Spine

Question 1

How many vertebrae are there and how are they organised?

Answer 1

33 in total

7 cervical

12 thoracic

5 lumbar

5 sacral

4 coccygeal

Question 2

What are the structures labelled 1-7?

Answer 2

1. Vertebral body
2. Spinous process
3. Transverse process
4. Pedicle
5. Foramen/spinal canal
6. Lamina
7. Superior facet

Question 3

What kind of joints are facet joints?

Answer 3

Synovial

Question 4

What is the angle of the transverse processes at the cervical, thoracic and lumbar levels?

Answer 4

45, 60 and 90 degrees respectively

Question 5

What do the transverse foramen in the cervical spine transmit?

Answer 5

Vertebral artery, vein and nerve fibres

Question 6

Is there much movement in the thoracic spine?

Answer 6

No, due to attachment of ribs

Question 7

Where is there greatest risk of injury to the spine and why?

Answer 7

Cervico-thoracic and thoraco-lumbar junctions

Junctions between fixed and mobile segments

Question 8

Where is the risk of rupture to the vertebral disc highest?

Answer 8

Posterior annulus fibrosis - this is where it’s thin

Question 9

Which ligaments run along the surface and length of the vertebral column?

Answer 9

Anterior longitudinal ligament
Posterior longitudinal ligament

Question 10

Which structure links the vertebral laminae?

Answer 10

Ligamentum flavum

Question 11

Which structures link the spinous processes of the vertebrae and what strength are they?

Answer 11

Interspinous ligaments - between processes, relatively weak

Surpaspinous ligament - along the posterior aspect of the spinous processes, tough

Question 12

What is the three column theory of Denis?

Answer 12

Assessment of stability of spinal injury

1 Column injured: stable
(OP wedge #)

2 columns injured: may be unstable

3 columns injured: unstable

Question 13

What are the superficial/extrinsic muscles of the spine?

Answer 13

Trapezius

Latissimus dorsi

Rhomboid minor & major

Levatus scapularis

Question 14

What is the function of the superficial/extrinsic muscles of the spine?

Answer 14

Movement of shoulder and upper limb

Question 15

Which muscle is being indicated here, and what is its function and innervation?

Answer 15

Trapezius

Elevates and depresses scapula, retracts scapula

Spinal accessory nerve (CN XI)

Question 16

Which muscle is being indicated here and what is its function and innervation?

Answer 16

Latissmus doris

Adducts, extends and internally rotates the humerus

C6, 7, 8

Question 17

Which group of muscles are being indicated here and what are their names?

Answer 17

Erector spinae:

Laterally - iliocostalis

In between - longisimus thoracis

Medially - spinalis thoracis

Question 18

What is the origin and insertion of the erector spinae muscles?

Answer 18

Occiput of the skull

Inserts on the pelvis

Question 19

What is the innervation of the erector spinae muscles?

Answer 19

Posterior rami of the spinal nerves

Question 20

Where does the spinal cord exit the skull?

Answer 20

Foramen magnum

Question 21

Where does the spinal cord terminate?

Answer 21

At the cauda equina, level L2

Question 22

What is a myotome?

Answer 22

Muscles controlled by the motor element of the nerve root from a specific level

Question 23

What is a dermatome?

Answer 23

Skin sensation supplied by the sensory element of the nerve root from a specific level

Question 24

What are the parts of the spinal cord labelled 1-4?

Answer 24

1. Grey matter
2. White matter
3. Posterior horn
4. Anterior horn

Question 25

What is contained within the white matter of the spinal cord?

Answer 25

The ascending sensory tracts The descending motor tracts

Question 26

What is significant about the path of the crossed pyramidal or lateral cerebrospinal tract? (This is a descending motor tract)

Answer 26

Crosses over in the medulla Descends in the spinal cord on the contralateral side

Question 27

What is significant about the path of the uncrossed pyramidal or anterior cerebrospinal tract?

Answer 27

Descend the spine on the ipsilateral side of the cord Crosses (decussates) at the same level it exits the cord so exits from the contralateral side

Question 28

What is significant about the path of the posterior & anterior spinocerebellar tracts and what do these nerves carry?

Answer 28

Ascend the spine on the ipsilateral side of the cord Enter the cerebellum Carry information relating to proprioception

Question 29

What is significant about the path of the lateral and anterior spinothelamic tracts and what do they carry?

Answer 29

Enter then ascend the spine on the ipsilateral side of the cord for a couple of levels Then cross and ascend the spine on the contralateral side of the cord Enter the thalamus Carry information relating to pain & temperature

Question 30

Which ascending tracts carry fine touch and proprioception to the brain?

Answer 30

Posterior columns: Fasciculus gracilis of Goll Fasciculus cuneatus of Burdach

Question 31

Which are the descending tracts which cross over and descend on the contralateral side of the brain?

Answer 31

Crossed pyramidal or lateral cerebrospinal tract

Question 32

Which are the ascending tracts which initially ascend on the ipsilateral side of the cord but cross over to contralateral side to reach the brain?

Answer 32

Lateral and anterior spinothelamic tracts

Question 33

What happens in the grey matter to ascending and descending tracts?

Answer 33

The descending tracts enter the anterior horn of the grey matter and are transmitted via the ventral root to the nerve root then the muscle of action Sensation is transmitted via the spinal nerve root to the dorsal root and into the posterior horn of the grey matter and via the ascending sensory tracts enter the brain

Question 34

Which roots of the spinal cord join to become the nerve root?

Answer 34

Ventral and dorsal roots

Question 35

Through which foramen does the spinal nerve exit the spinal column?

Answer 35

Intervertebral notch

Question 36

What structure forms the intervertebral notch?

Answer 36

The pedicle of the vertebrae has a notch above and below When the vertebrae are stacked, the two notches form a hole

Question 37

When the nerve travels through the intervertebral foramen, what is it as risk of?

Answer 37

Injury from facet joint osteophyte formation, disc prolapse or foraminal stenosis

Question 38

What is the cauda equina?

Answer 38

A bundle of spinal nerves and nerve roots

Question 39

What nerves are contained within the cauda equina?

Answer 39

L2 – L5 S1 – S5 Coccygeal nerve

Question 40

What is Batson's venous plexus?

Answer 40

A network of valveless veins Connect the deep pelvic veins and thoracic veins (draining the inferior end of the urinary bladder, breast and prostate) to the internal vertebral venous plexuses