Unit 4: neuroanatomy Flashcards
what structures are unique to c-spine vertebra?
- compound spinous processes (2 projections, AKA bifid)
+C2-C5: almost always bifid
+C6: 50% of the time is bifid
+C7: usually a single spinous process (0.3% of population have a bifid C7) - vertebral foramen have a larger diameter
+the spinal cord is much larger at the top because it processes more information here than the bottom of the cord - transverse foramen
+these allow vertebral arteries to pass through - transverse processes with SULCUS
+this allows spinal nerves to pass through
the vertebral arteries pass through all of the transverse foramen except for:
C7 transverse foramen
in the C-spine, spinal nerves pass through the ______ and vertebral arteries pass through the ______
spinal nerves: transverse process SULCUS
vertebral arteries: transverse foramen
how is C1 different than the rest of the cervical vertebrae?
C1 is named “Atlas” because it “bears the weight” of the “globe” AKA our skull
also has special connections with C2 vertebra
what is C2’s nickname
axis
what is a major difference between C1 and C2; what structures does C1 have to help connect to C2 vertebra?
C1 does not have a vertebral body or a spinous process
C1 has an anterior arch comprised of the:
+anterior tubercle
+facet for dens
these structures help connect to C2
where do the occipital condyles lie on the atlas (C1)?
in the superior articular facets
why is the atlantoocipital ligament named like this?
atlanto – atlas
occipital – occipital bone
these ligaments (anterior and posterior) connect the atlas and the occipital bone
the occpital condyle/superior articular facets of C1allow for what type of head movement?
up/down – “nodding yes”
what structure of C2 is unique to C2?
what structures of C2 connects with C1?
the Dens is unique to C2
the Dens fits into the facet for Dens in C1, located in the anterior arch of C1
the anterior articular facet rubs against theposterior side of the anterior arch of C1
what type of movement does the head gain from the Dens of C2?
nodding head “no” – swiveling from side to side
list the generalized model of spinal ligaments
- anterior longitudinal ligament
- posterior longtiudinal ligament
- intertransverse ligament
- supraspinous ligament
- interspinous ligament
- ligamentum flava
what is special about the anterior and posterior longitudinal ligament?
these ligaments run all the way from the base of the skull to the sacrum/pelvis
how is ligamentum flava different from the rest of the spinal ligaments?
the ligamentum flava is stretchier than the other ligaments
+elasticity
the other ligaments are made of RIGID fibrous collagen
intertransverse ligament connects:
the vertebral transverse processes together
the supraspinous ligaments connect:
the OUTER vertebral spinous processes TIPS together
the interspinous ligaments connects:
the vertebral spinous processes together (inter = inside)
the ligamentum flava connects:
the vertebral arches together
when landmarking with a needle through the ligamenta flava, it is best to approach in this fashion:
off-midline
because there is a hollow opening in the middle of the ligamentum flava
the posterior atlanto-occipital ligament connects:
the arch of C1 and the back of the foramen magnum
the nuchal ligament and the supraspinous ligaments connect at this location:
external occipital protuberance
what is the vertebral prominens?
a landmark where the spinous process of C7 is palpable
Dr. Schmidt’s answer: where the T1 spinous process is palpable
t-spine curvature:
kyphotic/concave “)”
what is the best approached angle for thoracic spinal anesthesia?
off-center d/t the downward facing spinous processes
T-spine injuries are more prevalent than head/neck injuries: true or false?
false:
t-spine has more stability; it is strong and robust d/t attachment structures
what are the 3 locations a rib can connect to the t-spine?
- transverse process costal facet
- inferior costal facet
- superior costal facet
which rib pairs are “true ribs”
pairs 1-7
which rib pairs are “false ribs”?
pairs 8, 9, and 10
which rib pairs are the floating ribs?
pairs 11 and 12
differentiate true ribs vs false ribs
rib pairs 1-7 are “true ribs” because they have costal cartilage that connects directly to sternum
false rib pairs are 8, 9, and 10 because they indirectly connect to the sternum via rib pair #7’s costal cartilage
why are rib pairs 11 and 12 “floating” ribs?
not connected very well to t-spine; very prone to trauma
which 4 structures are unique to t-spine vertebra?
- transverse process costal facets
- superior costal facets
- inferior costal facets
- downward angled spinous processes
the head of ONE rib connects to the thoracic vertebra via these TWO facets:
- inferior costal facet of the thoracic vertebra above the rib head
- the superior costal facet of the thoracic vertebra the rib head is aligned with
ex) Rib #6 will connect with inferior costal face tof T5, and superior costal facet of T6
the neck of the rib comes into contact with the transverse process here:
costal tubercle
the vertebral bodies on the t-spine are ____ shaped
heart
think: “thoracic cavity houses the heart”
why is the t-spine vertebral body flatter on the L side versus a more curved right side?
the left side is flatter due to the aortic compression
lumbar spine anesthesia is best approached in the fashion:
midline, having the patient lean forward d/t spinous processes being out of the way
how many bones comprise the sacrum at birth?
5
when does the sacrum fuse into one bone?
during teenage years
where does the sacrum connect with the lumbar spine?
the sacrum’s superior articular processes connect with the inferior articular processes of L5
how many sacral foramina total are there?
8
what is the median sacral crest?
remnants of fused sacral spinous processes
what fuses to make the mediAL sacral crest?
inferior and superior articular processes
what fuses to form the lateral sacral crest?
transverse processes
what is the opening of the sacrum called closest to the coccyx?
sacral hiatus
how many vertebra make up the coccyx at birth? after birth?
4 at birth
2 after
the vertebra closest to the sacrum is one vertebral; the other 3 original vertebra fuse to form one bone after birth
how can you landmark areas for lumbar epidural/anesthetics?
palpate across the most superior parts of the iliac crests, you will find L4 medially
how can you landmark areas to estimate access to S2 posterior sacral foramina?
palpate the posterior-superior illiac spine and move down approximatley 1 cm distally, and 1 cm medially
PSIS - posterior-superior illiac spine
why would you landmark the posterior S2 sacral foramina and not S1?
S1 has a more lateral openingl; you cannot access it midline
where does the inguinal ligament connect?
it connects at the pubic tubercle and anterior superior iliac spine
ASIS
what does the iliolumbar ligament connect?
L4 & L5 transverse processes to posterior pelvis
what is the pubic symphysis made of? what does it connect?
cartilage
the two pelvic bones
what structures can you palpate/landmark in the sacral/lumbar/pelvic region?
- anterior superior iliac spine (ASIS)
- greater trochanter
- iliac crests
- posterior-superior iliac spine (PSIS)
(landmark L3/L4 at the transumbilical plane)
what makes up an intervertebral disc?
nucleus pulposus
annulus fibrosis
hyaline cartilage
explain the differences of the anterior intervertebral disc vs the posterior intervertebral disc
the anulus fibrosus has a “cross-hatch” fiber system anteriorly but it is not cross-hatched in the back
the posterior intervertebral dics are more prone to herniation
what are 3 different ways to treat a disk herniation?
- spinal fusion - screws are placed into the vertebral discs to create stability; however, this will cause stress on the immediate above and below unaffected discs
- discectomy - disc removal
- laminectomy - part of the vertebral arch (the lamina) is removed to create more space to alleivate the pressure on the spinal nerves
