Gray's Anatomy – Back Exam
Questions and Answers
11 A 27-year-old man is admitted to the emergency department after a car crash.
Physical examination reveals weakness during medial rotation and adduction of the
humerus. Which of the following nerves was most probably injured? A.
Thoracodorsal B. Axillary C. Dorsal scapular D. Spinal accessory E. Radial - answer-
@ 11 A. The thoracodorsal nerve innervates the latissimus dorsi, one of major
muscles that adduct and medially rotate the humerus. The axillary nerve supplies the
deltoid muscle, the dorsal scapular nerve supplies the rhomboids and levator
scapulae muscles, and the spinal accessory nerve innervates the trapezius. None of
these nerves medially rotates or adducts the humerus. The radial nerve is
responsible for the innervation on the posterior aspect of the arm and forearm. The
medial and lateral pectoral nerves and the lower subscapular nerve supply the other
medial rotators of the humerus. GAS 87, 99; N 174; McM 101
12 A 39-year-old woman complains of an inability to reach the top of her head to
brush her hair with her right hand. History reveals that she had undergone a
mastectomy procedure of her right breast 2 months earlier. Physical examination
demonstrates winging of her right scapula. Which nerves were most likely damaged
during surgery? A. Axillary B. Spinal accessory C. Long thoracic D. Dorsal scapular
E. Thoracodorsal - answer- 12 C. The long thoracic nerve innervates the serratus
anterior, which is responsible for elevation and protraction of the scapula beyond the
horizontal level while maintaining its position against the thoracic wall. Along with the
thoracodorsal nerve, the long thoracic nerve runs superficially along the thoracic wall
and is subject to injury during a mastectomy procedure. The axillary nerve, the spinal
accessory nerve, and the thoracodorsal nerve supply the deltoid muscle, trapezius
muscle, and latissimus dorsi muscles, respectively. The dorsal scapular nerve is
responsible for innervation of the rhomboids and levator scapulae. Aside from the
long thoracic and thoracodorsal nerves, the remaining nerves do not course along
the lateral thoracic wall. GAS 726; N 180, 413; McM 140
13 A 19-year-old man is brought to the emergency department after dislocating his
shoulder while playing football. Following treatment of the dislocation, he cannot
initiate abduction of his arm. An MRI of the affected shoulder shows a torn muscle.
Which muscle was most likely damaged by the injury? A. Coracobrachialis B. Long
head of the triceps brachii C. Pectoralis minor D. Supraspinatus E. Teres major -
answer- 13 D. The rotator cuff muscles are common sites of damage during shoulder
injuries. These muscles include the supraspinatus, infraspinatus, teres minor, and
subscapularis (SITS). Initiation of abduction of the humerus (the first 15 degrees) is
performed by the supraspinatus, followed by the deltoid from 15 to 90 degrees.
Above the horizontal, the scapula is rotated by the trapezius and serratus anterior
muscles, causing the glenoid fossa to turn superiorly and allowing the humerus to
move above 90 degrees. The teres major and the pectoralis major are responsible
for medial rotation and adduction of the humerus. These muscles are therefore not
involved in abduction at the glenohumeral joint. GAS 711-712, 717; N 134-135; McM
411, 413
,14 A 1-year-old girl is brought to the clinic for a routine checkup. The child appears
normal except for a dimpling of the skin in the midline of the lumbar region with a tuft
of hair growing over the dimple. What is this relatively common condition that results
from incomplete embryologic development? A. Meningomyelocele B. Meningocele
C. Spina bifida occulta D. Spina bifida cystica E. Rachischisis - answer- 14 C. Spina
bifida is a developmental condition resulting from incomplete fusion of the vertebral
arches within the lumbar region. Spina bifida occulta commonly presents
asymptomatically with midline, lumbar, cutaneous stigmata such as a tuft of hair and
a small dimple. More severe forms (spina bifida cystica) are categorized into three
types: Spina bifida cystica with meningocele presents with protrusion of the
meninges through the unfused vertebral arches; spina bifida with myelomeningocele
is characterized by protrusion both of the meninges and central nervous system
(CNS) tissues and is often associated with neurologic deficits; and rachischisis, also
known as spina bifida cystica with myeloschisis, results from a failure of neural folds
to fuse and is characterized by protrusion of the spinal cord or spinal nerves and
meninges. GAS 74; N 14, 160; McM 77, 88
15 A young resident complains of an itch on his back that appears to be caused by
an insect bite. Which nerve fibers carry the sensation of a mosquito bite on the back,
just lateral to the spinous process of the T4 vertebra? A. Somatic afferent B. Somatic
