The Spine Flashcards

Question

Arthrokinematics of the Thoracic Spine

Answer 1

* Superior facets face posteriorly + laterally + superiorly * Inferior facets face anteriorly + medially + inferiorly * Facet oriontation: - 60 degrees to the transverse - 20 degrees to the frontal → Upper thoracic: facets are more in the frontal plane ⇒ Designed for lateral flexion and rotation → Lower thoracic: facet joints are more in sagittal plane ⇒ Designed for flexion and extension * Sidebending coupled with rotation to the opposite side * ROM is different than that of the cervical spine b/c the facet joints are oriented differently * ROM → Flexion 40 → Extension 35 → Sidebending 20 → Rotation 35

Answer 2

* Kidney shpaed body * Transverse process → long, slender, directed laterally * Accessory proccess → Base of TP = Attachment for intertransversarii * Mammillary process → On post surface of superior art. process = Attachment for multifidus

Answer 3

• Large bodies

Answer 4

• SP project horiyontally (compare to thoracic)

Answer 5

* Superior facet faces medially and posteriorly * Inferior facet faces anteriorly and laterally * Desgined for Flex / Ext * Coupling: SB w/ contra rotation

Answer 6

* Flexion 60-78 degrees * Extension 35-40 degrees * Sidebending 20 degrees * Rotation 5-10 degrees

Answer 7

The region of the lamina located between the superior and inferior processes

Answer 8

* Ear - Superior articular process * Nose - Transverse process * Eye - Pedicle * Neck - Pars interarticularis (isthmus) * Foreleg - Inferior articular process * Tail - Superior articular process of opposite side * Body - Lamina and Spinous process * Hindleg - Inferior articular process of opposite side

Answer 9

* Fracture of Pars Interarticularis * Appears black on the oblique L-Spine x-ray * Giving "Scotty Dog" a black collar

Answer 10

* 5 fused vertebrae * Strength and stability → Support the vertebral column → Load Transver to pelvic girdle → Functions in load transfer and stress relief * Sacral canal → Nerve root for cauda equina * Lumbosacral angle 130-160 degrees * Sacral hiatus * Auricular surface * Cauda equina → all spinal nerve roots caudal to L1 * Movement → Rotation \< 2 degrees → Translation \< 7 mm * Nutation vs. Counternutation → now: Sacral Felxion vs. Sacral Extension

Answer 11

* Tailbone * 4 rudimentary vertebral bones * Provides attachment for pubococcygeus and Gluteus Maximus

Answer 12

• Vertebral bodies → ALL (Anterior Longitudinal Ligament → PLL (Posterior Longitudinal Ligament) ⇒ PLL injury: swells against Spinal Cord • Vertebral Arches → Ligamentm flavum (underneath arch) → Supraspinosous → Interspinosous → Intertransversous → Ligamentum nuchae (only on cervical spine - Base-C7; prevents hyperflexion)

Answer 13

**ALL** • connect vertebral bodies with discs • prevent hyperextension **PLL** • weaker / thinner • inside canal • prevent hyperflexion and disc protrusion

Answer 14

**Ligamenta flava** • Join laminae of vertebral arches • Elastic • Prevent Flexion **Interspinous ligament** • between Spinous Processes **Supraspinous Ligament** • C7 to sacrum • Merges with nuchal ligament **Nuchal Ligament** • External occipital protuberance and posterior border of foramen magnum to spinous process of C3 - C5 (C3 - C7) • Becoming increasingly recogniyed for its role in prorioception

Answer 15

**Central Stenosis** • Narrowing of vertebral canal • usually caused by disc or bone spur **Lareal stenosis ** • Narrowing of lateral foramen • Caused by disc or bone spur **Lumbar Spinal Stenosis:** * one ore more vertebrae * hereditary anomaly, making a person more vulnerable to age-related degnerative changes such as IV disc bulging * Lumbar spinal nerves increase in size as the vertebral collumn decends, but the IV foramina decrease in size * Narrowing is usually maximal at the level of IC discs * Stenosis of a lumbar vertebral foramen alone may cause compression of 1+ spinal nerve roots * Surgica treatment: decopressive laminectomy **Possible causes:** • IV disc protrusion • Spinal stenosis possible • Arthritic proliferation • Ligamentous degeneration

Answer 16

* Fracture of laminae with anterior migration * Verteral body moves anterior in relation to vertebral below * Can also fracture articular facets and rupture interspinous ligament resulting in psinal cord injury * Extension in head butting, weight lifting * Flexion in diving injury, head on collision * Seat belt across low abdomen in MVA Inferior articular processes of L5 normally interlock with the articular processes of the sacru. When the defect is bilateral, the body of the L5 vertebrae may slide anteriorly on the sacrum so that it overlaps the sacral promontory. The intrusion of the L5 body into the pelvic inlet reduces the AP diameter of the pelvic inlet. This may compress spinal nerves → low back or lower limb pain

