Sievert: Back, Vertebral Column, and Spinal Cord Flashcards
1
Q
T/F: Fractures may cause compression of nerve roots or spinal cord.
A
True
2
Q
Spondylolisthesis can cause these things.
A
damage to the cord, roots, or exiting spinal nerves.
3
Q
This can put pressure on exiting nerve roots.
A
Herniating discs
4
Q
T/F: osteophytes may impinge on the exiting spinal nerve.
A
True
5
Q
Components of the axial skeleton - is the pelvis included?
A
Skull Vertebral column Ribs Sternum No pelvis!
6
Q
How many cervical vertebrae are there? Thoracic? Lumbar? Sacral? Coccygeal?
A
7; 12; 5; 5; 4
7
Q
How many vertebrae are there?
A
33, but it can vary from 32-34
8
Q
Which sections of the vertebral column contains primary curvatures? Secondary curvatures?
A
thoracic and sacral; cervical and lumbar
9
Q
What is C1 called? What is C2 called?
A
atlas; axis
10
Q
T/F: abnormal curves may be exaggerated normal curves or simply curves that don’t belong.
A
True
11
Q
Three components of the vertebral foramen of the spinal cord.
A
body, pedicle, and lamina
12
Q
What are the three processes that protrude from the vertebra?
A
transverse processes
spinous process
articular processes (superior and inferior)
13
Q
What two components make up the intervertebral foramen?
A
inferior and superior vertebral notches.
*note: the inferior vertebral notch forms most of the foramen and is actually up top!
14
Q
These structures are found on the lateral surface of each superior articular facet for muscle attachment
A
mammillary processes
15
Q
What are two specific features of the sacrum?
A
anterior and posterior foramina
sacral hiatus
16
Q
What two spinal nerves exit out of the sacral hiatus?
A
S5 and the spinal nerve of the coccyx
17
Q
How can you distinguish a cervical vertebra?
A
spinous process is bifid
transverse foramen for the passage of the vertebral artery as it courses toward the brain
18
Q
What way are the articular facets pointing in a cervical vertebra?
A
inferior and superior
19
Q
How can you distinguish a thoracic vertebra?
A
larger vertebral body
has articular facets for the ribs
has spinous process that points inferiorly
20
Q
How can you distinguish a lumbar vertebra?
A
largest body
massive neural arch
large squarish spinous process
articular facets are facing medially and laterally
21
Q
Which vertebral region has the most “degrees of freedom?” Which has the least?
A
cervical has the most; lumbar has the least
22
Q
This vertebral body has an anterior and a posterior arch to hold the dens in place, a transverse foramen, and a superior and inferior articular fovea
A
atlas C1
23
Q
This vertebral body has a dens
A
axis C2
24
Q
Which vertebral body does the head “spin” on? Which does it “rock” on?
A
spins on the atlas; rocks on the axis
25
Along which axis does flexion/extension occur?
transverse axis
26
Along which axis does lateral bending occur?
anteroposterior
27
Along which axis does rotation occur?
vertical
28
What four factors can allow or restrict movement of the trunk?
1. the thickness of the intervertebral discs
2. the orientation of the articular facets
3. the attachment of ribs
4. the size, elasticity and orientation of the muscles of the back, and abdominal wall
29
Which region of the vertebral column is the most mobile?
cervical region
30
Which region of the vertebral column is least mobile? Why?
thoracic region; ribs and thin discs
31
Which region of the vertebral column allows for considerable flexion and extension?
lumbar
32
Stress fracture of pars interarticularis
spondylolysis
33
Where is the pars interarticularis located?
in between the superior and inferior articular facets
34
What is a characteristic sign of spondylolysis (fracture of pars interarticularis) on an xray?
Scotty dog sign in posterolateral oblique view -- a "collar" on the neck
35
Fracture of pars interarticularis, portion forming dog’s neck where collar belongs
Scotty dog
36
Repeated stress to the spine can cause this
spondylolysis
37
What can bilateral spondylolysis cause?
spondylolithesis
38
What is spondylolithesis?
"slipping" of one vertebra relative to the others
39
List the three vertebral ligaments
anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
40
What does the anterior longitudinal ligament do? Where is it located?
limits extension; anterior half of the vertebral body
41
What does the posterior longitudinal ligament do? Where is it located?
limits flexion; posterior side of vertebra, beneath the lamina
42
What does the ligamentum flavum do? Is it continuous between each vertebra?
limits flexion; no, does not run the whole length of the vertebral column
43
If a herniated disc came out of place, which direction would it move in?
postero-lateral
44
Two other important ligaments of the spinal column
interspinous ligament
| supraspinous ligament
45
What ligament attaches the dens of the atlas to the occipital bone? What do these ligaments do?
alar ligaments on either side; limit rotation
46
This feature of the atlanto-occipital joint adds strength
capsule
47
How many components does the cruciate ligament have? What are they?
