Lecture 4: Part 3 (Vertebral Ligaments and Herniation Flashcards
1
Q
Vertebral Ligaments:
- Unite individual _______ into one ________
- Allow for _________ for ________
A
Vertebral Ligaments:
- Unite individual vertebra into one vertebral column
- Allow for flexibility for movement
2
Q
Supraspinous ligament
- Goes from one ______ to ______
- runs from ______ (vertebral level) to ______, connecting to the _______
A
Supraspinous ligament
- Goes from one spinous process to the next
- runs from C7 (vertebral level) to the mid-lumbar spine, connecting to the tips of spinous processes
3
Q
Nuchal Ligament (ligamentum nuchae)
- a continuation of the _______
- runs from _____ to ______
- large, ____ shaped extension of ______ tissue that is very tight with _____
A
Nuchal Ligament (ligamentum nuchae)
- a continuation of the supraspinous ligament
- the supraspinous ligament changes to the nuchal ligament from C7 up to the occipital protruberance
- runs from the external occipital protruberance and atlas to the spinous processes of cervical vertebrae, ending at C7
- large, fan-shaped extension of dense irregular connective tissue that is very tight with collagen
4
Q
Interspinous Ligament
- runs between ______ of adjacent vertebrae
- exists in _____ regions of the spinal column
A
- runs between spinous processes of adjacent vertebrae
- exists in all regions of the spinal column
5
Q
Intertransverse Ligaments
- runs between ______ of adjacent cervical, thoracic, and lumbar vertebra
- made of ______ tissue
A
Intertransverse Ligaments
- runs between transverse processes of adjacent cervical, thoracic, and lumbar vertebra
- made of dense irregular connective tissue
6
Q
ligamentum flavum
- L. flavum means ______
- has a lot of _____
- allows you to (3)
- attaches to _____ of adjacent vertebrae
- forms the _____ wall of the spinal cord
A
ligamentum flavum
- L. flavum means yellow or blonde
- has a lot of elastic fibers
- allows you to:
- bend or move
- maintain changes in gravity
- move your neck
- allows you to:
- attaches to lamina of adjacent vertebrae
- forms the posterior wall of the spinal cord
7
Q
Posterior Longitudinal Ligament
- between _____
- attaches to the posterior surface of _____ and _____, running continuously from ____ vertebral level to the _____
- forms the ______ surface of the spinal cord
- the _______ sits on top of the PLL
A
Posterior Longitudinal Ligament
- between vertebral bodies
- attaches to the posterior surface of vertebral bodies and IV discs, running continuously from C2 vertebral level to the sacrum
- forms the anterior surface of the spinal cord
- the spinal cord (completely wrapped in it’s meninges) sits on top of the PLL
8
Q
Anterior Longitudinal Ligament
- between ______
- attached to anterior surface of ______ and ______
- runs continuously from ______ to ______
- anterior longitudinal ligament is in contact with what surface?
A
Anterior Longitudinal Ligament
- between vertebral bodies
- attached to anterior surface of vertebral bodies and IV discs
- runs continuously from occipital bone to sacrum
- anterior longitudinal ligament is in contact with the body (i.e. in contact with abdominal aorta)
9
Q
why is the red section relevation? what is going on?
A
- in this view, we have cut the pedicles and removed the entire lamina and spinous process - as if you are lying in this space and have lost your ceiling (the vertebral arch)
- we have also cut through several ligaments
- this is important because these ligaments need to be punctured in this way if we want to gain access to the spinal column (like during a lumbar puncture)
10
Q
Label Ligaments 1-7
A
Ligaments of the lower cervical spine
- (a) Lateral view, (b) sagittal section, (c) cranial view*
1) Anterior longitudinal ligament
2) Inter-transversal ligament
3) Joint capsule (of zygopothosial joint)
4) Ligamentum flavum
5) Inter-spinous ligament
6) Supra-spinous ligament
7) Posterior longitudinal ligament
11
Q
Label vertebral ligaments 1-5
A
Spinal ligaments
(1) Anterior longitudinal ligament (ALL)
(2) Posterior longitudinal ligament (PLL)
(3) Ligamentum Flavum
(4) Interspinous ligament
(5) Supraspinous ligament
* (3), (4), and (5) are in continuity in the horizontal plane but they are not in continuity in the vertical plane as (1), (2), and (5)*
12
Q
Lumbar Puncture:
- done from what approach?
- what position is patient in and why?
A
Lumbar Puncture:
-
done from what approach?
- done from posterior approach
-
what position is patient in and why?
- patient is placed back into primary curvature we had as a fetus (kyphosis)
- this is done because we need to stretch the ligamentum flavum to allow a gap to occur so we can access the CSF bathing the cauda equina
13
Q
Lumbar Puncture:
- where do we insert the needle and why?
- what is the surface landmark we use as reference?
A
Lumbar Puncture:
-
where do we insert the needle and why?
- want to insert around L4-L5
- This is below the conus medullaris, where the cauda equina lie
- essentially, we want to insert the needle below the conus medullaris, which is at L1-L2
-
what is the surface landmark we use as reference?
