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Neuroanatomy > The Vertebral Column, Spinal Cord And Spinal Tracts > Flashcards

The Vertebral Column, Spinal Cord And Spinal Tracts Flashcards

1
Q

Function of vertebral column

A

Protecting the spinal cord
Supporting the head and torso
Providing attachments for muscles and ribs
Site of haematopoesis

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2
Q

Number of vertebra in vertebral column

A

33

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3
Q

Number of cervical vertebrae

A

7

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4
Q

Number of thoracic vertebrae

A

12

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5
Q

Number of lumbar vertebrae

A

5

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6
Q

Number of sacral vertebrae

A

5- fused to form sacrum

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7
Q

Number of coccygeal vertebrae

A

4 - fused to form coccyx

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8
Q

Lordosis

A

Inwards curvature of the vertebral colimn

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9
Q

Kyphosis

A

Outwards curvature of the vertebral column

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10
Q

Where is lordosis of the vertebral column

A

Cervical lordosis of neck
Lumbar lordosis of lower back

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11
Q

Where is kyphosis in the vertebral column

A

Thoracic kyphosis of upper back

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12
Q

Scoliosis

A

Spine curves laterally

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13
Q

Body of vertebrae structure

A

Large, often cylindrical, structure located most anteriorly

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14
Q

Body of vertebrae function

A

Supports weight of vertebral column above it

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15
Q

What separates neighbouring vertebral bodies

A

Intervertebral discs

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16
Q

Pedicle

A

Stems posteriorly from vertebral body
Forms lateral wall of the spinal canal

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17
Q

Lamina

A

Posterior wall of spinal canal
Spinous process stems from the lamina

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18
Q

Spinal canal

A

Hole formed by the body, pedicle and Lamina
Spinal cord travels within the spinal canal

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19
Q

Transverse processes structure

A

Lateral protrusions from the vertebrae at the junction between the pedicle and Lamina

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20
Q

Transverse processes function

A

Provide an attachment for muscles

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21
Q

Cervical transverse processes

A

Form a canal for the vertebral arteries

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22
Q

Thoracic transverse processes

A

Form the primary site of articulation for the ribs

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23
Q

Articular processes structure

A

Vertical protrusions from the vertebrae

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24
Q

Articular processes function

A

Provide attachment site to the vertebrae above and below

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25
Q

Facet joints

A

Synovial articulations between vertebrae via Articular processes

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26
Q

Intervertebral foramina

A

Holes at the side of each vertebra formed by the spaces between the bodies and pedicles of neighbouring vertebra
Spinal nerves leave the cord via these foramina

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27
Q

Name of C1 vertebrae

A

Atlas

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28
Q

Atlas C1 articulates with

A

Articulates directly with the occipital bone of the skull- allows us to nod our heads

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29
Q

Atlas C1 structure

A

Shaped like a ring
The atlas bone has a space where the vertebral body should be
No spinous process

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30
Q

Name of C2 vertebra

A

Axis

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31
Q

Axis C2 structure

A

Body that protrudes vertically upwards = odontoid process- which takes the place of the body of the atlas above it so the atlas can spin around the axis
Allows us to then our heads = atlanto-axial joint (pivot joint)

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32
Q

Odontoid process

A

Body of axis C2 which protrudes vertically up into the body of the atlas

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33
Q

Name of pivot joint between atlas and axis

A

Atlanto-axial joint

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34
Q

C7 vertebrae

A

More prominent spinous process
Vertebra prominens = most superior spinous process that you can palpate through skin
No bifid spinous process
No transverse foramina

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35
Q

Distinctive Features of cervical vertebrae

A

Smaller body- support less weight
Transverse foramina to transmit vertebral arteries
Bifid spinous process

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36
Q

Distinctive features of thoracic vertebra

A

Additional Articular surface for rib
Long, sharp and downwards pointing spinous process - protect spinal canal
Increasingly large as must support more weight
Heart-shaped vertebral body

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37
Q

Distinctive features of lumbar vertebrae

A

Very large vertebral bodies
Transverse processes project laterally- provide attachment for additional muscles
Large, short and rectangular spinous processes

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38
Q

Joint between sacrum and pelvis

A

Sacroiliac joints

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39
Q

Sacral promontory

A

Anterior prominence at top of sacrum

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40
Q

Primary movements of C3-C7

A

Flexion, extension and lateral flexion

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41
Q

Primary movements of T1-T12

A

Rotation

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42
Q

Primary movements of L1-L5

A

Flexion, extension and lateral flexion

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43
Q

Function of intervertebral discs

A

Strong fibrocartilaginous structures able to withstand compression forces whilst also allowing flexibility and movement between each vertebrae

