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0
Q

1st part of the vertebral artery

A

goes from subclavian to in front of C7 TP

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1
Q

vertebral artery

A

longest branch of subclavian, has segmental cords, divides into 4 parts, does not pass through C7
supplies: vertebral bodies, posterior arch, and deep spinal muscles

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2
Q

2nd part of vertebral artery

A

C6-C, ascends through all the transverse foramen starting at C6 (NOT C7) with a slight lateral jog between C2 and C1

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3
Q

3rd part of vertebral

A

from C1 - foramen magnum, travels MEDIAL and POSTERIOR to lateral masses

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4
Q

4th part of vertebral artery

A

foramen magnum - basilar artery, rests on posterior clivus

left and right vertebral arteries merge

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5
Q

what is the nerve root at C4/5 IVF, L4/5, and disk herniation at L4/5 disk

A

5, 4, 5

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6
Q

what are the arteries of the cord

A

anterior spinal
posterior spinal
redicular

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7
Q

anterior spinal artery

A

comes from 2 medial branches of vertebral and forms 1 artery
supplies anterior 2/3 of cord, narrows at conus medllaris (inferior boarder of L1

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8
Q

posterior spinal arteries

A

there are 2, each is a branch of vertebral artery, supplies posterior 1/3 of cord, most of the blood flowing from here to spine flows through redicular arteries, ends at conus medullaris

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9
Q

redicular arteries

A

reinforcing network of arteries, enter through IVFs or sacrum foramina, develop from: vertebral, deep cervical (ascending), posterior intercostals, lumbar and lateral sacral arteries

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10
Q

Adamkiewicz artery

A

arises from left posterior intercostals, enters between T9 and L3

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11
Q

watershed area

A

loss of one artery can lead to a widespread deficit in the thoracic spine

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12
Q

redicular arteries supply

A

meninges
vertebrae
spinal cord

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13
Q

denticulate ligaments

A

between arachnoid and dura, tooth like, create “floor” for spinal nerve, function: hold spinal nerve in central position

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14
Q

Batson’s venous plexus and valsalva maneuver

A

no valves in the veins of spinal column, separate from the veins of thoracic and abdominal region, valsalva maneuver causes an increase in abdominal pressure, the plexus can lead to active neoplasms

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15
Q

anterior external venous plexus

A

collects blood from vertebral body

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16
Q

internal venous plexus

A

has 4 main channels, 2 anterior - anterior and posterior to PLL, and 2 posterior - one to left and one to right to ligamentum flavum, anastomose with posterior external venous plexus

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17
Q

basiverterbral veins

A

largest network of veins in body, Hahn’s venous clefts - shadows that are nothing serious

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18
Q

intervertebral veins

A

pass through IVFs, drains spinal cord, internal venous plexus and external venous plexus

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19
Q

what are the 3 parts of a disk

A

anulus fibrosus, nucleuss pulposis, and end plate

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20
Q

pressure on the disk leads to increased pressure within the ______ ______ which then leads to pressure being exerted radially into the ______ ______ which is then exerted onto the ______ , the pressure from here is then transferred to the __________

A

nucleus polposis , anulus fibrosus, nucleus, endplates

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21
Q

forces on the disks are balanced by what 2 things

A

anulus fibrosis and nucleus

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22
Q

force is transmitted how

A

though endplates at adjacent levels

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23
Q

disk hydration

A

need H2O to maintain disk hydration but protyoglycans can help with disk hydration as well