efferent C. Visceral afferent D. Visceral efferent E. Somatic efferent and visceral
afferent - answer- 15 A. Somatic afferents are responsible for conveying pain,
pressure, touch, temperature, and proprioception to the CNS. Afferent fibers carry
only sensory stimuli, whereas efferent fibers convey motor information. Visceral
innervation is associated with the autonomic nervous system. Visceral afferents
generally carry information regarding the physiologic changes of the internal viscera
whereas visceral efferents deliver autonomic motor function to three types of tissue:
smooth muscle, cardiac muscle, and glandular epithelium. GAS 32-35; N 174; McM
211
16 A 15-year-old woman was suspected of having meningitis. To obtain a sample of
cerebrospinal fluid by spinal tap in the lumbar region (lumbar puncture), the tip of the
needle must be placed in which of the following locations? A. In the epidural space
B. Between anterior and posterior longitudinal ligaments C. Superficial to the
ligamentum flavum D. Between arachnoid mater and dura mater E. In the
subarachnoid space - answer- 16 E. CSF is found within the subarachnoid space
and is continuous with the ventricles of the brain (CSF flows from the ventricles to
the subarachnoid space). The epidural space, positioned between the dura mater
and periosteum, contains fat and the internal vertebral venous plexus (of Batson).
The subdural space, between the arachnoid mater and dura mater, exists only as a
potential space and does not contain cerebrospinal fluid. The anterior and posterior
longitudinal ligaments traverse the length of the vertebral bodies. GAS 106, 114-116;
N 166; McM 97
17. A 19-year-old man is diagnosed with a herniated disc but he has no symptoms of
spinal cord injury. In the event of intervertebral disc herniation in the cervical region,
which of the following ligaments is in an anatomic position to protect the spinal cord
from direct compression? A. Supraspinous B. Posterior longitudinal C. Anterior
longitudinal D. Ligamentum flavum E. Nuchal ligament - answer- 17 B. The posterior
,longitudinal ligament is the only ligament spanning the posterior aspect of the
vertebral bodies and intervertebral discs. With inter vertebral disc herniation, the
nucleus pulposus of the intervertebral disc protrudes posterolaterally. The anterior
longitudinal ligament traverses the anterior side of the vertebral bodies and thus
would not protect the spinal cord from direct compression. The supraspinous and
ligamentum flavum ligaments connect the spinous processes and the laminae of
adjacent vertebrae, respectively. The nuchal ligament is a continuation of the
supraspinous ligaments near the C7 vertebrae and runs to the occipital
protuberance. GAS 80-81; N 159; McM 94
18 In spinal anesthesia, the needle is often inserted between the spinous processes
of the L4 and L5 vertebrae to ensure that the spinal cord is not injured. This level is
safe because in the adult the spinal cord usually terminates at the disc between
which of the following vertebral levels? A. T11 and T12 B. T12 and L1 C. L1 and L2
D. L2 and L3 E. L3 and L4 - answer- 18 C. This is the location of the conus
medullaris, a tapered conical projection of the spinal cord at its inferior termination.
Although the conus medullaris rests at the level of L1 and L2 in adults, it is often
situated at L3 in newborns. The cauda equina and filum terminale extend beyond the
conus medullaris. GAS 99, 100; N 161; McM 97
19 A 22-year-old woman is diagnosed with Raynaud's disease. In such a case, the
patient suffers chronic vasospasm in response to cold. This can lead to arterial
constriction and painful ischemia, especially in the fingers or toes. Relief from the
symptoms in the hands would require surgical division of which of the following
neural elements? A. Lower cervical and upper thoracic sympathetic fibers B. Lower
cervical and upper thoracic ventral roots C. Lower cervical and upper thoracic dorsal
roots D. Lower cervical and upper thoracic spinal nerves E. Bilateral spinal
accessory nerves - answer- 19 A. The sympathetic division of the autonomic nervous
system is primarily responsible for vasoconstriction. Separation of ventral or dorsal
roots would lead to undesired consequences, such as a loss of motor or sensory
activity. Similarly, surgical division of spinal nerves would also have unwanted
consequences, but such are not related to the increased arterial constriction and the
painful ischemia in the digits. Division of selected sympathetic chain ganglia,
however, would decrease the sympathetic outflow to the upper limbs. GAS 38-39; N
163; McM 94-95
20 A 69-year-old woman visits her physician due to severe neck pain. Radiologic
studies reveal bony growths (osteophytes) in the intervertebral foramen between
vertebrae C2 and C3. Which of the following muscles would be most likely affected
by this condition? A. Rhomboideus major B. Serratus anterior C. Supraspinatus D.
