Arthrology of the Vertebral Column Flashcards
What is the latin term for joint?
arthron
What fibrous connective tissue classically fills the joint space in a syndesmosis?
interosseous ligament
What protein fiber is the dense connective tissue primarily composed of?
collagen fibers which give it a whitish color
Besides collagen, what other proteins are ligaments composed of?
elastin fibers which can give a yellowish tinge to the ligament
What are the characteristics of a (amphiarthrosis) symphysis?
limited motion, median plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
What are the characteristics of type I articular receptors?
located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint “at rest”
What are the characteristics of type II articular receptors?
located in deeper strata of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
What are the characteristics of type III articular receptors?
present in collateral and intrinsic ligaments, resemble golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion
What is the function of type IV articular receptors?
nociceptive, they monitor pain
Type IVa articular receptors would be present in what locations?
fibrous capsule, articular fat pads, or adventitia of blood vessels
Type IVb articular receptors would be present in what locations?
accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
What are the three modifications of articular synovial membrane?
(1) synovial villi, (2) articular fat pads or Haversian glands, (3) synovial menisci and intra-articular discs
What is the generic function of modifications of articular synovial membrane?
aid in spreading synovial fluid
What is the apparent function of synovial villi?
increase the surface of synovial membrane available for secretion - absorption phenomena
Articular fat pads are most numerous in what location along the vertebral column?
lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartillage projections of the synovial membrane are called ______
synovial menisci or intra-articular discs
Synovial menisci are a feature of what joint examples?
femur-tibia articulation, cervical zygapophyses, and lumbar zygapophyses
What are the layers of the synovial membrane?
outer fibrous layer and an inner (lumenal) cellular layer AKA synovial lamina intima
What are the specific functions of type A synovial cells?
are phagocytic
What is the specific function of type B synovial cells?
secrete proteinaceous substances and hyaluronic acid
What is the common function of type A and Type B synovial cells?
formation and absorption of synovial fluid
What is the source of nutrition for articular cartilage?
blood vessels in the synovial membrane, sinuses of the bone marrow cavity, and from synovial fluid itself
What is unique about the surface of articular cartilage?
a true perichondrium is absent
Which collagen fiber type predominates in articular cartilage?
type II
What is the primary function of bound glycosaminoglycans?
form a network for water retention
Cartilage is able to change shape due to compression, a characteristic known as _______.
deformation
What is implied when cartilage is said to have elastic properties?
cartilage can deform and returns to original volume rapidly, a time independent property
What is implied when cartilage is said to have viscoelastic properties?
cartilage can deform but returns to original volume slowly, a time dependent property
What is the function of articular cartilage?
to provide a wear-resistant, low friction, easily lubricated surface for joint movement
What are the properties of synovial fluid?
it is yellow-white, viscous, slightly alkaline, and tastes salty
Synovial fluids consists of what specific chemical groups?
fats, salts, albumins, and hyaluronate
Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?
hyaluronate
What substance of synovial fluid has been proposed to be responsible for its viscocity and lubricating behavior?
lubricin
What are the classifications of synovial joints (diarthroses) based on the number of articulating surfaces?
simple and compound synovial joints
What is a complex synovial joint (diarthrosis)?
within the simple joint or the compound joint, the articulating surfaces are separated by an articular disc (intra-articular disc) or meniscus
What morphological classification of synovial joints is classified as nonaxial?
plane (diarthrosis arthrodia)
What morphological classifications of synovial joints would be classified as uniaxial?
hinge (diarthrosis ginglymus) and pivot (diarthrosis trochoid)
What morphological classifications of synovial joints would be classified as biaxial?
