Session 2: Deep Back & Spinal Cord Flash Cards

 
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myelomeningocele a congenital defect that results in the failure of the closure of the neural arches, resulting in herniation of the spinal cord and its meninges through the defect in the vertebral column. (Greek, myelos = spinal cord + menin- = membrane + cele = hernia) 0 mcs5109 Thu, 27 Jan 2011 16:24:55 GMT view revision history
hydrocephalus a condition that causes dilation of the cerebral ventricles due to excessive accumulation of cerebrospinal fluid. This may lead to separation of the cranial bones and enlargement of the head.(Greek, hydro = water) 0 mcs5109 Thu, 27 Jan 2011 16:24:55 GMT view revision history
spina bifida a defect in the spinal column due to failure of development or fusion of the vertebral arches with varying levels of severity depending on the involvement of the spinal cord and meninges. The incidence of this has been dramatically reduced with the discovery that proper maternal intake of folic acid can prevent this in most cases. 0 mcs5109 Thu, 27 Jan 2011 16:24:55 GMT view revision history
caudal anesthesia this procedure is done using an in-dwelling catheter in the sacral canal; the catheter is inserted through the sacral hiatus, and the anesthetic bathes the sacral nerve roots; the position of the patient and the amount of fluid injected determines the height to which the anesthetic ascends 0 mcs5109 Thu, 27 Jan 2011 16:24:55 GMT view revision history
spinal anesthesia an anesthetic agent is injected directly into the subarachnoid space at the L3/L4 vertebral level, anesthetizes essentially everything inferior to the waist; the anesthesia takes effect in about a minute; this procedure can result in the patient experiencing a headache due to fluid leaking from the puncture site. Patients must be carefully monitored as sometimes (about 1 out of every 100) the anesthetic agent can travel upward and block autonomic nerves slowing the heart and depressing respirations. 0 mcs5109 Thu, 27 Jan 2011 16:24:55 GMT view revision history
epidural anesthesia injection of anesthetic agents into the epidural space as opposed to injection into the subarachnoid space; usually takes 10 to 20 minutes to take effect and has a direct effect on the spinal nerves; this procedure is often used in childbirth and cesarean sections 0 mcs5109 Thu, 27 Jan 2011 16:23:31 GMT view revision history
meningitis infection of the meninges (either bacterial or viral). Patients typically present with the triad of fever, headache, and signs of meningeal irritation (such as neck stiffness). (Greek, menin- = membrane, -itis = inflammation) 0 mcs5109 Thu, 27 Jan 2011 16:23:31 GMT view revision history
lumbar puncture (aka spinal tap) this procedure is used to gather CSF fluid, which is an excellent diagnostic tool; CNS infections, blood and other pathologies can affect content of this vital fluid; to perform a lumbar puncture, the patient is lying on the side with the back flexed (spreads everything out). A needle is inserted between the spinous processes of L3 and L4 or L4 and L5. A superficial landmark for finding this point is the supracristal line which runs on a line from the iliac crests and passes through L4's spinous process 0 mcs5109 Thu, 27 Jan 2011 16:23:31 GMT view revision history
nerve root avulsion tearing away of the nerve roots from the spinal cord. This does not often occur in the cervical spine as the transverse processes of vertebrae here have chutes or grooves in which the spinal nerves lie. Connective tissue attaches the nerve fibers to the chutes and any trauma will sever the nerves distal to the chutes instead of tearing them from the spinal cord. Distal injuries are easier to repair. 0 mcs5109 Thu, 27 Jan 2011 16:23:31 GMT view revision history
laminectomy removal of one or more laminae of the vertebrae; this is often done to remove a herniated disc (Latin, lamina = thin plate) 0 mcs5109 Thu, 27 Jan 2011 16:22:02 GMT view revision history
pinched nerve refers to spinal nerves compressed by herniated discs or spondylosis; pain and sensory loss follows the dermatome; motor loss may also occur 0 mcs5109 Thu, 27 Jan 2011 16:22:02 GMT view revision history
radiculopathy compression or lesion of spinal nerve roots 0 mcs5109 Thu, 27 Jan 2011 16:22:02 GMT view revision history
slipped/herniated disc herniation of the nucleus pulposis through a weakened anulus fibrosus, usually posterolaterally; it commonly puts pressure on the nerve roots or dorsal root ganglion exiting the intervertebral foramen at or below this level, leading to the symptoms of a "slipped disk;" these occur most frequently in the cervical and lumbar regions due to these segments being the most mobile. Cervical disk disease usually presents in patients older than the age of 50, and patients complain of pain (radiating down the arm), paresthesia and dysasthesia (abnormal sensations), and weakness. Lumbar disease presents with similar symptoms in the lower extremities. Both conditions are diagnosed via MRI. 0 mcs5109 Thu, 27 Jan 2011 16:22:02 GMT view revision history
subarachnoid space the space between the arachnoid and the pia mater