3 components; strong transverse component and two weaker superior and inferior parts
48
What covers all three portions of the cruciate ligament posteriorly?
tectorial membrane (a continuation of the posterior longitudinal ligament)
49
Two important components of the intervertebral discs
annulus fibrosis
| nucleus pulposis
50
peripheral ring of fibrocartilage around each intervertebral disc
annulus fibrosis
51
Is the annulus fibrosis thinner anteriorly or posteriorly?
posteriorly
52
gelatinous core of the intervertebral disc
nucleus pulposis
| *think pulp = juicy
53
In what direction do herniated discs usually occur?
posterolateral
54
In what region are herniated discs most common?
L5-S1 and second L4-5 levels
55
When a disc herniates, which nerve roots are affected?
the herniated disc will push on the nerve root of the level below
ex: L4 herniated disc will compress L5 nerve root
56
What is different between the way spinal nerves exit in the cervical region vs the lumbar, thoracic and sacral levels?
Spinal nerves in the cervical region exit ABOVE the vertebra with the same number, while spinal nerves in the lumbar, thoracic and sacral levels exit BELOW the vertebra with the same number
57
Herniating discs most frequently impinge the root (blank) the herniating level
BELOW
58
Spinal nerves in the cervical region exit (blank) the vertebra with the same number. Spinal nerves in the thoracic, lumbar and sacral levels exit (blank) the vertebra with the same number.
ABOVE; BELOW
59
How can exiting nerve fibers avoid the herniation?
rather large opening created by the inferior intervertebral notch
60
Spinal meninges: list the layers from the spinal cord out
```
spinal cord
pia mater
subarachnoid space
arachnoid
subdural space (potential space)
dura mater
epidural space (fatty)
vertebra
```
61
What's contained in the subarachnoid space?
CSF
62
What does the pia mater form in order to stabilize the spinal cord within the column?
denticulate ligaments
63
Portions of the pia mater that poke out and project through the arachnoid to attach to the dura.
denticulate ligaments
64
Is the "H shaped" center of the spinal cord gray or white matter? What's unique about the white matter?
gray matter; there are ascending and descending fibers in the white matter. Some go up, some go down. If you cut these fibers, you will lose signal from the brain to everything below the cut. If you cut a tract that is going up to the brain (ex: L4), you will deprive that person of all sensory information below the site of the cut
65
What kind of neurons leave via the lateral horn?
autonomic preganglionic neurons (T1-L2: sympathetic, sacral S2-4: parasympathetic)
66
If someone sustains a spinal cord injury, they can experience a level loss or a segmental loss. What's the difference?
Ex of level loss: if you cut L1, everything motor and sensory will be lost below the cut. Generally have to cut white matter.
If you damage the gray matter (like a tumor growing in there), this would cause a segmental loss. Segmental loss is like loss in sensation in a particular dermitome.
Level loss: generally have to "cut" white matter.
Segmental loss: have to "cut" the gray matter.
67
Put these in order: dura mater, pia mater, arachnoid
pia mater closest to spinal cord, then arachnoid, then dura mater
68
In which regions of the spinal column are there enlargements? Why?
cervical and lumbosacral regions, because C5-8 and T1 must give rise to ALL neurons of the upper limbs and carry lots of fine motor information. This is different from regions of the spinal cord that innervate large motor units, like the glutes.
69
At what vertebral level does the spinal cord end?
L2
70
The inferior, tapered end of the spinal cord
conus medullaris
71
How many cervical nerves are there? Thoracic? Lumbar? Sacral? Coccygeal?
8 pairs, 12 pairs, 5 pairs, 5 pairs, 1 pair
72
As you move down the spinal cord towards the cauda equina each successive nerve root must get (blank) to reach its appropriate intervertebral foramen
longer and longer
73
Where does the dural sac end? What significance does this have for injecting anesthesia?
ends at S2 vertebral level; can inject anesthesia outside of the dural sac to bathe the most caudal spinal nerves --> epidural block
74
Because the spinal cord ends at vertebral level L2, the dorsal and ventral roots for more caudal spinal nerves must descend within the vertebral canal before exiting through the correct intervertebral foramina. What are these nerve roots collectively called?
the cauda equina
75
What is the middle nerve at the caudal end referred to as?
filum terminale
76
T/F: cauda equina is important for lumbar puncture and epidural anesthesia
True
77
What is the first "thing" that gets pushed on if a disc is herniated? What can this cause?
ventral/motor nerve roots; this can lead to motor weakness or paralysis in the body part innervated by that nerve
78
What dermatome is along the side of the foot? The butt hole? The umbilicus? The nipple? Back of head?