Answer 17

**⇒** Laminae fail to develop normally → Don't fuse together to form covering over SC * Spina Bifida Occulta → one level without lamina formation, usually at L5 and/or S1 → Location is concealed by skin, often indicated by tuft of hair → most have no back problems * Spina Bifida Cystica → multiple levels (more severe) → Meningocele: Meninges herniate thorugh opening → Meningomyelocele: Menginges + neural tissue herniate through opening → usually neurological symptons → e.g.: paralysis of the limbs and disturbance in bladder and bowel control * Severe forms result from neural tube defects (devective closure of the neural tube during the 4th week of embryonic development) * Congeital

Answer 18

* Usually seen in thoracic spine * Usually anterior aspect of body * R/O burst fracture (CT scan) **Causes: ** • Exessive or sudden violent movement • Movement of a type not permitted in a specific region • Sudden forceful flexion (car accidents) • Violent blow to the back of the head

Answer 19

* Nucleus distends past annular ring → Protrusion of the gelatinous nucleus pulposus into or through the anulus fibrosus * Symptons differ depending on severity of distension and location of bulge * Caused by loss of lumbar extension, lumbar flexion with sitting posture and frequency of flexion in older population * Can also occur traumatically by forceful load esp. in flexion in adolescents **Causes: ** → Violent hyperflexion my rupture and IV disc → Flexion of the vertebral column produces compression anteriorly and stretching/tension posteriorly, squeezing the nucleus pulposus further post. toward the thinnest part of the anulus fibrosus → n.p. may herniate into the vertebral canal and compress the SC / nerve roots of cauda equina • Usually extends posterolaterally, where a.f. is relatively thin and does not receive support form post. / ant. longitudinal ligs.

Answer 20

**Extrinsic:** • Superficial • Produce / control movement • Connect UE to trunk • Respiratory movements **Intrinsic:** • True back muscles • Superficial and deep layer • Maintain posture + control movements of vertebral column • Innercated by dorsal rami

Answer 21

* Connect the vertebral column witht he pectoral girdle * Trapezius (upper, middle, lower) * Latissimus dorsi * Rhomboids * Levator scapulae * Serratus posterior sup / inf are intermediate

Answer 22

**Upper:** • Elevate • Adduct • Upward rotation • Point of reference of scapula: Glenohumeral joint **Middle:** • Adduct **Lower:** • Depress • Adduct • Upward Rotation

Answer 23

* Thoracodorsal nerver * What other muscle has the exact same actions? → Lower Trap?

Answer 24

* Adduct * Donward Rotation * Elevate * Dorsal scapula nerve (C5) (disc C5 would be pushing on it)

Answer 25

* Adduct * Downward Rotation * Elevate * Dorsal scapula nerve (C5)

Answer 26

* Abduct * UR * Stailize medial border against thoracic wall * Long thoracic nerve palsy

Answer 27

* Splenius - cervicis - capitus * Erector spinae - Illiocostalis thoracis, cervicis - Longissimus thoracis, cervicis, capitus - Spinalis thoracis, cervicis, capitus

Answer 28

* Origin: SP C7 - T4 * Insertion: Mastoid process + lateral 3rd of superior nuchal line * Nerve: Dorsal Rami * Action: - Bilaterally: Extend head - Unilaterally: Ipsilateral lateral flexion + ipsilateral rotation

Answer 29

* Origin: SP T3 - T6 * Insertion: TP C1 - C3 * Nerve: Dorsal Rami * Action: - Bilaterally: Extend cervical spine - Unilaterally: Ipsilateral lateral flexion + ipsilateral rotation

Answer 30

* Spinalis * Longissimus * Iliocostalis

Answer 31

* Semispinalis - thoracis, cervicis, capitus * Multifidus * Rotatores

Answer 32

* Origin: TP T1-T12 * Insertion: SP C2-T4 * Nerve: Dorsal Rami * Action: Extends cervical spine

Answer 33

* Origin: TP C7 - T7 * Insertion: Occipital bone * Nerve: Dorsal Rami * Action: Extend head

Answer 34

* Origin: Sacrum + TP C4 - L5 * Insertion: SP C, T, L vertebrae (spanning 2-4 segments) + meniscus * Nerve: Dorsal Rami * Action: - Bilaterally: Extension of vertebrae - Unilaterally: Contralateral rotation ⇒ May play a role in proprioception of the lumbar spine

Answer 35

* Rectus capitus posterior - major - minor * Obliquus capitus - inferior - superior

Answer 36

* Vertebral artery * Suboccipital nerve (dorsal rami of Cervical nerve 1) - Vertigo - Headaches

