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Spine Flashcards

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1
Q

What is the structure of the cervical vertebra?

A

Body - has the joints of lushka, uncinate process posteriorly

2 pedicles
- superior articular process
- inferior articular process
- intervertebral foramen

2 transverse processes
- transverse foramen; from C6 - C1 will contain vertebral artery

Anterior tubercle
Posterior tubercle

2 lamina

bifid spinous process

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2
Q

What are the three joints in the C spine?

A

Zygopophyseal facet joint
- synovial joint; therefore has capsule
- in between the superior and inferior articular processes of adjacent vertebra

Intervertebral disc
- fibrocartilaginous joint
- Annulus fibrosis, nucleus pulposus

Uncovertebral joint
- in cervical vertebra
- between lushka’s joint in one vertebra + inferior surface of vertebrae above (uncinate processes + vertebral body)

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3
Q

What do the joints of the cervical vertebrae permit movement wise?

A

flexion and rotation of head

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4
Q

What are the ligaments involved with the cervical vertebra?

A

Anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
ligamentum nuchae

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5
Q

What is the artery associated with the cervical vertebra?

A

vertebral artery

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6
Q

What are the nerves associated with the cervical spine?

A

Spinal cord (runs in the vertebral foramen)
Intervertebral Foramina - spinal nerves, dorsal root ganglion

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7
Q

What are the key relations of the cervical vertebra?

A

At C6, the vertebral artery enters the transverse foramen

Cervical vertebra are unique in that they have uncovertebral joints

Anterior - anterior longitudinal ligament, longus capitus, pharyngeal constrictors

Posterior - ligamentum nuchae, suboccipital muscles

Lateral - anterior sclene, middle scalene, posterior scalene, brachial plexus

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8
Q

What are the anatomical variants associated with the vertebra - cervical and thoracic?

A

Hemi vertebra (lack of formation of vertebra so get a wedge shaped vertebra)
Block vertebra (2 vertebra fused together)
Butterfly vertebra (failure of fusion of two halves of vertebral body)
Posterior element fusion
Arcuate foramen (caused by calcification of atlantooccipital ligaments)

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9
Q

What are the transitional vertebra?

A

At the atlantooccipital joint - base of skull to C1 (atlantooccipital assimilation) so C1 and occiput is fused

at cervicothoracic junction - cervical rib

at thoracolumbar junction - lumbar rib

lumbosacral junction - lumborilsation of S1, sacralisation of L5

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10
Q

What are the variants within the ossicles?

A

Os odontium - the atlas (C2), has the dens (odontoid process) which can apppear as an ossicle.

Peristent ossiculum terminale - tiny ossicle above the top of the dens

Anterior arch of accessory ossicle

Oppenhemiers ossicle - lumbar spine ossicle with facet joints

Sesamoid ossicles of the nuchal ligament

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11
Q

What is the osteology / structure of a thoracic vertebra?

A

Superior demifacet
Inferior demifacet

Transverse process from the body of vertebra
-> articulates with the rib at the costotransverse joint

Pedicle
- superior articular process
- inferior articular process
- intervertebral foramen

Lamina
- with pedicle and lamina, it encloses the vertebral column

Spinous process

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12
Q

What are the joints involved with the thoracic vertebrae?

A

Intervertebral disc
- fibrocartilaginous joint
between adjacent vertebral bodies is the nucleus pulposis + annulus fibrosis

Zygopophyseal joint
- synovial joint
- between superior and inferior articular processes of vertebral bodies

Costovertebral joint
- this is where the rib head articulates with vertebral body facets
- synovial joint, radiate ligament between demifacets and rib head

Costotransverse joint
- where rib tubercle articulates with transverse process
synovial, costotransverse ligament (superior and lateral)

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13
Q

What are the ligaments involved with the thoracic vertebra?

A

Radiate ligament
costotransverse ligament

anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
interspinous ligament
supraspinous ligament

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14
Q

What are the various rib anomalies?

A

Bifid/forked, hypoplasia, cervical rib, lumbar rib, only 11 ribs

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15
Q

What is the gross anatomy of the lumbar vertebra?

A

Body - has 2 transverse processes

2 pedicles -
- superior articular process
- inferior articular process

Intervertebral foramen; transmit spinal nerve, DRG medial

Lamina and pedicles make vertebral column
- spinal cord + cauda equina

Spinous process

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16
Q

What are the joints involved with the lumbar vertebrae?

