The presacral vertebral column is flexible because it consists of vertebrae joined together by:
semi-rigid intervertebral (IV) discs.
When looking at the spinal cord from a side view the thoracic and sacral(pelvic) curvatures are ___________ where as the cervical and lumbar curvatures are __________.
Convex (kyphoses)
Concave (lordoses)
What is the name of a an abnormal spinal curvature where there is an increase in the thoracic curvature?
Excessive thoracic kyphosis (clinically shortened to kyphosis; colloquially called “humpback”)
Dowager’s hump:
a colloquial name forvexcess thoracic kyphosis in older women resulting fromvosteoporosis; however, kyphosis occurs in geriatricpeople of both sexes
_____________ is characterized by ananterior rotation of the pelvis, producing an abnormal increase in the lumbar curvature; the vertebral column becomes more convex anteriorly
Excessive lumbar lordosis (clinically shortened to lordosis; colloquially called “hollowback”)
______________ is characterized by an abnormal lateral curvature that is accompanied by rotation of the vertebrae.
Scoliosis (curvedback
The spinous processes turn toward the cavity of the abnormal curvature. Scoliosis is the most common deformity of the vertebral column in pubertal girls(aged12–15years).
What are the causes of Scoliosis?
Asymmetri cweakness of the intrinsic back muscles(myopathicscoliosis)
Failure of half of a vertebra to develop(hemivertebra)
A difference in the length of the lower limbs are causes of scoliosis.
The __________________ becomes prominent when an infant begins to hold his or her head erect.
cervical curvature
The ________________ becomes apparent when an infant begins to walk and assumes the upright posture.
lumbar curvature
This curvature, generally more pronounced in females, ends at the _____________ , formed at the junction of the L5 vertebra with the sacrum.
lumbosacral angle
The ______________ of females is reduced so that the coccyx protrudes less into the pelvicoutlet (birth canal).
sacral curvature
A ____________ consists of a vertebral body, vertebral arch,and seven processes.
typical vertebra
The _______________ (the anterior, more massive part of the vertebra)gives strength to the vertebra lcolumn and supports body weight.
vertebral body
The ______________ lies posterior to the vertebral bodyandis formed by right and left pedicles and laminae.
vertebral arch
The _____________ are short, stout processes that join the vertebral arch to the vertebral body. The pedicles project posteriorly to meet two broad, flat plates of bone, called __________ ,which unite in the midline.
pedicles
laminae
The vertebral arch and theposterior surface of the vertebral body form the walls of the ______________ .
vertebral foramen
What are the seven processes that arise from a typical vertebra?
One median spinous process projects posteriorly (and usually inferiorly)from the vertebral arch at the junction of the laminae and typically overlaps the vertebra below.
Two transverse processes project posterolaterally from the junctions of the pedicles and laminae.
Four articular processes—two superior and two inferior—also arise from the junctions of the pedicles and laminae, each bearing an articular surface(facet).
A ________________ is the surgical excision of one or more spinous processes and their supporting laminae in a particular region of the vertebral column and also commonly denotes the removal of most of the vertebral arch by transecting the pedicles.
laminectomy
The most common congenital anomaly of the vertebral column is _____________, in which the laminae (embryonic neural arches) of L5 and/or S1 fail to develop normally and fuse.
spina bifida occulta
_______________ is associated with herniation of the meninges (meningocele)and/or the spinal cord (meningomyelocele).
Spina bifida cystica
_________________ is a condition in which a bone (vertebra) in the lower part of the spine slips out of the proper position onto the bone below it.
Spondylolisthesis
________________ describes a stenotic (narrow) vertebral foramen in one or more lumbar vertebrae.
Lumbar spinal stenosis
The ________________ a ring consisting of concentric lamellae of fibrocartilage forming the circumference of the IV disc.
anulus fibrosusis
The __________________ the central core of the IV disc and, at birth, the nuclei are about 85% water.
nucleus pulposusis
The _____________________ is a strong, broad fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs.
anterior longitudinal ligament
The _______________________ is a much narrower, somewhat weaker band compared to the anterior longitudinal ligament.
