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