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Anatomy 1-4 Vertebral Column
Anatomy lecture 8.31 on spinal cord, column, and related injuries
58
Anatomy
Professional
09/04/2011

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Term
Which set of bones constitutes the axis of the body?
Definition
vertebral column?
Term
How many bones are in the spinal column?
Definition
33 (7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral vertebrae, and 4 fused coccygeal vertebrae)
Term
Which areas of the spine represent the primary curvatures? The secondary curvatures?
Definition
primary = sacral/thoracic vertebrae
secondary= cervical/lumbar vertebrae
Term
What is meant by primary curvature?
Definition
Curvature of the spine that develops in embryo
Term
What is meant by secondary curvature?
Definition
Curvature that develops after birth, due to holding head erect (cervical) or by load bearing (lumbar)
Term
What is kyphosis?
Definition
An exxagerated thoracic curvature, usually the result of degeneration or compression fracture of the thoracic vertebrae. Causes "humpback"
Term
What is scoliosis?
Definition
It is a lateral curvature of the vertebral column. Can be caused by asymmetric weakness of supporting muscles/ligaments (myopathic) improper development of vertebrae, or unequal length of lower extremities. Causes "curved back"
Term
What is lordosis?
Definition
Exaggerated lumbar curvature seen in obese the obese or pregnant. Causes "hollow back"
Term
A pregnant woman is at risk for which type of abnormal curvature of the spine?
Definition
Lordosis
Term
An elderly person whose thoracic vertebrae have degenerated is at risk for which type of abnormal curvature of the vertebral column?
Definition
Kyphosis
Term
A person who has a two different sized legs is at risk for which type of abnormal curvature of the vertebral column?
Definition
scoliosis
Term
What are some of the unique features of the cervical vertebrae?
Definition
Have transverse foramen containing vertebral artery, vein, and plexus of sympathetic nerves. Smallest body of the vertebrae
Term
What are some of the unique characteristics of the thoracic vertebrae?
Definition
costal facets for attachment to ribs
Term
What are some of the unique characteristics of the lumbar vertebrae?
Definition
Large body for structural support, large transverse processes
Term
What is the purpose of the superior and inferior articular processes?
Definition
Form synovial joints between contiguous vertebrae, which are surrounded by a fibrous capsule, strengthened by ligaments, filled with synovial fluid.
Term
What is a zygopophysial joint? Where would one be located on the spinal column?
Definition
A zygopophysial joint is a synovial joint that "glides"; located between super/infer articular facets of adjacent vertebrae
Term
What are the components of an intervertebral disc?
Definition
nucleus pulposus=acts as a cushion, filled with fibrogelatinous pulp
anulus fibrosus=concentric circles of fibers where each layers fibers are perpendicular to the previous layer
Term
How does a disc herniation occur?
Definition
Tears in the anulus fibrosis cause the nucleus pulposus to push out of the disc.
Term
What can the different kinds of pain (localized, chronic, sciatica or intermittent pain) tell you about the type of herniation?
Definition
localized=usually pressure exerted on posterior longitudinal ligament and inflammation related to leakage of nucleus pulposus

chronic pain is likely from compressed nerve root, is felt over the dermatome it supplies

