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Spine (brian) Flashcards

1
Q

the occiput-c1 joint provides most of what ROM? how much?

A

flexion. 50%

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2
Q

c1-c2 joint provides most of what ROM? how much?

A

rotation. 50%

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3
Q

surface land marks:

C2-3

C3

C4-5

A

C2-3: mandible

C3: hyoid

C4-5: thyroid cartilage

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4
Q

surface landmarks:

C6

C7

T3

A

C6: cricoid cartilage

C7: vertebral prominens

T3: scapular spine

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5
Q

surface landmarks:

T4

T7

L4-5

A

T4: nipples (variable)

T7: distal tip of scapula

L4-5: iliac crest

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6
Q

what is a motion segment? what is it also called?

A

smallest segment of spine that shows biomech characteristics of the entire spine

i.e. 2 adjacent vertebrae and intervening ligamentous tissues

AKA functional spinal unit

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7
Q

what spinal vertebrae have bifid spinous processes?

A

C2-6

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8
Q

at what level is the spinal cord largest in the c-spine?

A

c2

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9
Q

what shape is the vertebral body in the t-spine?

A

heart

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10
Q

L-spine vert bodies are what shape?

A

kidney

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11
Q

mamillary processes occur in what spinal region?

from what structure do they project from?

A

L-spine

from superior articular process

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12
Q

how many sacral foramina are there?

A

4 pairs dorsal and ventral

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13
Q

how many vertebrae fused embryologically to form the coccyx?

A

usually 4

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14
Q

most common site of disc herniation?

second most common?

A

L5/S1 first, L4/5 second

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15
Q

transverse ligament of the c-spine occurs where?

A

posterior to Dens, stabilizes a-a joint and keeps dens up against anterior arch of c1

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16
Q

alar ligaments joint what to what?

embryologically they are remnants of what?

A

from occiput to tip of dens

remnant of notochord

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17
Q

cruciform ligament of atlas is made of what?

A

includes the transverse ligament

plus inferior and superior longitudinal bands

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18
Q

annulus fibrosus is mostly what type of collagen?

A

type I

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19
Q

nucleus pulposis is mostly what collagen type?

A

type II

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20
Q

in the saggital and coronal planes, c-spine facet joints are oriented how?

A

saggital: 45 deg

coronal 0 deg

i.e. roof shingles angled posteriorly at 45 deg

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21
Q

T-spine facet joints are oriented how in the sagg and coronal planes?

A

saggital 60 deg

coronal 20 deg

i.e. similar to roof shingles but tilted 20 deg towards being saggital

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22
Q

L-spine facet joints are oriented how in the saggital and coronal planes?

A

saggital: 90 deg
coronal: 45 deg
i. e. straight up and down plane of joint, but tilted out 45 deg

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23
Q

amount of “intoeing” for pedicle screws is greatest where? least where?

