week 1 Back pain/vertebral column Flashcards
what does your back include?
Skin Subcutaneous tissue Vertebral column Spinal cord and meninges Ribs Nerves and vessels Muscles
how many cervical verterbral column are there?
7
how many thoracic verterbral column are there?
12
how many lumbar verterbal column are there?
5
how many sacral verterbral column are there?
5
how many coccygeal verterbral column are there?
depends on who you ask. From 1 too 4 does not really matter
how much of the verteral column does the intervertebral disc acount for?
1/4 of the length
why do you get smaller as you get older?
the intervertebral disc dehydrate and shrink–> so get smaller
when you tilt your head forward what vertebra can be palpated?
C7
where are the vertebral notches positioned?
superior and inferior to the pedicles on the vertebra
what forms the intervertebral foramen?
the inferior vertebral notch of the superior vertebra and the superior vertebral notch of the inferior vertebra plus the intervertebral disc
what passes through the interverebral foramen?
spinal nerves
what are the general key structures of the vertebra?
Vertebral foramen Processes Articular facets Vertebral arch Body
how does the body of the cervical vertebra vary?
it is smaller and has a uncus
what is the position of the uncus in cervical vertebra and what do they do?
positioned laterally and hold together adjacent bodies
how does the body of vertebra change as you go down the vertebra column?
it gets bigger/thicker
what part of the neck does the scalene muscles attach to and what is there action?
it attatched to the transverse proces and pedicles of cervical vertebrae. Allows fine movements of the neck
how does the spinous process of cervical vertebrae vary?
it is BIFID –> split
what is the directions of the articular facets of the cervical vertebrae
superior directed superoposteriorly
- inferior directed infero-anteriorly
what passes through the transverse foramina of the cervical vertebrae?
Passage of vertebral artery and vein to/from the brain
however do not pass through C7
which cervical verbrae does vertebral artery and vein not pass through?
C7 because it has a small or absent transverse foramina
why is cervical vertebrae prone to dislocation?
Relatively flat articular facets –> not the best fit
why might a sublaxation of the cervical vertebrae not compress the spinal nerves?
The transverse foramen is relatively wide
which two cervical vertebrae are atypical and what are there names?
C1–> Atlas
C2–> Axis
what is different about C1 atlas
1) The atlas has no spinous process or body
2) Consists of anterior and posterior arches (each of which has a tubercle and a lateral mass.
3) There is a tubercle each on the medial surface of the lateral mass for the transverse ligament, which holds in place the dens of the axis.
what does Atlas articulate with?
the base of the skull and sits on Axis –> C2
what are the key features of C2 –> Axis
C2 has two large flat surfaces, the superior articular facets, upon which the atlas rotates.
It’s distinguishing feature is the dens (G. tooth), also known as the odontoid process
how is the Dens of C2 held in place and why?
This held in position by the transverse ligament of the atlas - prevents horizontal displacement of the atlas
what movements does the Dens allow?
The dens acts as a pivot that allows the atlas and
attached head to rotate from side to side
why is the dens prone to fracture?
it is less dense so therefore more prone to fracture
what causes the fracture of dens?
hyperextension or hyper flexion
what is the shape of the body of thoracic vertebrae?
heart shaped with superior and inferior costal demi-facets for articulation with head of rib
what are the features of the spinous and transverse process of the thoracic vertebrae?
Spinous process - Long and extends postero-inferiorly
Transverse process – costal facet for articulation with tubercle of rib
what direction does the articulate facet face of the thoracic vertebrae?
superior faces posteriorly,
inferior faces anterior
what articualation occurs in Costovertebral joints?
Head of rib articulates with the superior demifacet of the corresponding (same number) vertebra and the inferior demifacet of the vertebra above
what are the varations of the lumbar vertebrae?
Spinous process short and sturdy
Vertebral body - large
Articular facets –> Inferior face laterally + Superior face medially
what are vertebrae held together by?
zygapophysial joints, intervertebral discs and ligaments
how are zygapophysial joints formed?
Zygapophysial joints occur between superior and inferior articular processes of adjacent vertebrae
what does the orientation of articulate facets determine?
determines the types of movements that are possible
what is the Intervertebral discs made up of?
Annulus fibrosis
Nucleus pulposus
what is Annulus fibrosis ?
fibrocartilage ring attached to epiphysial rim of vertebral body
what is Nucleus pulposu?
gelatinous substance that acts as a shock absorber
what determines the intervertebral discs flexibility?
thickness
What does Ligamentum flavum do?
Binds lamina of adjacent vertebrae
what does the Posterior longitudinal ligament do? Give the origion and insertion?
C2 to sacrum
Prevents posterior herniation of IV discs
what does Anterior longitudinal ligament do? Also what is its origion and insertion?
Occipital bone and C1 to sacrum
Only ligament to resist hyperextension of vertebral column, all the others resist hyperflexion
what is the action of ligaments to the vertebral column?
make the vertebral column more stable
what is whip lash and how is commonly caused?
