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Block 2 > Vertebral Column & Back > Flashcards

Vertebral Column & Back Flashcards

1
Q

What are the 5 functions of the vertebral column?

A
  1. Carries + protects spinal cord + nerves
  2. Provides support to thoracic/rib cage
  3. Transfers weight from upper body to lower limbs
  4. Shock absorbing
  5. Muscle attachment point
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2
Q

In order from top to bottom, list the vertebral regions.

A 
7x cervical (C1-C7)
12x thoracic (T1-T12)
5/6x lumbar (L1-L5/6)
5x sacral (S1-S5)
Coccyx
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3
Q

How many cervical spine nerves are there?

A

8

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4
Q

What is unique about the sacral vertebral bodies?

A

They are fused together

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5
Q

What muscle is attached to the coccyx? What can therefore happen if you damage your coccyx?

A

Leviator ani so if you damage the coccyx, defecation + coughing for e.g. will become painful due to this muscles involvement in these processes

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6
Q

What structures make up the neural arch?

A 
Pedicle
Transverse process
Lamina
Spinous process
Vertebral canal
Articular facets (synovial joint attachment)
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7
Q

What does the vertebral canal of the neural arch house?

A 
Spinal cord (enters L1-2)
Spinal nerves
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8
Q

What is the function of the C1 vertebrae?

A

AKA atlas

Carries the weight of cranium

Joins to occipital condyle on base of skull + permits movement i.e. flexion + extension (nodding)

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9
Q

What in unique about the C1 vertebrae?

A

It has no body as C2 steals it in development

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10
Q

What part of C1 can you palpate in your neck?

A

Transverse process/lateral mass of axis via lateral neck deep to sternocleidomastoid

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11
Q

What is a Jefferson fracture? What can cause it?

A

Express compression can shatter the ring of atlas i.e. C1 vertebrae

Causes:

  • Diving into shallow water + landing on head
  • Jumping from height + landing on feet as force transmits up
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12
Q

How does the C2 (axis) provide rotation movement of the head and neck?

A

Odontoid process/peg (used to be the body of C1 in development) forms pivot joint with C1 (atlas) allowing axial rotation of head

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13
Q

Where in the spine could you attain a displacement fracture that was fatal? Below which level would you survive?

A

C1 is lethal as respiratory centre is at C3, 4 + 5

So below C6, you would survive

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14
Q

What can happen to the odontoid process of C2 in trauma i.e. car crash?

A

Can become fractured + impinge on the spinal cord as a result of rapid flexion/extension snapping it

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15
Q

What is whiplash? If its particularly bad what can happen?

A

Rapid hyperextension + flexion of neck e.g. in car crash causing ligamentous injury mostly

Hangman’s fracture if particularly bad

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16
Q

What are the typical structures features of cervical vertebrae?

A

Small bodies + holes/foramens (foramen transversarium) in short transverse processes where arteries pass up into cranial cavity to supply top of spinal cord, brain stem + lower part of brain

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17
Q

What do cervical vertebrae have small bodies?

A

Less weight at top of vertebral column

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18
Q

What would happen if the vertebral artery of the foramen transversarium of cervical vertebrae got compressed?

A

Transient loss of consciousness (could last longer) due to deficit in brainstem blood supply so would cause stroke-associated symptoms

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19
Q

What are the structural features of the thoracic vertebrae?

A

Progressively increase in size

Possess articulations for ribs i.e. articular facet + transverse process (synovial joint attachment)

Heart-shaped body

Spinous processes go from backwards pointing -> downwards pointing -> stumpy/square shape

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20
Q

Why do the bodies of the vertebrae increase in size when moving inferiorly?

A

More weight + force being applied to vertebral column as you move inferiorly

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21
Q

What are the holes called at every level of the vertebral column where spinal nerves escape?

A

Intervertebral foramen

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22
Q

What are the functions of the lumbar vertebrae?

A

Articulations aligned to prevent rotational movements so facet joints can balance mobility with stability (< mobility = > stability)

Allows them to cope with large forces + lots of weight

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23
Q

What are the structural features of the lumbar vertebrae?

A

Big kidney-shaped bodies

Spines squat + square

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24
Q

What is the function of the sacral vertebrae?

A

Transmit weight to pelvic girdle into hips, lower limbs + then the floor so there is more weight transmission at top than bottom

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25
Q

What are the structural features of the sacrum?

A

Wedge-shaped so its pushed between hip bones

Fused bodies decreasing in size inferiorly

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26
Q

Where do the ventral and dorsal rami exit the vertebral column?

A

Ventral rami of sacral nerves exit via anterior sacral foramen

Dorsal rami of sacral nerves exit via posterior sacral foramen

27
Q

What is a ramus?

A

Branch of spinal nerves that is mixed sensory + motor that comes off of the ventral or dorsal roots

28
Q

What can the sacral hiatus be used for?

A

A sacral epidural can be performed through this foramen

29
Q

What can spinous processes be used for?

A

Palpated, counted + used to landmark key structures

30
Q

What spinous process landmarks the apex of the lung? What must you be careful of here?

A

C7

In surgery/needle insertion, do not go too far forward at this level due to risk of pneumothorax

31
Q

What spinous processes indicate the level of the transpyloric plane?

A

T12/L1

32
Q

How is the vertebral column inherently stable with little muscle activity?

A

Connections of ligaments + joints

33
Q

What is the function of intervertebral discs?

A

Resit compression + form a mobile joint

34
Q

What are intervertebral discs? Where are they?