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24
proteoglycan
large protein molecule, attach to and surrounds collagen fibrils which ensures hydration of ground substance
25
what happens if disks dry up
desiccate - occurs naturally starting around age 30
26
disk bulge
involves more than 1/4 of disk
27
protrusion
type of herniation, base is wider than outward extent, <25% of disk is involved (so it is not a bulge)
28
extrusion
outward extension is greater than base, <25% of disk involved, but nucelus polposis extends through torn anulus fibers
29
sequestered disk fragment
nucleus polposis seperates from parent disk, may extend up or down central canal
30
annular fissure
tear circumferentially along anulus fibrosis
31
why do disk herniations hurt
chemical irritation by inflammation mediators
32
ligaments contain ________ which may inhibit or stimulate muscle contractions
proprioceptors
33
yellow fibers result in
ligaments with more stretch and flexibility
34
function of spinal ligaments
smooth motion and protect cord
35
3 ligaments the run the length of the spine
anterior longitudinal ligament posterior longitudinal ligament ligamentum flava
36
anterior longitudinal ligament (ALL)
VB of C2 -> sacrum connects at mid-portion of VB thickest fibers in the middle
37
3 layers of ALL
superficial: 3-4 vertebral segments intermediate: 2-3 segments deep: 2 segments
38
DISH is related to
ALL and diabetes
39
ALL helps prevent
extensive extension of the spine
40
Posterior longitudinal ligament (PLL)
extends from posterior body of C2 -> sacrum, inside the spinal canal, attaches to IVD and margins of VB, denticulate in lower thoracic and upper lumbar
41
2 layers of PLL
superficial: bridge 3-4 segments deep: reinforce the disk, contains greatest innervation of nociceptors of all spinal ligaments
42
what motion does PLL inhibit
flexion of spine
43
central canal dimension reduction is due to
PLL ossification
44
ligamentum flavum
C2-> sacrum, connects lamina on posterior aspect of central canal, increases in thickness from cervicals to sacrum, very elastic
45
what does the ligamentum flavum prevent
excessive flexion
46
supraspinous ligament
C7-> sacrum, expands into nuchal ligament, limits flexion and extension
47
3 layers of supraspinous ligament
superficial: 3-4 segments middle: 2-3 segments deep: 2 segments
48
interspinous ligament
root os SP to apex, C1-sacrum, limits flexion
49
intertransverse ligament
C1-> L5, round in thoracic, thin membranous in lumbar, thin/ tenuous in cervical, limits lateral flexion and rotation
50
articular capsules
C1/2-> L5/S1, attaches just outside of the margins of facet joints, thin and loose in Cervical, taut in T and L, has 2 capsules (outer(ligamentus) and inner( yellow lig.))
51
upper cervical ligaments
tectorial membrane, transverse ligament of atlas, alar ligaments, apical ligament of dens, posterior atlanto-occipital ligament, posterior atlanto- axial ligament, lateral atlanto-occipital ligament, anterior atlanto-occipital ligament, nuchal ligament
52
tectorial membrane
inside spinal canal occiput -> C2, blends with PLL, protects cord from compression
53
transverse ligament
aka cruciate ligament, has 3 parts transverse band, superior band, and inferior band, results in ADI movement if ruptured,
54
alar ligament
"check" ligament, left and right pairs, strong rounded cord, from upper/ later dens to medial aspect of foramen magnum, prevent excess rotation
55
apical ligament
apex of dens to anterior foramen magnum, stabilizes the dens
56
posterior atlanto-occipital ligament
upper boarder of posterior arch of C1 to posterior foramen magnum, forms am arch for vertebral artery, vein and C1 spinal nerve, can show up as posterior ponticle on xrays
57
posterior atlanto-axial ligament
from posterior arch of C1 to lamina of C2, flexion
58
lateral atlanto-occipital ligament
jugular process to C1 TP
59
anterior atlanto-occipital ligament
anterior foramen magnum to upper boarder of anterior arch of C1
60
anterior atlanto-axial ligament
aka epistrophic ligament | anterior arch of atlas to anterior body of axis
61
nuchal ligament
EOP, C1 posterior tubercle, and C2-C7 SP, limits flexion of spine
62
posterior sacralcoccygeal ligament
superficial: continuation of supraspinous ligament, protects S5 and coccygeal nerves deep: continuation of PLL, from posterior body of S5 to posterior surface of coccyx
63
illiolumbar ligament
L5 TPs to iliac crest upper band:attaches to posterior portion of iliac crest lower band: attaches to anterior lateral portion of sacral ala calcification leads to DISH
64
interosseous sacroiliac ligament
strongest, connect sacral and iliac tuberosities
65
posterior sacroiliac ligament
short: horizontal fibers, connects S1-2 tubercles and iliac tuberosity to PSIS long: verticle fibers, connects S3-4 tubercles and PSIS and sacrotuberous ligament
66
articular ligament
margins of auricular surface of sacrum and ilium, holds them together
67
anterior sacroiliac ligament
thickening of anterior and inferior portion of SI joint capsule
68
inguinal ligament
connects ASIS to pubic tubercle, protects soft tissues under it
69
sacrotuberous ligament
connects inferolateral sacrum, ischial tuberosity and blend with long posterior sacroiliac ligament
70
sacrospinous ligament
triangular shape, connects lateral portion of sacrum and coccyx to ischial spine, helps limit movement between sacrum and ilium and ischium
71
greater sciatic foramen
contains piriformis and sciatic nerve
72
lesser sciatic foramen
anterior boarder: body of ischium superior boarder: sacrospinous ligament and ischial spine posterior boarder :sacrotuberous ligament obturator internus and obturator nerve
73
anterior sacralcocccygeal ligament
resembles anterior longitudinal ligament
74
lateral sacrococcygeal ligament
lateral/ inferior sacrum with TP of coccyx, forms foramen for S5 nerve root
75
intercornual ligament
between sacral cornu and coccygeal cornu on same side
76
pubic ligaments
superior: across top of pubic symphysis | inferior :across bottom of pubic symphysis (aka arcuate ligament)
77
mamillo-accessory ligament
from mamillary process to accessory process, creates foramen for medial branch of posterior ramus, main site for nerve blocks
78
spinal stenosis
thickening of ligamentum flavum, age related

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