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44
Q

Nucleus pulposus

A

Central gelatinous core of intervertebral disc

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45
Q

Annulus fibrosus

A

Concentric rings of collagen surrounding the nucleus pulposus of the intervertebral discs

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46
Q

Secondary cartilaginous joint

A

Joint between vertebral bodies
Bone - hyaline cartilage - fibrocartilage - hyaline cartilage - bone

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47
Q

Function of spinal ligaments

A

Maintain upright position
Prevent hyperflexion and hyper extension injuries

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48
Q

5 spinal ligaments

A

Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous ligament
Supraspinous ligament

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49
Q

Location of anterior longitudinal ligament

A

Along the anterior surfaces of the vertebral bodies

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50
Q

Location of posterior longitudinal ligament

A

Along the posterior surfaces of the vertebral bodies
Anterior to spinal canal

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51
Q

Location of ligamentum flavum

A

Along the inside of the laminae

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52
Q

Why does the Ligamentum flavum appear yellow

A

Amount of elastin protein within it

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53
Q

What colour does the Ligamentum flavum appear

A

Yellow

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54
Q

Location of interspinous ligament

A

Between the spinous processes

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55
Q

Location of supraspinous ligament

A

Along the very tips of the spinous processes

56
Q

Erector spinae structrue

A

A group of paraspinal muscles which form a column either side of the spinous processes

57
Q

Erector spinae function

A

Maintain an upright posture

58
Q

Where can the erector spinae muscles be palpated

A

Either side of the lumbar spine when standing

59
Q

Disc herniation

A

Repetitive compression of the intervertebral discs can lead to weakening of the annulus fibrosus and posterior herniation of the nucleus pulposus which can narrow the intervertebral foramina or spinal canal. If an intervertebral foramen is narrowed and the transiting spinal nerve is compressed, this can cause weakness in muscles supplied by that nerve or altered sensation in the dermatome. If the spinal cord or cauda equina is compressed by the herniated disc, this can cause significant neurological deficit below that level and is a surgical emergency.

60
Q

Lumbar puncture

A

This procedure involves sampling some CSF from the subarachnoid space in the lower vertebral canal. As the spinal cord terminates at L1/L2, a lumbar puncture (LP) must be performed lower than L2 to avoid damaging the cord. Below this level, the nerves of the cauda equina are simply pushed out of the way of the needle rather than being damaged by it.

To find an appropriate space between the vertebrae, the patient is positioned either sitting on the edge of a bed, or in the foetal position, and asked to push out their lower back to widen the space between the vertebrae. The L4/L5 space is in line with the intercristal plane (top of the iliac crests) so this is an appropriate space to aim for. As the needle reaches the subarachnoid space, the clinician can usually feel several gentle ‘pops’ when the needle pushes through the ligamentum flavum and dura mater. When CSF starts flowing out, the needle is in far enough.

Anaesthetic drugs may also be injected into the subarachnoid space through the same approach to give anaesthesia for surgery of the lower pelvis or lower limbs. This is known as spinal anaesthesia. A similar method involves injecting anaesthetic into the extradural space in the lower back and this is known as an ‘epidural’ anaesthetic.

61
Q

Between which vertebra is a lumbar puncture conducted

A

L4/L5

62
Q

What do spinal nerves leave the spinal cord through

A

Intervertebral foramina

63
Q

Where do the cervical spinal nerves leave the spine

A

Directly above their corresponding vertebra (as far as C7)

64
Q

C8 spinal nerves

A

Additional pair of spinal nerves that leave the vertebral column below the C7 vertebra

65
Q

Where do all spinal nerves after C8 spinal nerves leave the vertebral column

A

Directly below their corresponding vertebra

66
Q

Number of spinal nerve pairs

A

31

67
Q

Conus medullaris

A

At level of L1-L2 junction
Spinal cord tapers off into a cone shape and terminates

68
Q

At what level does the spinal cord terminate

A

L1/L2

69
Q

Filum terminale structure

A

Dura and arachnoid meninges continue down to the sacrum
Pia mater thickens after the cord terminates to form a thin strand of fibrous tissue which continues down to the coccyx

70
Q

Filum terminale function

A

Helps tether spinal cord in position

71
Q

Which spinal nerves are given off just before the spinal cord terminates

A

L3-L5, S1-S5, Co1

72
Q

Cauda equina

A

The mass of spinal nerves dangling within the spinal canal of L3-L5, S1-S5 and Co1 that descend so that can exit the canal at the correct level

73
Q

What forms the spinal nerves

A

2 roots- dorsal and ventral roots

74
Q

Dorsal root

A

Carries sensory fibres into the spinal cord
Contains dorsal root gangliom

75
Q

Ventral root

A

Carries motor fibres out of spinal cord
No ganglion
Also carries sympathetic firbes

