Vertebral column and back

Question 1

During surgery, which procedure is used to access the vertebral canal?

Answer 1

Laminectomy

Question 2

The atlas (C1) permits movement of the cranium via synovial joints which attach to what?

Answer 2

Occipital condyles on the base of the skull

Question 3

Where is the transverse process of C1 (atlas) palpable?

Answer 3

Via the lateral neck just deep to the sternocleidomastoid and medial to the lobule of the auricle (ear)

Question 4

Which bony landmark of C2 can be seen on an axial CT of C1?

Answer 4

Dens

Question 5

Describe what a Jefferson fracture is.

Answer 5

A fracture of C1 usually involving both anterior and posterior arches – classical presentation is bilateral fractures of both the anterior and posterior arches, producing four fractures in all

Question 6

What kind of injury causes a Jefferson fracture? Give an example.

Answer 6

Axial-loading injury, such as diving into a swimming pool and hitting your head on the bottom

Question 7

Is there usually neurological deficit associated with Jefferson fractures? Explain why

Answer 7

No – the spinal canal at the level of the fracture is usually wide enough to accommodate any swelling of the cord

Question 8

What is another name for the dens?

Answer 8

Odontoid process

Question 9

A fracture of the dens can affect which spinal nerves?

Answer 9

C3,4,5

Question 10

A dens fracture can occur due to what kind of movement of the neck?

Answer 10

Rapid flexion-extension of the neck

Question 11

What is a Hangman’s fracture?

It is a risk of which type of injury?

Answer 11

Fracture of the posterior elements of C2

Whiplash

Question 12

Which hole is a unique feature of the cervical vertebrae?

Answer 12

Foramen transversarium

Question 13

What 3 things pass through the foramen transversarium?

Answer 13

Vertebral artery

Vertebral vein

Sympathetic nerves

Question 14

What procedure can the sacral hiatus be used for?

Answer 14

Sacral epidural

Question 15

C7 can be used to landmark which structure?

Answer 15

Lung apex

Question 16

Which component of the centre of IV discs attracts water and helps maintain a rubbery consistency that resists compression?

Answer 16

Glycosaminoglycans

Question 17

Describe the 2 layers of IV discs and what each layer contains.

Answer 17

Nucleus pulposus – glycosaminoglycans

Anulus fibrosus – collagen and fibrocartilage

Question 18

What kind of joints are located between articular facets of adjacent vertebrae?

Answer 18

Zygapophyseal joints

Question 19

In which area does the supraspinous ligament increase in size and what is it renamed to?

Answer 19

Cervical region – ligamentum nuchae

Question 20

In which direction do most IV disc herniations occur and why?

Answer 20

Posterolateral direction because the posterior longitudinal ligament is narrower and weaker compared to the anterior longitudinal ligament

Question 21

List 3 functions of the curvatures of the vertebral column.

Answer 21

Shock absorption

Balance and upright posture

Flexibility and mobility

Question 22

Which type of curvature is present at birth and which type develops after birth?

Answer 22

Kyphosis is present at birth and lordosis develops after birth

Question 23

Which regions of the vertebral column have kyphosis?

Answer 23

Thoracic and sacral

Question 24

Which regions of the vertebral column have lordosis?

Answer 24

Cervical and lumbar

Question 25

At what age does lordosis of the cervical region occur and why?

Answer 25

6 months of age – forms when the infant begins to lift their head

Question 26

Why does lordosis of the lumbar region occur in early years of life?

Answer 26

Forms when the child begins to stand and walk

Question 27

What causes loss of curvatures of the vertebral column as we age?

Answer 27

Disc degeneration

Question 28

What is a wedge compression injury?

Answer 28

Collapse of the anterior portion of a vertebral body, leading to a wedge-shaped deformity

Question 29

What is spondylolysis?

Answer 29

Fracture in the region of the articular facets without displacement

Question 30

What feature on a scan would indicate spondylolysis?

Answer 30

Collar or break on the neck of the “scotty dog”

Question 31

What can spondylolysis progress into?

Answer 31

Spondylolisthesis – vertebra slips forward on the one below it

Question 32

Spondylolysis most commonly occurs in which vertebra?

Answer 32

L5

Question 33

The superficial muscles of the back are innervated by what?

Answer 33

Brachial plexus or CN XI

Question 34

The deep muscles of the back are innervated by what?

Answer 34

Dorsal rami of spinal nerves

Question 35

Which muscle keeps the head upright?

Answer 35

Splenius capitis

Question 36

What is the innervation of erector spinae?

Answer 36

Dorsal rami of the spinal nerves from C1 to S5

Question 37

Entrapment of which nerves in the sub-occipital triangle can cause posterior headache or occipital neuralgia?

Answer 37

C2 + C3

Question 38

Which muscle connects hip flexion and the vertebral column, therefore meaning that hip flexion can exacerbate mechanical back pain?

Answer 38

Psoas major