Vertebral column and back Flashcards
During surgery, which procedure is used to access the vertebral canal?
Laminectomy
The atlas (C1) permits movement of the cranium via synovial joints which attach to what?
Occipital condyles on the base of the skull
Where is the transverse process of C1 (atlas) palpable?
Via the lateral neck just deep to the sternocleidomastoid and medial to the lobule of the auricle (ear)
Which bony landmark of C2 can be seen on an axial CT of C1?
Dens
Describe what a Jefferson fracture is.
A fracture of C1 usually involving both anterior and posterior arches – classical presentation is bilateral fractures of both the anterior and posterior arches, producing four fractures in all
What kind of injury causes a Jefferson fracture? Give an example.
Axial-loading injury, such as diving into a swimming pool and hitting your head on the bottom
Is there usually neurological deficit associated with Jefferson fractures? Explain why
No – the spinal canal at the level of the fracture is usually wide enough to accommodate any swelling of the cord
What is another name for the dens?
Odontoid process
A fracture of the dens can affect which spinal nerves?
C3,4,5
A dens fracture can occur due to what kind of movement of the neck?
Rapid flexion-extension of the neck
What is a Hangman’s fracture? It is a risk of which type of injury?
Fracture of the posterior elements of C2
Whiplash
Which hole is a unique feature of the cervical vertebrae?
Foramen transversarium
What 3 things pass through the foramen transversarium?
Vertebral artery
Vertebral vein
Sympathetic nerves
What procedure can the sacral hiatus be used for?
Sacral epidural
C7 can be used to landmark which structure?
Lung apex
Which component of the centre of IV discs attracts water and helps maintain a rubbery consistency that resists compression?
Glycosaminoglycans
Describe the 2 layers of IV discs and what each layer contains.
Nucleus pulposus – glycosaminoglycans
Anulus fibrosus – collagen and fibrocartilage
What kind of joints are located between articular facets of adjacent vertebrae?
Zygapophyseal joints
In which area does the supraspinous ligament increase in size and what is it renamed to?
Cervical region – ligamentum nuchae
In which direction do most IV disc herniations occur and why?
Posterolateral direction because the posterior longitudinal ligament is narrower and weaker compared to the anterior longitudinal ligament
List 3 functions of the curvatures of the vertebral column.
Shock absorption
Balance and upright posture
Flexibility and mobility
Which type of curvature is present at birth and which type develops after birth?
Kyphosis is present at birth and lordosis develops after birth
Which regions of the vertebral column have kyphosis?
Thoracic and sacral
Which regions of the vertebral column have lordosis?
Cervical and lumbar
At what age does lordosis of the cervical region occur and why?
6 months of age – forms when the infant begins to lift their head
Why does lordosis of the lumbar region occur in early years of life?
Forms when the child begins to stand and walk
What causes loss of curvatures of the vertebral column as we age?
Disc degeneration
What is a wedge compression injury?
Collapse of the anterior portion of a vertebral body, leading to a wedge-shaped deformity
What is spondylolysis?
Fracture in the region of the articular facets without displacement
What feature on a scan would indicate spondylolysis?
Collar or break on the neck of the “scotty dog”
What can spondylolysis progress into?
Spondylolisthesis – vertebra slips forward on the one below it
Spondylolysis most commonly occurs in which vertebra?
L5
The superficial muscles of the back are innervated by what?
Brachial plexus or CN XI
The deep muscles of the back are innervated by what?
Dorsal rami of spinal nerves
Which muscle keeps the head upright?
Splenius capitis
What is the innervation of erector spinae?
Dorsal rami of the spinal nerves from C1 to S5
Entrapment of which nerves in the sub-occipital triangle can cause posterior headache or occipital neuralgia?
C2 + C3
Which muscle connects hip flexion and the vertebral column, therefore meaning that hip flexion can exacerbate mechanical back pain?
Psoas major