A

Intervertebral Disc
- fibrocartilaginous joint
- between adjacent vertebral bodies
- nucleus pulposus + annulus fibrosis

zygophyphophyseal joint
- synovial joint
- between superior and inferior processes of adjacent vertebra

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17
Q

What are the ligaments of the lumbar vertebra?

A

anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
interspinous ligament
supraspinous ligament

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18
Q

What are the muscles involved with the lumbar vertebra?

A

Psoas
Quadratus lumborum
erector spinae

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19
Q

What are the nerves involved with the lumbar vertebrae?

A

vertebral column
- contains spinal cord until T12 / L1, then it is the conus medullaris, cauda equina
- intervertebral foramen - transmits the relevant spinal nerve

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20
Q

What are the relations of the lumbar vertebra?

A

Laterally - psoas, quadratus lumborum
L5 is the largest lumbar vertebra

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21
Q

What is the gross anatomy of the sacrum?

A

Wedge shaped bone at the bottom of the spine
Made of 5 fused vertebra

Articulates laterally with iliac bones, inferiorly coccyx, superiorly lumbar

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22
Q

What are the different parts of the sacrum?

A

Base - superior articular facet only

Body -
2 sacral ala (wings) - for iliac bones

central canal - transmits sacral N, coccygeal roots, filum terminale

foramina for transmission for spinal nerves -
4 anterior - pelvis
4 posterior - dorsal

median sacral crest - posterior

apex - articulates with coccyx

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23
Q

What are the joints involved with the sacral vertebrae?

A

intervertebral disc
- fibrocartilaginous joint
- between L5 and sacrum base
- annulus fibrosis + nucleus pulposus

zygophophyseal joint
- between the superior and inferior articular facets of vertebrae above and below

sacroiliac joint
- synovial joint
- sacroiliac joint

sacrococcygeal joint
- sacral apex to coccyx

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24
Q

What are the ligaments involved with the sacrum?

A

Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Sacroiliac ligament
Sacrococcygel ligament
Sacrotuberous ligament
Sacrospinous ligament
Iliolumbar ligament