Hyperextension of cervical neck
Commonly caused by rear-end car crashes, especially if head rest too low
which ligament is torn in whip lash
anterior longituidinal ligament
what occurs in severe cases of whip lash?
part of vertebral body is avulsed and vertebrae dislocate – compression of spinal cord
how does the movement of the vertebral column vary?
Movements vary in different regions depending on orientation of zygapophysial joints and thickness of intervertebral discs
what part of the vertebral column is lordosis?
cervical and lumbar
what part of the vertebral column is kyphosis?
sacral and thoracic
who is most likely to have Osteoporosis
menopusal females
why is it more likely for menopusal females to get Osteoporosis?
the decrease in estrogen causes a reduction in trabeculae and cause compression
what occurs in Osteoporosis?
loss of trabeculae and this causes comperession of the column
What is the effects of ageing on the vertebral column?
Loss of bone density with age leads to concave vertebral bodies
This puts increased force on rims of vertebrae and osteophytes develop in response
what is another name for slipped disc?
herniation of nucleus pulposus
where does slipped disk commonly happen?
Normally happens in posterolateral direction between L4/L5 or L5/S1
what is the symptoms of slipped disk?
Can compress spinal nerve roots – lower back pain or sciatica
In severe cases, compresses most of cauda equina – cauda equina syndrome
Which of the vertebrae sections is the smallest?What is there distinctive feature?
Cervical vertebrae is the smallest.
Distinctive feature is the transverse foramen
Which of the cervical vertebrae has a smaller or absent transverse foramen?
C7
What are the features of the spinous process of C3-C6?
Short and Bifid
Wht are the features of the spinous process of C7?
It is very long and is used as a bony landmark to count vertebra –> Vertebra prominens
Where are intervertebral diss found and what are there function?
Intervertebral discs between all non-fused vertebrae provide flexibility to the spine and act as shock absorbers
What do the intervertebral discsin the vertebral column do?
Intervertebral discs between all non-fused vertebrae provide flexibility to the spine and act as shock absorbers
What do the ligaments in the vertebral column do?
The ligaments bing vertebrae together
What are the primary content of the vertebral canal?
Spinal cord, spinal nerve roots and there meningeal covering
At which verebral level does the spinal cord end in adults ?
L1/2
At which verebral level does the spinal cord end in children?
L2/3
At which verebral level does the spinal cord end in adults ?
CSF
What does the epidural contain?
Fat
Venous plexus
loose connective tissue
What do you administrate in the epidural space?
Administer anaesthetics for an epidural nerve block
What is the venous drainage of the spinal cord?
Veins that drain the spinal cord form a number of longitudinal channels
These longitudinal channels drain into an extensive internal vertebral plexus in the extradural
(epidural) space of the vertebral canal, which then drains into segmentally arranged vessels that
connect with major systemic veins, such as the azygos system in the thorax.
What are the different longitudinal channels in the spinal cord?
two pairs of veins on each side bracket the connections of the posterior and anterior roots to
the cord;
one midline channel parallels the anterior median fissure;
one midline channel passes along the posterior median sulcus.
What is the venous arrangement at each vertebral level
There are connections at each level with thoracic, abdominal and intercostal veins and the external vertebral venus plexus.
Describe the structure of the spinal veins?
They have no valves and blood passess directly into the systemic venous system
What is the theory of how prostatic neoplastic cells metastasize to the CNS?
It can occur by the continuity of the vertebral venous plexuses with the prostatic plexus –> possible cause
What is cauda equine?
Collection of nerve rootlets
How many cervical nerves are there ?
8
What two groups are the muscles of the back divided into?
Superfecia (extrinsic) group and deep (intrinsic) group
What muscles are in the superficial group of the extrinsic muscles?
Rhomboid major and minor
Levator scapulae
Trapezius
Latissimus dorsi
What muscles are in the intermediate group extrinsic muscles?
Serratus posterior superior
Serratus posterior inferior
What two groups is the extrinsic muscles divided into?
Superficial and intermediate group
What innervates extrinsic muscles of the back?
Ventral rami of spinal nerve and accessory nerve
What are the actions of the extrinsic back muscles?
Act as weak accessory muscles for respiration
What innervates the deep intrinsic back muscles?
Posterior rami of spinal nerve
What 3 groups is the intrinsic back muscles divided into?
Superficial
Intermediate
Deep
What muscels are invovled in the superfecial group of the intrinsic back muscles?
Splenic muscles of the posterolateral surfaces of the neck.
Subdivided into splenius capitus and cervicis
What muscles is in the intermediate group of the intrinsic back muscle??
The large erector spinae muscles that lie on each side of the vertebral column.
It is the chief extensor of the vertebral column and consists of 3 muscles:
Spinalis
Longissimus
iliocostalis
What is the deep group of the intrinsic muscles? What are there attachments?
