Module 1 Flashcards by Christine Le

Ankylosing spondylitis

“not moving well” - “inflammation of the vertebra”

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Primary vs. secondary curvature

Fetus: primary curvature - khyphosis
to minimize volume; maintained throughout
developemnt

Newborn: C-spine lordosis
develops due elevation of head/neck once
child is mobile

Child: L-spine appears once they are walkers
and are upright

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Segmental arteries:

C-spine
T-spine
L-spine
S-spine

cerebral arteries

POSTERIOR intercostal arteries; subcostal arteries for T12

lumbar arteries

lateral sacral arteries

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Go to Image 01 - identify

“Segmental artery”

Equatorial branches

Anterior & Posterior canal branch of ______ artery

Spinal canal branch of _______artery

check slide 12 - L02

eq. branches - for ant/lat v-body

anterior vertebral canal branch - goes to anterior side
of the spinal canal

posterior canal branch - goes post. side of canal

posterior branch of the ____ artery - toward TVP and SP

spinal branch of the ____ artery - goes around pedicles

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Go to Image 02 - identify

intervertebral vein

basivertebral vein

anterior/posterior longitudinal sinuses (veins) of internal vertebral (epidural) plexus

anterior external vertebral venous plexus

check slide 12 - L02

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Clinical Applications

Schmorl’s node(s)
Pediculectomy vs. laminectomy
Spinal stenosis

S-node: degeneration of the v-body (typically in L spine), causing the nucleus pulposus to break out of the v-disc and into the superior vertebra

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Go to Image 03 - C1 - Atlas - identify:

anterior &amp; posterior arch
lateral masses
anterior tubercle
facet for dens
transverse ligament
vertebral foramen
posterior tubercle
groove for vertebral artery

what are some distinctive features of C1?

4 structures that pass in the groove?

widest C-vertebra
posterior tubercle instead of SP
facet for the dens
articular facets are very horizontal
vertebral artery & vein, periarterial sympathetic nerve plexus, suboccipital nerve

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Go to Image 04 - C2 - Axis - identify:

SAP/IAP facets/processes
foramen of the TVP
posterior articular facet for transverse
dens

Distinguishing features.

-strongest bifid

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Go to Image 05 - identify:

occipital condyles
mastoid process
superior nuchal line
external occiptal protuberance 
foramen magnum
interior nuchal line

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Distinctive features of C7

UNIFID

- vertebral prominens

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Typical vs. Atypical vertebra ranges

C-spine
T-spine
L-spine

Typical: C3-C6; T2-T8; L1-L4
Atypical: C1, C2 ,C7; T1, (T9), T10, T11, T12; L5

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Jefferson’s fx of atlas

Hangman’s fx of axis

Downs Syndrome & c-adjustments - why not?

burst/compression fx

pedicle/lamina fx (common in MVA)

laxity of supporting ligaments around atlas/axis

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Distinctive features of T1 & T12

T11

vertigial uncus of T1
superior notch = deeper than lower Ts

T12

narrow body
no or vestigial TP
no costal facet!
mamillary process

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Clinical applications

Scheurmann’s Disease

Kummel’s fx

severe kyphosis + distinctive slants on anterior v-body - allows for hyper-FL

osteonecrosis post trauma (delayed) - fx in the v-body

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Vertebral sternal bones (true)

Vertebral chondral bones (false)

Floating/free ribs

Typical Ribs - ranges?

Atypical Ribs?

R1-R7

R8-R10

R11-R12

R3-R9 (R10)

R1, R2, R11, R12

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Image 10 - Fill in the diagram of the first rib

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Movements of the thoracic wall

hint: handle movements

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upper 6 - pump handle

lower 6 - bucket handle

Funnel vs. pigeon chest

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pectus excavates

pectus carinatum

11 - label typical lumbar spine

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L4/L5 - Herniation of IVD

What nerve levels would be affected?

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Pars interarticularis

Spondylosis

Spondylolisthesis

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Spondylosis can affect the spine’s intervertebral discs (eg, degenerative disc disease) and facet joints. As people grow older, normal age-related cellular changes, coupled with the effects of daily wear and tear can cause or contribute to discs losing normal shape, size, and height.

Spondylolisthesis is a condition in which one bone in your back (vertebra) slides forward over the bone below it. It most often occurs in the lower spine. In some cases, this may lead to your spinal cord or nerve roots being squeezed. This can cause back pain and numbness or weakness in one or both legs. In rare cases, it can also lead to losing control over your bladder or bowels.

Label the following Images:

12-16

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Why posterior ligaments of the SI joint stronger than the front?

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tendency for the pelvis to rotation forward (nutation)

nutation - Relative movement btw sacrum & ilium by
which the base of sacrum rotates anteriorly
(pic), or ilium rotates posteriorly (Stedman’s
medical Dictionary), or both

counter-nutation - Relative movement btw sacrum & ilium by
which the base of sacrum rotates posteriorly
(pic), or ilium rotates anteriorly, or both

3 germ layers:

CNS, PNS, epidermis, sensory epithelia

muscle, bone, CT, blood and blood vessels, urogenital system

gut tube and its glands

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ectoderm (dorsal)

mesoderm (middle)

endoderm (ventral)

