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Flashcards in Spine Deck (80):
1

Which vertebrae do not increase in width in a craniocaudad direction?

T1 and T3

2

Mandible spinal level?

C2-3

3

Hyoid cartilage spinal level?

C3

4

Thyroid cartilage spinal level?

C4-5

5

Cricoid cartilage spinal level?

C6

6

Vertebra prominens spinal level?

C7

7

Scapular spine spinal level?

T3

8

Distal tip of scapula spinal level?

T7

9

Iliac crest spinal level?

L4-5

10

Where does 50% of neck flexion/extension occur?

Occiput-C1

11

What is the cartilaginous junction bt dens and vertebral body and when does it fuse?

Subdental synchondrosis = 7 years

12

How many ossification centers for axis?

5

13

Where does 50% of neck rotation occur?

C1-C2

14

Where does pannus occur in RA in neck?

Atlantoaxial joint--must get c-spine films before procedures

15

Where does vertebral a traverse?

C6-C1 transverse foramina

16

Where is the carotid (Chassaignac's) tubercle?

C6

17

What is the diameter of the cervical spine canal and when is it compromised?

17mm normal, 13mm abnormal

18

Where is the most rigid region of the axial skeleton?

Thoracic vertebral articulation with ribs

19

Degrees of normal lumbar lordosis? Where is the apex? Where is the majority of lumbar lordosis?

1) 55-60 degrees
2) L3
3) 66% from L4 to sacrum

20

Most common cause of back pain in children and adolescents?

Spondylolysis = defect in pars interarticularis

21

What attaches to the coccyx?

1) Gluteus maximus
2) External anal sphincter
3) Coccygeal muscles

22

Which is stronger, anterior or posterior longitudinal lig?

Anterior

23

Where does the posterior longitudinal lig extend?

Occiput (tectorial membrane) to posterior sacrum

24

What passes thru the PLL in the center of the vertebral bodies?

Dorsal branches of spinal a and v

25

Shape of PLL?

Hour-glass = wider yet thinner over the discs (where ruptured discs occur)

26

What connects the laminae?

Ligamentum flavum = is constantly in tension, contributes to nerve root compression when hypertrophied

27

What ligs overlie the zygapophyseal joints?

Intertransverse ligs

28

What lig is in continuity with the ligamentum nuchae (which runs from C7-occiput)?

Supraspinous lig

29

Denis model of spine columns?

1) Anterior = ALL, anterior 2/3 of annulus and body
2) Middle = posterior 1/3 of annulus and body, PLL
3) Posterior = everything posterior to PLL

30

What causes C1-2 instability without cord compression?

Disruption of transverse axial ligament (TAL) with intact alar ligaments

31

What is the major stabilizer of the AA joint?

TAL

32

What atlanto-dens interval or posterior space is a relative CI to elective ortho surgery?

AD interval = >7-10mm
Posterior space =

33

What connects the TP of L5 with the ilium?

Iliolumbar lig = can be avulsed in pts with unstable vertical shear fxs of pelvis

34

Annulus fibrosis description?

Obliquely oriented fibers, type I collagen

35

Central nucleus pulposis description?

Type II collagen, softer than annulus, high polysaccharide content, 88% water
Aging = results in water loss and conversion to fibrocartilage

36

What accounts for 25% of total height of spinal column?

Intervertebral discs

37

What accounts for the vertical growth of the column?

IV discs

38

What influences intradisc pressure?

Position = lowest in supine, highest when sitting, flexed forward with weights on hands

39

What innervates strap muscles?

Ansa cervicalis (C1-3)

40

Spinal muscle relationships of SNS chain and vertebral a?

From anterior to posterior:
1) SNS chain
2) Longus capitis
3) Longus colli
4) Vertebral a

41

What triangle is used for the anterior C5 approach?

Carotid

42

Triangles of neck?

1) Anterior
2) Submandibular
3) Carotid
4) Posterior

43

Suboccipital triangle borders?

