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Clinical Anatomy Course > 6. Spine > Flashcards

6. Spine Flashcards

1
Q

How many vertebrae are there?

A

33

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2
Q

How many of each type of vertebrae are there?

A
  • Cervical -> 7
  • Thoracic -> 12
  • Lumbar -> 5
  • Sacral -> 5 (fused)
  • Coccygeal -> 4
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3
Q

To what vertebral level does the spinal cord descend?

A
  • L1-L2 in adults
  • L3-L4 in newborns
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4
Q

Label this vertebra.

A
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5
Q

What are the important structures of a typical vertebra?

A
  • Body
  • Pedicle
  • Canal
  • Lamina
  • Transverse and spinous processes
  • Articulation facets
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6
Q

What is a pedicle of a vertebra?

A
  • The two pedicles are the two short columns of bone that connects the lamina to the vertebral body to form the vertebral arch.
  • They form a hollow archway that protects the spinal cord.
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7
Q

What is the body of a vertebra?

A

The thick oval segment of bone forming the front of the vertebra (also called the centrum).

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8
Q

What is a lamina of a vertebra?

A

The lamina is the part of the vertebra that connects the spinous process and the transverse process. There are two laminae, located on either side of the spinous process.

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9
Q

What is the canal of a vertebra?

A

It is the opening through which the spinal cord passes. It is also known as the foramen.

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10
Q

What is the spinous process of a vertebra and what is the function?

A
  • Spinous process is a bony projection off the posterior of each vertebra.
  • The spinous process protrudes where the laminae of the vertebral arch join and provides the point of attachment for muscles and ligaments of the spine.
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11
Q

What are the two types of process on a vertebra?

A
  • Spinous
  • Transverse
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12
Q

What are the transverse processes of vertebra and what is their function?

A
  • Small bony projections off the right and left side of each vertebrae.
  • The two transverse processes of each vertebrae function as the site of attachment for muscles and ligaments of the spine as well as the point of articulation of the ribs (in the thoracic spine).
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13
Q

What are the articulation facets of a vertebra and what is their function?

A
  • Each vertebra has two sets of facet joints.
  • One pair faces upward (superior articular facet) and one downward (inferior articular facet).
  • There is one joint on each side (right and left). Facet joints are hinge–like and link vertebrae together.
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14
Q

What are some forms of abnormal curvature of the spine?

A
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15
Q

Describe the curvature of the different parts of the spine.

A
  • Cervical -> Lordosis
  • Thoracic -> Kyphosis
  • Lumbar -> Lordosis
  • Sacral -> Lordosis
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16
Q

What are some structural specialisations of cervical vertebrae?

A
  • Small bodies
  • Large vertebral foramina
  • Foramina transversaria -> Small foramina in the pedicles that allow passage of an artery and vein
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17
Q

Which cervical vertebrae is most prominent?

A

C7 (vertebra prominens)

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18
Q

What are some structural specialisations of thoracic vertebrae?

A
  • Small vertebral foramen
  • Long spines
  • Costal facets for rib articulation (on transverse processes)
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19
Q

What are some structural specialisations of lumbar vertebrae?

A
  • Large bodies
  • Interlocking facets prevent rotation
  • Stabilisation of L5 on sacrum
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20
Q

What are some structural specialisations of sacral vertebrae?

A
  • Fused
  • Large surface of articulation with the pelvis
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21
Q

What are some structural specialisations of the coccygeal vertebrae?

A
  • Lower 3 are fused
  • Attachements to pelvic bone via sacroiliac (synovial) joint
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22
Q

What type of vertebra is this?

A

Thoracic

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23
Q

What type of vertebra is this?

A

Sacral

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24
Q

What type of vertebra is this?

A

Coccygeal

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25
Q

What type of vertebra is this?

A

Lumbar

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26
Q

What type of vertebra is this?

A

Cervical

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27
Q

Which vertebra is stabilised by the sacrum?

A

L5

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28
Q

What determines the directions of movement that are possible between different vertebrae?

A

The shapes of articulation facets on the superior and inferior side.

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29
Q

Describe the movements that are possible at different regions of the spine. [IMPORTANT]

A
  • Atlanto-occipital -> Flexion/Extension, Lateral flexion
  • Atlanto-axial -> Rotation
  • Cervical -> Flexion/Extension, Lateral flexion
  • Thoracic -> Rotation (and almost no flexion/extension)
  • Lumbar -> Flexion/Extension

Remember this as alternating between flexion/extension and rotation.

