Arthrology of the Vertebral Column Flashcards
What is the maximum number of common ligaments identified with a vertebral couple?
eight
What is the reason that nine common ligaments are identified but only right will be attached at any specific vertebral couple?
the ligamentum nuchae and supraspinous ligament attach to the spinous tubercles, but only one of these will be identified at a single vertebral couple
What is the number of true intervertebral discs identified in the adult?
twenty-three
In the adult, which vertebral levels will demonstrate a true intervertebral disc?
those between C2 and S1 inclusive
What is the percent of intervertebral disc height contribution to the length of each region of the vertebral column?
cervical 22-25%…thoracic 20%…lumbar 33%
What are the names of central, peripheral, and horizontal zones of the intervertebral disc?
nucleus pulposus…central zone, annulus fibrosis…peripheral zone, cartilagenous end plate…horizontal zone
What is the cervical nucleus pulposus composed of?
fibrocartilage
What is the consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus?
the nucleus pulposus will loose water under deformation conditions
What cell is associated with nucleus pulposus until about age 11?
notochord cells
What type of collagen is dominate in the nucleus pulposus?
collagen type II
What is the organizational pattern for collagen fibers in the nucleus pulposus?
they are irregularly oriented and randomly scattered
What is the appearance of the cervical annulus fibrosus?
a horse-shoe with the anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
What compensates for the thinness of the posterior part of the cervical annulus fibrosus?
posterior longitudinal ligament
What is the organization of the lumbar annulus fibrosus?
it has 12-14 concentric cylindrical lamellae
What is the water concentration in the lumbar annulus fibrosus at birth and after 30?
birth…78%; after 30…70%
What is the organizational pattern for glycosaminoglycans in the lumbar annulus fibrosus?
they typically have a binding sit for for hyaluronic acid and thus are aggregated
What type of collagen is dominant in the annulus fibrosus?
type I collagen
What is the organizational pattern for collagen fibers in the annulus fibrosus?
they are parallel with one another in a single lamellas and angled
What is the organization of collagen fibers between lamellae?
collagen fibers will be angled in the opposite direction such that a spiral - counter spiral organization is observed
What is the attachment site for collagen fibers within the annulus fibrosus?
collagen fibers of the outer lamellae will become Sharpey’s fibers and penetrate the epiphyseal rims; collagen fibers of the inner lamellae will attach to the cartilaginous end plate
What is the origin for the cells of the annulus fibrosus?
sclerotomites
What is the principal type of collagen fiber within the cartilage end plate?
the type two collagen fiber
What is the direction of collagen fibers within the cartilage end plate?
collagen fibers are aligned anterior to posterior
What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus?
the cartilaginous end plate
What are the types of receptor endings in the intervertebral disc?
nociceptors and proprioceptors
What morphological classifications of receptor endings are present in the intervertebral disc?
free nerve endings, Pacinian corpuscles, Golgi tendon organs, Ruffini endings and Meissner’s corpuscles
What is the relationship between the size of the the intervertebral disc and receptor endings?
the larger the disc, the greater the variety of receptor endings
What part of the intervertebral disc is innervated by the recurrent meningeal/sinu-vertebral/sinus vertebral nerve?
the outer lamellae of the annulus fibrosis at the posterior part of the intervertebral disc
What forms the anterior neural plexus of the vertebral column?
fibers from the ventral primary ramus
What forms the lateral neural plexus of the vertebral column?
fibers from the ventral primary rams, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
What is the name given to the white ramus communicanswhich becomes embedded within the annulus fibrosus of the intervertebral disc?
the paradiscal ramus communicans
What part of the intervertebral disc is innervated by fibers from the paradiscal ramus communicans?
the outer lamellae of the annulus fibrosus at the lateral part of the intervertebral disc
How does the intervertebral disc attach to the vertebral body?
