Spine - Spinal Cord & Pathology

brain and spinal cord

the CNS consists of the

cerebrum, cerebellum, brain stem

the brain consists of the

midbrain, pons, medulla oblongata

the brainstem consists of

meninges, cerebrospinal fluid, spinal column

medulla passes thru foramen magnum to become the spinal cord. It is protected by ______ and cushioned by _______ ______ & protected by the bony ________ ______

conus meddularis

pointed end of spinal cord

L1-2

where does the spinal cord end?

31

how many pairs of spinal nerves exit on both sides through the bony intervertebral and sacral foramina

cauda equina (horse tail)

refers to spinal nerves that extend from the conus thru the foramina to innervate the body and transmit sensory impulses back to the brain

epidural space

between the skull/vertebrae and dura mater

dura mater

tough outer meningeal covering

subdural space

between dura and arachnoid mater

arachnoid mater

delicate middle meningeal layer

subarachnoid space

below arachnoid and above pia mater, contains CSF

pia mater

delicate inner layer adhered to brain/cord; contains blood vessels

myelography

a surgical aseptic imaging of the spinal cord & nerve root branches with contrast injected into the subarachnoid space of the thecal sac to outline the spinal cord & nerves

subarachnoid space

into what part of the spinal cord is a myelogram injected

L3-4; C1-2

most common area for a lumbar puncture is ______ or sometimes ______

trendelenburg

pt placed in __________ position to move contrast to cervical and thoracic areas

hyperextended

pt’s neck will be ___________ to avoid contrast entering the cisterna magna behind brain stem (causes headache)

C2 and C6-7

most spinal fx occur where?

C1

least common spinal fx?

ligament/cord

MRI is best imaging for _________ injuries

61%

plain x-ray detects spine injury only ________ percent of the time

clay shoveler’s fx

avulsion fx of the spinous process C6-T1, results from hyperextension of the neck

compression fx

collapse of body from osteoporosis, kyphosis, trauma, or pathologic disease. Anterior wedge collapses, changing the shape to a wedge, best demoed on a lateral spine

chance fx

fx through body & posterior elements of a vertebra (lap seat belt- not common anymore)

hangman’s fx

fx of anterior arch/pedicles of C2 w/ or w/o subluxation of C2 on C3, occurs w/ extreme hyperextension

jefferson fx

fx of anterior and posterior arches of C1 caused by severe axial loading (fall on head), best demoed by open mouth views

odontoid fx

fx of dens and/or lateral masses or arches of C2, demoed by open mouth view

teardrop fx

comminuted vertebral body w/ triangular fragments extending from body; caused by compression & hyperflexion of c-spine, best demoed on lateral or CT

unilateral subluxation of facet

1 zygapophyseal jt misaligned from overflexion, distraction & rotation during trauma

bilateral locks facet

if extreme subluxation, both zygapophyseal jts at same level can be disrupted, creating locked facets

herniated nucleus pulposus (HNP)

when nucleus pulposus protrudes through fibrous cartilage layer into spinal canal, presses on spinal cord or nerves causing pain & numbness in extremities, most frequently L4-5

sciatica

low back pain radiating down the leg due to HNP pressing on the sciatic nerve

scheuermann’s disease

common abnormal scoliosis & kyphosis, more common in young females

spondylitis

inflammation of vertebra

ankylosing spondylitis

systemic illness (predominantly in men 20-40) variant results in pain and stiffness in SI, intervertebral & costovertebral joints, along w/ abnormal union of spinal joints, complete rigidity of spine, usually seen in SI jts (bamboo spine)

spondylosis

neck stiffness from degeneration of disks, may affect the zygapophyseal jts and intervertebral foramen

transitional vertebra

vertebra looks like adjacent spinal region (most common in LS region, or cervical/lumbar rib)

spina bifida

congenital; posterior aspects of vertebra don’t develop exposing part of the spinal cord (varies greatly in severity)

spina bifida occulta

mild form where there is a defect in the posterior arch of the L5-S1 vertebra without protrusion in the vertebra

meningocele

semi severe form of spina bifida; meninges protrude thru the undeveloped opening

myelomeningocele

most severe form of spina bifida where meninges and spinal cord protrude through the opening

spondylolisthesis

forward movement vertebra on another, most common at L5-S1, due to spondylosis of pars or severe osteoarthritis

spondylolysis (lumbar)

separation of pars interarticularis (neck), most common at L4-5

arthrodesis

surgical immobilization by fusion to adjacent vertebra

laminotomy

done to decompress the spinal cord or nerves by removing a portion of the lamina that is impinging on the cord or nerve

laminectomy

decompression surgery where the entire lamina is removed that is impinging on the spinal cord or nerves

spinal fusion

using rods, plates, & screws to stabilize vertebra

microdiskectomy

microscopic surgery to remove protruding disk fragments by making a small hole in the annulus without removal of any bone from the vertebra

epidural steroid injection

ESI

median (nerve) branch block

MBB

radiofrequency ablation

RFA