30
Q

Draw the structure of the atlas. How is it specialised?

A

You need to know:

  • Anterior arch
  • Posterior arch
31
Q

Draw the structure of the axis. How is it specialised?

A

You need to know:

  • Odontoid process (a.k.a. dens)
  • Transverse ligament -> Retains the dens against the anterior arch of the atlas
32
Q

Which parts of the spine have a lordosis? [IMPORTANT]

A

Lumbar and sacral (these are the only ones mentioned in the spec)

33
Q

What is the name for the C1 and C2 vertebrae?

A
  • C1 -> Atlas
  • C2 -> Axis
34
Q

What does the atlas articulate with superiorly?

A

Occipital condyles

35
Q

What is the name of the process that points vertically upwards from the axis? What is its function?

A

Dens -> Allows rotation of the atlas on top of the axis.

36
Q

What is the most distinct feature of the atlas as a vertebra?

A

It has no spinous process and it has large facets for articulation with the condyles of the occipital bone.

37
Q

What is the joint type of intervertebral discs? Describe the structure.

A

Secondary cartilaginous:

  • Nucleus pulposus -> Gelatinous with high water content
  • Anulus fibrosus -> Fibrocartilage
38
Q

Summarise the different joint types in the spine.

A
  1. Intervertebral joints -> Secondary cartilaginous joints (fibrocartilaginous intervertebral disc) located between vertebral bodies of vertebrae. Designed for weight-bearing, strength and shock absorption. Intervertebral discs consist of a margin of fibrocartilage (annulus fibrosus), surrounding a central gelatinous core (nucleus pulposus).
  2. Zygapophyseal (facet) joints -> Plane synovial joints between the inferior articulating facet of the superior vertebra with the superior articulating facet of the inferior vertebra.
  3. Atlanto-occipital joint -> Condyloid synovial joints between superior articular surfaces of lateral masses of the atlas and the occipital condyles.
  4. Atlanto-axial joints -> Pivot synovial joint between the dens of the axis with the anterior arch of the atlas, and gliding synovial joints between the superior facets of the axis with the inferior facets of the lateral masses of the atlas
39
Q

What ligaments of the spine do you need to know about?

A
  • Ligamentum flavum
  • Anterior longitudinal
  • Posterior longitudinal
  • Transverse ligament
40
Q

Draw the position and function of the posterior longitudinal ligament of the spine.

A

Prevention of hyper-flexion and helps prevent posterior herniation of the nucleus pulposus.

41
Q

Draw the position and function of the anterior longitudinal ligament of the spine.

A

Prevents hyper-extension of vertebral column.

42
Q

Draw the position and function of the supraspinous ligament of the spine.

A
  • Along spinous process tips, C7 to sacrum. Merge superiorly with nuchal ligament in the neck.
  • Prevention of hyper-flexion of vertebral column.
43
Q

Draw the position and function of the ligamentum flavum of the spine.

A
  • Between laminae of adjacent vertebrae
  • Elastic tissue resisting separation of vertebral lamina by limiting abrupt flexion of the vertebral column. Assist with straightening of column after flexing.
44
Q

Draw the position and function of the inter-transverse ligament of the spine.

A
  • Between transverse processes of adjacent vertebrae.
  • Limit lateral flexion of vertebral column.
45
Q

Draw the position and function of the interspinous ligament of the spine.

A
  • Between spinous processes of adjacent vertebrae
  • Limit flexion of vertebral column
46
Q

What ligaments in the atlas and axis do you need to know?

A
  • Transverse ligament of atlas -> Keeps the dens in contact with the atlas.
  • Alar ligaments -> Run from the sides of the foramen magnum of the skull to the dens of the axis.
47
Q

What is whiplash injury?

A
  • Severe hyper-extension of the neck injury that commonly occurs during motor vehicle collisions.
  • In these injuries, the anterior longitudinal ligament is severely stretched and may be torn.
48
Q

What are some muscles that enable movement of the spine?

A
49
Q

What are the two types of back muscles?

A
  • Extrinsic -> Those that controlling upper limb movements and include the rhomboids, levator scapulae, trapezius and latissimus dorsi.
  • Intrinsic muscles -> Innervated by the dorsal (posterior) rami of the spinal nerves and act to maintain posture and control the movements of the vertebral column. These muscles include the splenius muscles, erector spinae muscles (chief extensors) and the transversospinales muscles.
50
Q

What are the main flexors of the vertebral column?

