Vertebral column, spinal cord, suboccipital triangle Flashcards
0
Q
Secondary curvatures of the spine (concaved dorsally)
A
Cervical curvature
Lumbar curvature
1
Q
Primary curvatures of the spine (concaved ventrally)
A
Thoracic curvature
Sacral curvature
2
Q
The vertebral arch consists of:
A
Two pedicles and two laminae (both form the vertebral foramen)
3
Q
Spinal canal is formed by:
A
The alignment of the vertebral foramen from all of the cervical, thoracic, lumbar and sacral vertebrae
4
Q
Where is the pedicle of the vertebrae located?
A
The region between the vertebral body and the transverse process
5
Q
Where is the lamina of the vertebrae located?
A
Between the transverse process and the spinous process.
6
Q
What forms the intervertebral foramen?
A
Superior and inferior vertebral notch + bodies and intervertebral disk from adjacent vertebrae + superior and inferior articular processes
7
Q
What is the function of the intervertebral foramen?
A
Accommodates the exit of spinal nerves from the spinal cord.
8
Q
Shape of the cervical vertebrae:
A
Small, broad vertebral body with a triangular vertebral foramen, transverse foramen
The spinous process increases in size and prominence from cv1-7
9
Q
C7 is also called:
A
Vertebra prominens
10
Q
What structure is unique to the cervical vertebrae?
A
Transverse cervical foramen
11
Q
Transverse cervical foramen are located in:
A
Cervical transverse processes
12
Q
What transmits the vertebral artery?
A
C1-C6 transverse cervical foramen
13
Q
Which cervical vertebrae does not transmit the vertebral artery?
A
C7 (vertebral prominens)
14
Q
This passes through the C7 transverse cervical foramen:
A
Auxiliary vertebral vein
15
Q
The _____ surface of the body C3-C7 is concaved
A
Superior
16
Q
The ______ surface of the body C3-C7 is convexed.
A
Inferior
17
Q
What is responsible for the movements of the neck: rotation about its axis, anterior flexion, posterior extension
A
Articular facets (C2-C7: superior and inferior) are orientated almost horizontally and combine with relatively thick intervertebral disks (C2-C7) –> neck rotation
18
Q
____ lacks a vertebral body and true spinous process
A
Atlas (C1)
19
Q
The lack of spinous process of the atlas (C1) is replaced by:
A
Posterior tubercle
20
Q
The vertebral canal of the atlas is formed by two arches:
A
Anterior and posterior arch (each with a tubercle at the midline)
21
Q
The superior articular surface (of the atlas) forms a synovial joint with the ______ and allows for the _____ and _____ of the head (“yes” motion).
A
Occipital condyle of the cranium, anterior flexion, posterior extension
22
Q
Pivot point of lateral rotation of the head:
A
Dens of the axis (C2)
23
Q
Dens supports the:
A
Alignment of the atlas
24
The vertebral foramen is smaller in diameter for the ______ vertebrae:
Thoracic
25
Thoracic vertebrae body are what shape?
Heart-shaped
26
All 12 thoracic vertebrae articulate with a ____ and have ____
Rib; costal facets (demifacets)
27
Costal facets are located on:
The posterior-lateral wall of each vertebral body
28
Costal facets articulate with:
the head of the rib to form a synovial joint
29
What is the function of transverse costal facets?
Articulate with the tubercle of ribs 1-10 and also form a true synovial joint
30
What facets are unique to thoracic vertebrae?
Costal and transverse costal facets
31
Thoracic vertebrae articular processes are orientated _____ and allow for what movments?
Vertically, extension of the thorax and anterior flexion
32
Which vertebrae have interlocking articular facets?
Lumbar vertebrae
33
Interlocking articular facets of the _____ allow for:
(In the lumbar vertebrae); posterior extension and anterior flexion of the lumbar region
34
Interlocking articular facets prevent:
Lateral rotation of the lumbar region
35
Lumbar vertebrae lack _______.
Costal facets
36
The sacrum provides strength to the ____ by transmitting the weight of the body to the _________ through the _______ joint.
