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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
Which layer is spinal anaesthesia inserted into?
CSF in subarachnoid space
26
What 4 things might require spinal anaesthesia?
Operative Obstetrics Orthopaedics Pain management
27
Where is the sacral hiatus?
Inferior apex of equilateral triangle measured between posterior superior iliac spines In upper part of natal cleft
28
How is the needle inserted for caudal anaesthesia?
Introduced at right angle at sacral hiatus | Then angled towards head and advanced
29
What is the blood supply to the vertebral body and spinal cord?
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
Why is the internal plexus of the extradural space of vertebral column a route for cancer spread?
Communicates with pelvic veins - prostate cancer spread | Valveless veins so metastases can spread easily
31
In which region of the spinal cord is intervertebral disc prolapse common?
Lumbar
32
Which spinal nerve is affected by an intervertebral disc prolapse?
Spinal nerve of intervertebral foramen one level below disc
33
What is cauda equina syndrome?
Compression of sacral spinal nerves
34
What can cause cauda equina syndrome?
``` Disc herniation Tumour (Metastatic spread) Spinal stenosis Spondylolisthesis Vertebral canal stenosis ```
35
What are possible symptoms of cauda equina syndrome?
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
What does the vertebral column do?
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
What does the C1 atlas bone do?
Carries the weight of cranium | Joins to occipital condyle on base of skull and permits movement
38
Where does axis bone form joint with atlas?
Odontoid process forms pivot joint with atlas
39
How can you identify cervical vertebrae?
Small bodies, holes in their transverse processes for blood vessels (Foramen transversarium), bifid spines
40
Which artery can get compressed within foramen transversarium?
Vertebral
41
How can you identify thoracic vertebrae?
Progressively increase in size, possess articulations for ribs, heart shaped body
42
How can you identify lumbar vertebrae?
Cope with large forces so large body, articulations are aligned to prevent rotational movements, Large ‘kidney’ shaped body, Square Spinous process
43
What is the sacrum?
x5 fused vertebrae and transmits weight to pelvic girdle
44
What nerves exit sacrum via Anterior sacral foramen?
Ventral rami of sacral nerves
45
What nerves exit sacrum via Posterior sacral foramen?
Posterior rami of sacral nerves
46
What can the Sacral hiatus be used for?
Can perform sacral epidural via this foramen
47
What does the C7 spinous process landmark?
Lung apex
48
What does the T12/L1 space landmark?
Transpyloric plane
49
How is the vertebral column inherently stable with little muscle activity?
Joints & Ligaments
50
What are intervertebral discs and what do they do?
``` Resist compression, form mobile joint Secondary cartilagenous joints Present from beneath C2 Increase in thickness distally Cartilage end plate on bone ```
51
What are the layers in an intervertebral disc?
Annulus fibrosus = Layers of fibrocartilage | Nucleus pulposus = Rubbery central core (GAG)
52
Where are Zygapophyseal Joints?
Located between articular facets of adjacent vertebrae Simple synovial plane joints Facets change orientation from superior-to-inferior
53
What strong ligaments support the vertebral column?
Anterior Longitudinal Posterior Longitudinal Ligamentum Flavum: Elastic ligament joining adjacent lamina. Pierced during lumbar puncture
54
Where can the Ligamentum Nuchae be palpated?
Midline posterior neck
55
What ligaments are located between spinous processes?
Interspinous Ligament | Supraspinous Ligament
56
What will a midline (midvertebral line) needle insertion penetrate?
Skin, supraspinous and interspinous ligaments, ligamentum flavum
57
Describe Vertebral Column Mechanics in terms of movements of intervertebral discs etc
Forces applied to vertebral column increase nucleus polposus pressure = tenses annulus fibrosus, tension here limits movement between vertebral bodies
58
What happens to an intervertebral disc when it herniates?
Mobile nucleus pulposus can rupture through the annulus fibrosus
59
What are spinal curvatures related to?
Disc shape
60
What leads to loss of spinal curvatures?
Disc degeneration usually in old age
61
When might you see Lumbar Hyperlordosis?
Pregnant women
62
What is Scoliosis?
Lateral curvature of the spine
63
What is Spondylolysis?
Fracture in region of articular facets without displacement | Cause of lower back pain
64
What is Spondylolisthesis?
Lumbar vertebrae body slips / moves anteriorly Can be traumatic, degenerative, dysplastic Often accompanies spondylolysis
65
Where is the Suboccipital triangle? And which nerves can get trapped there?
Sits under the occiput on the upper neck | Entrapment of C2 & C3 dorsal rami produce posterior headache / occipital neuralgia
66
What does the erector spinae muscle group do?
Keeps you upright (extended)
67
Which muscle acts on head to keep it upright?
Splenius Capitis
68
What are the muscles of the vertebral column?
Erector spinae Quadratus lumborum Psoas major
69
What are the abdominal wall muscles that contribute to supporting the vertebral column?
External oblique Internal oblique Transversus abdominis Rectus abdominis
70
What parts of a vertebral body make up the neural arch?
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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