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25
What muscle is involved with the sacrum?
piriformis
26
What are the nerves involved with the sacrum?
Sacral and coccygeal nerve roots, travelling through central canal, so S1 - S5 are key Filum terminale
27
What are the relations to the sacrum?
anterior - median sacral artery lateral sacral artery median sacral vein sacral plexus rectum S3 - S5
28
What are the anatomical variants of the sacral vertebra?
Sacralisation of L5 Lumbarisation of L1
29
Where does the iliolumbar ligament run from?
Tip of the iliac crest to the transverse process of L5 Quadratus lumborum arises from it
30
What is the L4-L5 vertebral disc?
Structure which sits between the L4-L5 vertebral bodies Functions as a shock absorber
31
What is the gross anatomy of the L4-L5 intervertebral disc?
Contains a nucleus pulposus peripheral annulus fibrosis attached anteriorly to the anterior longitudinal ligament attached posterior to the posterior longitudinal ligament Is one of the joints of the vertebrae
32
What are the relations of the L4-L5 intervertebral disc?
bifurcation of the common iliac artery (L4 - L5) (anterolateral) anterior longitudinal ligament (anterior) ureter (anterolateral) posterior posterior longitudinal ligament cauda equina vertebrae lateral transverse processes iliopsoas
33
What is the arterial and venous supply of the intervertebral disc?
Is avascular. Does not have a vascular supply - recieves nutrition from diffusion from the intervertebral endplates
34
What is the nerve supply of the intervertebral discs?
peripheral annulus fibrosus is innervated by branches of dorsal root ganglia
35
What are the muscles / ligaments / fascia involved with the intervertebral discs at L4 - L5?
anterior longitudinal ligament posterior longitudinal ligament
36
What is the gross anatomy of the atlas?
C1 No body anterior ARCH - has an anterior tubercle for attachment of the anterior longitudinal ligament - facet on the inner surface for dens articulation Posterior ARCH - for ligamentum nuchae Transverse process - contains vertebral artery - is a horizontal running foramen Superior articular process - for occipital condyle Inferior articular process - for axis Joints - for atlanto occipital, atlantoaxial
37
What is the atlantooccipital joint?
synovial joint between the superior articular facet of the atlas, and the occipital condyle of skull vertebral A runs posterior to atlanto occipital joint (V3 segment)
38
What is the atlantoaxial joint?
the joint between C1 (atlas) and the C2 vertebra (axis) has 2 components dens of axis / anterior neural arch (synovial) and the facet joint. (synovial)
39
What are the ligaments involved in the atlantoaxial joint?
Cruciform ligament (transverse and longitudinal ligament) Alar ligament Apical ligament Tectorial membrane Accessory atlantoaxial ligament Also the anterior longitudinal ligament posterior longitudinal ligament ligamentum flavum
40
What are the anatomical variants associated with the atlantoaxial joint?
accessory ossicle of anterior arch of atlas anterior arch non union - looks like a jefferson fracture posterior arch non union
41
Describe the gross anatomy of the axis
It is an atypical cervical vertebra It has a body Dens - facet anteriorly: for articulation with anterior arch atlas facet posteriorly - for articulation with cruciform ligament transverse process - for vertebral artery V2 segment Lateral masses - superior articular process - inferior articular process pedicle lamina spinous process
42
What is the joint between the axis and c3?
synovial joint superior articular facet of axis, and inferior facet of atlas
43
What is the artery associated with the atlantoocipital joint?
V2 runs through transverse foramen
44
What is the nerve supply of the atlantooccipital joint?
Vertebral foramen - contains spinal cord intervertebral foramen - contains spinal nerves and dorsal root ganglia medially
45
What are the bones involved in the atlanto occipital joint?
Atlas Occipital condyles of the skull Axis (via dens) - via cruciform ligament, alar ligaments, apical ligaments IT IS A SYNOVIAL JOINT has hyaline cartilage, synovial membrane, fibrous capsule
46
What movement does the atlanto occipital joint allow?
Forward flexion and extension
47
What are the muscles involved with the atlanto occipital joint?
rectus capiitis posterior minor superior obliqus capitis inferior obliqus capitis rectus capitis splenius capitis
48
What are the key relations of the atlanto occipital joint?
Superior: foramen magnum, brainstem Inferior: axis Medial: spinal cord Lateral: vertebral arteries (V3 segement, leaving foramina to puncture dura to enter foramen magnum) Anterior: oropharynx, longus colli / capiitis Posterior: ligamentum nuchae
49
What are the joints involved in the lumbosacral articulations?
Intervertebral disc - between L5 and sacrum superiorly Secondary cartilaginous joint - ALL, PLL, ligamentum flavum, intervertebral disc
50
Where is the zygopophyseal joint in the lumbosacral articulation?
Between L5 inferior articular process and S1 superior aritcular process Synovial - hyaline cartilage, synovial membrane, capsule
51
Describe the sacroiliac joint in the lumbosacral articulation?
Between the sacrum + ilium Synovial - joint capsule (as synovial joint) iliolumbar ligament sacroiliac ligaments sacrotuberous ligament
52
Describe the sacrococcygeal joint in the lumbosacral articulation?
Between sacral apex and base of coccyx Secondary cartilaginous - anterior sacrococcygeal ligament (extension of ALL) - posterior sacrococcygeal ligament (extension of PLL) - sacrotuberous - sacrospinous
