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Block 2 AR > Spine > Flashcards

Spine Flashcards

1
Q

Which vertebra is most prominent in the neck?

A

C7

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2
Q

In which region of the spine are the vertebral bodies the largest?

A

Lumbar

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3
Q

What is the difference in naming of spinal nerves in cervical region and below?

A

In cervical region, spinal nerves exit above corresponding number vertebra
In thoracic region and below, spinal nerves exit below corresponding vertebra
C8 spinal nerve is anomaly, there is no c8 vertebra

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4
Q

What forms the border of the intervertebral foramen through which the spinal nerves emerge?

A

Pedicle
IV disc
Articular processes and synovial joints

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5
Q

What does the posterior ramus supply?

A

Muscle of back and small part of dermatome

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6
Q

Where does posterior ramus run and can this cause back pain?

A

Runs close to zygopophyseal joint which can be impinged and cause back pain

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7
Q

What happens in the anterior white commissure of the spinal cord?

A

Axons crossing left to right

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8
Q

In what regions of the spinal cord can the lateral horn be found?

A

T1-L2 and S2-4 autonomic region

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9
Q

What are the 3 meningeal layers and what is between them?

A 
Pia mater
Subarachnoid space - CSF
Arachnoid mater
Subdural space - potential space
Dura mater
Epidural space - veins and fat
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10
Q

At what level does the adult spinal cord terminate?

A

L1/2

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11
Q

At what level does the spinal cord terminate at, at birth?

A

L3/4

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12
Q

At what vertebral level does the subarachnoid space end at?

A

S2

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13
Q

Where does the filum terminale end?

A

At coccyx - fibrous cord

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14
Q

What is the cauda equina?

A

Collection of lumbar and sacral spinal nerves

Supplies lower limbs, pelvic floor, urinary & anal sphincters

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15
Q

At what vertebral level does the lumbar part of the spinal cord sit?

A

T12

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16
Q

At what vertebral level does the sacral spinal cord sit?

A

L1

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17
Q

Where do lumbar and sacral spinal nerves run?

A

Through subarachnoid space to exit below their correspondingly numbered vertebrae

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18
Q

How can the L4 spinous process be found?

A

Level of iliac crests - supracristal plane

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19
Q

How would you angle a needle in order to perform a lumbar puncture?

A

Antero superiorly

15% cephalad orientation

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20
Q

What structures will a lumbar puncture penetrate?

A

Skin
Supra spinous and inter spinous ligaments
Ligamentum flavum

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21
Q

Why do the patients oxygen sats need monitoring during a lumbar puncture?

A

Postural positioning - knees to chest

Reduced functioning of diaphragm in this position so if left there for too long, can cause issues

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22
Q

Where is the epidural space in 80% of population?

A

~4.5–5.5 cm from the skin in the midline

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23
Q

When performing an epidural in the thoracic region, what will you do differently to the approach in the lumbar?

A

Needle angle more cephalad to avoid contacting bone

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24
Q

At what points can spinal anaesthesia be performed?

A

L3/4, L4/5, L5/S1

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25
Q

Which layer is spinal anaesthesia inserted into?

A

CSF in subarachnoid space

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26
Q

What 4 things might require spinal anaesthesia?

A

Operative
Obstetrics
Orthopaedics
Pain management

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27
Q

Where is the sacral hiatus?

A

Inferior apex of equilateral triangle measured between posterior superior iliac spines
In upper part of natal cleft

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28
Q

How is the needle inserted for caudal anaesthesia?

A

Introduced at right angle at sacral hiatus

Then angled towards head and advanced

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29
Q

What is the blood supply to the vertebral body and spinal cord?

A

Radicular arteries - enter via intervertebral foramen, supply roots and rootlets. Anterior (1) and posterior (2) spinal arteries
Internal venous plexus - relatively valve-less and drains spinal cord, vertebral body and meninges

30
Q

Why is the internal plexus of the extradural space of vertebral column a route for cancer spread?

A

Communicates with pelvic veins - prostate cancer spread

Valveless veins so metastases can spread easily

31
Q

In which region of the spinal cord is intervertebral disc prolapse common?

A

Lumbar

32
Q

Which spinal nerve is affected by an intervertebral disc prolapse?

A

Spinal nerve of intervertebral foramen one level below disc

33
Q

What is cauda equina syndrome?

A

Compression of sacral spinal nerves

34
Q

What can cause cauda equina syndrome?

A 
Disc herniation 
Tumour (Metastatic spread) 
Spinal stenosis 
Spondylolisthesis 
Vertebral canal stenosis
35
Q

What are possible symptoms of cauda equina syndrome?

