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Medicine Year 1 Semester 1 - Part 2 > The Back > Flashcards

The Back Flashcards

1
Q

Functions of the vertebral column

A

Enables upright posture

Supports body weight

Protects and transmits spinal cord and spinal nerves

Supports the skull and allows for its movement

Contributes to the thorax (ribcage)

Locomotion : Provides attachment for trunk muscles

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2
Q

Describe the vertebral column

A

SPINE
Series of irregular bones, vertebrae

x7 - Cervical
x12 - Thoracic
x5 - Lumbar
x5 - Sacral (fused to 1 sacrum)
x1-4 - Coccygeal (fused)

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3
Q

How are the vertebrae separated ?

A

BY fibro-cartilaginous intervertebral discs

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4
Q

Describe the general morphology of the vertebral column

A

The vertebral column has primary and secondary curvatures.

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5
Q

Primary curvatures

A
  • Present in-utero
  • In the thoracic and sacral regions
  • concave anteriorly (KYPHOSIS)
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6
Q

Secondary curvatures

A
  • Don’t develop until the infant lifts his/her head and stands to walk (develop as myelination occurs)
  • Found in cervical and lumbar regions
  • Are concave posteriorly (LORDOSIS)
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7
Q

Kyphosis

A

Concaved anteriorly

Thoracic and Sacral

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8
Q

Lordosis

A

Concaved posteriorly

Cervical and Lumbar

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9
Q

Describe the features of the typical vertebrae, from each region

A

Intervertebral surface (endplate)
Pedicle
Lamina
Vertebral foramen -> canal
Transverse process

Superior vertebral notch
Inferior vertebral notch

Superior articular process (FACET)
inferior articular process (FACET)

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10
Q

Vertebral foramen function

A

Protects and transmits spinal cord and spinal nerves

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11
Q

What are the articular facets and joints susceptible to ?

A

Arthritis
Back Pain

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12
Q

Where is the superior articular process (facet) found ?

A

At the junction between the pedicle and lamina

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13
Q

Describe the cervical region of vertebrae

A

Spinous process - short and bifid, except C7
Vertebral body - small

Superior Articular Facet
Ulcinate processes

Transverse foramen
Posterior tubercle - Transverse process

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14
Q

Describe the thoracic region of vertebrae

A

These contribute to the formation of ribcage by articulating with the ribs.

Superior articular facets - flat and facing potero-laterally, on the arc of a circle —> allows rotation

Transverse process with a transverse costal facet for articulation with the tubercle of its own rib.

Spinous process, long and pointing inferiorly, overlapping 2 vertebrae.

Costal Demi-facets, upper demi-facet for articulation with head of own rib, lower Demi-facet is for articulation with the rib below.

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15
Q

Describe the lumbar region of vertebrae

A

Largest body

Superior Articular facets - concave and facing postero-medially, interlocking with inferior facets.

Spinous process - sturdy, stumpy, quadrangular

Extension is greatest movement –> flexion and some lateral flexion, but no rotation.

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16
Q

Describe the sacrum region of vertebrae

A

Formed by the fusion of 5 vertebrae

Link between the spine and iliac bones –> pelvis –> lower limbs

Sacral promontory
Posterior sacral foramen
Anterior sacral foramen
Sacral canal
Median, intermediate, lateral crests
Sacral hiatus

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17
Q

Importance of sacral hiatus

A

Important in anaesthesia (with coruna)

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18
Q

Sacral canal function

A

Contains the caudal equina

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19
Q

Anterior and Posterior sacral foramen function

A

Anterior : anterior rami of spinal nerves pass

Posterior : posterior rami of spinal nerves pass

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20
Q

Median, Intermediate and Lateral crests

A

Projections from the sacrum : median (centre), intermediate (middle), lateral (outer)

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21
Q

Importance of the sacral promontory

A

It is the anterior projection of the S1 and is important in females.

It is said that the normal female sacrum tends to be flat while the normal male sacrum tends to be more curved.