posterior longitudinal ligament
The laminae of adjacent vertebral arches are joined by broad,pale, yellow elastic fibrous tissue called the ____________ (L. flavus, yellow), which extend almost vertically from the lamina above to the lamina below.
ligamenta flava
Herniation or protrusion of the gelatinous ______________ into or through the _______________ is a well-recognized cause of lowback and lower limb pain.
nucleus pulposus
anulus fibrosus
The _________________ of a herniated disc results from pressure on the longitudinal ligaments and periphery of the anulus fibrosus and from local inflammation, resulting from chemical irritation by sustances from the ruptured nucleus pulposus.
localized back pain
_________________ resulting from the spinal nerve roots being compressed by the herniated disc is referred to the area(dermatome) supplied by that nerve.
Chronic pain
_________, pain in the lower back and hip and radiating down the back of the thigh into the leg, is often caused by a herniated lumbar IV disc or osteophytes that compress the L5 or S1 component of the sciatic nerve.
Sciatica
When the transverse ligament of the atlas ruptures, the dens is set free, resulting in ____________________or incomplete dislocation of the median atlanto-axial joint.
atlanto-axial subluxation
When complete dislocation occurs, the dens may be driven into the upper cervical region of the spinal cord, causing ______________________, or into the medulla of the brainstem, causing death.
quadriplegia (paralysis of all four limbs)
Rupture of an ______________ results in an increase of approximately 30% inthe range of movement to the opposite side.
alar ligament
Vasculature of Vetebral Column
Spinal branchs supplying the vertebrae are branches of the:
Vertebral and ascending cervical arteries in the neck.
Posterior intercostal arteries in the thoracic region.
Subcostal and lumbar arteries in the abdomen.
Iliolumbar and lateral and medial sacral arteries in the pelvis.
Innervation of Vertebral Column
Other than the zygapophysial joints (innervated by articularbranches of the medial branches of the posterior rami), thevertebral column is innervated by _________________________ .
(recurrent) meningeal branches of the spinal nerves
The nerve branches outside the canal supply the:
anuli fibrosi and anterior longitudinal ligament
The nerve branches inside the canal supply the:
periosteum,ligamenta flava, anuli fibrosi posteriorly, posterior longitudinal ligament, spinal dura mater, and blood vessels within the vertebral canal.
Name the five categories of structures which receive innervation in the back and can be sources of pain:
Fibroskeletal structures: periosteum, ligaments,and anuli fibrosi of IV discs.
Meninges: coverings of the spinal cord.
Synovial joints: capsules of the zygapophysial joints.
Muscles: intrinsic muscles of the back.
Nervous tissue: spinal nerves or nerve roots exitingthe IV foramina.
What components make up the vertebral canal?
spinal cord
spinal meninges
spinal nerve roots
neurovascular structures suppyling the canal
The ___________,the major reflex center and conduction pathway between the body and the brain, is a cylindrical structure that is slightly flattened anteriorly and posteriorly.
spinal cord
The spinal cord begins as a continuation of the _________________ (commonly called the medulla), the caudal part of the brainstem.
medulla oblongata
The conus medularis may terminate as high as ____ or as low as ____ .
T12
L3
The _________________ extends from the C4 through the T1 segments of the spinal cord, and most of the anterior rami of the spinal nerves arising from it form the brachial plexus of nerves, which innervates the upper limbs.
cervical enlargement
The _______________________ extends from the L1 through the S3 segments of the spinal cord, and the anterior rami of the spinal nerves arising from it contribute to the lumbar and sacral plexuses of nerves, which innervate the lower limbs.
lumbosacral (lumbar) enlargement
The spinal nerve roots arising from the lumbosacral enlargement and conus medullaris form the ______________,the bundle of spinal nerve roots running through the lumbar cistern (subarachnoid space).
cauda equina
Structure of Spinal Nerves
The cell bodies of somatic axons contributing to the anterior roots are in the ______________________of the spinal cord, whereas the cell bodies of axons making up the posterior roots are outside the spinal cord in the ___________________________ at the distal ends of the posterior roots.
anterior horns of gray matter
spinal ganglia (posterior root ganglia)
The posterior and anterior nerve roots unite at their points of exit from the vertebral canal to form a ______________ .
spinal nerve
Spinal Meninges and Cerebrospinal Fluid
Collectively, the dura mater, arachnoid mater, and pia mater surrounding the spinal cord form the _________________ .
spinal meninges
True or False
The spinal dura mater is the outermost covering membrane of the spinal cord.
