Gross Anatomy Lecture 2 - Bones of Back

The sacrum is formed by _____ fused sacral vertebrae

5

How can you tell if Lordosis will be problematic?

Asking the pt to bend over, if it's rigid then it can be painful/problematic. If it disappears when they bend over then it won't be problematic.

Name the atypical cervical vertebrae:

Atlas and Axis

What is the function of the pedicle?

Attaches vertebrae to body

What vertebrae do not have intervertebral discs?

C1 & C2, last disc is L5/S1

Name the types of spinal curves

Cervical (Lordosis) Thoracic (Kyphosis) Lumbar (Lordosis) Sacral (Kyphosis)

List some ways you can get a Hangman's fracture?

Hanging, diving, MVA, or contact sports.

A patient presents to the ER after diving into shallow water, the x-ray shows a fx across the pedicles of the axis. What is the diagnosis?

Hangman fx

How do you treat a Hangman's fx?

Hard collar

Functions of Intervertebral discs (IV Discs)

Provide strong attachment between vertebral bodies, permit movement and absorb shock.

What type of spina bifida is usually asymptomatic?

Spina Bifida Occulta

What branches of arteries supply the abdomen?

Subcostal & lumbar arteries

Where do vertebrae articulate with each other?

Superior/inferior articular process

Where do the head of ribs attach to the vertebrae?

Superior/inferior costal facets

Ligaments that connect between the spinous processes at the most posterior point are called

Supraspinous ligament

What is lordosis?

Swayback in the lumbar region (Lumbar, Lordosis)

What branches of arteries supply the neck?

Vertebral & ascending cervical arteries

Zygapophysial joints are

between the superior and inferior articular process

What is a hangman's fracture?

bilateral fracture of the pedicles of C2

Lumbar vertebrae have long transverse processes for what reason?

for muscle attachment

Where does the vertebral artery enter the skull?

foramen magnum

How is the intervertebral foramen formed?

formed by superior and inferior vertebral notches of adjacent vertebrae

What is scoliosis?

lateral curvature and rotation of the spine

What is the function of the vertebral foramen?

passage for spinal cord

What is the function of the alar ligaments?

prevent excessive rotation

What population is scoliosis most common in?

pubertal girls

Anterior Longitudinal Ligament (ALL)

runs along the anterior vertebral bodies from sacrum to C1; limits extension

Posterior Longitudinal Ligament (PLL)

runs along the posterior vertebral bodies and discs from the sacrum to C2 (sits in the spinal canal); limits hyperflexion anteriorly

What branches of arteries supply the thoracic region?

Posterior intercostal arteries

What is a Jefferson fracture?

Fx of Atlas through the anterior and posterior arches. Can be two fx sites up to four fx sites.

Approx how many vertebrae are there?

33-34 7 Cervical 12 Thoracic 5 Lumbar 5 (fused) Sacral 4-5 (fused) coccygeal

What ligament connects sides of the dens to the lateral borders of the foramen magnum?

Alar Ligaments

The nuchal ligament covers what portion of the cervical spine? What does this do?

Covers the cervical spinal processes, which is why the cervical spine does not protrude as much.

Surgical treatment for Lumbar Spinal Stenosis includes...

Decompressive Laminectomy, which is the removal of spinous process and attached laminae to help relieve pressure in the vertebral canal

Jefferson fx occur when there is a lot of force on the top of the head. Give an example of a situation that could result in a Jefferson Fx?

Diving in shallow water

What is cauda equina syndrome?

Due to injury of lumbosacral nerve roots in spinal canal. S addle anesthesia P ain in legs I ncontinence/loss of bowels N umbness E mergency

Why has there been a decrease in the occurrence of Spina Bifida?

Due to pregnant women taking folic acid, which is necessary for neural tube formation.

T/F: Fracturing the tip of the dens is very common.

False, it is very rare.

T/F: Lateral protrusion of a disc affects more nerves than medial protrusion.

False, more nerves are affected with medial protrusion.

T/F: The spinal nerve that's affected with a lumbar IV disc herniation is usually the nerve at the level of the herniation.

False, usually affects the nerve at the level below the herniation

T/F: Surgery is the only option for Kyphosis

False. Kyphosis can be resolved with PT/brace, surgery may be required if the nonsurgical option fails

Cervical vertebrae have transverse foramen for what reason?

For vertebral arteries to pass through to enter the skull.

Spina Bifida Cystica Meningocele is characterized by

Herniation of the meninges (meninges coming out of the spinal column)

Spina Bifida Cystica Meningomyelocele is characterized by

Herniation of the meninges and spinal cord. Symps: paralysis of lower limbs, loss of bladder/bowel control.

List the functions of the vertebral column.

Houses and protects spinal cord Posture Support of body weight Locomotion Provides muscle attachment

What connects articulating surfaces of adjacent vertebral bodies?

IV Discs & ligaments

What branches of arteries supply the pelvis?

Iliolumbar sacral arteries

Ligaments that connect between the spinous processes are called

Interspinous ligaments

Where does the Venus plexuses drain blood into?

Intervertebral Veins (IV Veins)

A patient presents to the ER after diving into shallow water, the x-ray shows a fx on the posterior and anterior arches of the atlas. What is the diagnosis?

Jefferson Fx

What is the most common type of IV Disc herniation?

L4-L5/L5-S1 (posterolateral herniation)

Spina Bifida Occulta occurs when...

Lamina of L5 or S1 fail to completely form/fuse

Ligaments that are between adjacent lamina are called

Ligamentum Flavum

Narrowing of the vertebral foramen in one of more lumbar vertebrae is called

Lumbar Spinal Stenosis

The supraspinous ligament merges with what ligament?

Nuchal Ligament

Spina Bifida Cystica occurs when...

One or more vertebral arches fails to develop

Palpation of what sacral structure can assist you with placing epidurals?

Sacral cornua

Where does the rami of the first 4 sacral nerves exit?

Sacral foramina

Lumbar herniation often leads to...

Sciatica

When one rib is more pronounced than the other when a pt bends at the waist, what does that indicate?

Scoliosis

T/F: The spinal nerve that's affected with a cervical IV disc herniation is usually the nerve at the level of the herniation.

True

What is the most common C2 fx?

Type II Fx of Dens (fx of the base of the dens)

What is the treatment for a Jefferson Fx?

Usually a hard collar if ligaments are intact, as the bone can heal itself.

In what populations can you find Lordosis?

Usually children but can appear late in pregnancy too.

Where do you see Kyphosis most frequently?

Usually elderly women with osteoporosis (Dowager Hump)

How do you treat a dens fx?

Usually surgery is required and a screw will be placed in the dens.

IV Veins exit the IV foramina before they empty into...

Vertebral veins and segmental veins of the trunk

Are there more than one type of Spina Bifida Cystica?

Yes, there are two. Meningocele & Meningomyelocele

What is kyphosis?

abnormal thoracic curvature (hunchback) Can be congenital or degenerative disease. Can cause pain and loss of height

transverse ligament of atlas

holds odontoid process in place by connecting from tubercle on one side of the atlas to the other, passing along the posterior articular facet of the dens.

Where do spinal nerves exit the vertebral column?

intervertebral foramen

What # vertebrae do ribs usually articulate with?

the same # and the one above

Where does the tubercle of the rib articulate?

transverse costal facet

The cruciate ligament is comprised of

transverse ligament & superior/inferior longitudinal ligaments