Spine anatomy Flashcards
- Anterior tubercle
- Anterior arch
- Superior articular facet
- Transverse process
- Foramen of transverse process
- Lateral mass
- Posterior arch
- Posterior tubercle
- Vertebral foramen
- Dens
- Superior articular facet
- Transverse foramen
- Transverse process
- Pedicle
- Lamina
- Spinous process
r/v
What type of joint is the atlanto-axial joint?
What ligament reinforces it?
Synovial joint
Reinforced by transverse ligament
Outline the course of the vertebral artery
The vertebral artery is a branch of the first part of the subclavian artery
Paired arteries travel between scalenus anterior and longus coli
Ascend through foramen transversarium of the upper 6 cervical vertebrae
Pass postero-medially to run in groove on top of atlas
Enter skull through foramen magnum
Join to become basillar artery as they reach anterior surface of Medulla oblongata
Which cervical vertebrae are typical?
Outline features of typical cervical vertebrae (5)
C3-6
- Broad flat body
- Small bifid spinous process
- Formania present in transverse process
- Oblique facet joint
- Movement: flexion/extension, lateral flexion
Outline features of typical thoracic vertebrae (5)
Heart shaped body
Long spinous process that points inferiorly
Costal facets present
horizontal-oblique plane
Lateral rotation
- Spinous process
- Transverse process
- Superior vertebral notch
- Vertebral foramen
- Body
- Pedicle
- Lamina
Outline features of lumbar vertebrae (5)
- Kidney shaped body
- Quadrangular spinous process
- Transverse process: no foramen, no costal facets
- Medial plane
- Flexion/extension, lateral flexion
Cervical
Thoracic
Lumbar
Ligaments of vertebral column
Which ligaments provide support to vertebral bodies?
Where is the ligamentum flavum located?
Anterior and posterior longitudinal ligaments provide support to anterior and posterior aspect vertebral body
Located on posterior border of intervertebral foramina. Bind adjacent laminae
What are the articulations between adjacent vertebrae?
What types of joint are these?
Vertebrae articulate with eachother through superior and inferior articular facets bilaterally
Synovial
Describe composition of intervertebral disc
What is the content of nucleus pulposus
What is the commonest pattern of disc herniation
Which nerve roots are most commonly affected
Vertebral bodies joint by intervertebral discs through secondary cartilaginous joints. The periphery of the disc is made of fibrous tissue known as annulus fibrosis. The centre is composed of a gelatinous matrix known as nucleus pulposus.
Type II collagen fibers in a mucoprotein gel containing polysacharide
A herniation is more likely to occur posterolaterally, where the annulus fibrosus is thinner and lacks the structural support from the anterior or posterior longitudinal ligaments.
L4/5 and L5/S1 resulting in L5 root compression and S1 root compression respectively
Where is this from and how do you know?
This is a typical cervical vertebrae
Round shaped vertebral body
Bifid spinous process
Large triangular vertebral foramen
Small transverse process with Foramina transverarium present
What is the uncus of cervical vertebrae?
What is attached to anterior and posterior tubercles?
What is a cervical rib?
Small upturned lip on lateral margins of cervical vertebrae- permit rotational movement
Scalenus anterior, middle and posterior
Supernumery rib that arrises from anterior tubercle of C7. Occur in 0.5% of population. May lead to T1 root impingement and compression of subclavian vessels
How many spinal nerves are there?
How many vertebrae are they?
31 pairs of spinal nerves:
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
35 vertebrae
7 cervical
12 thoracic
5 lumbar
5 fused sacral
4 fused coccygeal
Describe articulation between ribs and thoracic vertebrae
Every thoracic vertebae articulates with a pair of ribs via demifacets on lateral aspect of vertebral bodies apart from T1, T11, T12.
Each rib articulates with vertebrae at its own level and the vertebrae above (except T1, T11, T12).
There are further synovial joints between ribs and transverse processes of vertebrae at their own level
Where does spinal cord terminate in neonates? adults?
List all layers you pass through during LP
L3
L1/2
Skin
Subcutaneous tissue
Deep fascia
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Dura
In subarachnoid space where CSF flows
Describe the relationship between spinal nerves and vertebrae
In the cervical spine (C1-7): Spinal nerves exit above their coresponding vertebral body. C7 nerve root exits through the C6/7 neural foramen.
C8 nerve root exits between C7/T1 neural foramen.