Pelvis; pelvic girdle; sacroiliac joint
37
The sacral canal is made up by the fusion of:
Vertebral canal from S1-S3 and terminates at S4, then opens posteriorly - sacral hiatus
38
Sacral hiatus is formed by:
The incomplete closure of the lamina of S4 and S5 - easily palpate the sacral horns *cornua*
39
What is the promontory?
On the ventral surface of the body of S1 with a sharp ventral displacement at the upper margin
40
Two wing-like structures on the anterior surface of the sacrum, lateral to the vertebral body
Ala
41
Anterior and posterior sacral foramina
4 pairs that allow the passage of sacral spinal nerves S1-S4 (ventral and dorsal rami, respectively)
42
Articular surface of the sacrum
Lateral to the ala, on the posterior side of the sacrum are a pair of roughened spaces, articulate with the anterior surface of the ilium to form the sacroiliac joint
43
Sacroiliac joint
Articular surface articulates with the anterior surface of the ilium to form this synovial joint
44
4 vertebral elements that are fused and rudimentary - embryological remnant of a tail
Coccyx
45
What maintains the integrity of the vertebral column?
Series of ligaments, intervertebral disks, and the superior/inferior articulating processes and corresponding synovial joints
46
Anulus fibrosus encapsulating the nucleus pulposus
Intervertebral disks
47
Intervertebral disks
23, inferior to the bodies of C2-L5 (no disks between cranium/C1 and C1/C2)
Maintain alignment and provide cushion
48
What is the function of the anterior longitudinal ligament? (Of the vertebral column)
Maintain support and alignment of the vertebral column.
49
Where does the anterior longitudinal ligament attach?
A bony tubercle located at the midline on the anterior rim of foramen magnum (occipital bone), anterior tubercle of C1, and on the anterior midline surface of the vertebral bodies of C2-S1
basically: on the anterior edge of the vertebral body (imagine spine... Runs down the anterior border where all of the vertebral bodies run)
50
In the _____, the intervertebral disks are ossified.
Sacrum
51
What is the origin of the posterior longitudinal ligament?
C2 (as it merges with the tectorial membrane, which connects C2 to the clivus of the occipital bone)
***looks like it is connected to the skull, but it is NOT. It is connected to the tectorial membrane
52
Where does the posterior longitudinal ligament attach?
Vertebral bodies of C2-S1 (and the intervertebral disks)
| Posterior side of the vertebral bodies... Runs inside the vertebral foramen
53
Supraspinous ligament extends from ____ to ____ ?
Spinous processes of C7-S3
54
Superior to ____, the supraspinous ligament is continuous with _________.
C7; ligamentum nuchae
55
What is the free border of the ligamentum nuchae?
Free border: continuous with the supraspinous ligament and extends from the external occipital protuberance --> spinous process of C7
56
Superior border of ligamentum nuchae?
Superior border: attaches to the occipital bone along the external occipital crest to the base of foramen magnum
57
Attach border of the ligamentum nuchae?
Attach border - attaches to the base of the foramen magnum, to the posterior tubercle of C1, and spinous processes of C2-C7
58
Location of Interspinous ligament:
Between the adjacent spinous processes from C2-S1
59
Ligamentum flavum
Paired set of elastic membranes that attach adjoining lamina between C1-S1
60
Ligamentum flavium is absent between ____ and ____.