A

Abdominal obliques and rectus abdominis.

51
Q

What are the main lateral flexors of the cervical spine?

A

The scalene muscles (e.g. scalenus anterior) and sternomastoid

52
Q

What is the function of sternomastoid?

[IMPORTANT]

A
  • Unilateral contraction of the sternocleidomastoid muscle laterally flexes the cervical vertebral column to the same side and rotates the head.
  • Bilateral contraction of these muscles causes flexion of the cervical spine.
53
Q

What is torticollis?

A
  • Torticollis, also known as wryneck, is a twisting of the neck that causes the head to rotate and tilt at an odd angle.
  • It can be congenital or spasmodic
54
Q

What is spina bifida?

A

Spina bifida is a neural tube defect resulting from a failure of closure of the posterior vertebral canal at the mid-line. Spina bifida occulta, affecting up to 25% of the population, is most commonly asymptomatic and usually occurs at the level of L5/S1, which may be seen on the surface of the skin as a tuft of hair.

55
Q

What is the name for the lower tip of the spinal cord?

A

Conus medullaris

56
Q

After the spinal cord ends, what do the nerve roots continue as?

A

Cauda equina

57
Q

What layers is the spinal cord surrounded by?

A
  • Meninges:
    • Pia mater
    • Arachnoid mater
    • Dura mater
  • Fat in the extradural space
58
Q

Where is CSF found?

A

Subarachnoid space

59
Q

At what vertebral level does the subarachnoid space end at?

A

S2

60
Q

What anchors the conus medullaris?

A

A fine thread of pia mater, called the filum terminale, anchors the conus medullaris to the coccyx.

61
Q

Do nerve roots exit above or below their corresponding vertebra?

A
  • The spinal nerves exit the cervical spine above their corresponding vertebral level (e.g. C7 nerve root exits above C7 vertebra through the C6-C7 foramen).
  • C8 exits between C7 and T1 vertebrae since there is no C8 vertebra.
  • In the thoracic and lumbar region, the nerve roots exit below their corresponding vertebra.
62
Q

Describe the exit of spinal nerves via intervertebral foramina.

A
  • There is a dorsal and ventral nerve root
  • The dorsal root has a dorsal root ganglion
  • These join to form the spinal nerve root, which exits via the intervertebral foramen
  • This then splits into the dorsal and ventral rami
63
Q

What happens to the angle of spinal nerve roots from C1 to S5?

A
  • The obliquity increases
  • This is due to the spinal nerve roots exiting below the vertebrae below C7 and also due to the lumbar enlargement ending around the L1 level
64
Q

What intervertebral disc prolapse direction is most common?

A

Postero-lateral

65
Q

What is cauda equina syndrome?

A
  • Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.
  • Cauda equina syndrome may be caused by a herniated disk, tumor, infection, fracture, or narrowing of the spinal canal.
66
Q

In spinal and epidural anaesthesia, where is the injection site? Draw a diagram of this.

A
  • Spinal -> In the L2-L5 region, Lumbar CSF which bathes the cauda equina
  • Epidural -> In the lumbar epidural space (but can also be in the thoracic and sacral areas)
67
Q

Describe anterior cord syndrome.

A

An incomplete cord syndrome that predominantly affects the anterior 2/3 of the spinal cord, characteristically resulting in motor paralysis below the level of the lesion as well as the loss of pain and temperature at and below the level of the lesion.

Features: Complete motor deficit

68
Q

Describe posterior cord syndrome.

A

A rare type of incomplete spinal cord injury that affects the dorsal or posterior columns of the spinal cord, which are responsible for the perception of vibration, fine-touch and body positioning (i.e. proprioception).

Features: Sensory loss

69
Q

Describe central cord syndrome.

A

The most common form of incomplete spinal cord injury characterized by impairment in the arms and hands and to a lesser extent in the legs. The brain’s ability to send and receive signals to and from parts of the body below the site of injury is reduced but not entirely blocked.

70
Q

Where is lumbar puncture performed?

A

Lumbar punctures are usually performed between L3/L4 or L4/L5 interspinous levels in order to avoid the termination of the spinal cord and risk nerve injury.

71
Q

What makes C7 an atypical cervical vertebra?

A

It does not have pronounced tubercles (anterior or posterior).

72
Q

What sort of injury is a hangman’s injury?

A

Hyperextension

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