76
Q

Grey matter

A

In centre of spinal cord
H shaped
Forms 2 dorsal horns and 2 ventral horns

77
Q

Shortly after spinal nerve formation

A

Divides into 2 rami- dorsal ramus and ventral ramus

78
Q

Dorsal ramus

A

Contains both sensory and motor fibres supplying dorsal structures eg skin over the back and paraspinal msucles

79
Q

ventral ramus

A

Carries both sensory and motor fibres to ventral structrues

80
Q

Which spinal rami is larger

A

Ventral

81
Q

Thoracic ventral rami=

A

Intercostal nerves

82
Q

Number of neurones in sensory pathways

A

3

83
Q

First order sensory neurones

A

Receptor to CNS

84
Q

Where are the cell bodies of first order sensory neurones

A

Dorsal root ganglion

85
Q

Second order sensory neurones

A

Spinal cord or brainstem —> thalamus

86
Q

Third order sensory neurones

A

Thalamus —> somatosensory cortex

87
Q

Number of neurones in descending motor pathways

A

2

88
Q

First order motor neurones (UMN)

A

Motor cortex —> ventral horn of spinal cord

89
Q

Second order motor neurones (LMN)

A

Spinal cord —> target muscle

90
Q

Spinal tracts

A

Bundles of axons within the peripheral white matter of the spinal cord

91
Q

Function of dorsal column-medial lemniscus

A

Sensory
Fine touch, two-point discrimination, vibration and proprioception

92
Q

dorsal column-medial lemniscus first order neurones

A

Enter spinal cord via the dorsal root and enter the ipsilateral dorsal columns

93
Q

2 distinct tracts of dorsal columns

A

Fasciculus gracilis (medial)
Fasciculus cuneatus (lateral)

94
Q

Function of Fasciculus gracilis

A

Sensory information from lower limbs

95
Q

Function of Fasciculus cuneatus

A

Sensory information from upper limbs

96
Q

Where do the dorsal column-medial lemniscus first order neurones synapse

A

Medulla
Gracile / cuneate nuclei

97
Q

dorsal column-medial lemniscus second order neurones

A

Decussate in medulla
Continue to thalamus on contralateral side= medial lemniscus

98
Q

Medial lemniscus

A

Second order neurones of dorsal column-medial lemniscus decussate in medulla and travel to contralateral thalamus

99
Q

Where does the dorsal column-medial lemniscus decussate

A

Medulla

100
Q

dorsal column-medial lemniscus third order neurones

A

Thalamus to primary somatosensory cortex in parietal lobe via internal capsule

101
Q

Location of spinothalamic tracts

A

Antero-laterally in spinal cord

102
Q

Function of spinothalamic tracts

A

Sensory
Crude touch, pain and temperature

103
Q

Spinothalamic tract first order neurones

A

Enter spinal cord via dorsal root and synapse within dorsal horn

104
Q

Spinothalamic tract second order neurones

A

Decussate in spinal cord after travelling up one or two vertebrae
Continues to thalamus on contralateral side

105
Q

Where do the Spinothalamic tract decussate

A

Spinal cord - usually 1/2 levels above entry

106
Q

Spinothalamic tract third order neurones

A

Thalamus —> primary somatosensory cortex in parietal lobe via internal capsule

107
Q

What do third order neurones travel via from thalamus to primary somatosensory cortex

A

Internal capsule

108
Q

Function of lateral corticospinal tract

A

Motor imoulses

109
Q

Lateral corticospinal tract first order neurones

A

Leave motor cortex and pass through internal capsule
Decussate within medulla at level of medullary pyramids
Continue contralaterally in spinal cord
Synapse in ventral horn at desired spinal cord level

110
Q

Where do Lateral corticospinal tract first order neurones decussate

A

Medulla at level of medullary pyramids

111
Q

Where do Lateral corticospinal tract first order neurones synapse

A

Ventral horn of spinal cord

112
Q

Lateral corticospinal tract second order neurones

A

Leave the cord via the ventral root towards target muscles

113
Q

Anterior and posterior Spinocerebellar tracts location

A

Most laterally in cord

114
Q

Anterior and posterior Spinocerebellar tracts function

A

Carry unconscious proprioceptive information to cerebellum

115
Q

Anterior Spinocerebellar tracts

A

Decussates twice - once at level of entry to spinal cord and once as soon as it enter the cerebellum through the superior peduncle
Terminates ipsilaterally

116
Q

Where does the Anterior spinocerebellar tracts decussate

A

Level of entry to spinal cord
As soon as it enters the cerebellum

117
Q

Posterior Spinocerebellar tracts

A

Does not decussate
Ipsilateral cerebellum

118
Q

Brown-sequard syndrome

A

This syndrome is caused by damage to one side of the cord only (hemisection of the cord). In clinical practice, it is quite a rare injury but causes characteristic findings on examination that explain the decussations of the tracts.

