Back/Vertebral column (+blue box)
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How many vertebral columns are there total? Cervical, thoracic, lumbar, sacral, coccygeal?
- total: 33
- cervical: 7
- thoracic: 12
- lumbar: 5
- sacral: 5
- coccygeal: 4
How is the vertebral column "c"-shape different in each section?
cervical/lumbar: convex anteriorly (C-cave region behind me with thumb being vertebral prominens)
thoracic/sacral/coccygeal: concave aneteriorly
what is kyphosis? lordosis? scoliosis?
1. kyphosis: hunchback (aka increase posterior convexity) in thoracic region
2. lordosis: increase anterior convexity in lumbar region (can be compensatory for kyphotic curve)
3. scoliosis: increased lateral curvature and rotation due to weak back muscles, congenital defects in vertebrae development, inequality in length of lower limbs
vertebral arch is composed of?
- 1. pari of laminae
- 2. pair of pedicles
Intervertebral foramina are formed from?
superior and inferior process
What are spinous and transverse processes?
Spinous processes form posterior to vertebral body
2 transverse processes stick out sides (posterolaterally)
What do the superior and inferior processes form?
Zygapophyseal joint (synovial fluid filled; enables slidding of vertebrae)
What differentiates cervical vertebrae from the rest?
- Transvere foramen (for Right/Left vasculature)
- C7 - vertebra prominens
- C1 (atlas) - facet for dens; lateral masses; no vertebral body
- C2 (axis) - dens; bifid spinous process; (has vertebral body)
Characteristics of thoracic vertebrae?
Costal faces on 'long' transverse processes
characteristics of lumbar vertebrae?
no costal faces, LARGE vertebral body, spinous processes short (make "butterfly" shape)
characteristics of sacrum?
5 fused vertebrae with median sacral crests (protrusions posteriorly like spinous processes)
smooth anterior surface
"U"-shaped sacral hiatus
characteristics of coccyx?
4 fused vertebrae (small, no pedicles, laminae, or spinous processes)
allows movement up and down (flexion/extension)
joint between dens and anterior arch (allows shaking of head laterally)
Intervertebral disc is made of two components?
annulus fibrosus (outside layer of concentric cartilage)
nucleus pulposus (gelatinous inner core)
Name the ligaments in the order from most anterior to most posterior?
Anetior Longitudinal Ligament: damaged during whiplash
Posterior Longitudinal Ligament: damaged during head smashing into thorax
Ligamentum Flava: covering dura mater near spinous processes
Interspinous Ligaments: between spinous processes
- Supraspinous Ligaments: over spinous processes (becomes ligamentum nuchae in cervical region)
Triangle of auscultation is formed from what?
Trapezius, latissimus dorsi, vetebral (medial) border of scapulae (can hear lungs better here)
Why are surgical laminectomies performed?
to fix tumor, herniated disc, bony hypertrophy
If you dive into a pool and hit the bottom with your head what could happen?
Jefferson (burst fracture) in which lateral masses are pushed outwards. Injury is only serious if the transverse ligament (which holds dens into its socket on atlas) is ruptured.
Fractures to axis are most likely to occur where?
What is a fracture at this location called?
What is the result of dislocation of axis?
1. right after the transverse foramina (posteriorly) pars interarticularis
2. Spondylolysis of C2
3. Sometimes Quadriplegia (which is paralysis of all four limbs)
Lumbar spinal stenosis occurs in what patient population? What is more likely to cause as a result of this?
How to treat this?
1. old patients b/c lumbar region of vertebral foramina are smaller than cervical, thoracic
2. disc herniation
3. decompressive laminectomy
Where does cervical rib usually happen?
What can it cause?
Can cause thoracic outlet syndrome from pressure on subclavian artery/brachial plexus
Sacral hiatus is covered by what ligament?
How to find where to put anesthesia?
Effect of anesthesia?
What is transsacral epidural anesthesia?
- 1. saccrococcygeal ligament
- 2. palpate medial sacral crest
- 3. sensation lost inferior to location of anesthesia
- 4. put drug into posterior sacral foramina
What happens when coccyx is injured?
When can this happen?
- 1. removal is common
- 2. childbirth, falling down
- 3. pain from coccygeal trauma
What is spina bifida occulta? Spina bifida cystica?
1. failure of joining laminae of L5 to S1 (hard to notice, 24% population have it, no back pain)
2. one or more vetebral archs fail to develop completely as a result of neural tube defect
Meningocele vs. meningomyelocele? Symptoms?
- 1. spina bifida associated with meningeal cyst
- 2. spina bifida associated with spinal cord (symptoms: paralysis of limbs)
In which direction is herniation of the nucleus pulposus most likely to occur? why?
anulus fibrosus is thin; there is no ALL or PLL blocking it
As you move inferior on the spine, what happens to IV foramina diameter and vertebral formaina diameter?
What happens to IV disc height (IV space)?
They both shrink.
the height shrinks
As you get older what happens to the nucleus pulposes? What does this mean about diagnosing an elderly patient with herniation?
be suspecious bc chances are it is increased ossification of IV foramen compressing nerve roots
Lumbago (middle, low back pain) and sciatica generally happen what disc level?
Hyperflexion of vertebral column from head-on collision affects L4-L5. Which nerve is affected?
Affects C4-C5. Which nerve is affected?
Where does dens most likely fracture?
What happens from fracture?
- At the base (junction of dens and body of C2)
- no blood supply (avascular necrosis)
(Info.) The sources of back pain?
Localized back pain is usually nerve-related or muscular/joint related?
1. IV discs, ligaments, meninges (dura, pia, arach.), synovial joint (zygapophysial), muscles of back, nervous tissues)
2. is generally muscular-related from guarding (contraction of muscles in anticipation of pain)
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