A

Weakness of pelvic floor
Weakness of anal & urinary sphincter Lack of ‘anal-wink’ reflex
Altered bladder function
Perineal sensory loss/changes
Can’t feel self going to toilet - red flag
Reduced ankle jerk (S1/2)
Lower limb sensory loss/changes

36
Q

What does the vertebral column do?

A

Carries & protects spinal cord & nerves
Provides support to thoracic / rib cage
Transfers weight from upper body to lower limbs
Shock absorbing
Muscle attachment point

37
Q

What does the C1 atlas bone do?

A

Carries the weight of cranium

Joins to occipital condyle on base of skull and permits movement

38
Q

Where does axis bone form joint with atlas?

A

Odontoid process forms pivot joint with atlas

39
Q

How can you identify cervical vertebrae?

A

Small bodies, holes in their transverse processes for blood vessels (Foramen transversarium), bifid spines

40
Q

Which artery can get compressed within foramen transversarium?

A

Vertebral

41
Q

How can you identify thoracic vertebrae?

A

Progressively increase in size, possess articulations for ribs, heart shaped body

42
Q

How can you identify lumbar vertebrae?

A

Cope with large forces so large body, articulations are aligned to prevent rotational movements, Large ‘kidney’ shaped body, Square Spinous process

43
Q

What is the sacrum?

A

x5 fused vertebrae and transmits weight to pelvic girdle

44
Q

What nerves exit sacrum via Anterior sacral foramen?

A

Ventral rami of sacral nerves

45
Q

What nerves exit sacrum via Posterior sacral foramen?

A

Posterior rami of sacral nerves

46
Q

What can the Sacral hiatus be used for?

A

Can perform sacral epidural via this foramen

47
Q

What does the C7 spinous process landmark?

A

Lung apex

48
Q

What does the T12/L1 space landmark?

A

Transpyloric plane

49
Q

How is the vertebral column inherently stable with little muscle activity?

A

Joints & Ligaments

50
Q

What are intervertebral discs and what do they do?

A 
Resist compression, form mobile joint 
Secondary cartilagenous joints  
Present from beneath C2 
Increase in thickness distally 
Cartilage end plate on bone
51
Q

What are the layers in an intervertebral disc?

A

Annulus fibrosus = Layers of fibrocartilage

Nucleus pulposus = Rubbery central core (GAG)

52
Q

Where are Zygapophyseal Joints?

A

Located between articular facets of adjacent vertebrae
Simple synovial plane joints
Facets change orientation from superior-to-inferior

53
Q

What strong ligaments support the vertebral column?

A

Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum: Elastic ligament joining adjacent lamina. Pierced during lumbar puncture

54
Q

Where can the Ligamentum Nuchae be palpated?

A

Midline posterior neck

55
Q

What ligaments are located between spinous processes?

A

Interspinous Ligament

Supraspinous Ligament

56
Q

What will a midline (midvertebral line) needle insertion penetrate?

A

Skin, supraspinous and interspinous ligaments, ligamentum flavum

57
Q

Describe Vertebral Column Mechanics in terms of movements of intervertebral discs etc

A

Forces applied to vertebral column increase nucleus polposus pressure = tenses annulus fibrosus, tension here limits movement between vertebral bodies

58
Q

What happens to an intervertebral disc when it herniates?

A

Mobile nucleus pulposus can rupture through the annulus fibrosus

59
Q

What are spinal curvatures related to?

A

Disc shape

60
Q

What leads to loss of spinal curvatures?

A

Disc degeneration usually in old age

61
Q

When might you see Lumbar Hyperlordosis?

A

Pregnant women

62
Q

What is Scoliosis?

A

Lateral curvature of the spine

63
Q

What is Spondylolysis?

A

Fracture in region of articular facets without displacement

Cause of lower back pain

64
Q

What is Spondylolisthesis?

A

Lumbar vertebrae body slips / moves anteriorly
Can be traumatic, degenerative, dysplastic
Often accompanies spondylolysis

65
Q

Where is the Suboccipital triangle? And which nerves can get trapped there?

A

Sits under the occiput on the upper neck

Entrapment of C2 & C3 dorsal rami produce posterior headache / occipital neuralgia

66
Q

What does the erector spinae muscle group do?

A

Keeps you upright (extended)

67
Q

Which muscle acts on head to keep it upright?

A

Splenius Capitis

68
Q

What are the muscles of the vertebral column?

A

Erector spinae
Quadratus lumborum
Psoas major

69
Q

What are the abdominal wall muscles that contribute to supporting the vertebral column?

A

External oblique
Internal oblique
Transversus abdominis
Rectus abdominis

70
Q

What parts of a vertebral body make up the neural arch?

A

Pedicle - connects body to transverse process
Transverse process
Lamina - connects transverse process to spinous process
Spinous process

Block 2 AR (9 decks)

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