Answer 37

* Origin: SP C2 * Insertion: Lateral aspect of the inferior nuchal line * Nerve: Dorsal Rami C1 (Suboccipital nerve) * Action: Extends head + ipsilateral rotation

Answer 38

* Origin: C1 * Insertion: Medial aspect of inferior nucha line * Nerve: Dorsal Rami C1 (Suboccipital nerve) * Action: Extends head

Answer 39

* Origin: SP C2 * Insertion: TP C1 * Nerve: Dorsal Rami C1 (Suboccipital nerve) * Action: Rotates atlas + turning head ipsilaterally

Answer 40

* Origin: TP C1 * Insertion: Between superior and inferior nucha lines * Nerve: Dorsal Rami C1 (Suboccipital nerve) * Action: Extension + lateral flexion of head

Answer 41

• Suboccipital Triangle

Answer 42

* RCP Major * Superior Oblique * Inferior Oblique * Contents: - Dorsal Rami C1 (Suboccipital nerve) - Vertebral artery

Answer 43

* Iliopsoas * Ext. / Int. Obliques * Transverse Abdominus * Rectus Abdominus

Answer 44

* Foramen magnum to L2 * Cervical enalrgement (C4 - T1) - brachial plexus * Lumbosacral enlargement (T11 - L1) - cauda equina (collection of the dorsal and ventral roots which make up the lower lumbar and sacral spinal nerves)

Answer 45

* Ventral / dorsal roots * Spinal nerve * Ventral / dorsal rami

Answer 46

**Dorsal root** • Afferent sensory • Cell bodies outside of spinal cord • Dorsal root ganglia - found at the dorsal root and contains the cell odies of the neurons which make up the sensory components of the spinal nerves. **Ventral root** • Effernet motor • Cell bodies in anterior horn gray matter **⇒** Unit to form Spinal Nerve

Answer 47

**Horns** • found within the SC • Dorsal + ventral **Roots** • Dorsal + ventral **Rami** • Dorsal + ventral

Answer 48

**31 pairs** **8 Cervical** (but only 7 vervical bodies) • First 7 exit above the vertebral level • C8 exits below C7 body **12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal** • exit below level • longer in length at lower level • cauda equina with filum terminale

Answer 49

**Ventral** • Innervate limbs + trunk • Divide into medial + lateral branches **Dorsal** • Innervate skin over back + true intrinsic back muscles • Sensory + proprioceptive to facet joints • Divide into medial + lateral branches

Answer 50

**Dermatomes** = Sensory area that a particular spinal nerve supplies **Myotomes** = all muscles receiving innervation from one spinal nerve

Answer 51

**Protect and support spinal cord + spinal nerve roots** * Dura mater * Arachnoid mater * Pia mater

Answer 52

* Tough * Separated from vertebrae by epidural space * Contious with cranial dura * Terminal filum → anchors dura to coccyx * Dural root sleeves → Extend distal to the dorsal root ganglia

Answer 53

* Fibrous / elastic * Subarachnoid space * Supported by pressure of CSF

Answer 54

* Innermost covering * Covers blood vessels * Denticulate ligaments - 2 pair - Attach pia to arachnoid and dura

Answer 55

* Subarachnoid space from L2 to second segment of sacrum * Area around cauda equina * Spinal tap / sponal block / nerve block - Meningitis - Electrolyte balance - Pressure

Answer 56

By themselves the ASA and the PSAs can supply the short superior portion of SC entirely **Anterior Spinal Artery** (medulla to medullary cone) • Derived from multiple branche dunions form vertebral arteries • Located in anteromedian fissure • Gives rise to sulcal arteries - supply 2/3rd of x-section cord **Posterior Spinal Artery** (paired as 2) • Vertebral artery or posteroinferior cerebellar artery • Anastomosing channels with ASA in pia mater

Answer 57

Anterior / posterior segmental medullary + dorsal / ventral radicular arteries Originate from: • Ascending cervical • Deep cervical • Vertebral • Posterior intercostal • Lumbar arteries Enters vertebral canal via lateral foramen

Answer 58

* Anterior Spinal Artery * Posterior Spinal Arteries

Answer 59

Ischemia = deficient blood supply * Fractures, dislocations may intefere with the blood supply to the spinal cord from the spinal arteries + medullary arteries * Affects function - Muscle weakness - Paralysis * Circulatory impairment if segmental medullary arteries are narrowed by Obsturctive Arterial Disease * Arterial disease - Death of Neuron * Secondary to death ot neurons: Paraplegia (loss of voluntary movement inferior to the the level of impaired blood supply to the spinal cord) * Surgery w/ Aorta cross clamped