(diarthrosis) bicondylar, (diarthrosis) condylar, (diarthrosis) ellipsoidal, and saddle (diarthrosis sellar)
What morphological classifications of synovial joints would be classified as multiaxial?
ball and socket (diarthrosis enarthrosis), (diarthrosis spheroidal), (diarthrosis cotyloid) are all classifications given to the same type of joint
Diarthrosis ginglymus joints are commonly called ________ joints based on action.
synovial hinge
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 eight will be attached at any specific vertebral couple?
the ligamentum nuchae and supraspinous ligaments 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 inclusively
What percent of the vertebral column length is contributed by the intervertebral disc?
twenty to twenty-five percent
What is the percent of intervertebral disc height contribution to cervical region length?
cervical .. 22-25%
What is the percent of intervertebral disc height contribution to thoracic region length?
thoracic.. 20%
What is the percent of intervertebral disc height contribution to lumbar region length?
lumbar.. 33%
What is the cervical nucleus pulposus composed of?
fibrocartilage
What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?
birth… 88%; thirty…70%
What cell is associated with the nucleus pulposus until about age eleven?
notochord cells
What cells are associated with the mature nucleus pulposus?
reticulocyte-fibroblast and chondroblast
Which type of collagen is dominant 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 unusual about the cervical annulus fibrosus?
it lacks any lamellar or layered organization
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 bith and after thirty?
birth… 78%; thirty…70%
Which type of collagen is dominant in the annulus fibrosus?
collagen type I
What is the organizational pattern for collagen fibers in the annulus fibrosus?
they are parallel with one another in a single lamellus and angled
What is the organization of collagen fibers between lemellae?
collagen fibers will be angled in the opposite direction such that a spiral - counterspiral organization is observed
What is the average angle of collagen fibers within the annulus fibrosus?
they average 50 to 60 degrees
What is the thickest part of the cartilage end plate?
around the periphery
What is the principle type of collagen fiber within the cartilage end plate?
the type II 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 is the relationship between size of the intervertebral disc and receptor endings?
the larger the disc, the greater the variety of receptor endings
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?
they provide feedback during extension
What innervates the annulus fibrosus at the posterior part of the intervertebral disc?
the recurrent meningeal/sinu-vertebral/sinus vertebral nerve
What innervates the annulus fibrosus at the anterior part of the intervertebral disc?
fibers from the ventral primary ramus
What innervates the annulus fibrosus at the lateral part of the intervertebral disc?
fibers from the ventral primary ramus, 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 communicans which becomes embedded within the annulus fibrosus of the intervertebral disc?
the paradiscal ramus communicans
What is the popular theory of intra-abdominal cavity pressure and intervertebral disc response to weight bearing?
increasing the intra-abdominal cavity pressure will diminish the amount of resistance the intervertebral disc needs to generate by up to 50%
What part of the intervertebral disc will allow distribution of weight over a maximum surface area?
the nucleus pulposus
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 the function of the anterior longitudinal ligament?
it brakes or limits dorsi-flexion or hyperextension of the vertebral column
What was the ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s Disease
Anterior longitudinal ligament ossification in the lumbar region is now identified as ______?
Diffuse Idiopathic Skeletal Hyperostosis or DISH
What vertebral levels will the posterior longitudinal ligament attach to?
those between C2 and S3 inclusive are traditionally indicated
What is the innermost layer of the posterior longitudinal ligament called?
the perivertebral ligament
What is the function of the posterior longitudinal ligament?
it brakes or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified?
the cervical spine with an 80% incidence
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
a loss of hand and finger dexterity
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine?
about 10% at the thoracic and 10% at the lumbar spine
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 greater in males over 50 and has a higher incidence in the Japanese
What is the acronym for ossification of the posterior longitudinal ligament?
OPLL
At one time ossification of the posterior longitudinal ligament was an example of what condition?
Diffuse Idiopathis Skeletal Hyperostosis or DISH
What vertebral levels will the ligamentum flavum be attached to?
those between C2 and S1 inclusively are traditionally indicated
What is the relationship of the ligamentum flavum to the vertebral foramen?
it forms the posterior boundary of the spinal canal
What is the histology of the ligamentum flavum?
it is formed primarily with elastic fibers, which are yellow in appearance
What is the function of the ligamentum flavum?
it brakes or limits flexion of the vertebral column
What is now thought to be a major function of the ligamentum flavum?
it is an early prime factor in extension of the vertebral column
Where is ossification of the ligamentum flavum most commonly identified?
the thoracic spine or thoracolumbar transition zone
What is the acronym for ossification of the ligamentum flavum?