A

Secondary cartilaginous joints sitting between vertebral bodies present from beneath C2

Cartilage end plate on bone

Increase in thickness distally due to increased weight/force

35
Q

What are the 2 parts of the intervertebral discs?

A

Annulus fibrosus (AF): layers of fibrocartilage

Nucleus pulposus (NP): rubbery central core (GAG) with high water content

36
Q

What are zygapophyseal joints?

A

Simple synovial plane joints located between articular facets of adjacent vertebrae

Change orientation from superior -> inferior to decrease rotation available

37
Q

What can go wrong with the zygapophyseal joints?

A

Dislocation displacing the vertebral bodies

38
Q

What happens to the intervertebral discs if force is applied towards the back of the vertebral column?

A

Increased NP pressure which increases AF tension -> limits movement between vertebral bodies -> NP can rupture through AP = disc herniation posteriorly due to ligaments supporting the disc

39
Q

Why is the invertebral discs clever at dealing with loads?

A

If you correctly list a heavy load in the correct position, the NP changes shape pushing the AF too allowing the vertebral bodies to move closer together stabilising the vertebral column

40
Q

What is the function of the ligamentum flavum?

A

Helps vertebral column to return to upright position after being flexed

41
Q

Where are the supraspinous and interspinous ligaments?

A

Supraspinous: on top of vertebral body

Interspinous: between vertebral bodies

42
Q

What is the ligamentum nuchae useful for?

A

It can be palpated in the midline posterior to neck + used for surgery as it is a avascular + aneural plane

43
Q

What are the 3 ligaments that support the vertebral column?

A
  1. Anterior longitudinal
  2. Posterior longitudinal
  3. Ligamentum flavum
44
Q

Why is the posterior longitudinal ligament less supportive than the anterior one?

A

Relatively incomplete nature i.e. it has deficits + is narrow

45
Q

Where are disc herniations most common in the vertebral column?

A

Posterior (posterior-lateral) because the posterior longitudinal ligament is not fully supportive of the discs

46
Q

What can the ligamentum flavum be used for?

A

Pierced during lumbar puncture

47
Q

Where is the ligamentum flavum?

A

Elastic ligament joining the adjacent lamina

48
Q

What are the 2 types of spinal curvatures? Where do they occur along the spines?

A
  1. Lordosis (front): cervical (C) + lumbar (L)

2. Kyphosis (back): thoracic (T) + sacrum (S)

49
Q

What happens to the spines curvature as you age and why?

A

Curve (more specifically lumbar lordosis) starts to occur as babies hold their head up -> fully developed in adulthood -> disc degeneration as you age leads to loss of curvatures

50
Q

What occurs in the spine during pregnancy? Why?

A

Lumbar hyperlordosis because weight on ventral side of column has increased so curve becomes greater so that centre of gravity allows you to stand upright (reversible)

51
Q

What are some problems that may occur with the spinal curvature?

A

Age-related kyphosis
Hyperloidosis
Scoliosis
Disease IV disc degeneration

52
Q

What can happen if a patient lands too heavily on their feet?

A

Wedge compression fracture around T12-L1 as the shock cannot be absorbed by the vertebral column at this level

53
Q

What is spondylolysis? What can be seen in an X-ray?

A

Fracture in region of articular facets without displacement perhaps due to stress on bone

Scotty dog sign: lower back pain but no other problems

Scotty dog sign wearing collar: bad sign

54
Q

What is spondylolisthesis? What can cause it?

A

Lumbar vertebrae body slips + moves anteriorly (often accompanies spondylolysis)

Causes: traumatic, degenerative + dysplastic

55
Q

The overall vertebral column movement equates to?

A

Sum of many small movements i.e. movement between 2 vertebral body’s adds up allowing the structure to be mobile + dynamic

56
Q

What do the superficial vertebral column muscles do? What is their innervation?

A

Act on limbs

Supplied by brachial plexus + CN XI

57
Q

What do the deep vertebral column muscles do? What is their innervation?

A

Includes splenius capiitis (acts on head), intrinsic erector spinae muscles + quadratus lumborum

Act on vertebrae + head to keep you upright

Dorsal rami of spinal nerves innervate it at each level

58
Q

What is the nerve supply of the erector spinae muscles of the back?

A

Dorsal ramus given off by every spinal nerve supplies the muscle at the level closest to it

59
Q

What is the sub-occipital triangle? What is its clinical relevance?

A

Sits under occiput on upper neck adjacent to splenius capitis

Entrapment of C2 + C3 dorsal rami nerves can cause posterior headache/sub-occipital neuralgia (transient or permanent)

60
Q

How do the vertebral column muscles contract? Give a few examples.

A

Unilaterally or bilaterally

E.G. psoas major that help to support + move column

61
Q

What does the psoas major do? What is the clinical relevance of this?

A

Attaches to + flexes femur

Hip flexion can exacerbate mechanical back pain

62
Q

Other than the vertebral column muscles, what other muscles also aid in moving and supporting the vertebral column?

A

Abdominal wall muscles e.g. rectus abdominis, external oblique, internal oblique + transversus abdominis

Provide pneumatic support to vertebral column

63
Q

What problems are weight lifters at increased risk of when increasing their intra-abdominal pressure?

A

Valsalva manoeuvre increases intra-abdominal pressure helping to maintain posture by putting air in front of vertebral column = good

If used too much, hernias will pop out from any weakness in abdominal wall (defecation/micturition/rectal prolapse a risk too)

Block 2 (45 decks)

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