Cranium and C1
61
Where the ligamentum flavum is absent, it is replaced by a non-elastic membrane:
Posterior alantooccipital membrane
62
Anterior and posterior alantooccipital membranes:
Tendinous membrane (non-elastic) that encircle the region spanning from the rim of the foramen magnum (occipital bone) and the superior surfaces of the anterior and posterior arches of C1 respectively
63
Location of cruciate ligament:
Beneath the tectorial membrane
64
Function of cruciate ligament:
Holds the alantoaxial joint in place and limits the posterior displacement of the dens process into the spinal canal
65
Location of Alar ligament (paired):
Attaches to the dens process of C2 and inserts roughly 100 degree angle from its partner at the base of the occipital bone
66
Alar ligament function:
Prevents over rotation of the head
67
Location of Iliolumbar ligament:
Arises from the transverse processes of L4-L5 and inserts on the anterior surface of the iliac crest
68
Location of the sacroiliac ligaments:
Provides support for the synovial joint between the sacrum and the ilium from S1-S4
69
Zygapophyseal joint
Synovial joint between the inferior articular process (of the superior vertebrae) and the superior articular process of the neighboring inferior vertebrae
70
Alantooccipital joint (paired)
Synovial joint that encapsulates the occipital condyle and the superior articular process of C1 (atlas)
71
Atlantoaxial joint:
Synovial joint that forms between the dens process of the axis and the anterior arch of the atlas (C1) **strength of the cruciate ligament maintains this joint
BASICALLY GHE JOINT THAT COMMECTS CV 1 TO CV 2
72
Sacoiliac joint:
Synovial joint formed between the articular surface of the sacrum and the articular surface of the ilium
73
The 3 layers of meninges of the spinal cord:
Dura matter, arachnoid matter, and pia matter
74
Dura mater:
Thick, fibrous outer layer of a fluid-filled sac. Also blends with the exiting spinal nerve to form an outer covering - epineurium
75
Dura mater extends from ________ to _______.
Forament magnum; S2 (also continuous with dura matter of cranium)
76
Arachnoid mater:
Non-vascular membrane that is positioned between dura sac and pia matter. The space between the arachnoid layer and pia mater - contains cerebral spinal fluid - subarachnoid space
77
Arachnoid mater extends from _____ to _____.
Foramen magnum; S2
78
Pia mater:
Innermost layer of meninges, attached to the surface of the spinal cord and nerve rootlets
79
Denticulate ligament
One of 2 specialized ligaments from the pia mater which serve to suspend the spinal cord in the vertebral canal - along the lateral margins of the spinal cord (between the ventral and dorsal rootlets of the spinal nerves) - gives off tooth-like projections that anchor into the dura, to position the spinal cord centrally within the dural sac
80
Filum terminale
One of the pia mater specialized ligaments - single midline fiber that has its origin at the terminal end of the spinal cord (L2, Conus medullaris) and attaches to the base of the dural sac (S2)
81
Coccygeal ligament
The filum terminale attaches to the tip of the coccyx - at the point where the filum terminale adds the dural outer layer, it changes its name to this
82
Spinal cord begins at ____ and ends at _____.
Foramen magnum; L1-L2 (terminates as the conus medullaris)
83
Conus medullaris
End of spinal cord at L1-L2
84
There are __ cervical vertebrae and __ cervical spinal nerves.
7;8
85
The cervical nerves of C1-C7 exit _____ to each corresponding vertebrae.
Superior
86
Cervical nerve 8 exits _____ to C7 and _____ to T1.
Inferior; superior
87
Thoracic, lumbar, sacral, and coccygeal nerves exit _____ to their corresponding vertebrae.
Inferior
88
Spinal cord has 2 enlargements to accommodate:
Brachial plexus - cervical enlargement
| Lumbar/Sacral plexus - lumbosacral enlargement
89
Lumbar cistern
At L2 - the spinal cord ends but the dural sac continues down to the level of S2 within the vertebral/sacral canal - lumbar cistern. This contains CSF along with the spinal rootlets of lower lumbar, sacral, and coccygeal nerves (cauda equina) and the filum terminale. Used to obtain CSF via spinal tap
90
Cauda equina
CSF along with the spinal rootlets of lower lumbar, sacral, and coccygeal nerves
91
Cervical region blood supply:
Pair of posterior spinal arteries and one anterior spinal artery - primarily from the vertebral arteries
92
Thoracic region blood supply:
Spinal medullary arteries - coming off of the intercostal arteries that provide blood supply to the ant/post spinal arteries in this region
93
Lumbar/sacral region blood supply:
Great medullary artery (Artery of Adamkiewicz) - enlarged artery that is formed from the left subcostal artery at T12-L1 (major provider of nutrients and oxygen to the lower cord)
94
Vertebral arteries:
Paired, are the first branch off of the subclavian artery (at C7), these arteries ascend thru the transverse cervical foramen in C6-->C1. They pierce the posterior alantooccipital membrane and enter the cranial cavity by passing on the ventral side of the brainstem, then join to form the basilar artery.