OLF
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
The capsular ligament will blend with which other common ligament?
the ligamentum flavum
What muscle will blend with the capsular ligament posteriorly?
the multifidis
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its’ function?
it is probably involved in proprioceptive feedback to the muscles stabilizing the vertebral couple during movement
What verebral levels will the interspinous ligament be attached to?
those between C2 and S1 inclusive are traditionally indicated
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 will the ligamentum nuchae be attached to?
the external occipital protuberance, external occipital crest, the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C7 inclusive are traditionally indicated
What is the name given to the superficial layer of the ligamentum nuchae?
the funicular layer or part
What is the name given to the deep layer of the 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 make-up of the ligamentum nuchae in quadrupeds?
it is a yellow elastic ligament
What is the histological make-up of the human ligamentum nuchae?
it is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
What is the primary yellow elastic or elastic ligament of the spine?
the ligamentum flavum
What is the classic function of the human ligamentum nuchae?
it brakes or limits flexion of the cervical spine
What will the supraspinous ligament be attached to?
the spinous tubercles along the vertebral column from C7 to sacrum
What is the termination level inferiorly for the supraspinous ligament according to current literature?
primarily at L4 (73%); between L4 and L5 (5%)
Where is the supraspinous ligament said to be best developed?
in the lumbar spine
What is the classic function of the human supraspinous ligament?
it brakes or limits flexion of the spine
What is now thought to be a major function of the supraspinous ligament?
it is a proprioceptive transducer for the spinal reflex
What will the intertransverse ligament be attached to?
the transverse tubercles and transverse processes of adjacent vertebrae along the vertebral column from C1 to L5
What is the status of the cervical intertransverse ligament?
it is said to be paired with an anterior and a posterior intertransverse ligament present
What is the status of the lumbar intertransverse ligament?
it is well developed with two parts identified, a ventral slip and a dorsal slip
What part of the lumbar intertransverse ligament covers the intervertebral foramen?
the ventral slip
What part of the intertransverse ligament in the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment?
the dorsal slip
What are the characteristics of the capsular ligament of the atlanto-occipital joint?
it is said to be loose, thin, and composed of collagen fibers
What other joint space does the atlanto-occipital joint communicate with?
the posterior bursa of the medial atlanto-axial joint
What is the median thickening of the anterior atlanto-occipital ligament called?
the anterior longitudinal ligament
What is the classic function of the anterior atlanto-occipital ligament?
it brakes or limits “extension” of the skull over the cervical spine
Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?
an incomplete ponticulus ponticus or a complete ponticulus ponticus
What other name may be used to identify a ponticulus posticus?
Kimmerle’s anomaly
What names are given to the opening formed by the ponticulus posticus?
arcuate foramen or retroarticular canal
What is the classic function of the posterior atlanto-occipital ligament?
it brakes or limits axial rotation, flexion, and perhaps lateral bending of the skull on atlas
What amount of flexion-extension is accommodated by the atlanto-occipital joint?
about twenty-five 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 five degrees
Which motion is best accommodated by the atlanto-occipital joint?
flexion - extension
Which atlanto-axial joint is identified as a synovial pivot (diarthrosis trochoid)?
the median atlanto-axial joint
What are the names given to the synovial joint spaces of the medial atlanto-axial joint?
the anterior bursa and the posterior bursa
What are the joint surfaces of the median atlanto-axial joint at the anterior bursa?
the fovea dentis of C1 and the facet for the fovea dentis of C2
What are the joint surfaces of the median atlanto-axial joint at the posterior bursa?
the groove for the transverse atlantal ligament of C2 and the transverse atlantal ligament
What ligament is formed by the transverse atlantal ligament and its perpendicular extension?