Diaphragm E. Latissimus dorsi - answer- 20 D. The diaphragm is innervated by the
phrenic nerve, which arises from C3 to C5. The rhomboid, serratus anterior,
supraspinatus, and latissimus dorsi are innervated by the ventral rami of the brachial
plexus (C5 to T1). GAS 161-162; N 161; McM 194
21 A 42-year-old woman is diagnosed with stenosis of the cervical vertebral canal. A
laminectomy of two vertebrae is performed. Which of the following ligaments will
most likely also be removed? A. Anterior longitudinal B. Denticulate C. Ligamentum
flavum D. Nuchal E. Cruciate - answer- 21 C. The anterior longitudinal ligament runs
along the anterior-most aspect of the vertebral column from C1 to the sacrum and
, would therefore be unaffected by a laminectomy. Denticulate ligaments extend
laterally from the pia mater to the arachnoid mater along the length of the spinal
cord. The ligamentum flavum is one of the two ligaments found in the vertebral canal
and is adherent to the anterior aspect of the vertebral arches and often greatly
thickened in spinal pathology. It is thus simultaneously removed upon excision of the
lamina. The nuchal ligament is a thick longitudinal extension continuing from the
supraspinous ligament at the level of C7 to the external occipital protuberance
(inion). The cruciate ligament is an incorrect answer because it is located anterior to
the spinal cord, and thus would not be involved in laminectomy. GAS 80; N 159;
McM 98
22 A 28-year-old pregnant woman is admitted to the obstetrics department for
delivery. In the final stages of labor, a caudal anesthetic is administered via the
sacral hiatus. Into which of the following spaces in the sacral canal is the anesthetic
placed? A. Vertebral canal B. Vertebral venous plexus C. Epidural space D.
Subarachnoid space E. Subdural space - answer- 22 C. The vertebral canal is the
longitudinal canal that extends through the vertebrae, containing the meninges,
spinal cord, and associated ligaments. The internal vertebral venous plexus is the
mostly valveless network of veins extending longitudinally along the vertebral canal.
Neither of these answer choices describes a specific space. The spinal epidural
space is found superficially to the dura mater. It is a fat-filled space extending from
C1 to the sacrum. The subarachnoid space is a true space containing CSF. It is
found within the CNS and extends to the level of S2. The subdural space is a
potential space between the dura and the arachnoid mater. Normally, these two
layers are fused due to the pressure of CSF in the subarachnoid space. GAS 103-
110; N 166; McM 94, 96
23 A 12-year-old child was brought to the emergency department by his parents
because he has been suffering from a very high fever and severe stiffness in his
back. The initial diagnosis is meningitis. The attending physician orders a lumbar
puncture to confirm the diagnosis. Upon microscopic examination of the
cerebrospinal fluid, hematopoietic cells are seen. Which of the following ligaments
was most likely penetrated by the needle? A. Supraspinous B. Denticulate C.
Anterior longitudinal D. Posterior longitudinal E. Nuchal ligament - answer- 23 A.
Lumbar puncture is generally performed at the level of L4 or L5. The supraspinous
ligament extends between spinous processes on the dorsal aspect of the vertebrae.
The needle will bypass this structure. The denticulate ligaments are not correct
because they terminate with the conus medullaris at the level of L2 and are located
laterally. The anterior longitudinal ligament extends along the most anterior aspect of
the vertebral bodies and can be reached only ventrally. The posterior longitudinal
ligament is present at the correct vertebral level but will be punctured only if the
procedure is performed incorrectly as in this case, where hematopoietic cells were
aspirated from the vertebral body anterior to the ligament. The nuchal ligament
extends cranially from the supraspinous ligament in the lower cervical region to the
skull. GAS 103-110; N 159; McM 94, 96
24 A 25-year-old male racing car driver is admitted to the emergency department
after a severe car crash. Radiologic studies reveal damage to the tip of the
transverse process of the third cervical vertebra, with a significantly large pulsating
hematoma. What artery is the most likely to have been damaged? A. Anterior spinal
Questions and Answers
11 A 27-year-old man is admitted to the emergency department after a car crash.
Physical examination reveals weakness during medial rotation and adduction of the
humerus. Which of the following nerves was most probably injured? A.