subarachnoid space contains cerebrospinal fluid and spider web-like filaments (Greek, arachnoids = spider )
0 mcs5109 Thu, 27 Jan 2011 16:20:54 GMT view revision history
subdural space the space between the dura mater and the arachnoid mater

this is a potential space only; the pressure of CSF in the subarachnoid space pushes arachnoid against dura
0 mcs5109 Thu, 27 Jan 2011 16:20:54 GMT view revision history
pia mater delicate membrane that lies on surface of the brain and spinal cord

Latin, pia mater = delicate mother; it is the most delicate of the meninges; this layer faithfully follows all surface contours of the brain and spinal cord; pia mater has 2 specializations: denticulate ligament and filum terminale internum
0 mcs5109 Thu, 27 Jan 2011 16:20:27 GMT view revision history
meninges three layers of connective tissue covering the brain and spinal cord; dura mater, arachnoid mater, and pia mater

meninges provide protection and nourishment of the brain, brainstem and spinal cord (Greek, menin- = membrane)
0 mcs5109 Thu, 27 Jan 2011 16:20:27 GMT view revision history
filum terminale externum thread-like extension of the dura mater below the end of the dural sac at S2

it attaches to the coccyx; also known as the coccygeal ligament (Latin, filum = thread)
0 mcs5109 Thu, 27 Jan 2011 16:19:39 GMT view revision history
filum terminale internum thread-like extension of the pia mater from the conus medullaris of the spinal cord

filum terminale internum is best seen between vertebral levels L2 and S2; it becomes enclosed within the filum terminale externum (Latin, filum = thread)
0 mcs5109 Thu, 27 Jan 2011 16:19:39 GMT view revision history
epidural space the space external to the sac of spinal dura mater within the vertebral canal

the epidural space contains epidural fat and the internal vertebral plexus of veins which is valveless (clinically relevant as potential route for hematogenous metatasis)
0 mcs5109 Thu, 27 Jan 2011 16:18:27 GMT view revision history
epidural fat loose connective tissue within the epidural space

upon the dura mater
0 mcs5109 Thu, 27 Jan 2011 16:18:01 GMT view revision history
dura mater, spinal outermost covering of the spinal cord, it forms the dural sac containing the spinal cord within vertebral canal

dural sac ends at S2, coccygeal ligament (filum terminale externum) continues inferiorly to attach to coccyx (Latin, dura mater = tough mother)
0 mcs5109 Thu, 27 Jan 2011 16:17:47 GMT view revision history
dura mater outermost of the meningeal layers covering the brain and spinal cord

Latin for "tough mother"; it is the most durable of the meninges and provides support and protection for the brain and spinal cord; two types are described which differ in structure: cranial and spinal
0 mcs5109 Thu, 27 Jan 2011 16:17:47 GMT view revision history
denticulate ligament a lateral extension of pia mater from the spinal cord

denticulate ligament attaches to the dura mater to anchor the spinal cord; it forms a scalloped free border; there are 2 (one on each side)
0 mcs5109 Thu, 27 Jan 2011 16:17:09 GMT view revision history
arachnoid mater intermediate one of the three layers of meninges

arachnoid mater is a thin membrane which is pressed against the inner surface of the dura mater by cerebrospinal fluid pressure; (Greek, arachnoids = spider ), the space deep to this layer (subarachnoid space) has a spider web-like appearance
0 mcs5109 Thu, 27 Jan 2011 16:17:09 GMT view revision history
cauda equina dorsal and ventral roots of all spinal nerves inferior to L1

lies within the lumbar cistern (Latin, cauda equina = horse's tail)
0 mcs5109 Thu, 27 Jan 2011 16:17:09 GMT view revision history
conus medullaris cone-shaped inferior end of the spinal cord; located at vertebral level L1

at birth, the conus medullaris is at the level of L2/L3 (Latin/Greek, conus = cone)
0 mcs5109 Thu, 27 Jan 2011 16:17:09 GMT view revision history
lumbosacral enlargement vertebral level T11 through L1

created by the rootlets of spinal nerves L1-S4 that form the lumbosacral plexus
0 mcs5109 Thu, 27 Jan 2011 16:15:48 GMT view revision history
cervical enlargement vertebral level C4 through T1

created by the rootlets of spinal nerves C5-T1 that form the brachial plexus
0 mcs5109 Thu, 27 Jan 2011 16:15:48 GMT view revision history
posterior median sulcus a longitudinal midline groove located on the dorsal surface of the spinal cord 0 mcs5109 Thu, 27 Jan 2011 16:15:48 GMT view revision history
anterior median fissure a longitudinal midline fissure located on the ventral surface of the spinal cord

the anterior spinal artery lies in this fissure ventrally
0 mcs5109 Thu, 27 Jan 2011 16:14:52 GMT view revision history
white matter surrounds the gray matter of spinal cord, contains nerve processes ascending and descending the cord

white color derives from fatty myelin covering of nerve processes
0 mcs5109 Thu, 27 Jan 2011 16:14:52 GMT view revision history
gray matter butterfly-shaped core of the spinal cord, containing neuron cell bodies

ventral horns of gray mater contain motor neurons, dorsal horns contain sensory neurons, lateral horns contain autonomic nerve cell bodies
0 mcs5109 Thu, 27 Jan 2011 16:14:52 GMT view revision history
spinal cord lies within the dural sac in vertebral canal; continuous with medulla oblongata at foramen magnum of skull; ends inferiorly at L1/2 intervertebral disc

spinal cord and brain are the central nervous system; their branches comprise the periperal nervous system
0 mcs5109 Thu, 27 Jan 2011 16:14:52 GMT view revision history
Ventral Root Source

multiple rootlets from the ventral horn of the spinal cord to the spinal nerve

Branches

none

Motor

to skeletal mm.; preganglionic sympathetic (T1-L2)

Sensory

none

Notes

entirely motor in function; located ventral to the denticulate ligament; at all spinal core levels it contains GSE for skeletal mm.; at levels T1-L2 it contains GVE (preganglionic sympathetic) for blood vessels, sweat glands, thoracic viscera, abdominal viscera, pelvic viscera
0 mcs5109 Thu, 27 Jan 2011 16:03:32 GMT view revision history
ventral primary ramus Source

first branch off of the ventral side of the spinal nerve

Branch

numerous

Motor

to skeletal mm. of the neck, trunk and extremities; sympathetic innervation to the skin

Sensory

general sense (touch, pressure, pain, heat, cold, etc.) to the skin of the trunk (except the back) and extremities; visceral pain via the white rami of the sympathetic nervous system (T1-L2)

Notes

a mixed nerve containing both motor and sensory fibers (Latin, ramus = branch)
0 mcs5109 Thu, 27 Jan 2011 16:02:03 GMT view revision history
spinal nerve Source

formed at the point where the dorsal and ventral rootlets meet; it ends where the dorsal and ventral primary rami diverge

Branches

dorsal primary ramus; ventral primary ramus to skeletal mm.; some levels carry preganglionic sympathetic axons (T1-L2)

Sensory

general sense (touch, pressure, pain, heat, cold, etc.) from the entire surface of the neck, trunk and extremities; visceral pain (via the white ramus communicans and the sympathetic nervous system)

Notes

located at the intervertebral foramen; there are 31 pairs of spinal nerves - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
0 mcs5109 Thu, 27 Jan 2011 16:01:07 GMT view revision history
dorsal root ganglion Source

dorsal rootlets

Branches

dorsal root

Motor

none

Sensory

one dermatome

Notes

a sensory ganglion located along the dorsal root within the intervertebral foramen - one per spinal nerve; location of the cell bodies of somatic afferent (sensory) neurons
0 mcs5109 Thu, 27 Jan 2011 15:23:55 GMT view revision history
dorsal root Source

multiple rootlets from the dorsal horn of the spinal cord to the spinal nerve

Branches

none

Motor

none

Sensory

general sense (touch, pressure, pain, heat, cold, etc.)

Notes

dorsal root is entirely sensory in function; it is located dorsal to the denticulate ligament
0 mcs5109 Thu, 27 Jan 2011 15:22:37 GMT view revision history
dorsal primary ramus Source

first branch off of the dorsal side of the spinal nerve

Branches

numerous

Motor

to the deep back mm.; sympathetic innervation to the skin

Sensory

general sense (touch, pressure, pain, heat, cold, etc.) to the skin of the back

Notes

a mixed nerve containing both motor and sensory fibers (Latin, ramus = branch)
0 mcs5109 Thu, 27 Jan 2011 15:21:06 GMT view revision history
vertebral plexus, internal vein Drains into

adjacent segmental vs.

Region drained

spinal cord, meninges, vertebral column

Notes

connects with external vertebral plexus
0 mcs5109 Thu, 27 Jan 2011 15:17:29 GMT view revision history
vertebral plexus, external vein Drains into

adjacent segmental vs.

Region drained

vertebral column & associated muscles

Notes

connects with internal vertebral plexus
0 mcs5109 Thu, 27 Jan 2011 15:17:29 GMT view revision history
spinal, posterior artery Source

contributions received from several arteries (posterior inferior cerebellar, vertebral, posterior intercostal, subcostal, lumbar, lateral sacral aa.)

Branch

pial arterial plexus

Supply to

spinal cord, especially the dorsal columns; medulla (nucleus cuneatus and nucleus gracilis)

Notes

paired; posterior spinal aa. anastomose with the posterior radicular brs. of the spinal rami of the vertebral, posterior intercostal, subcostal, lumbar and lateral sacral aa.
0 mcs5109 Thu, 27 Jan 2011 15:16:14 GMT view revision history
spinal, anterior artery Source

contributions received from several arteries (vertebral, posterior intercostal, subcostal, lumbar, lateral sacral aa.)

Branches

pial arterial plexus

Supply to

meninges; spinal cord; medulla (dorsal motor nucleus of cranial nerve X, nucleus ambiguus, spinal accessory nucleus and hypoglossal nucleus)

Notes

the anterior spinal a. anastomoses with the anterior radicular brs. of the spinal rami of the vertebral, posterior intercostal, subcostal, lumbar and lateral sacral aa.
0 mcs5109 Thu, 27 Jan 2011 15:15:28 GMT view revision history
radicular, posterior artery Source

they arise as multiple branches of several vessels (vertebral, posterior intercostal, lumbar, and lateral sacral aa.)

Branch

no named branches

Supply to

meninges; spinal cord; spinal nerve; dorsal rootlets

Notes

posterior radicular aa. accompany the dorsal rootlets; they anastomose with the posterior spinal aa.
0 mcs5109 Thu, 27 Jan 2011 15:11:15 GMT view revision history
radicular, great anterior artery Source

the spinal br. of the lower posterior intercostal a., subcostal a., or upper lumbar a., usually on left

Branch

no named branches

Supply to

lower spinal cord

Notes

great anterior radicular a. anastomoses with the anterior spinal a. at lower thoracic or upper lumbar spinal cord levels
0 mcs5109 Thu, 27 Jan 2011 15:09:47 GMT view revision history
radicular, anterior artery Source

they arise as multiple branches of several vessels (vertebral, posterior intercostal, lumbar, and lateral sacral aa.)

Branch

they accompany the ventral rootlets to reach

Supply to

the spinal cord meninges; spinal cord; spinal nerve; ventral rootlets

Notes

anterior radicular aa. anastomose with the anterior spinal a.
0 mcs5109 Thu, 27 Jan 2011 15:08:44 GMT view revision history
zygapophyseal joint Description

a small joint between the articular processes of adjacent vertebrae

Notes

a synovial plane joint
0 mcs5109 Thu, 27 Jan 2011 15:05:49 GMT view revision history
supraspinous ligament Description

a ligament that connects the tips of the spinous processes of thoracic and lumbar vertebrae

Notes

a syndesmosis; the supraspinous ligament begins at the C7 vertebra and ends at the mid-sacral segmental level; it serves as a muscle attachment site
0 mcs5109 Thu, 27 Jan 2011 15:05:20 GMT view revision history
posterior longitudinal ligament Description

a ligament that courses from superior to inferior along the posterior surfaces of all vertebral bodies

Notes

it is broader at the intervertebral discs and narrow at the vertebral bodies which gives it a scalloped edge; it is located in the vertebral canal; it is NOT penetrated by the needle during spinal tap
0 mcs5109 Thu, 27 Jan 2011 15:04:52 GMT view revision history
anterior longitudinal ligament Description

a ligament that courses from superior to inferior along the anterior surfaces of all vertebral bodies

Notes

it lies directly posterior to the thoracic and abdominal viscera
0 mcs5109 Thu, 27 Jan 2011 15:04:23 GMT view revision history
nuchal ligament Description

a midline ligament that extends posteriorly from the spinous processes of cervical vertebrae and extends from the base of the skull to the 7th cervical vertebra

Notes

a syndesmosis; it provides muscle attachments to the cervical spinous processes without the necessity of long spinous processes that would hinder extension of the neck; a.k.a. ligamentum nuchae (Latin, nucha = nape)
0 mcs5109 Thu, 27 Jan 2011 15:04:23 GMT view revision history
ligamenta flava Description

a ligament formed predominantly by elastic fibers which joins the laminae of adjacent vertebrae

Notes

a syndesmosis; paired; the ligamentum flavum is penetrated by the needle during spinal tap (Latin, flavus = yellow, a reference to the predominance of yellow elastic fibers which gives this ligament its grossly visible color)
0 mcs5109 Thu, 27 Jan 2011 15:03:26 GMT view revision history
intervertebral disc Description

a fibrocartilaginous disc between adjacent vertebral bodies

Notes

a symphysis; it is composed of two parts: an outer anulus fibrosus and an inner nucleus pulposus; the nucleus pulposus is the remnant of the notochord; the intervertebral discs are important shock absorbers between vertebrae
0 mcs5109 Thu, 27 Jan 2011 15:02:46 GMT view revision history
interspinous ligament Description

ligament that connects the spinous processes of two adjacent vertebra

Notes

a syndesmosis
0 mcs5109 Thu, 27 Jan 2011 15:02:46 GMT view revision history
erector spinae Origin

iliac crest, sacrum, transverse and spinous processes of vertebrae and supraspinal ligament

Insertion

angles of the ribs, transverse and spinous processes of vertebrae, posterior aspect of the skull

Actions

extends and laterally bends the trunk, neck and head

Innervation

segmentally innervated by dorsal primary rami of spinal nerves C1-S5

Artery

supplied segmentally by: deep cervical a., posterior intercostal aa., subcostal aa., lumbar aa.

Notes

the erector spinae m. is separated into 3 columns of muscle: iliocostalis laterally, longissimus in an intermediate position and spinalis medially; each of these columns has multiple named parts
0 mcs5109 Thu, 27 Jan 2011 14:57:15 GMT view revision history
serratus posterior superior Origin

ligamentum nuchae, spines of vertebrae C7 and T1-T3

Insertion

ribs 1-4, lateral to the angles

Action

elevates the upper ribs

Innervation

branches of the ventral primary rami of spinal nerves T1-T4

Artery

posterior intercostal aa. 1-4

Notes

a respiratory muscle, it receives ventral ramus innervation; embryonically related to the intercostal muscles, not the deep back mm. (Latin, serratus = to saw)
0 mcs5109 Thu, 27 Jan 2011 14:53:10 GMT view revision history
serratus posterior inferior Origin

thoracolumbar fascia, spines of vertebrae T11-T12 and L1-L2

Insertion

ribs 9-12, lateral to the angles

Action

pulls down lower ribs

Innervation

branches of the ventral primary rami of spinal nerves T9-T12

Artery

lowest posterior intercostal a., subcostal a., first two lumbar aa.

Notes

a respiratory muscle, it receives ventral ramus innervation; embryonically related to the intercostal muscles, not the deep back mm. (Latin, serratus = to saw)
0 mcs5109 Thu, 27 Jan 2011 14:51:25 GMT view revision history

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