Flashcards in Spine Deck (80):
Which vertebrae do not increase in width in a craniocaudad direction?
T1 and T3
Mandible spinal level?
Hyoid cartilage spinal level?
Thyroid cartilage spinal level?
Cricoid cartilage spinal level?
Vertebra prominens spinal level?
Scapular spine spinal level?
Distal tip of scapula spinal level?
Iliac crest spinal level?
Where does 50% of neck flexion/extension occur?
What is the cartilaginous junction bt dens and vertebral body and when does it fuse?
Subdental synchondrosis = 7 years
How many ossification centers for axis?
Where does 50% of neck rotation occur?
Where does pannus occur in RA in neck?
Atlantoaxial joint--must get c-spine films before procedures
Where does vertebral a traverse?
C6-C1 transverse foramina
Where is the carotid (Chassaignac's) tubercle?
What is the diameter of the cervical spine canal and when is it compromised?
17mm normal, 13mm abnormal
Where is the most rigid region of the axial skeleton?
Thoracic vertebral articulation with ribs
Degrees of normal lumbar lordosis? Where is the apex? Where is the majority of lumbar lordosis?
1) 55-60 degrees
3) 66% from L4 to sacrum
Most common cause of back pain in children and adolescents?
Spondylolysis = defect in pars interarticularis
What attaches to the coccyx?
1) Gluteus maximus
2) External anal sphincter
3) Coccygeal muscles
Which is stronger, anterior or posterior longitudinal lig?
Where does the posterior longitudinal lig extend?
Occiput (tectorial membrane) to posterior sacrum
What passes thru the PLL in the center of the vertebral bodies?
Dorsal branches of spinal a and v
Shape of PLL?
Hour-glass = wider yet thinner over the discs (where ruptured discs occur)
What connects the laminae?
Ligamentum flavum = is constantly in tension, contributes to nerve root compression when hypertrophied
What ligs overlie the zygapophyseal joints?
What lig is in continuity with the ligamentum nuchae (which runs from C7-occiput)?
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
What causes C1-2 instability without cord compression?
Disruption of transverse axial ligament (TAL) with intact alar ligaments
What is the major stabilizer of the AA joint?
What atlanto-dens interval or posterior space is a relative CI to elective ortho surgery?
AD interval = >7-10mm
Posterior space =
What connects the TP of L5 with the ilium?
Iliolumbar lig = can be avulsed in pts with unstable vertical shear fxs of pelvis
Annulus fibrosis description?
Obliquely oriented fibers, type I collagen
Central nucleus pulposis description?
Type II collagen, softer than annulus, high polysaccharide content, 88% water
Aging = results in water loss and conversion to fibrocartilage
What accounts for 25% of total height of spinal column?
What accounts for the vertical growth of the column?
What influences intradisc pressure?
Position = lowest in supine, highest when sitting, flexed forward with weights on hands
What innervates strap muscles?
Ansa cervicalis (C1-3)
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
What triangle is used for the anterior C5 approach?
Triangles of neck?
Suboccipital triangle borders?
Superior and inferior heads of obliquus capitis mm, and rectus capitis posterior major m
What's found within the suboccipital triangle?
Vertebral a, first cervical n (C1)
The greater occipital n (C2) is superficial to it
What innervates the deep back mm?
Dorsal primary rami of spinal nn
Where does the spinal cord extend?
Brainstem to inferior border of L1 (where it terminates to conus medullaris) and continues as filum terminale
Where is the greatest space in the spinal canal?
Widest points of cord?
At the plexuses
Function of dorsal columns?
Deep tactile, proprioceptive, vibratory
Function of lateral spinothalamic tracts?
Pain and temp
What is the site of cordotomies to relieve intractable pain?
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
Function of anterior spinothalamic tracts?
Function of anterior corticospinal tracts?
Delivers cortical messages of voluntary contraction
What interrupts bulbocavernosus reflex?
Injuries distal to conus medullaris
What innervates all structures within the spinal canal?
S/S of central cord syndrome?
UE > LE, quadriparetic with sacral sparing, flaccid paralysis of UE, spastic paralysis of LE
S/S of anterior cord syndrome?
Complete motor deficit
10% recovery (worst)
S/S of Brown-Sequard?
Unilateral cord injury with ipsilateral motor deficit, contralateral pain and temp deficit (2 levels below injury)
How to damage L5?
Sacral fractures (since it is fixed to anterior sacral ala) and errant anteriorly placed iliosacral screw
C5 = biceps
C6 = brachioradialis
C7 = triceps
L4 = patellar
S1 = Achilles
Contents of carotid sheath
1) Common carotid + internal carotid a = medial to IJV
3) Vagus n = posterior bt arteries and IJV
Disruption of which cervical SNS results in Horner's?
What is the distance from the spinous process of C1 laterally to the vertebral a?
Where is the artery of Adamkiewicz (great anterior medullary a) located?
T8-T12 = supplies interior 2/3 of anterior cord
Disruption of which a results in loss of anterior 2/3 of cord?
Anterior longitudinal a
Major risks of anterior cervical approach?
Recurrent laryngeal (right sided), thoracic duct (lower left sided)
How do you protect the stellate ganglion during anterior cervical approach?
Dissect longus mm subperiosteally = avoids Horner's
Major risks of posterior approach?
Vertebral a, greater occiptal n, third occipital n, C5 nerve
Most common complication of posterior approach?
How to locate incision for anterior transthoracic approach?
2 ribs above level of interest
How to avoid intercostal n palsy?
Dissect over top of rib = intercostal neuralgia is most common complication
Which side of favored during anterior transthoracic approaches?
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
Risks of posterior thoracolumbar approach?
Posterior primary rami, segmental vessels
Risks of anterior transperitoneal approach?
Lumbar plexus, superior hypogastric plexus of the SNS plexus over L5 (can cause sexual dysfunction)
Where does the aorta bifurcate?
L4-5 disc space
Where is the safe zone for halo pin placement?
1cm superior to orbital rim in outer 2/3 of orbit below equator
Orientation of nerves above eye?
Supraorbital n is lateral to supratrochlear n, lying anterior to frontal sinus