Vertebral Column, Spinal Cord and Back

Question 1

Main Function of the Vertebral column

Answer 1

Protects the spinal cord and spinal nerves
Supports weight of the upper body
Partly rigid and flexible posture and locomotion

Question 2

Vertebral column is made up of?

Answer 2

Extends from the cranium to the apex of the coccyx

Main part of the axial skeleton
articulated bones of the cranium, vertebral column, ribs and sternum

Presacral vertebral column is flexible in part to intervertebral discs

33 total vertebrae

Question 3

Name 4 curvatures that provide flexibility to the spine

Answer 3

Cervical curvature concave posteriorly (natural lordosis)

Thoracic curvature concave anteriorly (natural kyphosis)

Lumbar curvature concave posteriorly (natural lordosis)

Sacral curvature concave anteriorly (natural kyphosis)

Not as profound in females so that the coccyx protrudes less into the pelvic outlet (birth canal)

High” Curves C5, L3
“Low” Curves T5, S2

Question 4

Saddle block is used for what kind of block

Answer 4

Sacral plexus block

Question 5

What is Excessive thoracic kyphosis

Answer 5

Erosion and collapse of vertebrae- osteoporosis

Question 6

What is Excessive lumbar lordosis

Answer 6

Weakened trunk musculature

Temporary in late pregnancy

Question 7

What is Scoliosis

Answer 7

Abnormal lateral curvature with rotation of the vertebrae
Asymmetric weakness of intrinsic back muscles, failure of half of the vertebra to develop or difference in lower limb length(Causes)

Question 8

Vertebral body:

Answer 8

Strengthen vertebral column
Increases as move inferiorly
Bigger as move down

Question 9

Vertebral arch components

Answer 9

Formed by the 2pedicles and 2laminae

Question 10

Pedicles (2):

Answer 10

Short processes that join vertebral arch to vertebral body

Question 11

Laminae

Answer 11

Join with pedicles and meet in the midline to complete arch

Question 12

Vertebrae Structure and Function Continued

Answer 12

rtebral foramen the big hole
Formed by the arch and body
Provides passage way for spinal cord, meninges, fat, spinal nerve roots and vessels
Articulating facets (2 superior and 2 inferior):
With adjacent vertebrae form the Intervertebral Foramina which give passage to spinal nerve roots and vessels
Spinous process:
Projects posteriorly
Provides attachment for deep back muscles
Transverse process (2):
Projects posterolateral
Provides attachment for deep back muscles

Question 13

Vertebral foramen the big hole

Answer 13

Formed by the arch and body

Provides passage way for spinal cord, meninges, fat, spinal nerve roots and vessels

Question 14

Articulating facets (2 superior and 2 inferior):

Answer 14

With adjacent vertebrae form the Intervertebral Foramina which give passage to spinal nerve roots and vessels

Question 15

Spinous process:

Answer 15

Projects posteriorly

Provides attachment for deep

Question 16

Transverse process (2)
components and function

Answer 16

Projects posterolateral

Provides attachment for deep back muscles

Question 17

Atlas (C1)

Answer 17

Ring-like
No spinous process or body
Two lateral masses connected by anterior and posterior arches
Concave superior articular facets form atlanto-occipital joint with occipital condyle
Articular facet for the dens (odontoid process) of C2

Question 18

Axis (C2)

Answer 18

Strongest cervical vertebra

Dens- projects superiorly from body and provides a pivot for atlas to turn

Question 19

Cervical Vertebrae (7)

Answer 19

Small body
Large vertebral foramen
Transverse processes contain foramen (foramina transversarium) which allow vertebral arteries, vertebral veins and sympathetic plexuses to pass
Absent in C7

Spinous process of C3-C5 short and bifid(2 points) increases surface area

Spinous process of C7 is long- vertebra prominens,,,,the one that sticks out

Question 20

Thoracic vertebrae and components

Answer 20

Body contain one or two bilateral costal facets for articulation with head of rib…larger

Smaller vertebral foramen compared to cervical and lumbar regions

Transverse processes are long and strong
Length diminishes from T1-T12

T1-T10 contain costal facets for articulation with tubercle of corresponding rib

Spinous process slopes significantly postero-inferiorly, overlapping sub adjacent vertebral body

Question 21

Rib is named in relationship to what?

Answer 21

Spinous process it attaches to.

Question 22

Lumbar Vertebrae (5)

Answer 22

Massive body

Vertebral foramen larger than thoracic but smaller than cervical

Short and sturdy hatchet-shaped spinous process

Question 23

Sacrum and Coccyx

Answer 23

Sacrum:
Five fused, originally separate, vertebrae
Sacral cornu
Important landmark for identifying sacral hiatus
Sacral hiatus
Allows filum terminale of the spinal cord to pass and attach to the coccyx
Results from the absence of laminae and spinous process of the S4-S5 vertebrae
Allows for placement of caudal anesthetic into epidural space
Coccyx
Four fused vertebra

Question 24

C7 spinous process is called?

Answer 24

C7 spinous process is the vertebra prominens..sticks out

Question 25

Scapular spine correspond to?