Superior and inferior heads of obliquus capitis mm, and rectus capitis posterior major m

44

What's found within the suboccipital triangle?

Vertebral a, first cervical n (C1)
The greater occipital n (C2) is superficial to it

45

What innervates the deep back mm?

Dorsal primary rami of spinal nn

46

Where does the spinal cord extend?

Brainstem to inferior border of L1 (where it terminates to conus medullaris) and continues as filum terminale

47

Where is the greatest space in the spinal canal?

C-spine

48

Widest points of cord?

At the plexuses

49

Function of dorsal columns?

Deep tactile, proprioceptive, vibratory

50

Function of lateral spinothalamic tracts?

Pain and temp

51

What is the site of cordotomies to relieve intractable pain?

LST

52

Function of lateral corticospinal tracts?

Voluntary muscle contraction
-Sacral structures more peripheral
-Cervical structures more medial = which is why central cord syndrome affects upper extremities more

53

Function of anterior spinothalamic tracts?

Light tactile

54

Function of anterior corticospinal tracts?

Delivers cortical messages of voluntary contraction

55

What interrupts bulbocavernosus reflex?

Injuries distal to conus medullaris

56

What innervates all structures within the spinal canal?

Sinuvertebral nerve

57

S/S of central cord syndrome?

UE > LE, quadriparetic with sacral sparing, flaccid paralysis of UE, spastic paralysis of LE
75% recovery

58

S/S of anterior cord syndrome?

Complete motor deficit
10% recovery (worst)

59

S/S of Brown-Sequard?

Unilateral cord injury with ipsilateral motor deficit, contralateral pain and temp deficit (2 levels below injury)
90% recovery

60

How to damage L5?

Sacral fractures (since it is fixed to anterior sacral ala) and errant anteriorly placed iliosacral screw

61

Reflexes?

C5 = biceps
C6 = brachioradialis
C7 = triceps
L4 = patellar
S1 = Achilles

62

Contents of carotid sheath

1) Common carotid + internal carotid a = medial to IJV
2) IJV
3) Vagus n = posterior bt arteries and IJV

63

Disruption of which cervical SNS results in Horner's?

Inferior (stellate)

64

What is the distance from the spinous process of C1 laterally to the vertebral a?

2cm

65

Where is the artery of Adamkiewicz (great anterior medullary a) located?

T8-T12 = supplies interior 2/3 of anterior cord

66

Disruption of which a results in loss of anterior 2/3 of cord?

Anterior longitudinal a

67

Major risks of anterior cervical approach?

Recurrent laryngeal (right sided), thoracic duct (lower left sided)

68

How do you protect the stellate ganglion during anterior cervical approach?

Dissect longus mm subperiosteally = avoids Horner's

69

Major risks of posterior approach?

Vertebral a, greater occiptal n, third occipital n, C5 nerve

70

Most common complication of posterior approach?

C5 palsy

71

How to locate incision for anterior transthoracic approach?

2 ribs above level of interest

72

How to avoid intercostal n palsy?

Dissect over top of rib = intercostal neuralgia is most common complication

73

Which side of favored during anterior transthoracic approaches?

Right sided

74

Where to place pedicle screws in posterior thoracolumbar approach?

Junction of lateral border of superior facet and middle of TP, angled 15 degrees medialy and in line with slope of vertebra as seen on lateral films

75

Risks of posterior thoracolumbar approach?

Posterior primary rami, segmental vessels

76

Risks of anterior transperitoneal approach?

Lumbar plexus, superior hypogastric plexus of the SNS plexus over L5 (can cause sexual dysfunction)

77

Where does the aorta bifurcate?

L4-5 disc space

78

Where is the safe zone for halo pin placement?

1cm superior to orbital rim in outer 2/3 of orbit below equator

79

Orientation of nerves above eye?

Supraorbital n is lateral to supratrochlear n, lying anterior to frontal sinus

80

Most commonly injured CN during halo traction?

Abducens (CN VI) = loss of lateral gaze