Vertebral Column & Back Flashcards by frankiespeck@hotmail.co.uk Speck

What are the 5 functions of the vertebral column?

Carries + protects spinal cord + nerves
Provides support to thoracic/rib cage
Transfers weight from upper body to lower limbs
Shock absorbing
Muscle attachment point

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In order from top to bottom, list the vertebral regions.

7x cervical (C1-C7)
12x thoracic (T1-T12)
5/6x lumbar (L1-L5/6)
5x sacral (S1-S5)
Coccyx

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How many cervical spine nerves are there?

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What is unique about the sacral vertebral bodies?

They are fused together

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What muscle is attached to the coccyx? What can therefore happen if you damage your coccyx?

Leviator ani so if you damage the coccyx, defecation + coughing for e.g. will become painful due to this muscles involvement in these processes

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What structures make up the neural arch?

Pedicle
Transverse process
Lamina
Spinous process
Vertebral canal
Articular facets (synovial joint attachment)

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What does the vertebral canal of the neural arch house?

Spinal cord (enters L1-2)
Spinal nerves

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What is the function of the C1 vertebrae?

AKA atlas

Carries the weight of cranium

Joins to occipital condyle on base of skull + permits movement i.e. flexion + extension (nodding)

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What in unique about the C1 vertebrae?

It has no body as C2 steals it in development

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What part of C1 can you palpate in your neck?

Transverse process/lateral mass of axis via lateral neck deep to sternocleidomastoid

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What is a Jefferson fracture? What can cause it?

Express compression can shatter the ring of atlas i.e. C1 vertebrae

Causes:

Diving into shallow water + landing on head
Jumping from height + landing on feet as force transmits up

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How does the C2 (axis) provide rotation movement of the head and neck?

Odontoid process/peg (used to be the body of C1 in development) forms pivot joint with C1 (atlas) allowing axial rotation of head

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Where in the spine could you attain a displacement fracture that was fatal? Below which level would you survive?

C1 is lethal as respiratory centre is at C3, 4 + 5

So below C6, you would survive

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What can happen to the odontoid process of C2 in trauma i.e. car crash?

Can become fractured + impinge on the spinal cord as a result of rapid flexion/extension snapping it

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What is whiplash? If its particularly bad what can happen?

Rapid hyperextension + flexion of neck e.g. in car crash causing ligamentous injury mostly

Hangman’s fracture if particularly bad

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What are the typical structures features of cervical vertebrae?

Small bodies + holes/foramens (foramen transversarium) in short transverse processes where arteries pass up into cranial cavity to supply top of spinal cord, brain stem + lower part of brain

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What do cervical vertebrae have small bodies?

Less weight at top of vertebral column

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What would happen if the vertebral artery of the foramen transversarium of cervical vertebrae got compressed?

Transient loss of consciousness (could last longer) due to deficit in brainstem blood supply so would cause stroke-associated symptoms

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What are the structural features of the thoracic vertebrae?

Progressively increase in size

Possess articulations for ribs i.e. articular facet + transverse process (synovial joint attachment)

Heart-shaped body

Spinous processes go from backwards pointing -> downwards pointing -> stumpy/square shape

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Why do the bodies of the vertebrae increase in size when moving inferiorly?

More weight + force being applied to vertebral column as you move inferiorly

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What are the holes called at every level of the vertebral column where spinal nerves escape?

Intervertebral foramen

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What are the functions of the lumbar vertebrae?

Articulations aligned to prevent rotational movements so facet joints can balance mobility with stability (< mobility = > stability)

Allows them to cope with large forces + lots of weight

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What are the structural features of the lumbar vertebrae?

Big kidney-shaped bodies

Spines squat + square

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What is the function of the sacral vertebrae?

Transmit weight to pelvic girdle into hips, lower limbs + then the floor so there is more weight transmission at top than bottom

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What are the structural features of the sacrum?

Wedge-shaped so its pushed between hip bones Fused bodies decreasing in size inferiorly

Where do the ventral and dorsal rami exit the vertebral column?

Ventral rami of sacral nerves exit via anterior sacral foramen Dorsal rami of sacral nerves exit via posterior sacral foramen

What is a ramus?

Branch of spinal nerves that is mixed sensory + motor that comes off of the ventral or dorsal roots

What can the sacral hiatus be used for?

A sacral epidural can be performed through this foramen

What can spinous processes be used for?

Palpated, counted + used to landmark key structures

What spinous process landmarks the apex of the lung? What must you be careful of here?

C7 In surgery/needle insertion, do not go too far forward at this level due to risk of pneumothorax

What spinous processes indicate the level of the transpyloric plane?

T12/L1

How is the vertebral column inherently stable with little muscle activity?

Connections of ligaments + joints

What is the function of intervertebral discs?

Resit compression + form a mobile joint

What are intervertebral discs? Where are they?