95
Suboccipital triangle:
Deepest muscle region in the posterior neck (deep to trapezius, splenius, and semisplinalis capitis). Its boundaries are related to the inferior surface of the occipital bone and the lateral-posterior aspect of C1 (atlas) and C2 (axis)
96
Inferior boundary of suboccipital triangle:
Inferior obliqus capitus muscle
97
Lateral boundary of suboccipital triangle:
Obliqus capitus superior
98
Medial border of suboccipital triangle:
Rectus capitis posterior major muscle
99
Floor of suboccipital triangle:
Alantooccipital membrane
100
Roof of suboccipital triangle:
Semispinalis capitis muscle
101
Rectus capitis posterior minor:
Located outside and medial to the boundary of the triangle - all capitis muscles assist in extending the head at the alantoaxial joint and are innervated by the: suboccipital nerve (Dorsal rami of C1)
102
Origin - obliquus capitis inferior:
Spinous process of C2
103
Insertion - obliquus capitis inferior:
Transverse process of C1
104
Innervation - obliquus capitis inferior:
Suboccipital nerve
105
Origin - obliquus capitis superior:
Transverse process C1
106
Insertion - obliquus capitis superior:
Occipital bone
107
Innervation - obliquus capitis superior:
Suboccipital nerve
108
Origin - rectus capitis posterior major:
Spinous process C2
109
Insertion - rectus capitis posterior major:
Occipital bone
110
Innervation - rectus capitis posterior major:
Suboccipital nerver
111
Origin - rectus capitis posterior minor
Posterior tubercle C1
112
Insertion - rectus capitis posterior minor
Occipital bone
113
Innervation - rectus capitis posterior minor:
Suboccipital nerve
114
Contents of the suboccipital triangle:
```
Vertebral artery (origin: first part of the subclavian artery)
Suboccipital nerve (CN1)
```
115
Vertebral artery:
Originates from the first part of the subclavian artery. Enters the transverse foramen at the level of C6 and ascends through the transverse foramen C6-C1 where it hooks over the superior lamina region of the atlas. The artery courses medially in a groove with the suboccipital nerve on the superior surface of the posterior arch of the atlas, perforates the alantooccipital membrane, then ascends along the lateral ventral surface of the brainstem where it joins its pair ( left/right vertebral art) to become the basilar artery.
116
Greater occipital nerve:
(Dorsal ramus of C2) emerges inferior to the inferior oblique capitis muscle and communicates with a branch from C1 to provide SENSORY to the occipital region of the scalp
117
Occipital artery:
A branch of the external carotid artery and is found lateral to the superior oblique capitis muscle
118
Kyphosis:
Hunchback, results from an increased curvature in the sagital plane of the thoracic vertebrae, usually results from the erosion of the anterior portion of the bodies of the thoracic vertebrae
119
Lordosis:
Swayback, results from the abnormal increase in the lumbar curvature, which causes the pelvic girdle to rotate posterior-inferiorly. This causes the gluteal region to be accentuated posteriorly.
120
Scoliosis:
Lateral curvature of the vertebral column and can occur in cervical, thoracic, or lumbar region. 7x more likely in women and 90% of cases are hereditary
121
Spina bifida:
Non-fusion of the neural arch (lamina) at midline that creates an opening to the vertebral canal
122
Spondylolisthesis:
Dorsal or ventral displacement of the body of one vertebrae with respect to its neighbor - mostly between L5 and S1, where the vertebral arch of L5 (specifically the articular facets) is displaced from the body and fuses with S1. Ant/post longitudinal ligaments stretch and the body of L5 displaces usually ventrally from the body of S1 --> uneven pressure on the intervertebral disk induces disk herniation into the spinal cord --> pinching of nerve rootlets and loss of sensations/pain or motor function in lower limb
123
Herniation of the intervertebral disk:
"Slipped disk" - uneven compression on the anterior half of a disk will cause the gelatinous center (nucleus polposus) to be displaced into the spinal canal causing the disk to herniate --> could impinge on spinal cord or rootlets causing localized pain and possible loss of motor function
124
Disk herniation:
Usually occurs lateral to the posterior longitudinal ligament (since that is at the midline) and will impinge upon the spinal rootlets, rather than the spinal cord - herniated region will impinge on the next exiting spinal nerve compressing it against the lamina prior to its exit. Ex: disk herniation between L4 and L5 will compress the 5th lumbar spinal nerve and will not have any effect on L4, because L4 exits out its intervertebral foramen superior to the horizontal plane of the disk herniation
125
Lumbar cisternal puncture:
Obtain CSF via insertion of a needle into the lumbar cistern between the lamina of L3-L4 or L4-L5 to avoid damaging the spinal cord. Do a midline puncture, whereby the needle is stabilized by the supraspinous and interspinous ligaments (avoids puncturing the ligamentum flavum)
126
Epidural anesthesia:
Injection into the spinal canal, via the opening of the sacral hiatus or posterior approach between the lamina of neighboring vertebrae - drug will diffuse up the exiting spinal nerves (coccyx, sacral, and lower lumbar) without piercing the dural sac
127
How may vertebrae are there? Per region?