the cruciate ligament or cruciform ligament
What is the function of the transverse atlantal ligament?
it is the primary stabilizer of the atlanto-axial joint restricting the distance of C2 from the anterior arch of C1
What is the ADI?
the Atlanto-Dental interspace, a radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint
What is the ADI of children compared with that of an adult?
about 4.5 mm in children,; a range of 2-3 mm or about 2.5 mm in adults
What are the characteristics of the capsular ligament of the lateral atlanto-axial joint?
it is lax or loose and demonstrates a meniscoidal fold within the joint cavity
What are the degrees of movement facilitated at the atlanto-axial joint?
about 20 degrees flexion-extension, 40 degrees one side axial rotation, and 5 degrees of lateral bending
The occiput-C1-C2 complex accounts for what percent of all cervical axial rotation?
about 60%
What is the name given to the occipital-C2 region of the spine?
the craniovertebral junction
Embryologically, what forms the apical ligament of the dens or the apicodental ligament?
the notochord
What is the function of the apical ligament of the dens or the apicaldental ligament?
it has no known function
What ligament attaches to the posterolateral part of the odontoid process of C2 and to surfaces on the medial border of the occipital condyle or as far anterior as the anterolateral margin of the foramen magnum?
the alar ligament
What is the function of the alar ligament?
together they function to resist axial rotation
Which ligament lies behind the alar ligaments?
the cruciate ligament, specifically the superior crus ligament
what are the layers of the membrana tectoria or tectorial membrane?
a superficial and a deep layer are identified
The superficial layer of the membrana tectoria or tectorial membrane lies in front of what structure?
the dura mater of the medulla oblongata and the spinal cord
What is the function of the membrana tectoria or tectorial membrane?
it resists flexion and extension of the skull on the upper cervical spine
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 33 degrees or about 6 degrees per couple
Which vertebrae 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 are the attachment sites for the lumbosacral ligament?
the sacral ala and ventrolateral surface of sacrum attach to the transverse process of L5
What are the attachment sites for the iliolumbar ligament?
the iliac crest is attached to the transverse process of L5
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 of classic description?
the superior iliolumbar ligament
Which of the current ligaments from the iliolumbar ligament complex represents the lumbosacral ligament of classic description?
the inferior iliolumbar ligament
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
Which range of motion is least for L1-L5 vertebral couples?
one side axial rotation
Which 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 COLUMN.
the anterior atlanto-occipital ligament, anterior atlanto-axial ligament, anterior longitudinal ligament, and the anterior sacrococcygeal ligament
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 deep 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 auricular surface of sacrum composed of?
true articular cartilage, a modification of hyaline cartilage
What is the auricular surface of the ilium composed of?
articular cartilage, interspersed with fibrocartilage
What is the superficial appearance of the auricular surfaces of the sacro-iliac joint by age 15?
the sacrum develops a sacral groove while the ilium develops an iliac ridge
Which gender has greater unevenness of the auricular surface of the sacro-iliac joint?
males
What pathological or age-related modifications of the sacroiliac joint may occur?
degenerative arthrosis and ankylosis
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 and gender bias associated with ankylosis of the sacro-iliac joint?
age 50 and male bias particularly in African American males
What age and gender bias is associated with ossification of the anterior sacro-iliac ligament?
age 40 and male bias
Which is the strongest of the sacro-iliac ligaments?
the interosseous sacro-iliac ligament
What are the attachment sites of the interosseous sacroiliac ligament?
at the sacral tuberosity and the iliac sulcus
What passes between the layers of the interosseous sacro-iliac ligament?
dorsal rami from the sacral spinal nerves
What is formed by the continuation of the sacrotuberous ligament along the ischial ramus?
the falciform process
What separates the greater sciatic and lesser sciatic foramina?
the sacrospinous ligament
What is the function of the ssacrospinous and sacrotuberous ligaments?
they oppose the upward tilt of the sacral apex and resist the rotation of sacrum between the innominate bones