Thoracodorsal B. Axillary C. Dorsal scapular D. Spinal accessory E. Radial - answer-
@ 11 A. The thoracodorsal nerve innervates the latissimus dorsi, one of major
muscles that adduct and medially rotate the humerus. The axillary nerve supplies the
deltoid muscle, the dorsal scapular nerve supplies the rhomboids and levator
scapulae muscles, and the spinal accessory nerve innervates the trapezius. None of
these nerves medially rotates or adducts the humerus. The radial nerve is
responsible for the innervation on the posterior aspect of the arm and forearm. The
medial and lateral pectoral nerves and the lower subscapular nerve supply the other
medial rotators of the humerus. GAS 87, 99; N 174; McM 101
12 A 39-year-old woman complains of an inability to reach the top of her head to
brush her hair with her right hand. History reveals that she had undergone a
mastectomy procedure of her right breast 2 months earlier. Physical examination
demonstrates winging of her right scapula. Which nerves were most likely damaged
during surgery? A. Axillary B. Spinal accessory C. Long thoracic D. Dorsal scapular
E. Thoracodorsal - answer- 12 C. The long thoracic nerve innervates the serratus
anterior, which is responsible for elevation and protraction of the scapula beyond the
horizontal level while maintaining its position against the thoracic wall. Along with the
thoracodorsal nerve, the long thoracic nerve runs superficially along the thoracic wall
and is subject to injury during a mastectomy procedure. The axillary nerve, the spinal
accessory nerve, and the thoracodorsal nerve supply the deltoid muscle, trapezius
muscle, and latissimus dorsi muscles, respectively. The dorsal scapular nerve is
responsible for innervation of the rhomboids and levator scapulae. Aside from the
long thoracic and thoracodorsal nerves, the remaining nerves do not course along
the lateral thoracic wall. GAS 726; N 180, 413; McM 140
13 A 19-year-old man is brought to the emergency department after dislocating his
shoulder while playing football. Following treatment of the dislocation, he cannot
initiate abduction of his arm. An MRI of the affected shoulder shows a torn muscle.
Which muscle was most likely damaged by the injury? A. Coracobrachialis B. Long
head of the triceps brachii C. Pectoralis minor D. Supraspinatus E. Teres major -
answer- 13 D. The rotator cuff muscles are common sites of damage during shoulder
injuries. These muscles include the supraspinatus, infraspinatus, teres minor, and
subscapularis (SITS). Initiation of abduction of the humerus (the first 15 degrees) is
performed by the supraspinatus, followed by the deltoid from 15 to 90 degrees.
Above the horizontal, the scapula is rotated by the trapezius and serratus anterior
muscles, causing the glenoid fossa to turn superiorly and allowing the humerus to
move above 90 degrees. The teres major and the pectoralis major are responsible
for medial rotation and adduction of the humerus. These muscles are therefore not
involved in abduction at the glenohumeral joint. GAS 711-712, 717; N 134-135; McM
411, 413
,14 A 1-year-old girl is brought to the clinic for a routine checkup. The child appears
normal except for a dimpling of the skin in the midline of the lumbar region with a tuft
of hair growing over the dimple. What is this relatively common condition that results
from incomplete embryologic development? A. Meningomyelocele B. Meningocele
C. Spina bifida occulta D. Spina bifida cystica E. Rachischisis - answer- 14 C. Spina
bifida is a developmental condition resulting from incomplete fusion of the vertebral
arches within the lumbar region. Spina bifida occulta commonly presents
asymptomatically with midline, lumbar, cutaneous stigmata such as a tuft of hair and
a small dimple. More severe forms (spina bifida cystica) are categorized into three
types: Spina bifida cystica with meningocele presents with protrusion of the
meninges through the unfused vertebral arches; spina bifida with myelomeningocele
is characterized by protrusion both of the meninges and central nervous system
(CNS) tissues and is often associated with neurologic deficits; and rachischisis, also
known as spina bifida cystica with myeloschisis, results from a failure of neural folds
to fuse and is characterized by protrusion of the spinal cord or spinal nerves and
meninges. GAS 74; N 14, 160; McM 77, 88
15 A young resident complains of an itch on his back that appears to be caused by
an insect bite. Which nerve fibers carry the sensation of a mosquito bite on the back,
just lateral to the spinous process of the T4 vertebra? A. Somatic afferent B. Somatic
efferent C. Visceral afferent D. Visceral efferent E. Somatic efferent and visceral
afferent - answer- 15 A. Somatic afferents are responsible for conveying pain,