sciatica= chronic/interm pain of lower back, caused by compression L5 or S1 contributions to sciatic nerve
Term
Where are the most common sites of intervertebral disc herniation?
Definition
Between C5-C6, C6-C7, L4-L5, L5-S1
Term
When someone has a herniated lumbar disc, how can you tell which nerve root is compressed?
Definition
Back muscles spasm to immobilize the area, so the patient leans in the opposite direction of the compression.
Term
What ligament runs superior-inferior, connecting the anterior sides of the spinous processes to one another?
Definition
ligamentum flavum
Term
What ligament fills the space between each spinous process?
Definition
interspinous ligament
Term
What ligament runs superior-inferior along the spinal column, connecting the dorsal ends of the spinous processes to one another?
Definition
supraspinous ligament
Term
What ligament runs superior-inferior along the ventral side of the vertebral bodies, connecting them to one another?
Definition
anterior longitudinal ligament
* prevents hyperextension
Term
What ligament runs superior-inferior along the dorsal side of the vertebral bodies, connecting them to one another?
Definition
posterior longitudinal ligament
*prevents hyperflexion
Term
Where along the spinal column does the spinal cord end? What is that ending called?
Definition
L2; conus medullaris
Term
What extends from the conus medullaris and is made of pia? To what is it connected?
Definition
Filum terminale; coccyx
Term
What is the bundle of dorsal and ventral roots that make up the lumbar, sacral, and coccygeal nerves called?
Definition
cauda equina
Term
Where does the spinal cord extend in the embryo? At birth? At maturity?
Definition
full length of spinal column; L3;L2
Term
What are the 3 coverings of the spinal cord collectively known as?
Definition
meninges
Term
Cerebrospinal fluid is located between which two layers of the meninges?
Definition
arachnoid layer and the pia mater; also called the subarachnoid space
Term
What are the 3 layers of the meninges called, listed from the outer most layer inward?
Definition
1. Dura mater
2. arachnoid mater.
3. pia mater
Term
What are the outcroppings of the pia mater that attach to the dura mater and are associated with the dorsal and ventral roots?
Definition
denticulate ligaments
Term
The extradural(epidural) space separates which two bodies within the spinal cord or column?
Definition
Separates the vertebral arch (bone) from the dura mater; internal vertebral venous plexus is located here
Term
Where are the ideal sites for lumbar puncture in an adult? In a pediatric patient?
Definition
L3-L4, L4-L5; L4-L5 only
Term
What is the lumbar cistern?
Definition
Region of subarachnoid space between L2-S2, contains no spinal cord and only the cauda equina.
Term
Why do people who get a lumbar puncture get headaches following the procedure?
Definition
The change in intercranial pressure from having CSF extracted and leaking
Term
What tissues will a lumbar needle pass through during a lumbar puncture?
Definition
Skin->superficial fascia->supraspinous ligament->interspinous ligament-> ligamentum flavum->epidural space->dura->subdural space->arachnoid mater
Term
What is the toughest portion of the meninges?
Definition
dura mater
Term
Where do the dura and acrachnoid end?
Definition
S2
Term
What is the process for obtaining CSF from a patient?
Definition
Patient assumes fetal position to allow lumbar region to be flexed. Iliac crest is used as marker to approx L4, then needle is placed between L3/L4 or L4/L5
Term
What venous plexus is particularly susceptible to spreading infections and metastases? Why?
Definition
the Internal vertebral venous plexus can spread disease because it communicates with numerous veins in the thorax, abdomen, and pelvis and has no valves.
Term
What arteries supply the cervical region of the spinal cord?
Definition
Vertebral arteries, which run within the transverse foramen, give off anterior and posterior spinal arteries.
Term
Which arteries are associated with the thoracic region of the spinal cord?
Definition
Posterior intercostal arteries give off to segmental/spinal or radicular branches
Term
What does it mean to form an anastomotic connection?
Definition
When arteries connect with other arteries instead of ending in a capillary bed
Term
What do the posterior intercostal arteries anastomose with?
Definition
with the anterior and posterior spinal arteries, branches of the vertebral artery
Term
What problems may arise when adequate blood supply to the spinal cord is not maintained?
Definition
muscle weakness, paralysis, decreased or lost sensation due to death of nerve cells
Term
How are the extent and pattern of spinal cord injuries determined?
Definition
1) The position, direction, duration, and magnitude of the force
2) The position of the torso, neck, and head.
Term
Where does the majority of back pain associated with vertebral column trauma come from?
Definition
the pain is usually the result of injury to the periosteum, ligaments, intervertebral discs, or joints and is conveyed by meningeal branches of spinal nerves or the spinal nerves themselves, depending on the site/extent of injury
Term
What region of the spinal column is most susceptible to damage? Why?
Definition
The cervical portion of the vertebral column is most susceptible to damage do to its high degree of flexibility and inherent instability
Term
When do flexion injuries occur? What typical injuries result?
Definition
Following rapid deceleration (head-on collision)
Compression fracture (collapse of anterior part of vertebral wall), injury to posterior longitudinal ligament, or displacement of a vertebra (which can break adjacent facets, rupture ligaments, and usually results to permanent injury to spinal cord)
Term
What type of injuries to the spinal column are likely to result from a head on collision or rapid deceleration?
Definition
Compression fracture (collapse of anterior part of vertebral wall), injury to posterior longitudinal ligament, or displacement of a vertebra (which can break adjacent facets, rupture ligaments, and usually results to permanent injury to spinal cord)
Term
What typically results from vertical compression injuries to the spinal column?
Definition
They usually cause burst fractures where fragments from the vertebral body enter the vertebral canal and damage the spinal cord. quadriplegia is a frequent outcome. Damage like this will compromise blood flow to the spinal cord and be accompanied by swelling in the surrounding muscles since lymph drainage is interrupted too
Term
Extension injuries usually arise from which type of accident? What kind of damage do they produce?
Definition
Extension injuries occur when rear-ended. Usually produce compression fractures of vertebral arch, fragments of which can damage spinal cord. Strain on anterior longitudinal ligament may result in avulsion of a segment of the vetebral body, called a teardrop fracture
Term
What can happen in traumatic hyperextension injuries?
Definition
A vertebra might become displaced anteriorly. This can cause fractures of the articular facets, tearing of the interspinous ligaments, and damaging the cervical nerves or spinal cord.
Term
Where would osteophytes be located? What are they? What can they complicate?
Definition
Osteophytes are tiny projections of bone that arise during old age when bone density decreases. They can project into the vertebral canal and other areas. Traumatic vertebral injuries may be exascerbated by osteophytes.
Term
What are the consequences of the decrease in bone density in the vertebrae as people age?
Definition
Causes the vertebral body to become concave on both sides, which changes the structure and composition of the IV discs and result in an increase in compressive forces around the periphery of vertebrae. This can cause the formation of osteophytes
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