Spine: clinical anatomy Flashcards by Rachael Elmore

What is the purpose of the spine?

support
transmit and protect neurological structures (spinal column, nerve roots)
movement and flexibility

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How many bones are in spine? What are the sections? how many in each section?

33
Cervical (7)
Thoracic (12)
Lumbar (5)
Sacral (5)
Coccygeal (4)

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What are the adjoining areas of the spine?

occiput cranially
sacrum caudally (SI)

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What kind of joints are found in the spine? What is their purpose? Describe the joint

Facet joints
Stability whilst allowing movement
Synovial joint with hyaline cartilage

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What is the clinical importance of facet joints?

OA
Pain
osteophytes can cause nerve root impingement

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What is the angle of 
a)cervical facet
b)thoracic facet
c)lumbar facet
joints?

a) 45
b) 60
c) 90

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What are the bones of the upper cervical region? Describe them

C1-atlas-no body, articulates with occiput of skull

C2-axis-dens process

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What are the bones of the lower cervial region? Describe them

C3-C7
Large vertebral foramen (for spinal cord)
Transverse foramen (vertebral NVB)
Smaller body. wide lamina
Short transverse processes

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What are the movements of

a) antlanto-occupital joint
b) antalnto-dens joint?

a) flexion/extension and lateral flexion

b) rotation (dens is pivot)

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What is the clinical relevance of C7?

First palpable

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What areas of the spine are at greatest risk of injury? Why?

cervical-thoracic
and thoraco-lumbar junctions
Junctions of fixed and mobile segments

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What are the sections of the intervertebral discs?

annulus fibrosus (peripheral)
nucleus pulposus (central)

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What is the structure of a)annulus fibrosus

b)nucleus pulposus

a) thin posteriorly (rupture)

b) gelatinus, semi fluid

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What are the intervertebral disc responsible for?

1/4 spine length

secondary curvature of spine

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What are intervertebral discs clinically relevant?

atrophy in old age
height shrinks
curve returns to C shape of newborn

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What are the ligaments of the spine? What do they do?

anterior longitudinal
posterior longitudinal (both run length of v. column)
ligamentum flavum (link vertebral laminae, tough elastic)
Supraspinous ligament (tough)
Intraspinous ligaments (weak)

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What are ligaments of the spine important?

if damaged causes unstable spinal injury

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What is the 3 column theory of denis?

Damaged: 1 column=stable
2 coloumn=maybe unstable
3 column=unstable

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What are the muscles of the spine?

superficial (extrinsics)
intermediate
deep (intrinsics)

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What are the intermediate muscles of the spine? what are the origins? what arethe insertions?

serratus posterior, superior and inferior

origin: spinous processes
insertion: ribs

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What are the funtions of the serratus muscles?

aid repiration

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What are the superficial muscles of the spine?

trapezius
latissimus dorsi
rhomboid minor/major
levatus scapularis

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What is the clinical relevance of superficial muscles of the spine?

tenderness due to spasm

wasting from disuse or denervation

What is the function of the superficial muscle of the spine?

movement of shoulder and upper limb

Describe the trapezius muscle. Origin, insertion, innervation and function.

``` Trapezium shaped origin-spinous processes to T12 insertion- occiput and spine of scapula innervation - spinal accessory (CNXI) function-elevates, depresses,retracts scapula ```

Describe latissimus dorsi. origin, insertion, innervation, function.

``` broadest and back origin-spinous processes and pelvis insertion-humerous innervation-C6/C7/C8 function-adducts, extends, internally rotates humerous ```

Describe the rhomboid major/minor. origin, insertion, innervation, function.

rhomboid shaped Origin-major:spinous processes T2-T5 minor: spinous processes C7-T1 insertions-scapula innervation-dorsal scapula nerve C3/C4 function-keeps scapula against thoracic wall, retracts scapula

Give the origin, insertion, innervation, function of levatus scapularis.

origin-transverse process C1 insertion-superior angle of scapula innervation-branches C4/C5 function-elevated scapula

What are the deep muscles of the spine?

erector spinae muscles

Why are the deep muscles clinically relevant?

pain due to spasm or trauma weakness causes spinal instability largest muscle group

What is the function of the erector spinae muscles?

movement of vertebral column and posture

What are the names of the erector spinae muscles from lateral to medial?

Lateral: Iliocostas middle: longismus thoracis medial: spinalis thoracis

What are the origin, insertion, innervation of erector spinae muscles?

origin - occupit of skull insertion- pelvis (multiple attachments along thoracic wall) innervation - POSTERIOR RAMI of spinal nerves

What is involved in the macro anatomy of the spinal cord?

``` spinal cord (CNS) Spinal nerve roots (PNS) ```

What is involved in the micro anatomy of the spinal cord?

Grey matter-posterior/anterior horns | White matter-ascending/descending tracts

What does the spinal cord a) originate b) exit the skull c) terminate

a) medulla oblongata extension b) foramen magnum c) cauda equina (L2)

Where to nerves go from a) cervical spine b) thoracic spine c) lumbar spine d) sacral spine?

a) arms b) middle of body c) anterior aspect of legs d) pelvis and posterior aspect of legs

What are a) myotomes b) dermatomes?

a) muscles controlled by motor element at a specific level | b) skin sensation to sensory element at a specific level

Describe the pathway of crossed pyramidal descending motor tracts

cross at medullary level | descend at contralateral side of cord

Describe the pathway of the uncrossed pyramidal descending tracts

descend on ipsilateral side of cord | cross at same level it exits

Describe the pathway of the ant and post spinocerebellar tracts. What do they do?

ascend on ipsilateral side enter cerebellum carry info of proprioception

describe the pathway of lat and ant spinothelamic tract

enter and ascend on ipsilateral side then cross to contralateral side enter thalamus carry info of pain and temperature

describe the pathway of the posterior fasciculus oracillius/cuncatus

Ascend ipsilateral side | carry info of fine touch and proprioception

How does info enter grey matter?

through spinal nerve root to dorsal root to posterior horn

What makes up the nerve root?

ventral and dorsal root

What do the nerve roots divide into?

ant and post rami

Where do the posterior rami innervate?

intrinsic muscles of back | strip of skin sensation at centre of back

Where do anterior rami innervate?

all body limbs (peripheral nerves)

Where do nerve roots leave the spine?

through intervertebral foramina

What makes up the intervertebral foraminae?

pedicles of vertebrae

What is clinically important about the intervertebral foraminae?

root at risk from prolapsed disc | osteophytes, foraminal stenoisis

What is the cauda equina?

bundle of spinal nerves and nerve roots from L2-Coccygeal nerve

What structures do the cauda equina innervate? Motor? Sensory?

pelvic organs and lower limbs Motor: hips, knees, ankles, feets, internal/extrnal anal sphincter Sensory: hips, knees, ankles, feet, perineum, partial parasymp to bladder

What is the arterial supply to the spine?

ant and post spinal arteries

Where do spinal arteries arise from?

Descend from pia in intracranial part of vertebral artery

What is venous supply to the spine?

Cerebrospinal venous system (CSVS)

What is the clinical relevance of the CSVS?

valveless veins connect deep pelvic to thoracic veins drains inferior end of urinary bladder, breast and prostate. Haematogenous mets