pressure, touch, temperature, and proprioception to the CNS. Afferent fibers carry
only sensory stimuli, whereas efferent fibers convey motor information. Visceral
innervation is associated with the autonomic nervous system. Visceral afferents
generally carry information regarding the physiologic changes of the internal viscera
whereas visceral efferents deliver autonomic motor function to three types of tissue:
smooth muscle, cardiac muscle, and glandular epithelium. GAS 32-35; N 174; McM
211
16 A 15-year-old woman was suspected of having meningitis. To obtain a sample of
cerebrospinal fluid by spinal tap in the lumbar region (lumbar puncture), the tip of the
needle must be placed in which of the following locations? A. In the epidural space
B. Between anterior and posterior longitudinal ligaments C. Superficial to the
ligamentum flavum D. Between arachnoid mater and dura mater E. In the
subarachnoid space - answer- 16 E. CSF is found within the subarachnoid space
and is continuous with the ventricles of the brain (CSF flows from the ventricles to
the subarachnoid space). The epidural space, positioned between the dura mater
and periosteum, contains fat and the internal vertebral venous plexus (of Batson).
The subdural space, between the arachnoid mater and dura mater, exists only as a
potential space and does not contain cerebrospinal fluid. The anterior and posterior
longitudinal ligaments traverse the length of the vertebral bodies. GAS 106, 114-116;
N 166; McM 97
17. A 19-year-old man is diagnosed with a herniated disc but he has no symptoms of
spinal cord injury. In the event of intervertebral disc herniation in the cervical region,
which of the following ligaments is in an anatomic position to protect the spinal cord
from direct compression? A. Supraspinous B. Posterior longitudinal C. Anterior
longitudinal D. Ligamentum flavum E. Nuchal ligament - answer- 17 B. The posterior
,longitudinal ligament is the only ligament spanning the posterior aspect of the
vertebral bodies and intervertebral discs. With inter vertebral disc herniation, the
nucleus pulposus of the intervertebral disc protrudes posterolaterally. The anterior
longitudinal ligament traverses the anterior side of the vertebral bodies and thus
would not protect the spinal cord from direct compression. The supraspinous and
ligamentum flavum ligaments connect the spinous processes and the laminae of
adjacent vertebrae, respectively. The nuchal ligament is a continuation of the
supraspinous ligaments near the C7 vertebrae and runs to the occipital
protuberance. GAS 80-81; N 159; McM 94
18 In spinal anesthesia, the needle is often inserted between the spinous processes
of the L4 and L5 vertebrae to ensure that the spinal cord is not injured. This level is
safe because in the adult the spinal cord usually terminates at the disc between
which of the following vertebral levels? A. T11 and T12 B. T12 and L1 C. L1 and L2
D. L2 and L3 E. L3 and L4 - answer- 18 C. This is the location of the conus
medullaris, a tapered conical projection of the spinal cord at its inferior termination.
Although the conus medullaris rests at the level of L1 and L2 in adults, it is often
situated at L3 in newborns. The cauda equina and filum terminale extend beyond the
conus medullaris. GAS 99, 100; N 161; McM 97
19 A 22-year-old woman is diagnosed with Raynaud's disease. In such a case, the
patient suffers chronic vasospasm in response to cold. This can lead to arterial
constriction and painful ischemia, especially in the fingers or toes. Relief from the
symptoms in the hands would require surgical division of which of the following
neural elements? A. Lower cervical and upper thoracic sympathetic fibers B. Lower
cervical and upper thoracic ventral roots C. Lower cervical and upper thoracic dorsal
roots D. Lower cervical and upper thoracic spinal nerves E. Bilateral spinal
accessory nerves - answer- 19 A. The sympathetic division of the autonomic nervous
system is primarily responsible for vasoconstriction. Separation of ventral or dorsal
roots would lead to undesired consequences, such as a loss of motor or sensory
activity. Similarly, surgical division of spinal nerves would also have unwanted
consequences, but such are not related to the increased arterial constriction and the
painful ischemia in the digits. Division of selected sympathetic chain ganglia,
however, would decrease the sympathetic outflow to the upper limbs. GAS 38-39; N
163; McM 94-95
20 A 69-year-old woman visits her physician due to severe neck pain. Radiologic
studies reveal bony growths (osteophytes) in the intervertebral foramen between
vertebrae C2 and C3. Which of the following muscles would be most likely affected
by this condition? A. Rhomboideus major B. Serratus anterior C. Supraspinatus D.