-
posterior superior iliac spine - creates dimples just superior to the pant line
- we want to go above this at L4-L5
-
posterior superior iliac spine - creates dimples just superior to the pant line
*we do not have to worry about sucking up a rootlet from the cauda equina because the vacuum created in a lumbar puncture pushes all those little spinal nerves to the side and allows you to get a clean draw
14
Q
Lumbar puncture:
- what angle do you insert the needle? why?
A
Lumbar puncture:
-
what angle do you insert the needle? why?
- If you go slightly oblique (paramedial): you can ignore the supraspinous ligament and intraspinous ligament and begin your approach by going through the ligamentum flavum → epidural space → dura mater (will feel a pop or release) → subdural space → arachnoid mater → subarachnoid space (CSF)
15
Q
Lumbar puncture
- Involves extraction of ______ from _______
- layers you go through (10)
A
Lumbar puncture
- Involves extraction of CSF from lumbar cistern (subarachnoid space)
- layers you go through (10):
- skin
- superficial fascia
- supraspinous ligament -*can ignore if you go paramedian aproach
- interspinous ligament -*can ignore if you go paramedian approach
- ligamentum flavum
- epidural space
- dura matter
- subdural space - *potential space between dura and arachnoid that is only present if pathology
- arachnoid matter
- subarachnoid space (with CSF)
16
Q
Anulus Fibrosis:
- surround what structure?
- made of what type of tissue?
- organization forms what?
- posteriorly it is ______
- with age becomes _____ and develops _____
- vascular or avascular?
A
Anulus Fibrosis:
- prominant dense irregular connective tissue around intervertebral discs
- fibrocartilage rings (anuli)
- posteriorly it is thinner
- with age becomes thicker and develops fissures
- vascularized
17
Q
Nucleus Pulposus
- aka ______
- _____ : _____ (tissue type)
- made of 70%-90% _____
- how is this content affected by age?
- vascular or avascular?
A
Nucleus Pulposus
- aka “middle of jelly donut”
- mucoid : collagen
- made of 70%-90% water
- water content decreases with increasing age
- avascular
18
Q
Intervertebral Foramen
- lateral space between the _____ of adjacent vertebra, from which ______ emerge
A
Intervertebral Foramen
- lateral space between the pedicles of adjacent vertebra, from which spinal nerves and their vessels emerge
19
Q
Disc Herniation:
- Protrusion of _____ into, or through, ______
- Usually _____ (direction) because of
- Reason #1:
- Reason #2:__
A
Disc Herniation:
- Protrusion of gelatinous nucleus pulposus into, or through, anulus fibrosus
- Usually posterolateral because:
- anulus fibrosis is thinner posteriorly
- annulus fibrosis is not well supported by posterior longitudinal ligament (ALL is much thicker and broader than PLL)
- -does not herniate directly posterior because of PLL*
- -rarely does it herniate anteriorly because of thickness of the annulus fibrosis*
- -can also herniate completely lateral (and can encroach on space of intervertebral foramen)*
20
Q
Spinal Nerves:
- Spinal nerves are named according to the vertebra to which they are related to as they ______ (at the ______ )
- How many cervical spinal nerves and cervical vertebrae are there?
- First 7 cervical spinal nerves exit ______ vertebrae for which they are named
- C8 spinal nerve exits ______, between _____ and _____
- Therefore thoracic spinal nerves & lower exit ______ vertebra for which they are named
A
- Spinal nerves are named according to the vertebra to which they are related to as they exit (at the intervertebral foramen)
- recall that there are 8 cervical spinal nerves but only 7 cervical vertebrae - because C1 comes out above C1’s exit (between the occipit and C1)
- First 7 cervical spinal nerves exit ABOVE vertebrae for which they are named
- C8 spinal nerve exits through intervertebral foramen between C7 and T1
- Therefore thoracic spinal nerves & lower exit BELOW vertebra for which they are named
21
Q
what does the white arrow show?
A
white arrow shows = posterio-lateral disc herniation
22
Q
- Posteriolateral disc herniation will damage what nerve?
- Lateral disc herniation will damage what nerve?
A
- Posteriolateral disc herniation will damage the exiting nerve (larger #) because of it’s direction (can also damage the top nerve, but less likely)
- Ex: L2-L3 posteriorlateral disc herniation will damage L3 nerve
- If purely lateral disc herniation - will most likely damage the one above
23
Q
Disc Herniation in Cervical Region:
- C3-C4 posteriorlateral disc herniation will cause damage to ______
- why? (rule that supports it)
A
Disc Herniation in Cervical Region:
- C3-C4 posteriorlateral disc herniation will cause damage to C4 nerve (larger #)
- answer is the same (greater #) but rule is different; rule because we have 8 cervical nerves and only 7 cervical vertebrae
24
Q
Disc Herniation: Lumbar Region
- L3-L4 posterior lateral disc herniation will cause damage to _____
- why? (rule that supports this)
A
Disc Herniation: Lumbar Region
- L3-L4 posterior lateral disc herniation will cause damage to: L4 nerve (greater #)
- answer is the same (greater #) but reason why is different; reason is because the cauda equina and the fact that we have such a large spanse of bone in the lumbar region
