BACK Spinal cord and Nervous system

BACK UNIT OVERVIEW

Spinal cord & Nervous system review

Meninges and CSF

Vasculature

Skeletal structures / joint surfaces

Ligamentous support

Musculature

BACK OBJECTIVES

Describe the gross anatomy for each system (circulatory, muscular, nervous, and skeletal) in the region of the back.

Integrate the systems to discuss the vertebral column functions.

Analyze common dysfunctions in the vertebral column.

For each muscle, describe how the attachment sites result in an action around a joint.

For each muscle, identify the innervation (peripheral nerve and nerve roots).

GENERAL SKELETAL STRUCTURE

Lordosis vs. KyphosisJoints – vertebral discs & zygapophysial jointsMovements

VERTEBRAL SPINE DEVELOPMENT

Size (height) of vertebrae

SPINAL CORD DEVELOPMENT

Spinal cord level vs. vertebral level

LUMBAR CISTERN

Filled with CSF

Begins at L2

Contains cauda equina & internal filum terminale

Site of epidural anesthetic

Subarachnoid Space

NERVOUS SYSTEM OVERVIEW Central nervous system

Peripheral nervous system

Dermatomes and myotomes

NERVOUS SYSTEM OVERVIEW CONT’D Dorsal (posterior) and ventral (anterior) rami (ramus)

Spinal nerve roots vs peripheral nerves

Plexi (plexus)

AUTONOMIC VS SOMATIC

Functional divisions

Autonomic and somatic nerves throughout CNS and PNS

SPINAL CORD MENINGES

Dura Mater

Arachnoid Mater

Pia Mater

Epidural, Subdural, Subarachnoid spaces

WHICH OF THE FOLLOWING IS INCORRECT PERTAINING TO THE LUMBAR CISTERN?

A. It contains CSF.

B. It contains the cauda equina.

C. It contains the internal filum terminale.

D. It typically begins in adults at L2.

E. It contains epidural fat.

It co

ntains C

SF.

It co

ntains t

he cau

da equina.

It co

ntains t

he inter

nal filum

t...

It typ

ically

begins i

n adults at

L2.

It co

ntains e

pidural fa

t.

0% 3%

95%

0%3%

THE C1 SPINAL CORD SEGMENT IS LINED UP WITH THE C1 VERTEBRA, EVEN THOUGH IT IS NOT LINED UP IN THE LUMBAR REGION.

A. TrueB. False

3%

98%

A. They all doB. They all do notC. They do above

C8D. They do below

C8 0%

100%

0%0%

THE SPINAL NERVES EXIT THE INTERVERTEBRAL FORAMEN BELOW THE CORRESPONDING NUMBERED VERTEBRA.

VASCULAR SUPPLY

Vertebrae

Back muscles

Spinal cord

BLOOD SUPPLY OF VERTEBRAE

WHICH OF THE FOLLOWING IS INCORRECT PERTAINING TO THE NEUROVASCULAR SUPPLY OF THE VERTEBRAL COLUMN?

A. The vertebral bodies are supplied exclusively by the anterior and posterior spinal arteries.

B. Venous drainage is to both internal (within the vertebral canal) and external venous plexuses.

C. Zygapophyseal joints are supplied by medial branches of posterior rami of spinal nerves.

D. Pain fibers from the ligamentum flavum are conveyed by (recurrent) meningeal branches of spinal nerves.

E. Proprioceptive fibers from the anterior longitudinal ligament are conveyed by (recurrent) meningeal branches of spinal nerves. Th

e vert

ebral

bodies ar

e suppli..

Venous d

rainage is

to both in

ter..

.

Zyga

pophyseal

joints are su

ppli..

Pain fibers

from

the lig

amentum...

Proprio

ceptive

fibers f

rom th

e ...

97%

3% 0%0%0%

SKELETAL STRUCTURES – THE BACKBONE Physiological properties

General vertebral shape

CERVICAL REGION

Intervertebral foramina

Uncus (uncinated processes)

Bifid spinous processes

Angles of zygapophysial joints

VERTEBRAL ARTERY

Travels up in transverse foramina

Loops over C1 in groove for vertebral artery

Merges ventral to Pons to form Basilar artery

Supplies brainstem, cerebellum, and posterior cerebrum

ATLAS AND AXIS

Atlantoaxial joint

INTERPRETING LATERAL VIEW CERVICAL RADIOGRAPHS

JEFFERSON (BURST) FRACTURE

HYPERFLEXION WITH HERNIATION Disc herniation – nucleus pulposis squeezed posteriorly

OTHER VERTEBRAL INJURIES

Hyperextension (whiplash)

Hangman’s fracture

RUPTURE OF TRANSVERSE LIGAMENT OF ATLAS

WHICH OF THE FOLLOWING IS INCORRECT PERTAINING TO THE VERTEBRAL ARTERY?

A. It traverses the transverse foramina of the cervical vertebrae.

B. If partially occluded, it can cause dizziness upon turning the head.

C. It traverses a groove on the posterior arch of the atlas.

D. It only has branches that supply the brain.

It tra

verses t

he tran

sver

se fo

ra...

If parti

ally o

ccluded, it

can ca

use...

It tra

verses a

groove

on the p

ost...

It only has

branch

es th

at su

pply t..

0%

100%

0%0%

IN THE FOLLOWING IMAGE OF A LATERAL RADIOGRAPH OF THE CERVICAL PART OF THE VERTEBRAL COLUMN, THE ARROW POINTS TO A FRACTURE OF THE:

A. pars interarticularis of the axis (hangman's fracture).

B. posterior arch of the atlas.

C. lamina of the atlas.

D. spinous process of C3.

E. occipital condyles.par

s inte

rarticu

laris

of the a

xis (..

.

posterio

r arch

of the atla

s.

lamina o

f the atla

s.

spinous p

roce

ss of C

3.

occipita

l condyle

s.

95%

0% 0%5%0%

LIGAMENTOUS SUPPORT OF ATLANTOAXIAL JOINT Ligaments to hold atlantoaxial joint together: Cruciate ligaments (superior band, transverse, inferior band) Alar ligaments aka apical ligament (dens to occiput) Zygapophyseal articular capsule Atlanto-axial membranes Tectorial membrane