Answer 60

**Involuntary response to a sensory input** **Requirements:** * Receptor structure * Afferent neuron with cell body in ganglion * Efferent neuron with cell body in CNS * Interneuron (except stretch reflex) * Effector organ

Answer 61

**Knee jerk:** * Stimulus = tap on tendon * Tests for patency of LMN and its sensory input * Muscle Spindle (MS) is stetched + it sends and afferent signal to spinal cord * in SC the axons form the MS synapse onto the efferent motor neurons in the ventral horn (VH) * the axons from the VH exit as te ventral root and synapse onto the skeletal muscle of the quadriceps to initiate contraction * This reflex helps to keep our postural nad limb musculature at the correct tension in upright positions * It is unconscious and occurs at the SC level

Answer 62

* Stimulus: hean on finger, noxious stimuli * Afferent pathway to internuerons - Reciprocal innervation - Efferent motor to stimulate biceps - Efferent motor to inhibit tricepts (antagonist) * Brain can override reflex

Answer 63

**Sensory processing** • Synapse on neurons in gray matter on same side of spinal cord or medulla **Motor outflow ** • Cell bodies in anterior horn of SC • Innervate skeletal muscles • Reflex circuit and pathways that descend in white matter **Reflexes ** • All control in spinal cord, but can be moderated by high brain centers

Answer 64

Posterior Horn • Cell bodies for the sensory information of the spinothalamic tract reside • Also many cell bodie of interneurons Ventral / Anterior Horn • Cell bodies of large motor neurons • Lower motor neurons • If damaged by themselves patient will have flaccid pralysis, no reflexes (a reflexive) • Lateral enlargement in Cervical + Lumbar

Answer 65

* Dorsal Column (medial lemniscus) * Spinthalamic (Anterolateral) * Lateral Corticospinal

Answer 66

* Corticospinal tract * Descending pathway * Starts at motor cortex (pre-central gyrus) * Upper motor neurons carry information thorugh spinal cord in tracts * White matter

Answer 67

* Start at motor Cortex * Cell bodies located in the pre-central gyrus * Axons from these cells decend - thorugh cerebal hemispheres - thorugh mid brain - through pons - into the medulla * In medulla they are know as the pyramids - ca. 85% of these fibers cross over - decussate - in the ducusssation of the pyramids * The lateral corticospinal tracts are now on the contralateral side of the SC - end by synapsing with the motor cells of anterior horn * Lateral and anterior tracts

Answer 68

* Ascending * Pain / temperature + light touch * Originate from neuro receptors in the skin + sub Q. tissue - sensitive to pain, temp + light touch * The information travels to the Dorsal Root Ganglion - from there to the SCs posterior horn * They synapse in the posterior horn - then immediatley cross the midline - form the contralateral spinothalamic tract (STT) * The STT terminates int he thalamus * Thalamic cells project to somatosensory cortex in the post-central gyrus

Answer 69

* Carry information from receptors - on cutaneous proprioception - descriminative touch - two-point discrimination * Information travels on the axons of the cell bodies within the DRG + from there ot the DCs * Information acends within the DCs - synapses int he caudal Medulla - then corsses within the SENSORY decussation * Information ascends ot the contralateral thalamus - then synapses and travels formt he thalamus ot the primary somatosensory cortex within the post-central gyrus

Answer 70

**Upper Motor Neuron ** • Spastic paralysis • Hyper reflexia • No sig atrophy • No fasiculations / fibrillations **Lower Motor Neuron** • Flaccid paralysis • Hypo reflexia • Atrophy • Fasiculations / fibrillations

Answer 71

► Involuntary branch of effernet nervous system (vs. voluntary / somatic division) ► CNS to innervated organ ► 2 neuron chain - synapse in ganglion outside CNS • Preganglionic fiber - Cell bodies in CNS **•** Postganglionic fiber - Innervates effector organ - These cell bodies are located in the autonomic ganglia ► Has 2 division ► Sympathetic ► Parasympathetic ► Effect same organ and usually botha re active ► Control visceral activities normally outside conscious control ie. circulation + digestion

Answer 72

**Sympathetic ** • Originate in Tx/Lx • Short preganglionic fibers • Long posterior fibers • Synapse in sympathetic chaing (= sympathetic trunk = paravertebral ganglia) • Or synapse in the prevertebral ganglia • FIGHT or FLIGHT **Parasympathetic ** • Originate in cranial / sacral • Long preganglionic fibers • Short posterior fibers • Synapse in terminal ganglia that lie near effector organ • HOMEOSTASIS

Answer 73

**Spinal Block** • Anesthetic into CSF thorug ligamentum flavum into subarachnoid space **Epidural Block** • Soinal nerve after exit dural sac itno extradural space

The Spine Flashcards

(103 cards)