Transversospinalis group
Deep to erector spinae –> smaller muscles that originate from the TP of the vertebrae and insert onto the SP of more superior vertebrae
What muscels does the Transversospinalis group consist of?
Semispinalis
Multifiidis
Rotares
How is the spinal nerve formed?
Dorsal and ventral rootlets combine to form the spinal ganglion –> spinal nerve
What are the features of the lateral mass on the C1 (atlas)?
The lateral mass contains tubercle for the attachment for the transverse ligament.
Also contains transverse foramina, transverse process and a superior and inferior articular surface
what are the two facets of the den of the Axis? What do they articulate with?
Anterior articulate facet for anterior arch of the Atlas
Posterior articulate facet for transverse ligament of the Axis.
What are the 2 types of fracture of the Axis?
Fracture of the Dens
Fracture of the body of Axis as well as the Dens
How is fracture of the Axis treated?
Do surgery where you do atlantoaxial arthrodesis using bone graft from iliac crest
What are all the ligaments that prevent hyperflexion of the vertebral column?
Posterior longituidinal ligament Ligament flavum Superaspinous ligament Intertransverse ligament Interspinous ligament
What ligament prevents hyperextension of the vertebral column?
Anterior longituidinal ligamnet
Give examples of abnormal curvature of the spine?
Excessive lordosis
Excessive Kyphosis
Scoliosis
What is scoliosis?
It is lateral curvature of the spine
What happens with ageing of the intervertebral disc?
Hernation of the nucleus polposus
What is sciatica?
It is any pain or irritation caused by compression of the sciatic nerve
What are the symptoms of the sciatic nerve?
It is pain, tinglingness and numbness that radiates from your lower back down one of the leg to the toes and foot.
What structures run trough the transverse foramina of the cervical vertebrae?
The vertebral artery and vein
Plexus of sympathetic nerves
What is the distinctive feature of the cervical vertebrae?
Transverse foramina
Describe the spinous process of C7?
Long -> verebra prominens and used as a bony landmakr to count vertebra
What verterbral body does the iliolumbar ligament attach to?
It attaches to the transverse process of the fifth lumbar vertebrae. Much larger than the others and attaches it to the pelvic bone
What is the attachments of anterior longitudinal ligament and its action?
Attach to the base of the skull (occipital bone) to the anterior surface of sacrum. Along it length it is attached to the vertebral bodies and intervertebral discs.–> anterior surface of the vertebral body
Prevents hyperextension of the vertebral column
What is the attachments of posterior longitudinal ligament and its action?
From C2 to the posterior surface of sacrum–> on the posterior surface of the vertebral body but anterior surface of the vertbebral canal.
Prevent hernation of the IV discs into the spinal cord
What is the attachments of ligament flavum and its action?
It is on either side and attaches the lamina of adjacent vertebrae.
It resists seperation of the lamina in flexion and assists with extension back into the anatomical position.
What is the attachments of ligament nuchae and its action?
It is a triangular structure in the medial sagittal plane
Base is the skull attached to the external occipital protrubence too the foramen magnum
Apex is the spinous process of cervical vertebrae 7
Deep side of the triangle is the posterior tubercle of C1 and the spinous process of the rest of the cervical vertebraes
Action: Support the head, resist flexion and return the head back to its anatomical position
What is the attachments of infraspinatous ligament and its action?
It runs between the spinous process of adjacent vertebrae. They attach between the base and apex of adajcent vertebrae, blending with the supraspinatous ligament posteriorly and the ligament flavum anteriorly.
Prevent hyperflexion
What is the continuation of the ligament nuchae?
Supraspinatous ligament
What is the consequence on the lower spinal nerves that the vertebral column is longer than the spinal cord?
The lower spinal nerves are longer as they pass through the conus medullaris and into the respective intervebral foramina
Within the grey matter there is the dorsal, lateral and ventral horns. What do each of them contain?
The ventral horn contains motor nuerones
The dorsal horn cotains sensory neurones
The lateral horn contains preganglionic sympathetic neurones
In the spinal canal what is found in the subarachanoid space?
CSF and trubeculae
What is the epidural space?
Space between the dura and the vertebrae
What is the arterial supply to the vertebrae?
The vertebrae recieves arterial supply from 3 small longitudinal arteries; one anterior and 2 posterior spinal arteries
What is the origion of the anterior and posterior spinal arteries?
Originate from the vertebral arteries
ASA –> run into the anterior median fissue
PSA –> anastomose with one another in the pia matter
What supports the Anterior and posterior spinal arterie?
They are reinforced by radicular branches of the intercostal and lumbar arteries.
They enter the vertebral column via the intervertebral foramina
What supplies the extrinsic muscles of the back? They act as week accessory muscles for what?
Ventral rami of spinal nerves and accessory nerve
They act as weak accessory muscles for respiration
