ap 05 spinal cord

8/7/2019 AP 05 Spinal Cord

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Spinal CordSpinal Cord

Jerry D. King


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Lecture Outline Introduction

Protection

Structure

Spinal Nerves

Spinal Reflexes

http://www.healerwithin.org/press_room/images/nervous_sys.jpg


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Introduction



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Nervous System OutlineNervous System Outline


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Spinal CordSpinal Cord C1 L1

Spinal Nerves

Cauda Equina


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Protection



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Vertebral Column


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MeningesMeninges Pia mater

Filum terminale

Arachnoid

Subarachnoid space

Cerebrospinal fluid

Dura mater

Epidural

Subdural

LPAnatomy Coloring BookWynn Kapit, Lawrence M. Elson


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Lumbar Puncture


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Technique1. Place the patient in the lateral decubitus position lying on the edge of the bed and facing away from operator. Place the patient in a

knee-chest position with the neck flexed. The patient's head should rest on a pillow, so that the entire cranio-spinal axis is parallel to the

bed. Sitting position is the second choice because there may be a greater risk of herniation and CSF pressure cannot be measured

2. Find the posterior iliac crest and palpate the L4 spinous process, and mark the spot with a fingernail. Prepare the skin by starting at thepuncture site and working outward in concentric circles. Put on sterile gloves. Drape the patient

3. Anesthetize the skin using the 1% lidocaine in the 5 mL syringe with the 25-gauge needle. Change to 22-gauge needle beforeanesthetizing between the spinous process. Insert in the midline with the needle parallel to the floor and the point directed toward the

patient's umbilicus

4. Advance slowly about 2 cm or until a "pop'' (piercing a membrane of the dura) is heard. Then withdraw the stylet in every 2- to 3-mm

advance of the needle to check for CSF return. If the needle meets the bone or if blood returns (hitting the venous plexus anterior to thespinal canal), withdraw to the skin and redirect the needle. If CSF return cannot be obtained, try one disk space down

5. When cerebrospinal fluid begins to flow from the needle, discard the first few drops. Do not aspirated cerebrospinal fluid, because anerve root may be trapped against the needle and injuried

6. Measure the opening pressure with a manometer; allow the patient to relax, and check for good respiratory variation of the fluid level inthe manometer to ensure that the needle is properly positioned.

7. Remove the manometer and allow 1 to 2 cc of CSF to flow into each of the three sterile tubes. Send the first for glucose and protein, thesecond for Gram stain and culture and sensitivity (C&S), and the third for cell count and differential. A fourth tube, when indicated, iscollected for viral titer or cultures, India ink preparation, Cryptococcus antigen, VDRL, or cytology

8. Withdraw the needle without replacing the stylet

9. Dress the puncture site with a bandage. Have the patient lie in bed for a few hours

Author: Carlos Eduardo Reis, MD

http://www.medstudents.com.br/proced/lumbpunc.htm


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Review Bones, Meninges


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Structure



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Cross Section Ventral median

fissure Dorsal median sulcus

Gray matter

White matter

Central canal

biology.clc.uc.edu/.../ Spinal_Cord_Histology.htm


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White vs. Gray Matter

www.ussslater.org/parts/fusebox2.jpg


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Sensory and Motor Paths


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Spinal Nerves



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31 Pairs 8 Cervical

12 Thoracic 5 Lumbar

5 Sacral

1 Coccyxgeal

Note perpendicular tooblique pattern


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C1

C1

C2

C3

C4

C5

C6

C7

C8

T1

T2

T3

T2

C5

C3

C7

C2

T3

C6

C4

T1

VERTEBRAE NERVES

1st 7 exit above the bone

The rest below


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Nerve StructureNerve Structure


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DermatomesDermatomes


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RootsRootsSensory vs. Motor


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Dorsal root ganglionDorsal root ganglion

biology.clc.uc.edu/.../ Spinal_Cord_Histology.htm


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RamiRami (branches)(branches)


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From Above


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Ventral & DorsalVentral & Dorsal RamiRami


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Cervical Plexus (C1Cervical Plexus (C1--C4)C4) To skin over neck &

clavicle Diaphragm (phrenic)


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Brachial Plexus (C5Brachial Plexus (C5--T1)T1)

To upper limb


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No Thoracic PlexusNo Thoracic Plexus


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Lumbar Plexus (L1Lumbar Plexus (L1--L4)L4)

To anterior lower limb


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Sacral Plexus (L4Sacral Plexus (L4--S4)S4)

To posterior lower limb


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Stretch Reflex Muscle spindle

Response tostretch

Adjustable


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Reflex Circuit


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Golgi Tendon Reflex


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Pain Reflex


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The End


Quiz Preview


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The End


Bonus


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The End


Other thanthat, theresnothing on

the quiz.

http://samourais.free.fr/Ninja_010.jpg


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Spinal CordSpinal Cord

Jerry D. King

ap 05 spinal cord

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