Sharpey’s fibers from the outer lamellae of the annulus fibrosus are firmly embedded into the epiphyseal rims of the adjacent vertebral bodies
Based on histology, what is the classification of the intervertebral disc?
a cartilaginous (amphiarthrosis) symphysis
What are the divisions of the embryonic somite?
the sclerotome, myotome, and dermatome
What structure is formed following migration of the sclerotomes to surround the notochord?
the perichordal blastema
What is formed within the perichordal blastema between the sclerotomites?
the intrasclerotomal fissure or fissure of von Ebner
What does the sclerotomal fissure or fissure of von Ebner become?
the perichordal disc
What will the dense sclerotomite become?
the upper part of the vertebral segment forming below
What structure forms following the migration and subsequent missing of the sclerotomites?
the vertebral blastema
What part of the intervertebral disc will the notochord form?
the nucleus pulposus
What part of the intervertebral disc will the perichordal disc form?
the annulus fibrosus
What is the earliest indicator of the position of the adult intervertebral disc?
the intrasclerotomal fissure or fissure of von Ebner
What vertebral levels will the anterior longitudinal ligament attach to?
those between occiput and S3 inclusive are traditionally indicated
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
What is believed to form the anterior longitudinal ligament in the lumbar spine?
the tendon of the crura of the diaphragm
What innervates the anterior longitudinal ligament?
the anterior neural plexus formed by the fibers from the ventral primary ramus and the sympathetic postganglionic fibers from the paravertebral ganglia
What is the function of the anterior longitudinal ligament?
it brake or limits dorsi-flexionof hyperextension of the vertebral column
What was the ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s Disease
What is ossification of the anterior longitudinal ligament in the lumbar region now identified as?
Diffuse Idiopathic Skeletal Hyperostosis (DISH)
Newer research suggests what regional variation in the posterior longitudinal ligament ?
prominent in the cervicals, occasional in the thoracics, rare in the lumbars
What is the relationship of the posterior longitudinal ligament to the vertebral foramen?
it forms the anterior boundary of the spinal canal
What is the innermost layer of the posterior longitudinal ligament called?
the perivertebral ligament
What is the function of the posterior longitudinal ligament?
it breaks or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified?
the cervical spine with an 80% increase
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
a loss of hand and finger dexterity
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine?
faltering gait
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament?
it is greatest in males over 50 and has a higher incidence in the Japanese
What is the name given to the ligamentum flavum based on appearance and histology?
it is a yellow elastic ligament
What fibers are most ligaments made up of?
collagen type I fibers which are whitish in appearance
Where is ossification of the ligamentum flavum most commonly identified?
the thoracic spine or thoracolumbar transition zone
What is the relationship between the capsular ligament and mobility?
the more lax/loose the capsular ligament is, the greater the motion of the joint
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
the cervical and lumbar regions
What layers are present in the capsular ligament?
a superficial layer of collagen fibers and a deep layer of elastic fibers
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its’ function?
it is probably involved in propioceptive feedback to the muscles stabilizing the vertebral couple during movement
What is now thought to be a major function of the interspinous ligament?
it is more likely a proprioceptive transducer for the spinal reflex
What is the name given to the superficial layer of ligamentum nuchae?
the funicular layer or part
What is the name given to the deep layer of ligamentum nuchae?
the lamellar layer or part
What are the attachment sites for the superficial layer of the ligamentum nuchae?
the external occipital protuberance, external occipital crest, and spinous tubercle of C7
What is the histological makeup of the human ligamentum nuchae?
it is a yellow elastic ligament, but has more collagen fibers than quadrupeds
What is the classic function of the human ligament nuchae?
it brakes or limits flexion of the cervical spine
What is the termination level inferiorly for the supraspinous ligament accoring to current literature?
primarily at L4 (73%); between L4 and L5 (5%)
What is now thought to be a major function of the supraspinous ligament?
it is a proprioceptive transducer for the spinal reflex
What amount of flexion’extension is accommodated by the atlanto-occipital joint?
about twenty-fiver degrees
What amount of axial rotation is accommodated by the atlanto-occipital joint?
about three to eight degrees one side axial rotation
What amount of lateral bending is accommodated by the atlanto-occipital joint?
about 5 degrees
Which motion is best accommodated by the atlanto-occipital joint?
flexion-extension
What is the function of the transverse atlantal ligament?
it is the primary stabilizer of the antlanto-axil joint restricting the distance of C2 from the anterior arch of C!1
What movements are facilitated at the median atlanto-axial joint?
flexion-extension, rotation, telescoping (superior-inferior gliding)
What is the ADI?
the Atlanto-Dental Interspace, a radiographic dstance between the surfaces of the anterior bursa of the median antlanto-axial joint
What is the ADI of children compared with that of adults?
about 4.5mm in children ; a range of 2-3mm in adults or about 2.5mm in adults
What are the degrees of movement facilitated at the atlanto-axial joint?
about 20 degrees flexion-extension, 40 degrees one side axial roation, and 5 degrees of lateral bending
The occiput-C1-C2 joint complex accounts for what percent of all cervical axial rotation?