Answer 25

Scapular spine corresponds to T3

Question 26

Inferior angle of scapula corresponds

Answer 26

with T7 spinous process

Question 27

Last rib corresponds with

Answer 27

T12 spinous process

Question 28

Iliac crest- Tuffier’s line corresponds with?

Answer 28

L4 spinous process

Question 29

PSIS corresponds to

Answer 29

S2 spinous process

Question 30

Ligaments and functions

Answer 30

This is to stabilize the vertebral column

Question 31

Nuchal ligament

Answer 31

Strong, median ligament of the neck Extends from the occipital protuberance and posterior border of the foramen magnum to the spinous processes of the cervical vertebrae Acts as a point of muscle attachment from C3-C5

Question 32

Supraspinous ligament

Answer 32

Runs along the spinous process from C5 to sacrum after merging superiorly with the nuchal ligament

Question 33

Interspinous ligaments

Answer 33

Stabilizes and unites adjacent spinous processes | Weak and membranous, runs entire length of vertebral column.

Question 34

Ligamentum flava/ flavum

Answer 34

Broad, tough, pale, yellow, wedge shaped elastic fibrous tissue…lamina to lamina Adjoins laminae of adjacent vertebral arches, forming alternating sections of the posterior wall of the vertebral canal. Runs C2 to sacrum. Thickest at the midline at L3

Question 35

Posterior longitudinal ligament

Answer 35

Narrow, weaker band | Runs within vertebral canal along the posterior aspect of vertebral bodies from C2 to the sacrum

Question 36

Anterior longitudinal ligament

Answer 36

Strong broad fibrous band Covers vertebral bodies and IV discs Runs from pelvic surface of the sacrum to anterior tubercle of C1 (atlas) and occipital bone anterior to foramen magnum

Question 37

Spinal cord Location anatomically

Answer 37

Major reflex center and conduction pathway between the body and the brain Begins as a continuation of the medulla oblongata (caudal part of the brainstem) Ends in the conus medullaris, in most adults this corresponds with L1 (T12-L3) This is where u place ur spinal below the level of L1

Question 38

Cervical enlargement of the spinal cord

Answer 38

Cervical enlargement extends from C4-T1, anterior rami of these spinal nerves form the brachial plexus that innervate the upper extremity (see upper extremity lecture)

Question 39

Lumbosacral enlargement of the spinal cord

Answer 39

Lumbosacral (lumbar) enlargement extends from L1-S3 segments of the spinal cord, anterior rami of this region provides the lumbar and sacral plexuses of nerves for the lower extremities (see lower extremity lecture)

Question 40

Dural sac is created by?

Answer 40

the dura and arachnoid meninges (not pia) continue past the spinal cord to create the dural sac ends at the level of S2, corresponds with PSIS

Question 41

From the inferior end of the conus medullaris, the filum terminale internum(pia matter) continues to become?

Answer 41

filum terminale externum Filum terminale internum is the continuation of the PIA mater Filum terminale externum passes through the sacral hiatus and attaches to the coccyx posteriorly to anchor the spinal cord and dural sac Filum terminale externum contains dura, arachnoid AND pia mater

Question 42

Location of the spinal nerves

Answer 42

31 pairs of spinal nerves 8 cervical C1 emerges between skull and C1 vertebra C2-C7 emerge superior to corresponding pedicles C8 and below emerge inferior to corresponding pedicles 12 thoracic 5 lumbar 5 sacral 1 coccygeal Lower lumbar and sacral nerve roots are the longest since spinal cord ends high in the vertebral column Results in a bundle of spinal nerve roots in the lumbar cistern of the subarachnoid space caudal to the termination of the spinal cord- referred to as the cauda equina C1 –c8 comes out of the corresponding main vertebra

Question 43

What are the components of the spinal nerve

Answer 43

Gray Matter White Matter Multiple rootlets attach to the anterior and posterior surfaces of the spinal cord and converge to form the posterior and anterior roots of the spinal nerve

Question 44

Components of grey matter

Answer 44

Internally it is a butterfly shaped | Unmyelinated Interneurons and cell body

Question 45

Components of White Matter

Answer 45

Surrounds the Gray matter | Myelinated nerve cells/axons

Question 46

Posterior root (dorsal root)

Answer 46

carries afferent sensory information from periphery (skin/deep tissues/viscera) to CNS Cell bodies of the dorsal root are located outside of the spinal cord at the dorsal root ganglion

Question 47

Anterior root (ventral root)

Answer 47

carries efferent motor and autonomic signals from the CNS to periphery Cell bodies of the ventral root are located inside the anterior horns of the gray matter

Question 48

What forms the spinal nerve

Answer 48

The posterior and anterior roots unite to form a spinal nerve,

Question 49

Spinal nerve exits the exits the spinal canal through

Answer 49

intervertebral foramen

Question 50

Spinal nerve divides into 2 nerves namely?