```
33 total
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
```
128
What is the function of the vertebral body?
Provides support and weight loads
129
Where are the attachment sites on the vertebrae for the deep muscles of the back?
Transverse and spinous processes
130
Where is there a true synovial joint I the spinal column?
Between the superior and inferior articular facets of two vertebrae
131
What assists in the alignment of neighboring vertebra?
Superior and inferior articular process of the cervical, thoracic, and lumbar vertebrae
132
What passes through the cervical transverse foramen?
C1-6: vertebral artery
| C7: auxillary vertebral vein
133
What is unique about cv 1
No vertebral body, no true spinous process
| DOES HAVE A TRANSVERSE PROCESS (LIKE ALL CV 1-7)
134
What is the dens? Where is it found?
Prominent tooth-like process that extends superiorly from the C2 (axis) vertebral body.
It supports the atlas alignment and is a pivot point for lateral rotation ("no"movement)
135
What allows for lateral rotation of the head ("no" movement)
The dens on the axis (c2)
136
What changes to the vertebrae shape occur for T1-12?
1. Thickening and increase in mass of the vertebral body
| 2. Spinous process changes from long/slender/spikey (t1) to short and hatchet like t12
137
Where are transverse costal facets?
On T1-10
NOT the same as "coastal facet" (which are on all TV1-12)
Located on the lateral surface of transverse processes
138
What is the vertebral body shape in the Lumbar vertebrae?
Kidney shape, thick
139
What is the spinous process shape of Lumbar vertebrae
Thick,hatchet or quadrangle
140
What area on the sacrum is easily palpable
The sacral horns/cornua
141
What is the nucleus pulposus
Gelatinous center of the intervertebral disks that absorbs pressure and acts as a shock absorber /prevents erosion
142
What prevents the intervertebral disks from slipping out of place?
Annular epiphysis
143
What is the annular epiphysis
A smooth rim of bone located on the superior and inferior surfaces of the vertebral body that prevent the intervertebral disk from "slipping"
144
Posterior vs anterior longitudinal ligament
Anterior gets wider as it moves down(bigger/wider vertebral bodies). Posterior gets narrower as it moves down (the vertebral foramen gets smaller as you move down)
Anterior binds anterior to c1 and goes c2-s1. Posterior binds in tectorial membrane and runs c2-s1
145
Tectorial membrane
Connects c2 to the Clivus of occipital bone
146
Supraspinous ligament runs down the _____ so that ____ of the spine is prevented
Runs down the spinous process of c7-s3 to prevent overextension
147
What would happen if cruciate ligament ripped
The atlas would not be stabile to the axis(via dense)!
148
How is blood supplied to the spinal cord?
Regionally (each region is segmentally supplied. Not one artery that supplies all the way down. )
149
Action of rectus capitus posterior major and minor
extending the head at the alantoaxial joint
150
Action of obliqus capitus inferior
extending the head at the alantoaxial joint
151
Action of obliqus capitus superior
extending the head at the alantoaxial joint
152
What nerve is affected if disk between L2 and L3 is herniated
Nerve L2. Not L3. The nerves come inferior to their respective vertebrae after c7.