about 60%
What is the embryonic derivative of the apical ligament of the dens or the apicodental ligament?
the notochord
What is the function of the alar ligament?
together they function to resist axial rotation
What forms the cranial continuation of the posterior longitudinal ligament?
the membrana tectoria or tectorial membrane
List in order, the ligaments in a midsagital plane from the dura mater at the level of the medulla oblongata to the anterior bursa of the median antlanto-axial joint.
the membrana tectoria or tectorial membrane
the cruciate ligament
the capsular ligament of the posterior bursa of the median atlanto-axial joint
the apical ligament of the dens or apicodental ligament
For the cervical spine below C2, what is the range of flexion-extension?
about 90 degrees or about 18 degrees per couple
For the cervical spine below C2, what is the range of one side lateral bending?
about 50 degrees or about 10 degrees per couple
For the cervical spine below C2, what is the range of one side axial rotation?
about 3 degrees or about 6 degrees per couple
What are the locations of the costovertebral joints on the vertebra?
the costocentral joint at the vertebral body and the costotransverse joint at the transverse process
At what rib will the superior costotransverse ligament be absent?
the first rib
What ligaments will attach to the neck of the twelfth rib?
the superior costotransverse ligament from T11 and the lumbocostal ligament from L1
What are the attachment sites for the inferior costotransverse ligaments?
the neck of the rib and the transverse process of the vertebra at that level
At what rib will the inferior costotransverse ligament be absent?
T12
What is the name given to the space between the transverse process and the neck of the rib?
the costotransverse foramen
What ligament fills the costotransverse foramen?
the inferior costotransverse ligament
What are the attachment sites for the lateral costotransverse ligament?
the non-articular surface of the tubercle of the rib and the transverse tubercle of the transverse process of the vertebra at that level
Which vertebra will lack an attachment for the lateral costotransverse ligament?
T12
Which vertebral couples of the thoracic spine have the greatest motion?
T11/T12 and T12/L1
Which range of motion is greatest for lower thoracic vertebral couples?
flexion-extension
Which range of motion is least for lower thoracic vertebral couples?
one side axial rotation
Which ligaments replace the intertransverse ligament at the lumbosacral joint?
the iliolumbar ligament and lumbosacral ligament
What muscle is intimately attached to the superior iliolumbar ligament?
quadratus lumborum
Which of the current ligaments from the iliolumbar ligament complex represents the iliolumbar ligament in the classical description?
the superior iliolumbar ligament
Which ligament from the iliolumbar ligament complex will attach to the sacral ala?
the inferior iliolumbar ligament
Which ligament from the iliolumbar ligament complex represents the lumbosacral ligament of classical descriptions?
the inferior iliolumbar ligament
What are the attachment sites of the for the accessory iliolumbar ligament?
the transverse process of L4 and the iliac crest
Which vertebral couple of the lumbar spine has the greatest range of motion?
L5/S1
Which range of motion is greatest for all lumbar vertebral couples?
flexion-extension
What range of motion is least for L1-L5 vertebral couples?
one side axial rotation
What range of motion is least for the L5/S1 vertebral couple?
one side lateral bending
List in order from cranial to caudal the ligaments forming the anterior boundary of the spinal canal.
the membrana tectoria, posterior longitudinal ligament and the deeo posterior sacrococcygeal ligament
What ligament represents the homolog of the ligamentum flavum at the sacrococcygeal joint?
the superficial posterior sacrococcygeal ligament
list in order from cranial to caudal the ligaments forming the posterior boundary of the spinal canal?
the posterior atlanto-occipital ligament, posterior atlanto-axial ligament, ligamentum flavum and the superficial posterior sacrococcygeal ligament
What is the articular surface of the ilium composed of?
articular cartilage, interspersed with fibrocartilage
What does ankylosis mean?
a condition of fibrous adhesion occurs within the joint
What is the age and surface bias associated with degenerative arthrosis of the sacro-iliac joint
age 40, the iliac auricular surface
What is the age an gender bias associated with ankylosis of the sacro-iliac joint?
age 50 and male bias particularly in African American males
What is the relationship between the capsular and interosseus sarcoiliac ligaments?
the interosseus sacro-iliac ligament replaces the capsular ligament posteriorly
What passes between the layers of the interosseus sacro-iliac ligament?
dorsal rami from the sacral spinal nerves
