Neuro 1.2

Question 1

What are the spinal meninges?

Answer 1

Three layers than surround the spinal cord

Question 2

What do the meninges form distally?

Answer 2

form a strand of fibrous tissue, the filum terminale

Question 3

What does the filum terminale do?

Answer 3

• attaches to the vertebral bodies of the coccyx

- acts as an anchor for the spinal cord and meninges

Question 4

Where does the spinal dura mater extend?

Answer 4

1. from the foramen magnum to the filum terminal

2. separated from the walls of the vertebral canal by the epidural space

Question 5

What does the epidural space contain?

Answer 5

1. some loose connective tissue

2. the internal vertebral venous plexus

Question 6

How is the epineurium formed?

Answer 6

1. As the spinal nerves exit the vertebral canal
2. they pierce the dura mater
3. temporarily passing in the epidural space
4. In doing so, the dura mater surrounds the nerve root
5. and fuses with the outer connective tissue covering of the nerve, the epineurium

Question 7

What does the subarachnoid space have in it?

Answer 7

CSF

Question 8

What happens to the subarachnoid space distal to the conus medullaris?

Answer 8

subarachnoid space expands, forming the lumbar cistern

Question 9

What is the lumbar cistern used for?

Answer 9

• accessed during a lumbar puncture (to obtain CSF fluid)

- spinal anaesthesia

Question 10

What does the spinal pia mater fuse with inferiorly?

Answer 10

filum terminale

Question 11

What does the pia mater do between the nerve roots?

Answer 11

pia mater thickens to form the denticulate ligaments

Question 12

What do the denticulate ligaments do?

Answer 12

attach to the dura mater – suspending the spinal cord in the vertebral canal

Question 13

When would you use spinal anaesthetic?

Answer 13

in order to carry out procedures such as caesarean section or hip replacement in the elderly so any patients in which general anaesthetics are maybe contra indicated for safety reasons

Question 14

Where would the lumbar spinal puncture be for spinal anaesthesia?

Answer 14

sub-archanoid space

Question 15

Where would the lumbar injection be for epidural anaesthesia?

Answer 15

epidural space

Question 16

What is in the lumbar cistern?

Answer 16

• CSF

- Nerve roots of cauda equina

Question 17

When is epidural given?

Answer 17

childbirth (normal childbirth)

Question 18

When is spinal anaesthetic given?

Answer 18

might be given for delivery of a baby via caesarian section

Question 19

Why is there ready access to the sacral region?

Answer 19

no spinous process

Question 20

What is the theca sac?

Answer 20

dural sac that surrounds spinal cord and cauda equina (contains CSF)

Question 21

What happens if you insert a needle below S2?

Answer 21

1. Ready access to the epidural space
2. Nerves in this region that are on their way to emerge between vertebrae so infiltration of this lower caudal region of the verbal column epidural space is often used to provide pain relief for severe back pain and sciatica pain
3. Caudal epidural or sacral epidural injection as opposed to a lumbar epidural injection which is into the same space but at a different vertebral level

Question 22

What is spondylosis?

Answer 22

degeneration

Question 23

What is spondylolysis?

Answer 23

stress fracture of pars interarticularis

Question 24

What is spondylolisthesis?

Answer 24

forward displacement of vertebra

Question 25

What is spondylitis?

Answer 25

inflammation of vertebrae

Question 26

What are examples of some spinal pathology?

Answer 26

1. Fractures of vertebral column
2. Prolapsed intervertebral disc - sciatica
3. Spondylosis
4. Spondylolysis
5. Spondylolisthesis
6. Spondylitis
7. Spinal cord injury

Question 27

What happens in spondylolysis?

Answer 27

1. Fracture of pars interarticularis which is part of the vertebral column between the articular facet
2. Breaking of the part of vertebal column between the superior articular facet the inferior articular facet
3. can result in slippage of the vertebrae with respect to either the sacrum below or just between adjacent vertebrae

Question 28

What is prolapsed intervertebral disc?

Answer 28

Contents of the disc being able to be spilled out of the protective fibrous outer layer

Question 29

When do you have more severe symptoms with a prolapsed intervertebral disc?

Answer 29

• So the extent to which this internal substance impinges on the nerves in the space here with determine the extent of the symptoms of the person that has the slipped disc
• The more nerves that are impinged upon by this disc the greater the symptoms or the greater the amount of body that would be affected by the injury, so the more nerves will give a greater area of symptoms

Question 30

What are factors affecting the severity of the spinal lesion?

Answer 30

1. Loss of neural tissue
2. Vertical level
3. Transverse plane

Question 31

How is the loss of neural tissue affect a spinal lesion?

Answer 31

•Usually small if due to trauma but can be more extensive (e.g. metastases, degenerative disease)

Question 32

How does vertical level affect a spinal lesion?

Answer 32

•Higher the lesion, greater the disability

Question 33

What else determines the severity of symptoms/disability?

Answer 33

not just the level, but also how many tracts are involved in the lesion or how many tracts affected by the lesions are involved will determine the resulting symptoms/disability (brown sequard)

Question 34

What are the most common causes of spinal cord injury?

Answer 34

broken neck or back as a result of road traffic accidents, accidents during sports or recreation or falls (in older people)