Spine/Back Flashcards
GSA
Proprioception (GTO, MS) Exteroceptive (Pain and temp)
GSE
Innervate skeletal muscle
GVA
distention, pain from “viscera” (think gut or sweat glands, arrector pili)
GVE
autonomic, smooth muscle and gland innervation
Dermatome
area of skin innervated by cutaneous branches of spinal nerve
Sacralization
Fusion of the L5 with S1 ( only have 4 L vertebrae)
Lumbarization
Lack of fusion of S1 with Sacrum (6 lumbar vertebrae)
Number of vertebrae
33 ( 5C 12T 5L 5S 4C)
Body of vertebrae
largest part, most anterior
spongy on the inside, Compact on the outside
Covered by hyaline cartilage
What passes through the Transverse Cervical Foramen
Vertebral artery, vein and sympathetic plexus
Cervical superior articular processes
Flat
Obliquely in the coronal plane
why is the vertebral foramen of C1 enlarged
to accommodate the brain stem
C7
Vertebra prominens
May lack transverse foramina
- if they are there, only transmit vertebral vein
Complete Costal Facet
located on TV 1 10 11 12
Thoracic superior articular process
Vertically in the coronal plane
Face posterior
Lumar Superior Articular Process
Vertically in the sagittal plane
Lumbar Puncture
facilitated by short non-overlapping Laminae
L5/L5 (adult)
Lower in children
(spine ends L1/L2
Ala of sacrum
fused costal and transverse processes of SV1
Intervertebral discs (Structure)
outer= anulus fibrosis: concentric rings of fibrocartilage, attaches to body by hyaline cartilage
Inner= elastic, hydrated, gelatinous mass that can move under compression
Intervertebral discs
Thicker anterioral (C and L regions) to maintain secondary curves Absorb shock (can bulge past the margins under compression)
Ruptured vs. Herniated Disc
Ruptured= tear of A.F.
Herniated=N.P. squeezes thru ruptured disc
- press on spinal nerve and cause rediculopathy
Cervical herniation
affect spinal nerves at the same level as herniation
Lumbar regions
affect the spinal nerve one or more segments lower
Anterior longitudinal spinal ligament
Anterior surface of ALL vertebrae
from occipital bone to sacrum
Deep= short fibers that connect adjacent vertebrae
Superficial= Long fibers that connect many vert
PREVENT EXS EXTENSION
Posterior Longitudinal spinal ligament
posterior surface of all vertebral bodies from occipital bone to sacrum
> deep and superficial layers
prevents EXS flexion
directs IV disc herniation posteriorlaterally (thereby affecting spinal nerves)
fuses with tectorial membrane
Zygapophysis (Facet) joint
True synovial jt around the superior/inferior articulating processes
-do not limit ROM (soft tissue does)
ROM of cervical region
F, E, Rotation, lateral flexion
ROM of Thoracic region
Rotation, lateral flexion, little flexion
NO extension
limited by ribs, long spinous processes, and thin IV discs
ROM of lumbar region
F, E, Lateral rotation,
NO rotation
Ligamentum Flavum
Joins lamina of adjacent vert
Yellow due to lots of elastic fibers
Limits flexion and aligns facet joints
CV2 downwards
Interspinal ligament
Unites adjacent spinous processes
More robust in Lumbar region
Supraspinal ligament
connects tips of SPs from C7 to sacrum
Deep=span adjacent SPs
Superficial=Spans several vertebrae
Continuous with the nuchal ligament
Nuchal Ligament
Median extension of supraspinal ligament
Intermuscular septum for poster deep muscles of the neck
—>muscle attachment that does not require extra long spinous processes that would limit ROM
Intervertebral foramina contents
Dorsal and ventral roots DRG Spinal nerve Spinal a. Intervertebral v.
Lateral atlantoaxial articulation
synovial joint b/w C1 and C2 articular process
Median Atlantoaxial articulation
Pivot synovial joint b/w dens and anterior arch of C1
“No”
Alar ligament
from dens to the occipital condyles (very strong)
tear increase rotation by 30 degrees (think Owls)
Tectorial membrane
covers dens and associated ligaments
From foramen magnum to C2 where it becomes with posterior longitudinal spinal ligament
Spondylolysis
defect in the pars interarticularis of the neural arch of adjacent vertebrae (decreased integrity b/w)
bilateral=spondylolisthesis
Causes the entire part of spine above the defect to slide forward
most common in L5 and S1
Spinal arteries
run parallel to the vertebral column
enter the intervertebral foramen and divide into ossesous branches and neural branches
Osseous branches
anastomose with branches above, below, and across to form plexuses within the vertebral canal between the posterior longitudinal ligament and ligamentum flavum
Neural Branches
Provide radicular branches which travel with spinal nerve and beyond
Radicular arteries
All spinal nerve roots have an associated radicular artery
end before reaching the anterior or posterior arteries
Spinal veins
4 plexuses drain the vertebral column
all four run the entire length
all freely communicate with each other
DO NOT possess valves
Vein Plexuses
Anterior external
Posterior external
Anterior internal- in epidural space, next to posterior longitudianl ligament
Posterior internal- epidural space, next to laminae ligamenta flava
Basivertebral veins
drain bodies of teh vertebrae to the anterior internal plexus
intervertebral veins
receive drainage from ALL plexuses and pass through the intervertebral foramina
Suboccipital triangle
Lat/sup: Obliquus capitis superior Lat/inf: obliquus capitis inferior Medial: rectus capitis posterior major Roof: semispinalis capitis floor: posterior atlantooccipital membrane and the posterior arch of atlas
contains vertebral artery, Suboccipital nerve, Greater occipital nerve
Suboccipital nerve
C1 dorsal ramus
pierces posterior atlantooccipital membrane where it passes thru the triangle to innovate at suboccipital muscles
Greater occipital nerve
pierces semispinalis capitis and trap to innervate the posterior skull (think tension HA)
How to check for spinal accessory nerve integrity
ask pt to shrug shoulders against resistance, any disparity implies injury to spinal accessory