Answer 50

``` The (Dorsal)posterior Primary Rami The Ventral(Anterior) Primary Rami ```

Question 51

What is the Function of the dorsal(posterior) Rami

Answer 51

supply the deep muscles of the back and skin | Posture muscle

Question 52

What is the Function of the Ventral Rami

Answer 52

supply muscles, joints, and skin of the limbs and remainder of the trunk

Question 53

Where does the Dural Sac end

Answer 53

S2

Question 54

What is the function of the meninges

Answer 54

Surround, support, and protects the spinal cord and spinal nerve roots

Question 55

What is the meninges made up of

Answer 55

Dura mater: tough, fibrous outermost covering Separated from the vertebrae by the epidural space Highly vascularized Forms the spinal dural sac, which ends at S2 Arachnoid mater: delicate, avascular membrane lines the dural sac, is not attached to dura but is pressed against the dura due to cerebral spinal fluid (CSF) Encloses the subarachnoid space which contains CSF, spinal nerve roots, and spinal ganglia Pia mater: innermost covering membrane Directly covers the spinal cord, roots of the spinal nerves and spinal blood vessels Denticulate ligament- extensions that help anchor spinal cord centrally….no wiggling Continues as the filum terminale (internum)

Question 56

Where is the CSF in the spine

Answer 56

Sub arachnoid space is csf……pushes dura against arachnoid

Question 57

What location does the spinal work in

Answer 57

Spinal Roots

Question 58

where does the Three longitudinal arteries supply blood to?

Answer 58

medulla of the brainstem to the conus medullaris of the spinal cord

Question 59

One anterior spinal artery | supplies blood to

Answer 59

Arises from the union of branches of the vertebral arteries Anterior two-thirds of the spinal cord Blood supply

Question 60

Two posterior spinal arteries

Answer 60

Arise from a branch of either the vertebral arteries or the posterior inferior cerebellar artery Posterior one-third of the spinal cord Posterior spinal cord has better continuity of blood supply than the anterior spinal cord

Question 61

Both anterior and posterior spinal arteries only supply what location

Answer 61

These three arteries run the entire length of the spinal cord but only supply the short superior part

Question 62

What arteries supply the spinal cord except the superior part

Answer 62

cervical, deep cervical, vertebral, posterior intercostal and lumbar arteries Enter the vertebral column through the intervertebral foramina

Question 63

What does the artery of ADAMKIEWICZ(Great anterior segmental artery) supply

Answer 63

Provides circulation to the inferior two thirds of the anterior spinal cord Generally arises from T9-T12 on the left side of the aorta Branch from segmental spinal artery

Question 64

Explain Spinal cord venous Drainage

Answer 64

Veins of corresponding names follow the arteries Epidural space holds the internal vertebral venous plexus (Batson Plexus) Provides alternative venous return to the heart when the inferior vena cava is compressed Empty into the azygos vein or the hemiazygos vein which are located in the abdomen and thorax

Question 65

Serratus posterior Superior/Innervtion and function Superficial respiratory muscles

Answer 65

2nd-5th intercostal nerves (anterior rami) Proprioception for respiration

Question 66

Serratus posterior inferior Inn/Function Superficial respiratory muscles

Answer 66

9th-11th intercostal nerve (anterior rami) Proprioception for respiration

Question 67

Splenius Capitis and Splenius Cervicis INN/ACT

Answer 67

posterior rami of spinal nerves and act to maintain posture and control movements of the vertebral column Laterally flex neck and rotate head to side of active muscles. Extends head and neck together

Question 68

Longissimus Spinalis Illiocostalis

Answer 68

Bilaterally- extends vertebral column | Unilaterally- flexes vertebral column

Question 69

Components of Suboccipital triangle

Answer 69

Region is defined by four postural muscles of the head Posterior ramus of C1 suboccipital nerve Motor innervation Posterior ramus of C2 greater occipital nerve (lies slightly lateral) Sensory innervation Posterior ramus of C3 third occipital nerve (lies medially) Sensory innervation XXXAnterior ramus of C2-C3 lesser occipital nerve (lies laterally) Sensory innervation Lies outside region of suboccipital triangle but included for completeness

Question 70

Rectus capitis posterior major | Inn/Act

Answer 70

Spinous process C2; occipital bone Suboccipital nerve Head posture

Question 71

Rectus capitis posterior minor | INN/ACT

Answer 71

Posterior tubercle of C1; occipital bone Suboccipital nerve Head posture

Question 72

Obliquus capitis inferior inn/ACt

Answer 72

Spinous process C2; transverse process of C1 Suboccipital nerve Head posture

Question 73

Obliquus capitis superior

Answer 73

Transverse process of C1; occipital bone Suboccipital nerve Head posture

Question 74

Sensory Innervation of the Occipital Region and Head

Answer 74

Posterior ramus of C2 greater occipital nerve (lies slightly lateral) Sensory innervation – occipital area Posterior ramus of C3 third occipital nerve (lies medially) Sensory innervation- occipital area Anterior ramus of C2-C3 lesser occipital nerve (lies laterally) Sensory innervation- posterior to auricle (ear)

Question 75

Dermatomes C4-T6

Answer 75

Posterior cutaneous branch of C4-T6

Question 76

Dermatomes T7-T12

Answer 76

Posterior Cutaneous Branches T7-T12