53
What is the function of the spinal cord?
Carries important nerve ascending and descending tracts Involved in spinal reflex arcs
54
What is the gross anatomy of the spinal cord?
Is a thick mass of grey + white matter tracts - grey matter central, white matter peripheral - surrounded by spinal meninges - thecal sac
55
What do the spinal meninges consist of?
Dura, pia, arachnoid mater (spinal meninges blend with epineurium of spinal nerves) there are two enlargements - cervical bulge: for brachial plexus / cervical plexus - lumbar bulge: for lumbosacral plexus Central canal - filled with CSF - continuous with brain ventricular system
56
What are the contents of the spinal cord?
afferent tracts - sensory: spinothalamic, posterior column, medial leminiscal efferent tracts - corticospinal intervneurons are involved in spinal arcs
57
What is the course of the spinal cord?
origin: it is continuous superiorly with the medulla runs in the vertebral column and will be divided by vertebral levels Termination conus medullaris - in neonate L3 - in child L2/3 - in adult L1/2 each segment has a spinal nerve; which exits out of the intervertebral foramen
58
What is the arterial supply of the spinal cord?
Anterior spinal artery (comes off the intradural part of the vertebral A) Posterior spinal artery (comes off PICA or VA) Arterial vasocorona (anastomoses between the anterior spinal + posterior spinal A) Radicular arteries Artery of adamkiewicz
59
What is the artery of adamkiewicz?
dominant radicular artery provides blood supply to anterior spinal artery below T8 usually from the left comes off at the level of 9th + 12th intercostal A
60
What is the venous drainage of the spinal cord?
Mimics the arterial supply - anterior spinal vein - posterior spinal vein - anterior and posterior radicular veins - internal vertebral venous plexus (anterior / posterior)
61
What is the nerve supply of the spinal cord?
Spinal nerves + cauda equina
62
What are the muscles/ligaments /fascia involved with the spinal cord?
filum terminale
63
What are the variants associated with the spinal cord?
Tethered cord conus medullaris conjoined nerve roots ventricularis terminalis
64
What are the two main pathways for sensory information to the cortex?
2 most important ascending pathways use a 3 neuron system to convey information from sensory receptors to the cortex. Dorsal column - medial leminiscal fine touch, proprioception, vibration, pressure (decussates at level of brain stem) Anterolateral - spinothalamic pain, tempreature, crude touch and some proprioception (decussates at spinal cord level)
65
What is the important descending pathway in the spinal cord?
It is the corticospinal Only uses 2 neurons (an upper motor neuron) which is entirely in the CNS and a lower motor neuron which leaves at the segment of the spinal nerve Corticospinal decussates at the brainstem like the dorsal column medial leminisical pathway
66
What is the course of neurons in the dorsal column - medial leminiscus tract?
1st order neuron ascends in the dorsal column, the decussates in the medulla, continues upwards towards the thalamus in the medial leminiscus Will also use corona radiata + go to post central gyrus
67
What is the course of the spinothalamic - anterolateral tracts?
spinothalamic / anterolateral tracts enter, synapse and then decussate immediately and then head to the ventral posterolateral nucleus of thalamus Will also use corona radiata + go to post central gyrus
68
What is the course of the neurons in the corticospinal tract?
Starts at precentral gyrus -> posterior limb of internal capsule -> cerebral peduncles of midbrain -> decussate at the pyramids of the medulla descend in the corticospinal tract and synapse at the level they will leave at followed by going to the interneuron and then third order neuron (ventral root) Motor / efferent pathways use the ventral root
69
Describe the dorsal column / medial leminiscal pathway
Role: fine touch, proprioception, pressure, vibration 1st order neuron, synapses with the cell body in the dorsal root ganglia. and immediately ascends in the dorsal column. 2nd order neuron is in the medulla... Synapses in the medulla and decussates in the medulla, ascends from the medial leminiscus to thalamus Thalamus ventroposteriorlateral. nucleus synapses 3rd order neuron leaves by corona radiata of internal capsule (from thalamus to post central gyrus) Goes to post central gyrus of parietal lobe
70
What is the pathway of the neuron in the spinothalamic tract?
Role: pain, tempreature, gross touch 1st order neuron (cell body in dorsal root ganglion) - enters in spinal cord segment via dorsal root immediately synapses and decussates at the spinal cord segment + synapses 2nd order neuron ascends in the anterolateral tract of the spinal cord to the thalamus thalamus VPL + synapses 3rd order neuron leaves by corona radiata of internal capsule goes to post central gyrus of parietal lobe
71
What is the neuronal pathway of the corticospinal tract?
Role: major descending pathway from brain to the skeletal muscles. 1st order neuron: cell body in precentral gyrus Fibres descend in the corona radiata, go through posterior limb of internal capsule, cerebral peduncles of midbrain, pyramids of the medulla, Descend in the spinal column as the corticospinal tract At the segment they are going to leave, will synapse. 2nd order neuron in spinal cord segment, third order neuron will leave via ventral root (second order neuron is an interneuron)
72
What is the corticospinal tract?