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22
Q

Describe the atlas

A

C1 - Cervical 1
Holds the skull, doesn’t have a vertebral body.

Occipital condyles articulate with the superior articular facets

Anterior and posterior arches connection lateral masses.

Lateral mass, with superior and inferior articular facets.

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23
Q

Describe the axis

A

C2 - Cervical 2
Rotation of the head and neck at the atlanto-axial joint.

Odontoid process or Dens, for articulation with the anterior arch of the atlas.

Tooth - on top of the body

Superior Articular Facets - articulate with the inferior articular facets of the atlas.

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24
Q

Function of transverse foramen

A

Houses vertebral arteries and veins

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25
Q

Vertebra prominens

A

C7

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26
Q

Describe the features of the atypical vertebrae, from each region

A

Atlas
Axis

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27
Q

Zygapophyseal (facet) joint

A

Synovial joints between articular processes (spinal processes)

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28
Q

Intervertebral foramen

A

Gaps through which the spinal nerve emerges and is formed by superior and inferior vertebral notches, with contribution from the disc.

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29
Q

Symphysis joint
(Secondary cartilaginous joint)

A

Found between endplates and the intervertebral discs
(found between bodies of vertebrae)

30
Q

Functions of intervertebral discs

A

Contributes to the shape of the spinal curvatures

20-25% of the length of the column

31
Q

Describe the structure of intervertebral discs

A

Consists of an outer annulus fibrosus, which surrounded a central nucleus pulposus.

Sits on top of the vertebral endplate.

32
Q

Nucleus pulposus

A

Gelatinous, 70-90% water, relative collagen content increases with age

Absorbs compressive forces between vertebrae.

33
Q

Annulus fibrosus

A

Very strong, concentric lamellae of fibrocartilage

Attached and kept in place by anterior and posterior longitudinal ligaments.

34
Q

Describe supply to the intervertebral disc

A

Periphery of the disc is supplied by neighbouring capillaries.

Centre is nourished by diffusion from the body of the vertebra.

35
Q

Describe clinical relevance of intervertebral discs

A

Discs may deform to allow movement between the vertebral bodies.

This may put pressure on the nucleus pulposus.

The annulus fibrosus may degenerate and weaken.

36
Q

Describe herniated disc

A

The nucleus may herniate or prolapse to compress :

  • the spinal cord (which ends at L1/2)
  • the caudal equina
  • an emerging spinal nerve
37
Q

Describe a herniated L4/5 disc

A

The central position of the posterior longitudinal ligament means that most disc herniations are posterolateral, towards the intervertebral foramen.

The disc forms the anterior aspect of the foramen, but inferiorly, the spinal nerve probably emerges above the prolapsing disc and escapes injury.

A prolapsed L4/5 disc is likely to compress the L5 (and lower) nerves.

38
Q

Name the ligaments that support the vertebral column

A

Atlanto-Occipital and Anterior Atlanto-Axial Membranes
Tectorial Membrane
Alar ligament
Transverse ligament of atlas

The ligamentum flavum
The posterior longitudinal ligament
Anterior longitudinal ligament

Ligamentum Nuchae
Supraspinous ligament
Interspinous ligament

39
Q

Atlanto-Occipital and Anterior Atlanto-Axial Membranes

A

They continue downwards as anterior longitudinal ligaments.

40
Q

Tectorial Membrane

A

Ends between the foramen magnum and C2, and continues as posterior longitudinal ligament.

41
Q

Alar ligament

A

Prevents excessive rotation

42
Q

Transverse ligament of atlas

A

Keeps the dens close to the anterior arch

43
Q

The ligamentum flavum

A

This extends between the vertebral laminae and limit sudden flexion.

44
Q

The posterior longitudinal ligament

A

On the posterior surfaces of the bodies of vertebrae between C2 to sacrum, limiting hyper-flexion.