Secondary cartilaginous joints sitting between vertebral bodies present from beneath C2 Cartilage end plate on bone Increase in thickness distally due to increased weight/force

What are the 2 parts of the intervertebral discs?

Annulus fibrosus (AF): layers of fibrocartilage Nucleus pulposus (NP): rubbery central core (GAG) with high water content

What are zygapophyseal joints?

Simple synovial plane joints located between articular facets of adjacent vertebrae Change orientation from superior -> inferior to decrease rotation available

What can go wrong with the zygapophyseal joints?

Dislocation displacing the vertebral bodies

What happens to the intervertebral discs if force is applied towards the back of the vertebral column?

Increased NP pressure which increases AF tension -> limits movement between vertebral bodies -> NP can rupture through AP = disc herniation posteriorly due to ligaments supporting the disc

Why is the invertebral discs clever at dealing with loads?

If you correctly list a heavy load in the correct position, the NP changes shape pushing the AF too allowing the vertebral bodies to move closer together stabilising the vertebral column

What is the function of the ligamentum flavum?

Helps vertebral column to return to upright position after being flexed

Where are the supraspinous and interspinous ligaments?

Supraspinous: on top of vertebral body Interspinous: between vertebral bodies

What is the ligamentum nuchae useful for?

It can be palpated in the midline posterior to neck + used for surgery as it is a avascular + aneural plane

What are the 3 ligaments that support the vertebral column?

1. Anterior longitudinal 2. Posterior longitudinal 3. Ligamentum flavum

Why is the posterior longitudinal ligament less supportive than the anterior one?

Relatively incomplete nature i.e. it has deficits + is narrow

Where are disc herniations most common in the vertebral column?

Posterior (posterior-lateral) because the posterior longitudinal ligament is not fully supportive of the discs

What can the ligamentum flavum be used for?

Pierced during lumbar puncture

Where is the ligamentum flavum?

Elastic ligament joining the adjacent lamina

What are the 2 types of spinal curvatures? Where do they occur along the spines?

1. Lordosis (front): cervical (C) + lumbar (L) | 2. Kyphosis (back): thoracic (T) + sacrum (S)

What happens to the spines curvature as you age and why?

Curve (more specifically lumbar lordosis) starts to occur as babies hold their head up -> fully developed in adulthood -> disc degeneration as you age leads to loss of curvatures

What occurs in the spine during pregnancy? Why?

Lumbar hyperlordosis because weight on ventral side of column has increased so curve becomes greater so that centre of gravity allows you to stand upright (reversible)

What are some problems that may occur with the spinal curvature?

Age-related kyphosis Hyperloidosis Scoliosis Disease IV disc degeneration

What can happen if a patient lands too heavily on their feet?

Wedge compression fracture around T12-L1 as the shock cannot be absorbed by the vertebral column at this level

What is spondylolysis? What can be seen in an X-ray?

Fracture in region of articular facets without displacement perhaps due to stress on bone Scotty dog sign: lower back pain but no other problems Scotty dog sign wearing collar: bad sign

What is spondylolisthesis? What can cause it?

Lumbar vertebrae body slips + moves anteriorly (often accompanies spondylolysis) Causes: traumatic, degenerative + dysplastic

The overall vertebral column movement equates to?

Sum of many small movements i.e. movement between 2 vertebral body's adds up allowing the structure to be mobile + dynamic

What do the superficial vertebral column muscles do? What is their innervation?

Act on limbs Supplied by brachial plexus + CN XI

What do the deep vertebral column muscles do? What is their innervation?

Includes splenius capiitis (acts on head), intrinsic erector spinae muscles + quadratus lumborum Act on vertebrae + head to keep you upright Dorsal rami of spinal nerves innervate it at each level

What is the nerve supply of the erector spinae muscles of the back?

Dorsal ramus given off by every spinal nerve supplies the muscle at the level closest to it

What is the sub-occipital triangle? What is its clinical relevance?

Sits under occiput on upper neck adjacent to splenius capitis Entrapment of C2 + C3 dorsal rami nerves can cause posterior headache/sub-occipital neuralgia (transient or permanent)

How do the vertebral column muscles contract? Give a few examples.

Unilaterally or bilaterally E.G. psoas major that help to support + move column

What does the psoas major do? What is the clinical relevance of this?

Attaches to + flexes femur Hip flexion can exacerbate mechanical back pain

Other than the vertebral column muscles, what other muscles also aid in moving and supporting the vertebral column?

Abdominal wall muscles e.g. rectus abdominis, external oblique, internal oblique + transversus abdominis Provide pneumatic support to vertebral column

What problems are weight lifters at increased risk of when increasing their intra-abdominal pressure?

Valsalva manoeuvre increases intra-abdominal pressure helping to maintain posture by putting air in front of vertebral column = good If used too much, hernias will pop out from any weakness in abdominal wall (defecation/micturition/rectal prolapse a risk too)