Thorcolumbar spinal nerves now exit below their corresponding vertebrael body E.g T7 nerve root exits through T7/8 neural foramen
The spinal nerves exit the cervical spine above their corresponding vertebral body level. For example, the C7 nerve root exits above C7 through the C6-C7 neural foramen. C8 exits in between T1 and C7, since there is no C8 vertebral body level.
Anatomy of sympathetic chain
Cell bodies of sympathetic nerves in lateral horn of grey matter from T1-L2
Pre-ganglionic fibers pass through anterior roots of spinal nerves
Pass through white rami communicans to enter sympathetic chain
Some pass through without forming synapses (splanchnic nerves)
Synapse in sympathetic chain
Post-synaptic fibers pass through grey rami communicans to re-enter anterior ramus for distribution
3 cervical ganglia: superior, middle and inferior. Inferior cervical fused with first thoracic to form stellate ganglion
Describe the muscles involved in raising the arm above the head
Movements of shoulder: flexion, extension, abduction, adduction, rotation and circumduction
Anterior fibers of the deltoid = forward flexion
Initiation of abduction = supraspinatus
Deltoid then involved in abduction beyond 20 degrees
Beyond 90 degrees: external rotation by infraspinatus and teres minor
Scapula rotation to elevate glenoid: trapezius and serratus anterior
What is the brachial plexus?
Plexus of nerves
Originates from ventral primary rami of C5-T1
Extends into axilla and gives rise to most of the nerves that supply the upper limb
It is divided into 5 anatomic regions: roots, trunks, divisons, cords and branches
What muscle is supplied by long thoracic nerve?
How do you test it?
Long thoracic nerve (C567) supplies the serratus anterior
Ask patient to push both hands into wall. Weakness of serratus anterior results in characteristic winging of the scapula on the affected side.
What are the boundaries of the axilla?
Axilla is a pyramidal intermuscular space bounded by:
Anterior: Pectoralis major, pectoralis minor, claviopectoral fascia
Medial: Thoracic cage, serratus anterior
Posterior: Subscapularis, teres major, lat dorsi
Lateral: Intertubercular groove on humerus
Apex: Clavicle, 1st rib, scapula
What are the contents of the axilla?
Axillary artery
Axillary vein
Axillary lymph nodes
- Level 1 below pec minor
- Level 2 behind pec minor
- Level 3 above pec minor
Brachial plexus
Branches of axillary artery?
123
Superior thoracic
Thoracoacromial trunk
Lateral thoracic
Anterior circumflex humeral
Posterior circumflex humeral
Subscapular
what is the claviopectoral fascia?
What pierces it?
Thin layer of fibrous tissue that surrounds pectoralis minor
2 in:
- Lymphatics
- Cephalic vein
2 out:
- Thoracoacromial trunk
- Lateral pectoral nerve
Boundaries and contents of:
- Quadrangular space
- Triangular interval
- Triangular space
Quadrangular space
- Teres minor, teres major, long head triceps, humerus
- Posterior circumflex humeral artery
- Posterior circumflex humeral vein
- Axillary nerve
Triangular interval
- Teres major, long head triceps, humerus
- Radial nerve
- Profunda brachii vessels
Triangular space
- Teres major, teres minor, long head of triceps
- Circumflex scapular artery
Structures at thoracic inlet anterior to posterior
Subclavian vein
Phrenic nerve
Scalenus anterior (attached to 1st rib)
Subclavian artery
Brachial plexus
Middle scalene
What is thoracic outlet syndrome
What are the causes of thoracic outlet syndrome?
Syndrome caused by compression of neurovascular structures as they enter axilla. Arterial, neurogenic and venous phenotypes described.
ANATOMICAL
Congenital fibromuscular bands
Cervical rib
Scalene muscle enlargement
TRAUMATIC
Repetitive postural movements
Post-traumatic scaring
Axillary vein thrombosis
What is Roo’s test for thoracic outet syndrome?
Arm placed at 90 degrees abduction, external rotation and 90 degrees elbow flexion. Patient asked to repeatedly open and close fist. Positive test if symptoms reproduced.
Treatment for thoracic outlet syndrome?
CONSERVATIVE
Hot and cold packs
Stretching
Nerve gliding exercises
Posture advice
MEDICAL
Analgesia
Muscle relaxants
Cortisone injection
Botox
SURGICAL
Removal of cervical rib
Removal of 1st rib
Scalenectomy