If a patient suffers damage to the left-hand side of their spinal cord, for example, then descending lateral corticospinal tract fibres are interrupted on the left side. Ascending dorsal column fibres on the left side are also interrupted. However, the ascending spinothalamic fibres that are interrupted on the left side had already decussated, therefore they were providing sensory information about the right side.

In this example, clinical examination below the level of the lesion would reveal loss of motor control of muscles on the left, loss of two-point discriminative touch, vibration and proprioception sensation on the left, but loss of pain and temperature sensation on the right from one or two levels below the lesion.

119
Q
  1. What is the name of the joints that connect individual vertebrae together and allow movements between them?
A

Facet joints- intervertebral discs between them

120
Q
  1. The ligamentum flavum connects which parts of the vertebrae together?
A

Laminae

121
Q
  1. From where do sympathetic nerve fibres leave the spinal cord grey matter? Which root do they take to leave the cord? Where do they go after this?
A

T1 – L2 spinal cord, lateral horn. They leave via the ventral root alongside motor fibres and then travel with the spinal nerve towards the sympathetic trunk, where they join the sympathetic trunk and either synapse at that level, travel up or down the sympathetic chain to synapse at another level, or pass through it as a splanchnic nerve.

122
Q
  1. What type of joint is the atlanto-axial joint?
A

Synovial pivot joint

123
Q
  1. Where in the cervical spine does the majority of movement during nodding and turning the head take place?
A

C0-C1 = nodding (atlanto-occipital junction)
C1-C2 = turning head (atlanto-axial joint)

124
Q
  1. Which arteries supply the spinal cord?
A

Anterior and posterior spinal arteries

125
Q
  1. Describe the sensory and motor deficit (and which side is affected) by a lesion in the following locations:
    a. Right side of the spinal cord only.
A

a. Loss of right sided motor function below the affected level, loss of right-sided fine-touch, vibration and proprioception sensation below the affected level, loss of left-sided pain and temperature sensation below the affected level.

126
Q
  1. Describe the sensory and motor deficit (and which side is affected) by a lesion in the following locations:
    b. Posterior third of the cord bilaterally.
A

b. Loss of fine-touch, vibration, and proprioception sensation bilaterally below the affected level.

127
Q
  1. Describe the sensory and motor deficit (and which side is affected) by a lesion in the following locations:
    c. Left sided dorsal root.
A

c. Loss of all sensory modalities in the affected left-sided dermatome.

128
Q
  1. What layers of tissue must be penetrated to reach the CSF in a lumbar puncture?
A

Skin, subcutaneous fat, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, arachnoid mater.

129
Q
  1. Why are lumbar punctures performed as low as possible in the lumbar region? What might be the consequence of a ‘lumbar’ puncture in the thoracic region?
A

The spinal cord terminates at around L1/L2 and the cauda equina hangs in the spinal canal below this level. When a needle in inserted into the subarachnoid space below L1/L2, the needle can push the cauda equina nerves out of the way. If a lumbar puncture is performed higher than this level, the needle cannot push the spinal cord out of the way, and instead will penetrate it, which could cause neurological injury. The lower the lumbar puncture is performed, the less likely it is to damage the spinal cord.

130
Q
  1. Explain why there are 33 vertebrae but only 31 spinal nerves.
A

There are 8 cervical nerves, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal. In the cervical region, nerves leave above the corresponding vertebrae, except for the C8 nerves which leave below the C7 vertebrae. From that point onwards, all nerves leave the intervertebral foramina below their corresponding vertebrae. Finally, there is only one coccygeal nerve, but 4 fused coccygeal vertebrae.

 

131
Q

Most lateral tracts

A

Spinocerebellar

132
Q

Most posterior tracts

A

Dorsal columns

133
Q

Tracts posterior to anterior

A

Dorsal columns
Lateral corticospinal
Spinothalamic
Spinocerebellar (lateral)

134
Q

Most medial tract

A

Fasciculus gracilis

135
Q

Posterior circulation of spinal cord supplies

A

Dorsal column-medial lemniscus

136
Q

Anterior circulation of spinal cord supplies

A

Lateral corticospinal tracts
Spinothalamic tracts
Spinocerebellar tracts

137
Q

Where do the ascending tract first order neurones synapse

A

Grey matter of dorsal horn

Neuroanatomy (8 decks)

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