A

greatest at T1 and L5

least at T12

decreases from T1 and L5 towards T12

L1 approximately 5-10 deg

increases ~5 deg per level from L1 down to sacrum

24
Q

T-spine pedicle screw start point

A

intersection of middle of TP and middle of inferior articular facet

25
lumbar pedicle screw start point?
midpoint of TP midpoint of superior articular process nb: pars lines up with medial aspect of pedicle
26
upper spine largest pedicle? L-spine largest pedicle?
T1 L5
27
smallest pedicle? smallest within L-spine?
T4 L1
28
post-halo: what nerve injuries can occur?
basically supraorbital nerve, CN 4,6,10,11,12 CN VI - abducens n can hit it at petrosphenoidal junction. get eyes that look down and in Glossopharyngeal (4) + vagus (10) + hypoglossal (12) dysphagia, loss of palatal/pharyngeal reflexes, weakness of tongue from penetration of jugular foramen CN eleven accessory n supraorbital nerve - from anterior pins too medial
29
describe pin placement for halo
anterolateral pins: just below head equator, 1cm above orbit, in lateral 2/3 of orbit (avoid supraorbital nerve) posterior pins - avoid temporalis muscle. Usually place just directly above ear pinna
30
list the fixation options for c1-2 fusion
transarticular screw wiring lateral mass screw (c1) and pars screw (c2) clamp
31
list the c2 fixation options
transarticular screw (with c1) pars screw pedicle screw translaminar screw clamp wiring
32
what is pelvic incidence?
fixed parameter describing the tilt of the S1 endplate relative to the centre of the acetabulum on lateral view, make line from middle of S1 endplate to centre of acetabulum make another line perpendicular to S1 endplate angle between these lines is pelvic incidence Geometrically ends up being equal to pelvic tilt + sacral slope pelvic tilt=angle between vertical and line joining middle of S1 endplate to centre of acetabulum sacral slope=angle between s1 endplate and horizontal
33
describe the spinal cord blood supply - only immediately around the cord
single anterior spinal artery two posterior spinal arteries they have branches that form an anastmosis/plexus around the cord - vaso corona
34
what arteries feed the spinal arteries in c-spine?
vertebral a PICA segmental branches
35
what arteries feed the spinal arteries in the T-L spine?
radicular arteries
36
what is the artery of adamkiewicz?
principle arterial suply of lower 2/3 of spinal cord - feeds the anterior and posterior spinal arteries usually occurs on left side at T10 (between T9-11) can be between T7 and L4 AKA arteria radicularis magna it is a large segmental radicular artery enters through intervertebral foramen
37
extension of ALL from C1 to skull is called what?
anterior atlanto-occipital membrane
38
extension of PLL from C1 to skull is called what?
tectorial membrane
39
what is ligamentum nuchae?
c-spine supraspinous ligament
40
vertebral foramina occur in what vertebrae? through which does the vertebral artery pass?
C1-7 artery exists in c1-6
41
continuation of ligamentum flavum from C1 to skull is called what?
posterior atlanto-occipital membrane
42
what are: basion opisthion
basion: anterior point on the foramen magnum opisthion: posterior point on the foramen magnum
43
anterior cord syndrome presentation prognosis?
loss of spinothalamic and corticospinal tracts loss of pain/temp, motor worse prognosis (10% recover)
44
posterior cord syndrome: presentation?
loss of dorsal white columns loss of proprioception, fine touch rare
45
central cord syndrome: presentation, prognosis?
UE weaker than LE preserved perianal sensation 75% recover
46
brown-sequard syndrome: presentation, prognosis?
hemi-cord loss. lose contralateral pain and temp 2 levels below and ipsilateral motor 90% recovery. best prognosis
47
explain the ASIA scale ABCDE
A - complete loss below level B: incomplete - sensory intact, but no motor below level at all c: incomplete - motor function exists below level but most are \<3/5 d - incomplete - motor exists below level and most have 3/5 or more e: normal neuro exam
48
what is the definition of neurological level?
lowest (most caudal) level with intact motor AND sensory
49
where is the watershed region of the spinal cord?
T4-9. narrowest spinal canal and poorest blood supply.
50
Smith-robinson approach: from left or right side? Which is better and why?
left is better reasons: predictable clourse of recurrent laryngeal n (around aortic arch, runs between trachea and esophagus. Problem: most ppl right handed c.f. right side: loops around subclavian a and crosses field from lateral to medial to run next to trachea. can be abberant at thyroid level
51
name the 3 fascial layers you pass through in the smith robinson approach, from superficial to deep
deep cervical fascia pretracheal fascia prevertebral fascia
52
name 2 major anatomical structures superficial to deep cervical fascia (not skin and fat)
external jug v platysma
53
Describe the smith robinson approach, and identifiy the important intervals.
transverse incision split fibres of platysma (vertical) - CN VII facial n go through deep cervical fascia go between SCM (CN XI accessory) and strap muscles (omohyoid, sternothyroid, sternohyoid, thyrohyoid - all ansa cervicalis innervation) go through pretrachial fascia anterior to carotid sheath (contains IJV, vagus n, common carotid a) go between left and right longus colli (segmental n) go thorugh prevertebral fascia
54
dangers of smith robinson approach
carotid sheath (vagus n, common coarotid a, IJV) thyroid arteries trachea esopahgus recurent laryngeal n stellate ganglion/sympathetic chain vertebral a
55
explain posterolateral approach to spine AKA costotransversectomy
incision adjacent to spinous processes over rib split trapezeus fibres subperiosteal dissection around rib watch for intercostal bundle remove rib up to TP operate via retroperitoneal space
56
interval of wiltse approach (modern variant)
between multifidus and longissimus

Anatomy (13 decks)

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