45
Q

Anterior longitudinal ligament

A

On the anterior surfaces of the vertebral bodies between Atlas to the sacrum that limits extension.

46
Q

Ligamentum Nuchae

A

Nuchal Ligament which extends between occipital bone and spinous process of C7 to limit flexion and provide muscle attachment.

47
Q

Supraspinous ligament

A

Found between the tips of spines and run between sacrum to C7

48
Q

Interspinous ligament

A

May be damaged in whiplash injury

49
Q

Briefly describe the vascular supply of the vertebral column

A

Arteries form anastomotic rings that arise form the vertebral arteries and posterior intercostal and lumbar branches of aorta.

Venous plexuses (internal and external) coalesce and drain to the veins equivalent to the above arteries.

50
Q

Clinical relevance of venous plexuses

A

They facilitate tumour spread

e.g. prostate gland

51
Q

How can muscles of the back be classified ?

A

Extrinsic or Intrinsic, based on embryological origin and type of innervation.

52
Q

Describe extrinsic muscles

A

Derivatives of hypo axial myotome
Superficial

Involved with movements of the upper limbs and thoracic wall

Innervated by anterior rami of spinal nerves.

53
Q

Describe intrinsic muscles

A

Derivatives of epaxial myotome

Located deep, between the spinous processes and the angle of ribs.

Adapted to provide support and movement in resistance to the effect of gravity.

Move the vertebral column

Participate in moving the head

Innervated by the posterior rami of spinal nerves

54
Q

How are intrinsic muscles stronger than the flexors ?

A

As extension (such as lifting an object) is in opposition to gravity.

55
Q

What is the function of layer 1 muscles in the back ?

A

Superficial layers that are mainly for upper limb movement

56
Q

What muscles are found in layer 1 of the back ?

A

Trapezius
Latissimus dorsi

57
Q

Describe the trapezius muscle

A

From skull, spinous processes to scapula and clavicle (laterally)

Upper fibres elevate and rotate shoulders during abduction of the arm.

Supplied by spinal accessory nerve.

58
Q

Describe the latissimus dorsi

A

Iliac crest, fascia, spines of T6 to T12, lower ribs; to humerus

Shoulder extension and adduction

Supplied by the Thoracodorsal nerve

59
Q

What muscles are found in layer 2 of the back ?

A

Levator scapulae

Rhomboid major and minor

Serratus posterior superior
Serratus posterior inferior

60
Q

Levator scapulae

A

Scapular elevation

61
Q

Rhomboid major and minor

A

Scapular retraction and elevation

62
Q

Serratus posterior superior

A

Inspiration

63
Q

Serratus posterior inferior

A

Expiration

64
Q

What muscles are found in layer 3 of the back ?

A

Intrinsic back muscles

From the skull, though cervical, thoracic and lumbar regions to pelvis.

Keep the vertebral column upright and in extension against gravity.

Arranged in 3 layers :

  • Superficial
  • Intermediate
  • Deep
65
Q

Function of muscles found in the 3rd layer of the back

A

Keep the vertebral column upright and in extension against gravity.

66
Q

Superficial layer of 3rd layer of muscle

A

Splenius capitis and cervicis

Acting together : extend the neck and/or head

Acting alone : rotate and laterally flex

67
Q

Intermediate layer of 3rd layer of muscle

A

Erector Spinae
Keeps us upright
3 columns

  • Iliocostalis
  • Longissimus
  • Spinalis
68
Q

Deep layer of 3rd layer of muscle

A

Transversospinalis

  • Rotatores
  • Multifidus
  • Semispinalis
69
Q

Deep neck muscles

A

Obliquus captis : superior/inferior

Rectus capitis posterior major/minor

Sub-occipital triangle

70
Q

Function of the sub-occipital triangle

A

Transmits vertebral artery and vein as well as the sub occipital nerve.

  • Vertebral artery
  • Vertebral vein
  • Suboccipital nerve

Medicine Year 1 Semester 1 - Part 2 (37 decks)

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