# Define: neuromere (spinal cord segment) somite sclerotome myotome dermatome

SPINAL CORD SEGMENT (or NEUROMERE): elevation in the wall of neural tube where a pair of dorsal and ventral nerve roots attach SOMITE: one of the paired cell masses formed in the paraxial mesoderm next to the neural tube SCLEROTOME: mesenchymal cells of a somite to form the centrum of vertebra by intersomatically merging MYOTOME: mesenchymal cells of a somite to form a group of muscles innervated by 1 spinal nerve DERMATOME: mesenchymal cells of a somite to form a band of skin/dermis innervated by 1 spinal nerve

Spinal nerves? How many pairs? ``` C T L S C ```

``` C8 T12 L5 S5 C01 ```

Label image 17

Axons bundles + cell bodies of the dorsal root ganglion for the _____ root originates from the postero-lateral sulcus function:

- axon bundles with cell bodies in the dorsal root ganglion (DRG); - attachment to the postero-lateral sulcus of spinal cord through a series of small rootlets that diverge from the dorsal root - function: SENSORY (AFFERENT)

Axons bundles + cell bodies of the anterior of grey matter of spinal cord originates from the antero-lateral sulcus function:

- axon bundles with cell bodies in the anterior horn of grey matter of spinal cord - arises from many small rootlets attached to the antero-lateral sulcus of spinal cord that converge into the ventral root - function: MOTOR (EFFERENT)

dorsal + ventral roots within or proximal to IVF mixed - sensory + motor this called?

spinal nerve proper or trunk of spinal nerve

PPR - sensory, motor, or both? o Medial PPR C2-T6 o Lateral PPR C2-T6 o Medial PPR T7-S3: o Lateral PPR T7-S3:

``` o Medial PPR C2-T6 supplies skin and intrinsic muscles of the back o Lateral PPR C2-T6 supplies intrinsic muscles of the back o Medial PPR T7-S3: intrinsic muscles of the back o Lateral PPR T7-S3: skin and intrinsic muscles of the back ```

APR - sensory, motor, or both? Major body regions? o APRs C1-C4 form o APRs C5-T1 form o APRs T1 to T11 form o APR T12 o APRs L1-L4 o APRs L4-S4 o APRs S4-Co1

skin and muscles in the neck, antero-lateral trunk, upper and lower limbs ``` o APRs C1-C4 form Cervical plexus o APRs C5-T1 form Brachial plexus o APRs T1 to T11 form 1 st to 11 th Intercostal nn. o APR T12 becomes Subcostal n. o APRs L1-L4 form Lumbar plexus o APRs L4-S4 form Sacral plexus o APRs S4-Co1 form Coccygeal plexus ```

White ramus communicans (WRC) why white? between which levels? sympathetic or parasympathetic? where do the axon bundles originate? then heads where? WRC branches off the APR or PPR? How is the WRC related to paravertebral sympathetic (S) ganglion?

(C8) T1-L2 (L3) myelin + PREGANGLIONIC/SYNPATIC sympathetic - temperature - vascular dilation/constriction spinal sympathetic center; travels with the ventral root of the spinal nerve and spinal nerve APR fibers ascends, descends in the S chain, some pass through to become splanchnic nerve

Gray ramus communicans (GRC) what levels can they be seen? where do the axon bundles originate? then heads where? Travels with APRs and PPRs to innervate what?

all levels axon bundles originate from the neurons of the paravertebral sympathetic ganglion post synaptic sympathetic nerve - rejoins the spinal nerve and its branches skin gands, blood vessels

Sinuvertebral nerve or recurrent meningeal nerve Sensory or motor? where does it run?

sensory

What is protected by pia mater (and at risk of avulsion)? ``` rootlets lateral parts of roots medial parts of roots spinal cord spinal nerves ```

rootlets and medial parts of roots

What is protected by pia mater and dural sleeve? ``` rootlets lateral parts of roots medial parts of roots spinal cord spinal nerves ```

lateral part of roots and the spinal nerve

What marks the transition between dura mater and epineurium? nerve bundles within the APR and PPR are separated by what? each fiber within the bundle is separated by what?

IVF and spinal nerve perineurium endoneurium

Segmental arteries for each region: Cervical (3) Thoracic (2) Lumbar (1) Sacral (2)

CERVICAL: • vertebral a. (from subclavian a.)!!! • ascending cervical (from thyrocervical trunk (from subclavian a.)) • deep cervical a. (from costocervical trunk (from subclavian a.)) THORACIC • posterior intercostal aa. (PIA) (T1 and T2 PIA s originate from superior thoracic artery (from axillary artery); T3 to T11 PIAs from Thoracic Aorta); • subcostal a. originates from Thoracic Aorta LUMBAR • Lumbar aa. (L1 to L4 arteries originate from Abdominal Aorta); L5 artery, from iliolumbar trunk (from posterior division of Internal Iliac a.)) SACRAL • lateral sacral a. (from posterior division of Internal Iliac a.); • median sacral a. (from Abdominal Aorta at its bifurcation)

Blood supply for spinal nerve Segmental artery --> spinal branch through the IVF --> anterior, posterior, and ________...vertebral ______ artery What artery supplies the ventral root of the spinal nerve? What artery supplies the dorsal root of the spinal nerve? What is the Adamkiewicz artery?

neural; canal ant. radicular artery post. radicular artery (note: radicular = root)

Cutaneous innervation of the back T or F: dermatome C2-C3 cover the upper neck Greater Occipital nerve - PPR of C_ Least Occipital nerve - PPR of C_ Superior cluneal nerves - PPR of L_, L_, L_ Middle cluneal nerves - PPR of S_, S_, S_

F - posterior scalp C2 C3 L1 L2 L3 S1 S2 S3

Module 1 Flashcards

(41 cards)