It is the major descending pathway for motor control from brain to skeletal muscle
73
What is the gross anatomy of the corticospinal tract?
Origin - first order neuron descends from the frontal lobe pre central gyrus goes to the corona radiata, posterior part of the internal capsule cerebral peduncles of midbrain descends through brainstem pyramids of medulla - decussates and descends in the corticospinal tract at segment that they are going to leave at - they synapse Then second order interneuron at spinal cord segment, and third order neuron, which leaves at same segment and exits via the ventral root
74
What is the function of the spinothalamic / anterolateral tract?
Responsible for pain, tempreature, gross touch
75
What is the gross anatomy of the spinothalamic tract?
1st order neuron - whole cell body in the dorsal root ganglia enters via the dorsal root Synapses and decussates at the spinal level, second order neuron will ascend in the anterolateral tract of the spinal cord Thalamus (ventroposterior nucleus) will synapse 3rd order neuron will then form and from thalamus will travel to the corona radiata and to the post central gyrus in the parietal lobe
76
What is the function of the medial leminiscal tract?
responsible for fine touch, proprioception, vibration
77
What is the gross anatomy of the medial leminiscal tract?
1st order neuron (cell body in dorsal root ganglia) which enters via the dorsal root ascends in the posterior column of spinal cord decussates in the medulla second order neuron ascends through brainstem in the medial leminiscal tract to VPL of thalamus. Then synapses 3rd order neuron goes to the corona radiata (of internal capsule) and then to post central gyrus and parietal lobe
78
What are the anatomical variants for the arterial supply to the spine?
Anterior spinal artery can come from vertebral artery or posterior inferior cerebellar artery posterior spinal artery can come from vertebral artery or posterior inferior cerebellar artery Radicular arteries arterial vasocorona artery of adamkiewicz
79
What is the cauda equina?
It is the horses tail of lumbar/sacral/coccygeal nerve roots which hang inferior to the conus
80
What is the function of the cauda equina?
to transmit the lumbar, sacral and coccygeal nerve roots through the vertebral column
81
Where does the cauda equina sit?
Inferior to the conus medullaris neonate - L3 Child - L2 Adult - L1 / L2
82
What is the gross anatomy of the conus medullaris?
Marks the end of the spinal cord Made of nerve roots Enclosed in dural sac until S2 Filum terminale is inferior runs in the vertebral column
83
What are the relations to the cauda equina?
Superior - conus medullaris Inferior - sacral aperture Lateral - intervertebral foramina, nerve roots, radicular artery, intervertebral / radicular vein
84
What is the arterial suppy of the cauda equina?
The radicular arteries (through the intervertebral foramina)
85
What is the venous drainage of the cauda equina?
Intervertebral veins Internal venous plexus (both anterior and posterior)
86
What are the nerves contained in the cauda equina?
Spinal nerves of lumbar, sacral, coccygeal segments
87
What are the muscles / ligaments / fascia involved with the cauda equina?
Filum terminale
88
What is the anatomic variation of the cauda equina?
conus medullaris - changes with age ventricularis terminalis - cystic structure at transition of conus - filum terminale
89
What is the sympathetic trunk?
It is a paired bundle of nerve fibres which run from skull base to coccyx Essential part of the sympathetic autonomic nervous system Sphlanchic nerves arise from it Interacts with the spinal nerves
90
Where does the sympathetic trunk sit?
Is posterior which is lateral to vertebral bodies Continuous superiorly with cervical sympathetic trunk
91
What is the gross anatomy of the sympathetic trunk?
It is located lateral to the vertebral bodies covered by pleura or peritoneum continuous superiorly with cervical sympathetic trunk lateral to vertebral bodies and under median arcuate ligament of diagphram terminates to be lateral to the vertebra
92
What does the sympathetic trunk contain?
Paravertebral ganglia Ganglia along the trunk
93
What are the key relations of the sympathetic trunk?
It is lateral to the vertebral column Runs underneath the median arcuate ligament of the diapghram
94
What is the arterial supply of the sympathetic trunk?
Branches of intercostal / lumbar / sacral arteries Radicular arteries
95
What is the intervertebral foramina?
Lateral passageway where spinal nerves pass out from central vertebral column to the periphery
96
What is the gross anatomy of the intervertebral foramina?
Anterior - vertebral body, intervertebral disc Posterior - lamina, ligamentum flavum, facet joint Superior - pedicle of superior vertebra body Inferior - pedicle of inferior vertebra body Medial - spinal cord Lateral - spinal nerves
97
What is the contents of the intervertebral canal?
Dorsal root ganglion - spinal meninges fuse just distal to DRG spinal nerve radicular artery radicular vein epidural fat
98
What is the lateral recess?
It is the space between the thecal sac and intervertebral foramen
99
What are the boundaries of the lateral recess?
Space between INTERVERTEBRAL FORAMEN + Thecal Sac ANteriorly Vertebral body Intervertebral disc Posterior longitudinal ligament Posterior Ligamentum flavum Lamina Medial thecal sac Lateral Pedicle Facet joint Intervertebral foramen Contents nerve roots epidural vessels fat

Abdomen (8 decks)

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