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Anatomy > Spine (brian) > Flashcards

Spine (brian) Flashcards

1
Q

the occiput-c1 joint provides most of what ROM? how much?

A

flexion. 50%

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2
Q

c1-c2 joint provides most of what ROM? how much?

A

rotation. 50%

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3
Q

surface land marks:

C2-3

C3

C4-5

A

C2-3: mandible

C3: hyoid

C4-5: thyroid cartilage

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4
Q

surface landmarks:

C6

C7

T3

A

C6: cricoid cartilage

C7: vertebral prominens

T3: scapular spine

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5
Q

surface landmarks:

T4

T7

L4-5

A

T4: nipples (variable)

T7: distal tip of scapula

L4-5: iliac crest

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6
Q

what is a motion segment? what is it also called?

A

smallest segment of spine that shows biomech characteristics of the entire spine

i.e. 2 adjacent vertebrae and intervening ligamentous tissues

AKA functional spinal unit

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7
Q

what spinal vertebrae have bifid spinous processes?

A

C2-6

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8
Q

at what level is the spinal cord largest in the c-spine?

A

c2

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9
Q

what shape is the vertebral body in the t-spine?

A

heart

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10
Q

L-spine vert bodies are what shape?

A

kidney

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11
Q

mamillary processes occur in what spinal region?

from what structure do they project from?

A

L-spine

from superior articular process

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12
Q

how many sacral foramina are there?

A

4 pairs dorsal and ventral

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13
Q

how many vertebrae fused embryologically to form the coccyx?

A

usually 4

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14
Q

most common site of disc herniation?

second most common?

A

L5/S1 first, L4/5 second

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15
Q

transverse ligament of the c-spine occurs where?

A

posterior to Dens, stabilizes a-a joint and keeps dens up against anterior arch of c1

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16
Q

alar ligaments joint what to what?

embryologically they are remnants of what?

A

from occiput to tip of dens

remnant of notochord

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17
Q

cruciform ligament of atlas is made of what?

A

includes the transverse ligament

plus inferior and superior longitudinal bands

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18
Q

annulus fibrosus is mostly what type of collagen?

A

type I

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19
Q

nucleus pulposis is mostly what collagen type?

A

type II

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20
Q

in the saggital and coronal planes, c-spine facet joints are oriented how?

A

saggital: 45 deg

coronal 0 deg

i.e. roof shingles angled posteriorly at 45 deg

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21
Q

T-spine facet joints are oriented how in the sagg and coronal planes?

A

saggital 60 deg

coronal 20 deg

i.e. similar to roof shingles but tilted 20 deg towards being saggital

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22
Q

L-spine facet joints are oriented how in the saggital and coronal planes?

A

saggital: 90 deg
coronal: 45 deg
i. e. straight up and down plane of joint, but tilted out 45 deg

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23
Q

amount of “intoeing” for pedicle screws is greatest where? least where?

A

greatest at T1 and L5

least at T12

decreases from T1 and L5 towards T12

L1 approximately 5-10 deg

increases ~5 deg per level from L1 down to sacrum

24
Q

T-spine pedicle screw start point

A

intersection of middle of TP and middle of inferior articular facet

25
Q

lumbar pedicle screw start point?

A

midpoint of TP

midpoint of superior articular process

nb: pars lines up with medial aspect of pedicle

26
Q

upper spine largest pedicle?

L-spine largest pedicle?

A

T1

L5

27
Q

smallest pedicle?

smallest within L-spine?

A

T4

L1

28
Q

post-halo: what nerve injuries can occur?

A

basically supraorbital nerve, CN 4,6,10,11,12

CN VI - abducens n

can hit it at petrosphenoidal junction. get eyes that look down and in

Glossopharyngeal (4) + vagus (10) + hypoglossal (12)

dysphagia, loss of palatal/pharyngeal reflexes, weakness of tongue

from penetration of jugular foramen

CN eleven accessory n

supraorbital nerve - from anterior pins too medial

29
Q

describe pin placement for halo

A

anterolateral pins: just below head equator, 1cm above orbit, in lateral 2/3 of orbit (avoid supraorbital nerve)

posterior pins - avoid temporalis muscle. Usually place just directly above ear pinna

30
Q

list the fixation options for c1-2 fusion

A

transarticular screw

wiring

lateral mass screw (c1) and pars screw (c2)

clamp

31
Q

list the c2 fixation options

A

transarticular screw (with c1)

pars screw

pedicle screw

translaminar screw

clamp

wiring

32
Q

what is pelvic incidence?

