Vertebral Column

Question 1

What are the 5 regions of the vertabral column?

Answer 1

cervical

thoracic

lumbar

sacral

coccyx

Question 2

Which are the primary curvatures and when do they develop? Which are the secondary curvatures and when do they develop?

Answer 2

THe primary curvatures are the thoracic and sacral - they develop in the fetus.

THe secondary curvatures are convex and include the cervical and lumbar. They develop as an individual ages and assumes the upright posture

Question 3

What happens in kyphosis?

Answer 3

the cervical curvature is accentuated = dowager hump

Question 4

What happens in lordosis?

Answer 4

a genetic accentuation of the lumbar curvature

Question 5

What happens in scoliosis?

Answer 5

lateral curvature of the vertebral column

Question 6

Identify the parts…..

Answer 6

Question 7

What pathology can occur as the bones of the vertebrae become more porous?

Answer 7

osteoporosis develops and this can cause the vertebrae to compress = compression fractures

Question 8

What is the special name of the C1 vertebra?

WHat is the name of the C2 vertebra?

Answer 8

C1 = atlas

C2 = Axis

Question 9

What is special about the structure of C1 and C2?

Answer 9

The transverse processes of these vertebrae have foramen them in - the transverse foramen– through which the vertebral artery passes

THe other unique thing is that the atlas doesn’t have a body. It’s fused with the body of the axis to form the dens of the axis.

THere is a synovial joint over the dens that permits the rotation of the head on the vertebral column

Question 10

What artery flows through the transverse foramen?

Answer 10

the vertebral artery - it does NOT pass through the transverse foramen of C7, even though it has one

Question 11

What is the dense connective tissue that spans from C7 up to the occipital bone?

Answer 11

the ligamentum nuchae

Question 12

What is the deep muscle of the back that is innervated by the dorsal rami of the spinal nerves?

Answer 12

the erector spinae

Question 13

what does the erector spinae do?

Answer 13

it extensors of the trunk - especially the neck and back

Question 14

What are the three vertebral ligaments?

Answer 14

anterior and posterior longitudinal ligaments (located on anterior and posterior surfaces of the vertebral bodies

ligamentum flavum (between the laminae of adjacent vertebrae)

interspinous ligament (between spines of adjacent vertebrae)

Question 15

What is the space between the dura and the bone of the vertebral canal called? What two things are located inside?

Answer 15

The epidural space. It is filled with epidural fat and a venous plexus known as the internal vertebral plexus of beins

Question 16

What is unique about the veings in the internal vertebral plexus?

Answer 16

they do NOT HAVE VALVES. This means blood can flow in either direction of these vessels.

Question 17

How are the plexus veings connected to the veins outside the vertebral column?

Answer 17

they go thorugh the intervertebral foramen.

Question 18

What is the tough outer covering that encloses the spinal cord?

Answer 18

the dura mater

Question 19

What separates the dura from the vertebral column?

Answer 19

the epidural space

Question 20

As the dura continues through the intervertebral foramen, it surrounds the spinal nerve and is continuous with what structure?

Answer 20

the epineurium that surrounds the nerve

Question 21

What are the lines pointing to?

Answer 21

the anterior sacral foramina

the ventral rami of sacral spinal nerves exit through these

Question 22

What are the arrows pointing to?

Answer 22

black arrows - posterior sacral foramina

(the dorsal rami exit through these)

red - sacral hiatus

Question 23

What membrane lies directly beneath the dura in a living individual?

Answer 23

the arachnoid membrane

Question 24

What separates the arachnoid from the pia mater? What’s inside?

Answer 24

the subarachnoid space filled with CSF

Question 25

What is the pia attached to?

Answer 25

the pia is intimately attached to the spinal cord

Question 26

what do the denticulate ligaments do for the pia?

Answer 26

the denticulate ligaments are formed by the pia and extend from the spinal cord to pierce through the arachnoid membrane and attach to the dura

Question 27

At what level does the spinal cord end within the vertebral canal? What is this called?

Answer 27

It usually stops at L2 in the conus medullaris

Question 28

After the conus medullaris, the pia mater extends to become what?

Answer 28

the internal medullary filum, which will then fuse with the arachnoid and dura around S2

Question 29

When the internal medullary filum fuses with the arachnoid and dura at S2, they continue on as the what? What does it attach to?

Answer 29

They continue on as the external medullary filum, or coccygeal ligament which attaches to the coccyx.

Question 30

After the spinal cord ends, what is the subarachnoid space with its CSF called?

Answer 30

the lumbar cistern

Question 31

What occupies the lumbar cistern besides CSF?

Answer 31

the cluster of lumbar and sacral spinal nerves called the cauda equina.

Question 32

Where are the dorsal root ganglia located in relation to the vertebral column?

Answer 32

they are either near or in the intervertebral foramen

Question 33

What does the intervertebral disc consist of?

WHat is the outermost covering called? What is the core called?

Answer 33

It’s make of fibrocartilage

the outermost covering of the disc is the annulua fibrosus, which is dense connective tissue

the core is the nucleus pulposus, which is a jelly-like substance

Question 34

What happens in disc herniation?

Answer 34

pressure is placed on the intervertebral disc

if ther eis too much pressure, the annulus fibrosis will rupture and the nucleu pulposus will herniate out

Question 35

Where is the weak point of the intervertebral discs/where does herniation typically occur?

Answer 35

there is a weak point just adjacent to the posterior longitudinal ligaments, just above the pedicles

Question 36

In a lumbar puncture, what landmark do you use and where do you insert the needle?

Answer 36

you can find the region of L4 as a landmark by drawing a horizontal line from the tops of the iliac crests on both sides

you insert the needle between the L3 and L4 spinous processes.

Question 37

Where does the CSF come from in a spinal tap?

Answer 37

in the subarachnoid space

Question 38

Where do they put anesthesia if they’re doing a spinal nerve block?

Answer 38

the subarachnoid space

Question 39

Why do they typically administer a spinal block with the patient angled up?

Answer 39

they don’t want the anesthesia to reach too high up the spinal cord - you could paralyze the diaphragm

Question 40

If herniation of 4th lumbar intervertebral disc occurs, what spina nerve is effected? WHere will this cause pain?

Answer 40

Herniation of the L4 intervertebral disk will put pressure on the L5 spinal nerve. This causes pain to radiate into the back and down the lower extremity into the dorsum of the foot.

Question 41

If the L5 intervertebral disc herniates, what nerve is affected and where does the patient experience pain?

Answer 41

If the L5 intervertebral disc hernaites, pressure is put on the S1 spinal nerve. This causes pain to radiate into the lower back and down the back of the lower extremity to the lateral side of the foot.

Question 42

Besides pain, what will happen to the LE if the S1 spinal nerve is compressed?

Answer 42

plantar flexion of the foot and great toe reduced - can’t walk on toes

atrophy of the calf muscle

absent ankle jerk reflex

Question 43

What will happen if the L4 disc protrudes MEDIALLY?

Answer 43

You can have pressure on L5 and it may possible affect S1-4 as well

medial protrusion is rarer because of the additional support to the intervertebral disc by the posterior longitudinal ligament