movements occur at the lumbar vertebrae?

Answer 15

Flexion, extension, lateral flexion and axial rotation

Question 16

At what level does the spinal cord terminate in neonates and adults?

Answer 16

Neonates L3
Adults L1/2

Question 17

What is the contents of the spinal canal below L1/2?

Answer 17

Cauda equina

Question 18

What are the locations of the paravertebral venous plexus?

Answer 18

Anterior external vertebral venous plexus, the small system around the vertebral bodies

Posterior external vertebral venous plexus, the extensive system around the vertebral processes

Anterior internal vertebral venous plexus, the system running the length of the vertebral canal anterior to the dura

Posterior internal vertebral venous plexus, the system running the length of the vertebral canal posterior to the dura

Question 19

What are the contents of the epidural space?

Answer 19

Lymphatics
Spinal nerve roots
Loose connective tissue
Fatty tissue
Small arteries
Network of internal vertebral venous plexuses

Question 20

How do spinal metastases happen?

Answer 20

Spread from primary tumours is mainly by the arterial route
Retrograde spread through the Batson plexus
Direct invasion through the intervertebral foramina

Question 21

What is Batson’s venous plexus

Answer 21

A network of veins with no valves that connect the deep pelvic veins draining the bladder, prostate and rectum to the internal vertebral venous plexus

Question 22

Which tumours commonly metastasise to the spine?

Answer 22

Breast
Lung
Thyroid
GI tract
Prostate
Kidney
Lymphoma
Melanoma
Multiple myeloma

Question 23

What structures are found at C6

Answer 23

Termination of the phayrnx and beginning of the oesophagus
Termination of the larynx and beginning of the trachea
Entry of the vertebral artery to the foramen transversum
Intermediate tendon of omohyoid crosses the carotid sheath
MIddle thyroid vein emerging from the thyroid
Inferior thyroid artery entering the thyroid gland