S1; S3-S5; T10; T4; C2
79
The posterior intercostal arteries give rise to these branches
anterior medullary artery and posterior radicular artery
80
The posterior radicular artery communicates with what artery? The anterior medullary artery communicates with what artery?
posterior spinal artery; anterior spinal artery
81
This artery arises low in the brainstem and does not have enough blood flow to support the nervous system all the way down, so it gets tributaries from radicular branches
anterior spinal artery
82
Anterior spinal artery doesn't get enough flow to supply the entire length of the cord. Where does it get segmental contributions from to boost flow?
anterior segmental medullary arteries
83
Blockage of the anterior spinal artery can cause anterior spinal artery syndrome. What region is the origin of the most important medullary artery (Adamkiewicz) due to prevalence of aortic aneurysm in the area?
T8-L2
84
Does anterior spinal artery syndrome cause complete level loss for all different types of sensations?
No; it spares some types of sensations -- level losses are not complete
85
The internal vertebral venous plexus communicates with both the venous sinuses of the brain and a venous plexus associated with the pelvis (prostatic venous plexus). Why is this important?
It is possible for cancer of the prostate to metastasize to the CNS
86
Loss of sensation or muscle strength in a specific location that correlates with either a dermatome or a myotome
segmental loss
87
Loss of sensation or muscle strength that starts at the toes and ascends to a particular level
level loss
88
First notable spinous process on the posterior surface of the back? What other processes are notable?
C7 spinous process; T1, T2, supraspinous ligament, and T4
89
At what vertebral level are the iliac crests found?
L4/5
90
At what vertebral level are the dimples of the back?
spine of S2
91
List some extrinsic back muscles
```
Levator scapulae
Trapezius
Rhomboids
Latissimus dorsi
Serratus posterior superior and inferior
```
92
These two muscles are accessory respiratory muscles
serratus posterior superior and inferior
93
3 layers of intrinsic back muscles
spinotransverse (superficial)
erector spinae (intermediate)
transversospinae (deep)
94
Erector spinae muscles are (blank) oriented. There are 3 groups. (blank) – most medial, go from spine to spine. (blank) – more lateral, goes from spine to limbs. (blank) –most lateral, out to ribs from iliac crest. What do these do in terms of movement?
vertically; spinalis; longissimus; ileocostalis; Involved in bilateral movement and in flexion
95
This muscle attaches the spinous processes to the skull or to the transverse processes of cervical vertebrae
splenius muscle
96
Two components of the splenius muscle
```
splenius capitis (head)
splenius cervicis (neck)
```
97
Three erector spinae muscles. Which is most medial? Which is most lateral?
spinalis (medial)
longissimus
iliocostalis (lateral)
98
What innervates the erector spinae muscles?
dorsal rami
99
These muscles are oriented vertically along either side of the vertebral column and are powerful extenders
erector spinae
100
These muscles are oriented from inferior transverse to superior spine; divided into four muscles
transversospinae muscles
101
How many vertebrae do the long rotators span? How many do the short rotators span? How many do the semispinalis span? How about the multifidus?
2; 1; 6-8; 3-5
102
What do the transversospinae muscles do? What's an exception to this?
involved in rotation; the semispinalis capitis extends the head because of its attachment to skull instead of spinous process
103
What three muscles of the back of the head make up the suboccipital triangle?
rectus capitis minor/major (medial), superior oblique (lateral), and inferior oblique
104
C1 spine to occipital bone
| C2 spine to occipital bone
rectus capitis minor
| rectus capitis major
105
C1 transverse to occipital bone
| C2 spine to C1 transverse
superior oblique
| inferior oblique
106
This nerve is sensory to the back of the head, from the dorsal ramus of C2, nice landmark for inferior oblique muscle
greater occipital nerve
107
T/F: Anterior spinal artery syndrome is characterized by loss of motor function below the level of injury, loss of sensations carried by the anterior columns of the spinal cord (pain and temperature), and preservation of sensations carried by the posterior columns (fine touch and proprioception).
True