True
The ___________________ is a delicate, avascular membrane composed of fibrous and elastic tissue that lines the dural sac and the dural root sheaths. It encloses the CSF-filled subarachnoid space containing the spinal cord, spinal nerveroots, and spinal ganglia.
spinal arachnoid mater
True or False
The arachnoid mater is not attached to the dura but is held against the inner surface of the dura by the pressure of the CSF.
True
Therefore, in a lumbar spinal puncture,the needle traverses the dura and arachnoid mater simultaneously.
The __________________ ,the innermost covering membrane of the spinal cord, consists of flattened cells with long, equally flattened processes that closely follow all the surface features of the spinal cord.
spinal pia mater
The enlargement of the subarachnoid space in the dural sac, caudal to the conus medullaris, and containing CSF and the cauda equina is the _________________.
lumbar cistern
Lumbar Puncture
Under aseptic conditions, the needle is inserted in the mid-line between the spinous processes of the ____ and ___ vertebrae.
L3
L4
(or the L4 and L5)
At these levels in adults, there is reduced danger of damaging the spinal cord.
Vasculature of Spinal Cord and Spinal Nerve Roots
Three longitudinal arteries supply the spinal cord: an ______________, formed by the union of branches of vertebral arteries, and paired ________________ , each of which is a branch of either the vertebral artery or the posterior inferior cerebellar artery.
anterior spinal artery
posterior spinal arteries
Muscles of Back
The _______________ muscles include superficial and intermediate muscles that produce and control limb and respiratory movements, respectively. The ________________ muscles include muscles that specifically act on the vertebral column, producing its movements and maintaining posture.
extrinsic back
intrinsic back
Name the superficial extrinsic muscles and there funtion:
trapezius, latissimus dorsi, levator scapulae, and rhomboids
connect the upper limbs to the trunk
Name the intermediate extrinsic muscles and there function:
serratus posterior superior and inferior
They are thin muscles and are commonly designated superficial respiratory muscles but are more likely proprioceptive rather than motor in function.
The massive erector spinae, the chief extensor of the vertebral column, divides into three muscle columns:
Iliocostalis: lateral column
Longissimus: intermediate column
Spinalis: medial column
What is the difference between back sprain and back strain?
Back sprain is an injury in which only ligamentous tissue, or the attachment of ligament to bone, is involved, without dislocation or fracture.
Back strain involves some degree of stretching or microscopic tearing of muscle fibers.
What are the three major components of the spine?
The spinal column (i.e., bones and discs)
Neural elements (i.e., the spinal cord and nerve roots)
Supporting structures (i.e., muscles and ligaments)
The spine has four natural curves:
The cervical and lumbar curves are ________.
The thoracic and sacral curves are ________.
Lordotic
Kyphotic
The curves help to distribute mechanical stress as the body moves.
The _____________ is composed of the brain and spinal cord
Central nervous system
The spinal cord, which originates immediately below the brainstem, extends to the __________________.
first lumbar vertebra (L1)
Beyond L1 the spinal cord becomes the _______________.
Cauda Equina
Nerve impulses travel to and from the brain through the spinal cord to a specific location by way of the _________________.
Peripheral Nervous System (PNS)
The _____ is the complex system of nerve roots that branch off from the spinal nerve roots.
PNS
The PNS includes the _____________ system and the ______________ system.
Somatic Nervous System (SNS)
Autonomic Nervous System (ANS)
The ________________ includes the nerves serving the musculoskeletal system and the skin.
somatic nervous system
It is voluntary and reacts to outside stimuli affecting the body.
The __________________ is involuntary automatically seeking to maintain homeostasis or normal function.
autonomic nervous system
The ANS is further divided into the ___________ system and the ___________ system.
Sympathetic Nervous System
Parasympathetic Nervous System
The __________________ system is an involuntary system often associated with the fight or flight response.
sympathetic nervous system
The ______________ system is responsible for promoting internal harmony such as regular heartbeat during normal activity.
parasympathetic nervous system
Associated with the rest or digest response.