Diaphragm E. Latissimus dorsi - answer- 20 D. The diaphragm is innervated by the
phrenic nerve, which arises from C3 to C5. The rhomboid, serratus anterior,
supraspinatus, and latissimus dorsi are innervated by the ventral rami of the brachial
plexus (C5 to T1). GAS 161-162; N 161; McM 194
21 A 42-year-old woman is diagnosed with stenosis of the cervical vertebral canal. A
laminectomy of two vertebrae is performed. Which of the following ligaments will
most likely also be removed? A. Anterior longitudinal B. Denticulate C. Ligamentum
flavum D. Nuchal E. Cruciate - answer- 21 C. The anterior longitudinal ligament runs
along the anterior-most aspect of the vertebral column from C1 to the sacrum and
, would therefore be unaffected by a laminectomy. Denticulate ligaments extend
laterally from the pia mater to the arachnoid mater along the length of the spinal
cord. The ligamentum flavum is one of the two ligaments found in the vertebral canal
and is adherent to the anterior aspect of the vertebral arches and often greatly
thickened in spinal pathology. It is thus simultaneously removed upon excision of the
lamina. The nuchal ligament is a thick longitudinal extension continuing from the
supraspinous ligament at the level of C7 to the external occipital protuberance
(inion). The cruciate ligament is an incorrect answer because it is located anterior to
the spinal cord, and thus would not be involved in laminectomy. GAS 80; N 159;
McM 98
22 A 28-year-old pregnant woman is admitted to the obstetrics department for
delivery. In the final stages of labor, a caudal anesthetic is administered via the
sacral hiatus. Into which of the following spaces in the sacral canal is the anesthetic
placed? A. Vertebral canal B. Vertebral venous plexus C. Epidural space D.
Subarachnoid space E. Subdural space - answer- 22 C. The vertebral canal is the
longitudinal canal that extends through the vertebrae, containing the meninges,
spinal cord, and associated ligaments. The internal vertebral venous plexus is the
mostly valveless network of veins extending longitudinally along the vertebral canal.
Neither of these answer choices describes a specific space. The spinal epidural
space is found superficially to the dura mater. It is a fat-filled space extending from
C1 to the sacrum. The subarachnoid space is a true space containing CSF. It is
found within the CNS and extends to the level of S2. The subdural space is a
potential space between the dura and the arachnoid mater. Normally, these two
layers are fused due to the pressure of CSF in the subarachnoid space. GAS 103-
110; N 166; McM 94, 96
23 A 12-year-old child was brought to the emergency department by his parents
because he has been suffering from a very high fever and severe stiffness in his
back. The initial diagnosis is meningitis. The attending physician orders a lumbar
puncture to confirm the diagnosis. Upon microscopic examination of the
cerebrospinal fluid, hematopoietic cells are seen. Which of the following ligaments
was most likely penetrated by the needle? A. Supraspinous B. Denticulate C.
Anterior longitudinal D. Posterior longitudinal E. Nuchal ligament - answer- 23 A.
Lumbar puncture is generally performed at the level of L4 or L5. The supraspinous
ligament extends between spinous processes on the dorsal aspect of the vertebrae.
The needle will bypass this structure. The denticulate ligaments are not correct
because they terminate with the conus medullaris at the level of L2 and are located
laterally. The anterior longitudinal ligament extends along the most anterior aspect of
the vertebral bodies and can be reached only ventrally. The posterior longitudinal
ligament is present at the correct vertebral level but will be punctured only if the
procedure is performed incorrectly as in this case, where hematopoietic cells were
aspirated from the vertebral body anterior to the ligament. The nuchal ligament
extends cranially from the supraspinous ligament in the lower cervical region to the
skull. GAS 103-110; N 159; McM 94, 96
24 A 25-year-old male racing car driver is admitted to the emergency department
after a severe car crash. Radiologic studies reveal damage to the tip of the
transverse process of the third cervical vertebra, with a significantly large pulsating
hematoma. What artery is the most likely to have been damaged? A. Anterior spinal