A

fixed parameter describing the tilt of the S1 endplate relative to the centre of the acetabulum

on lateral view, make line from middle of S1 endplate to centre of acetabulum

make another line perpendicular to S1 endplate

angle between these lines is pelvic incidence

Geometrically ends up being equal to pelvic tilt + sacral slope

pelvic tilt=angle between vertical and line joining middle of S1 endplate to centre of acetabulum

sacral slope=angle between s1 endplate and horizontal

33
Q

describe the spinal cord blood supply - only immediately around the cord

A

single anterior spinal artery

two posterior spinal arteries

they have branches that form an anastmosis/plexus around the cord - vaso corona

34
Q

what arteries feed the spinal arteries in c-spine?

A

vertebral a

PICA

segmental branches

35
Q

what arteries feed the spinal arteries in the T-L spine?

A

radicular arteries

36
Q

what is the artery of adamkiewicz?

A

principle arterial suply of lower 2/3 of spinal cord - feeds the anterior and posterior spinal arteries

usually occurs on left side at T10 (between T9-11)

can be between T7 and L4

AKA arteria radicularis magna

it is a large segmental radicular artery

enters through intervertebral foramen

37
Q

extension of ALL from C1 to skull is called what?

A

anterior atlanto-occipital membrane

38
Q

extension of PLL from C1 to skull is called what?

A

tectorial membrane

39
Q

what is ligamentum nuchae?

A

c-spine supraspinous ligament

40
Q

vertebral foramina occur in what vertebrae?

through which does the vertebral artery pass?

A

C1-7

artery exists in c1-6

41
Q

continuation of ligamentum flavum from C1 to skull is called what?

A

posterior atlanto-occipital membrane

42
Q

what are:

basion

opisthion

A

basion: anterior point on the foramen magnum
opisthion: posterior point on the foramen magnum

43
Q

anterior cord syndrome

presentation

prognosis?

A

loss of spinothalamic and corticospinal tracts

loss of pain/temp, motor

worse prognosis (10% recover)

44
Q

posterior cord syndrome: presentation?

A

loss of dorsal white columns

loss of proprioception, fine touch

rare

45
Q

central cord syndrome: presentation, prognosis?

A

UE weaker than LE

preserved perianal sensation

75% recover

46
Q

brown-sequard syndrome: presentation, prognosis?

A

hemi-cord loss.

lose contralateral pain and temp 2 levels below and ipsilateral motor

90% recovery. best prognosis

47
Q

explain the ASIA scale ABCDE

A

A - complete loss below level

B: incomplete - sensory intact, but no motor below level at all

c: incomplete - motor function exists below level but most are <3/5

d - incomplete - motor exists below level and most have 3/5 or more

e: normal neuro exam

48
Q

what is the definition of neurological level?

A

lowest (most caudal) level with intact motor AND sensory

49
Q

where is the watershed region of the spinal cord?

A

T4-9. narrowest spinal canal and poorest blood supply.

50
Q

Smith-robinson approach: from left or right side? Which is better and why?

A

left is better

reasons:

predictable clourse of recurrent laryngeal n (around aortic arch, runs between trachea and esophagus. Problem: most ppl right handed

c.f. right side: loops around subclavian a and crosses field from lateral to medial to run next to trachea. can be abberant at thyroid level

51
Q

name the 3 fascial layers you pass through in the smith robinson approach, from superficial to deep

A

deep cervical fascia

pretracheal fascia

prevertebral fascia

52
Q

name 2 major anatomical structures superficial to deep cervical fascia (not skin and fat)

A

external jug v

platysma

53
Q

Describe the smith robinson approach, and identifiy the important intervals.

A

transverse incision

split fibres of platysma (vertical) - CN VII facial n

go through deep cervical fascia

go between SCM (CN XI accessory) and strap muscles (omohyoid, sternothyroid, sternohyoid, thyrohyoid - all ansa cervicalis innervation)

go through pretrachial fascia anterior to carotid sheath (contains IJV, vagus n, common carotid a)

go between left and right longus colli (segmental n)

go thorugh prevertebral fascia

54
Q

dangers of smith robinson approach

A

carotid sheath (vagus n, common coarotid a, IJV)

thyroid arteries

trachea

esopahgus

recurent laryngeal n

stellate ganglion/sympathetic chain

vertebral a

55
Q

explain posterolateral approach to spine

AKA costotransversectomy

A

incision adjacent to spinous processes over rib

split trapezeus fibres

subperiosteal dissection around rib

watch for intercostal bundle

remove rib up to TP

operate via retroperitoneal space

56
Q

interval of wiltse approach (modern variant)

A

between multifidus and longissimus

Anatomy (13 decks)

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