vertebral column Flashcards
spinal cord and nerve roots: describe the meninges, spinal cord, dorsal and ventral nerve roots, particularly in relation to root compression and the placement of epidural and spinal injections. Describe the anatomy relevant to performing a lumbar puncture
meninges of spinal cord vs brain
only meningeal dura present in spinal cord (periosteal dura reflects back at foramen magnum); large epidural space in vertebral column vs brain
what is coning
performing lumbar puncture at high intracranial pressure, resulting in dramatic pressure gradient and brain moving down through foramen magnum
where does spinal cord end
L2
what is the bundle of nerves after the end of the spinal cord at L2 called
chordae equina
vertebral region for spinal anaesthetics and lumbar puncture, and reason
L3-L4 or L4-L5, as no spinal cord (epidural spinal anaesthetics can be given L2 to S2)
what layers do you have to go through to a) deliver epidural anaesthetic and [b) get CSF in a lumbar puncture] (posterior to anterior)
skin -> fat -> muscle -> supraspinous ligament -> intervertebral ligament -> ligamentum flavum -> epidural space [-> dura mater -> subdural space -> arachnoid mater -> subarachnoid space]
why is there a discrepancy between size of anterior and posterior rami coming out of mixed spinal nerve
anterior innervates many muscles and limbs so large, posterior only innervates intrinsic muscles so small
where does pia end vs arachnoid and dura
pia is adherent to spinal cord so ends at L2, dura and arachnoid continue further down vertebral column
what is the filum terminale
strand of fibrous tissue coming out of pia mater, proceeding downward from apex of conus medullaris (where spinal cord ends)
what position is patient when giving epidural anaesthetic or getting CSF in lumbar puncture
on side to make epidural space bigger
through where else can epidural anaesthetics be administered for severe sciatica
sacral hiatus
spinal block vs epidural anaesthesia and use
spinal block inside subarachnoid space, and used for caesarean section/hip replacement (gives profound block of all motor and sensory function below level of injection; volume inserted as know duration of operation); epidural anaesthesia inside epidural space and used for duration of labour ( blocks a band of nerve roots around site of injection, with normal function above, and close-to-normal function below; don’t know when it might end)
