Vertebral Column Flashcards
What are the characteristic features of cervical and thoracic vertebrae?
Cervical vertebrae are immobile, have bifid spinous process (except C7), have transverse foramen Thoracic vertebrae are mobile, small vertebral foreman, singular spinous process
How many cervical vertebrae do we have?
7
How many thoracic vertebrae do we have?
12
What is the predominant movement achieved by the thoracic vertebrae?
Rotation
Which of the thoracic vertebrae contain demi-facets and which contain whole facets?
Demi-facets: T2- T8 Whole facets: T9-T10
The first cervical vertebrae is known as what?
Atlas
The Altas articulates with what structures superiorly and inferiorly?
Occiput of the skull (superiorly) C2 (Axis) (inferiorly)
What is the joint at the occiput of the skull and C1 known as and what movement is this res[onsible for?
The atlanto-occipital joint 50% of total flexion and extension “nodding”
What is the joint between C1 and C2 known as?What movement is it responsible for?
Atlanto-axial joint 50% of total rotation “head shaking”
Te atlas has what characteristic features?
It has no vertebral body, no spinous process, thick lateral mass and is the widest cervical vertebrae
What are the characteristic features of the axis?
It is the strongest cervial vertebrae, has an odontoid process (dens), a rugged lateral mass and a large spinous process
What is the purpose of the dens and transverse ligament?
To prevent horizontal displacement of the atlas (independent movement of C1 and C2)
Reumatoid arthiritis may result in what as a result of errosion of the transverse ligament where it attaches to the vertebrae?
May cause neurological injury as C1 and C2 can then move independently
What is the seventh cervical vertebrae known as? Why?
Vertebrae prominens It is the most prominent spinous process and can be used to orientate clinically
Does C7 have a bifid spinous process?
No
How do the transverse foramen of C7 compare to that of the other cervical vertebrae?
They are smaller in C7 and only transmit the accessory vertebral veins (does not contain the vertebral artery)
What is the nuchal ligament?
Thickening of the supraspinous ligament that connects all the tips of the spinous processes of C2 to C7
What is the nuchal ligament attached to?
External occipital protuberance Spinous processes of all cervical vertebrae Spinous process of C7
What is the role of the nuchal ligament?
Maintains secondary curvature of the spine Helps the C spine support the head A major site of attachment of the neck and trunk (Trapezius, Rhomboids)
Name the ligaments of the vertebral column?
Supraspinous ligament Ligamentum flavum Interspinous ligament Anterior longitudinal ligament Posterior longitudinal ligament
Which are the major ligaments of the vertebral column?Which is the strongest of these ligaments?
Anterior longitudinal ligament (Strongest)Posterior longitudinal ligament
What is the anterior cord of the nervous system responsible for? How might we test for the function of the anterior cord (anterior cord syndrome)?
Sensory and motor light touch, pinprick and pain
What is the posterior cord (dorsal columns) responsible for sensing? How might we test for posterior cord syndrome?
Vibration and proptioception Tuning forkSense of where limbs are without looking at them
What is the difference in reference between the central and more lateral tracts?
Central tracts move the arms Lateral tracts move the legs
In reference to dermatomes, what dermatome does the middle finger indicate?
C7
What is T10 dermatome found?
Umbilicus
What myotome primary supplies the deltoid?
C5
Myotome- Biceps?
C5,6
Myotome- wrist extensors?
C6
Myotome- Wrist flexors?
C7
Myotome- finger flexors?
C7
Myotome finger flexors?
C8
Myotome- interossei?
T1
Where would you test the reflex of C5 root?
Biceps
Where would you test for the reflex of C6 nerve root?
Brachioradialis
Where would you test for reflex of C7 nerve root?
Triceps
What is a neural level?
The last functioning level that occurs below an injury
What is the relevance of the level of the nipples?
This is the junction between C4 and T4
What is the difference in the way that nerve roots exit in the C spine compared to the T spine?