___________ fluid is a clear fluid found in the brain chambers (ventricles), spinal canal, and spinal cord.
Cerebrospinal fluid
The fluid is secreted from the Chroids Plexus, a vascular part in the ventricles of the brain.
True or False
Cerebrospinal fluid contains different electrolytes, proteins, and glucose.
In an average adult the total volume of CSF is about 150 milliliters
True
True
What are the three primary types of meninges:
Dura mater or dura
Arachnoid mater
Pia mater
Meninges are membranes that cover and protect the brain and spinal cord.
Meninges
The __________, is the gray outer layer of the spinal cord and nerve roots.
dura mater
It is made of strong connective tissue
Meninges
The _________ resembles a loosely wooven fabric of arteries and veins.
arachnoid mater
This layer is thinner thatn the dura mater
The Subarachnoid space is filled with cerebrospinal fluid.
The _________ is the innermost layer and is a delicate and highly vascular membrane providing blood to the neural structures.
pia mater
The intervertebral discs are:
The cartilaginous discs between vertebrae
They absorb and distribute shock and keep the vertebrae from grinding together during movement.
The intervertebral discs mke up one-fourth of the spinal columns length.
True or False
There are no discs between the Atlas (C1), Axis (C2), sacrum and Coccyx.
True
True or False
Discs are not vascular
True
Discs are not vascular and therefore depend on the end plates to diffuse needed nutrients.
The cartilaginous layers of the end plate anchor the discs in place.
What type of cartilage makes up the intervertebral discs?
The intervertebral discs are fibrocartilaginous cushoins serving as the spine's shock absorbing system, which protect the vertebrae, brain, and other structures (i.e. nerves)
Intervertebral discs are composed of what two structures?
Annulus fibrosus
Nucleus pulposus
The _____________ is a strong radial tire like structure made up of lamellae; concentric sheets of collagen fibers connected to the vertebral end plates.
annulus fibrosus
The annulus fibrosis encloses the ____________.
nucleus pulposus
True or False
Although both the annulus fibrosus and the nucleus pulposus are composed of water, collagen and proteoglycans (PGs), the amount of fluid (water and PGs) is greater in the nucleus pulposus.
True
PG molecules are important because they attract and retain water.
Facet Joints:
Each vertebra has two sets
One pair faces upward (superior articular facet) and one downward (inferior articular facet)
They are located at the back of the spine (posterior).
True or False:
Facet joints are synovial joints.
True
This means each joint is surrounded by a capsule of connective tissue and produces a fluid to nourish and lubricate the joint.
What are the three more important ligaments in the spine?
Ligamentum Flavum
Anterior Longitudinal Ligament
Posterior Longitudinal Ligament
The _____________ forms a cover over the dura mater.
Ligamentum Flavum
This ligament connects under the facet joints to create a small curtain over the posterior openings between the vertebrae.
The ________________ attaches to the front of each vertebra.
Anterior Longitudinal Ligament
This ligament runs up and down the spine (vertical or longitudinal)
The ______________ runs up and down behind the spine and inside the spinal canal.
Posterior Longitudinal Ligament
Spinal Anatomy
C1:
C2:
Head and Neck
Spinal Anatomy
C3:
C4:
C5:
Diaphragm
Diaphragm. Upper body muscles (e.g. Deltoids, Biceps) - (Anterior)
Diaphragm. Wrist Flexors
Spinal Anatomy
C6:
C7:
C8:
Wrist Flexors
Triceps. Hands -(posterior)
Hands
"_________" is a nonmedical term to describe hyperextension injury to the neck resulting from an indirect force, usually a rear-end automobile collision.
Whiplash
The diagnosis of whiplash is often one of exclusion
When considering a neck injury in all patients with a head injury what are the steps taken?
Immobilization of neck first step
Maintain BP and oxygenation to prevent further injury
Bladder catherization as awareness of bladder filling impaired/absent
Types of Severe spinal cord injuries:
Deep tendon reflex (DTR's):
High Cervical:
Midcervical:
Low Cervical:
Thoracic:
