Study Session 2: Deep Back & Spinal Cord Flash Cards
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Pile Management Card
Session 2: Deep Back & Spinal Cord
Session 2: Deep Back & Spinal Cord
| 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) |
| 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) |
| 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. |
| 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 |
| 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. |
| 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 |
| 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) |
| 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 |
| 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. |
| laminectomy |
| removal of one or more laminae of the vertebrae; this is often done to remove a herniated disc (Latin, lamina = thin plate) |
| pinched nerve |
| refers to spinal nerves compressed by herniated discs or spondylosis; pain and sensory loss follows the dermatome; motor loss may also occur |
| radiculopathy |
| compression or lesion of spinal nerve roots |
| 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. |
| subarachnoid space |
|
the space between the arachnoid and the pia mater
subarachnoid space contains cerebrospinal fluid and spider web-like filaments (Greek, arachnoids = spider ) |
| 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 |
| 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 |
| 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) |
| 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) |
| 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) |
| 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) |
| epidural fat |
|
loose connective tissue within the epidural space
upon the dura mater |
| 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) |
| 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 |
| 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) |
| 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 |
| cauda equina |
|
dorsal and ventral roots of all spinal nerves inferior to L1
lies within the lumbar cistern (Latin, cauda equina = horse's tail) |
| 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) |
| lumbosacral enlargement |
|
vertebral level T11 through L1
created by the rootlets of spinal nerves L1-S4 that form the lumbosacral plexus |
| cervical enlargement |
|
vertebral level C4 through T1
created by the rootlets of spinal nerves C5-T1 that form the brachial plexus |
| posterior median sulcus |
| a longitudinal midline groove located on the dorsal surface of the spinal cord |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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) |
| 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 |
| 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 |
| 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 |
| 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) |
| vertebral plexus, internal vein |
|
Drains into
adjacent segmental vs. Region drained spinal cord, meninges, vertebral column Notes connects with external vertebral plexus |
| vertebral plexus, external vein |
|
Drains into
adjacent segmental vs. Region drained vertebral column & associated muscles Notes connects with internal vertebral plexus |
| 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. |
| 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. |
| 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. |
| 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 |
| 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. |
| zygapophyseal joint |
|
Description
a small joint between the articular processes of adjacent vertebrae Notes a synovial plane joint |
| 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 |
| 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 |
| 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 |
| 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) |
| 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) |
| 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 |
| interspinous ligament |
|
Description
ligament that connects the spinous processes of two adjacent vertebra Notes a syndesmosis |
| 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 |
| 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) |
| 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) |
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