The C spine nerve roots exit more horizontally The T spine nerve roots exit more vertically and then travel outwards
At what point does the exit of the nerve root change from exiting below their vertebral body, to exiting above?
C7/T1 junction
How many C nerve roots are there? How many C vertebrae are there?
8 C nerve roots 7 C vertebrae
What is cervical spondylosis?
Degenerative osteoarthritis of the intervertebral joints in the cervical spine
How does cervical spondylosis present in patients depending on whether it leads to pressure on the nerve root or the cord?
Pressure on the nerve root causes radiculopathy-dematomal sensory symptoms- paraesthesia, pain-myotomal motor weakness Pressure on the cord causes myelopathy -global weakness-gait dysfunction -loss of balance -loss of bladder and bowel control
What is a hangman’s fracture? How is it caused?
Axis fracture through the pars interarticularis of C2 Caused by hyperextension of the head on the neck
What does a hangman’s fracture result in?
The forward displacement of C1 and body of C2 on C3 because it is unstable
What is an Odontoid fracture and how it it otherwise known?
Fracture through the adontoid process of C2 Known as a peg fracture or a dens fracture
How does a peg fracture usually occur?
Can occur with both hyperflexion and hyperextension of the neck Usually hyperextension
What is a Jefferson’s fracture? How might this be acquired?
Fracture of the anterior and posterior arches of the atlas Diving into shallow water, impact against the roof of a vehicle
How might a Jefferson’s fracture present?
Pain, neurological signs usually not present due to the wide vertebral foramen Damage to arteries at the base of the skull may occur with neurological consequence- ataxia, Horner’s syndrome
A whiplash injury is caused by _______ mobility, ______ stability impact
High Low
How does a whiplash injury occur?
Hyperextension of the neck followed by hyperflexion
How and why might a cervical prolapsed disc develop?
Lifting, whiplash, “woke up like this” Cause by tear to the annulus fibrosis which causes the nucleus pulposus to leak out and push into the spinal canal
What will a patient complain of with a left sided C5/6 prolapsed disc? Which nerve root is affected?
Pain: biceps into thumb and index finger Motor weakness: biceps and wrist extension Sensory: numbness/pins and needles in thumb and index finger C6
Which nerve root is affected if the patient has a prolapsed disc at C7/T1
C8
How will the patient present if they have a C7/T1 intervertebral disc prolapse?
Pain: Down to little and ring fingers Motor weakness: long finger flexors Sensory: Numbness/pins and needles in little and ring fingers
What is cervical myelopathy?
A condition caused by the narrowing of the spinal canal leading to whole cord dysfunction
What is cervical radiculopathy?
A problem that results when a nerve in the neck is irritates as it leave the spinal canal- usually at the nerve root (not whole cord)
How might cervical myelopathy occur?
Osteoarthritis of the cervical spine leading to the formation of osteophytes and therefore thinking of the ligamentum flavum - which then increased pressure to push on the spinal cord
What will a patient complain of with a cervical myelopathy at C3/C4?
Pain: Neck Motor weakness: Shoulder abduction Sensory: Numbness/pins and needles from shoulder down to feet
What will a patient complain of with a cervical myelopathy at C5/C6
Pain: Neck pain Motor weakness: Elbow flexion, wrist movements and finger movements Sensory: Numbness/ pins and needles from elbows down to feet
Is cervical myelopathy an acute or progressive condition?
Progressive (age-related degeneration)
How might thoracic cord compression occur?
As a result of a fracture of the vertebrae giving bony fragments or a tumour developing in the canal which compresses the spinal cord
How might a patient with thoracic cord compression at T10 present?
Pain: Thoracic pain Motor weakness: All leg muscles Sensory: Numbness/pins and needles from umbilicus down Loss of sphincter control
How would a patient with a T5 cord compression present?
Pain: High thoracic pain Motor weakness: All muscles in the legs and intercostals Sensory: Numbness/ pins and needles just below the nipples Loss of sphincter control
