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Spinal TRI 2 > Arthrology of the Vertebral Column (final exam) > Flashcards

Arthrology of the Vertebral Column (final exam) Flashcards

1
Q

What are the four consistent features of synovial (diarthrosis) joints?

A

Articular or fibrous capsule
Synovial membrane
Articular cartilage
Synovial fluid

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2
Q

Thickening of the fibrous capsule connective tissue will form the __?

A

Capsular ligament

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3
Q

What generic accessory ligaments may accompany and support the capsular ligament?

A

Intracapsular and Extracapsular ligaments

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4
Q

What are the common characteristics of type 1 articular receptors?

A

Located in the superficial layer of the fibrous capsule
Resemble Ruffini endings
Most numerous in cervical zygapophysis and they monitor the joint “at rest”

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5
Q

What are the characteristics of type II articular receptors?

A

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

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6
Q

What are the characteristics of type III articular receptors?

A

Present in collateral and intrinsic ligaments,
Resemble Golgi Tendon organs,
Not initially observed along the vertebral column and monitor extreme joint motion

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7
Q

What is the function of type IV articular receptors?

A

Nociceptive, they monitor pain

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8
Q

Type IVa articular receptors would be present in what location?

A

Fibrous capsule, Articular fat pads or adventitia of blood vessels

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9
Q

Type IVb articular receptors would be present in what locations

A

Accessory ligaments in general, dense in the posterior longitudinal ligament of spine

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10
Q

What are the three modifications of articular synovial membrane?

A

1) Synovial villi
2) Articular fat pads or Haversian glands
3) Synovial menisci and intra-articular discs

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11
Q

What is the generic function of modifications of articular synovial membrane?

A

Aid in spreading synovial fluid

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12
Q

What is the apparent function of synovial villi?

A

Increase the surface of synovial membrane available for secretion–absorption phenomena

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13
Q

Articular fat pads are most numerous in what location along the vertebral column?

A

Lumbar zygapophysis

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14
Q

Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called__.

A

Synovial menisci or Intra-articular discs

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15
Q

Synovial menisci are a feature of what joint examples?

A

Femur-tibia articulation,

Cervical zygapophysis and lumbar zygapophysis

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16
Q

What are the layers of the synovial membrane?

A

Outer fibrous layer and an inner (luminal) cellular layer AKA synovial lamina intima

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17
Q

What are the specific functions of type A synovial cells?

A

Are phagocytic

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18
Q

What is the specific function of Type B synovial cells?

A

Secrete proteinaceous substances and hyaluronic acid

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19
Q

What is the common function of Type A and type B synovial cells?

A

Formation and absorption of synovial fluid

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20
Q

What is the source of nutrition for articular cartilage?

A

Blood vessels in the synovial membrane, sinuses of the bone marrow cavity and from synovial fluid itself.

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21
Q

What is unique about the surface of articular cartilage?

A

true perichondrium is absent

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22
Q

Which collagen fiber type predominates in articular cartilage?

A

Type II

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23
Q

What is the primary function of bound glycosaminoglycans in articular cartilage?

A

Form a network for water retention

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24
Q

Cartilage is able to change shape due to compression, a characteristic known as ___?

A

Deformation

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25
Q

What is implied when cartilage is said to have elastic properties?

A

Cartilage can deform and returns to original volume rapidly, a time independent property

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26
Q

What is implied when cartilage is said to have viscoelastic properties?

A

Cartilage can deform but returns to original volume slowly, a time dependent property.

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27
Q

What is the function of articular cartilage?

A

Provide a wear-resistant, low-friction, easily lubricated surface for joint movement.

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28
Q

What are the properties of synovial fluid?

A

it is yellow-white, viscous, slightly alkaline and tastes salty

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29
Q

Synovial fluid consists of what specific chemical groups?

A

Fats, Salts, Albumins and hyaluronate

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30
Q

Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?

A

Hyaluronate

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31
Q

What substance of synovial fluid has been proposed to be responsible for its viscosity and lubricating behavior?

A

Lubricin

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32
Q

What are the classifications of synovial joints (diarthrosis) based on the number of articulating surfaces?

A

Simple and compound synovial joints

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33
Q

What is complex synovial joint (diarthrosis)?

A

Within the simple joint or the compound joint,

Articulating surfaces are separated by an articular disc (intra-articular disc) or meniscus

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34
Q

What morphological classification of synovial joints is classified as nonaxial?

A

Plane (diarthrosis arthrodial)

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35
Q

What morphological classifications of synovial joints would be classified as uniaxial?

A

Hinge (diarthrosis ginglymus) and pivot (diarthrosis trochoid)

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36
Q

What morphological classifications of synovial joints would be classified as biaxial?

A

(diarthrosis) bicondylar
(Diarthrosis) condylar
(Diarthrosis) Ellipsoidal
(Diarthrosis sellar) Saddle

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37
Q

What is the pivot point in the proximal radio-ulnar joint?

A

In the proximal radio-ulnar joint,
The pivot point is the head of the radius which rotates within the osteo-ligamentous ring formed by the radial notch of the ulna and the annular ligament.

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38
Q

Identify the common ligaments of the vertebral column.

A 
1)Anterior longitudinal ligament,
Intervertebral disc
Posterior longitudinal ligament
Ligamentum Flavum
Capsular ligament
Interspinous ligament
Ligamentum Nuchae
Supraspinous ligament
Intertransverse ligament
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39
Q

What is the maximum number of common ligaments identified with a vertebral couple?

A

8

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40
Q

What is the reason that nine common ligaments are identified but only eight will be attached at any specific vertebral couple?

A

the Ligamentum nuchae and supraspinous ligaments attach to the spinous tubercles, but only one of these will be identified at a single vertebral couple.

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41
Q

What is the number of true intervertebral discs identified in the adult?

A

23

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42
Q

In the adult, which vertebral levels will demonstrate a true intervertebral disc?

A

Those between C2 and S1 inclusive

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43
Q

What prevent of the vertebral column length is contributed by the intervertebral disc?

A

20-25%

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44
Q

What is the percent of intervertebral disc height contribution to cervical region, Thoracic region, and Lumbar region length?

A

Cervical 20-25%
Thoracic 20%
Lumbar 33%

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45
Q

What is the cervical nucleus pulposus composed of?

A

Fibrocartilage

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46
Q

What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?

A

Birth—- 88%

Thirty years old—-70%

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47
Q

What cell is associated with the nucleus pulposus until about age eleven?

A

notochord cells

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48
Q

What cells are associated with the mature nucleus pulposus?

A

Reticulocyte-fibroblast

Chondroblast

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49
Q

Which type of collagen is dominant in the nucleus pulposus?

A

Type II

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50
Q

What is the organizational pattern for collagen fibers in the nucleus pulposus?

A

Irregularly oriented and randomly scattered

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51
Q

What is unusual about the cervical annulus fibrosus?

A

Lacks any lamellar or layered organization

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52
Q

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

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53
Q

What compensates for the thinness of the posterior part of the cervical annulus fibrosus?

A

Posterior longitudinal ligament

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54
Q

What is the organization of the lumbar annulus fibrosus?

A

has 12-24 concentric cylindrical lamellae

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55
Q

What is the water concentration in the lumbar annulus fibrosus at birth and after thirty?

A

Birth—- 78%

Thirty— 70%

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56
Q

Which type of collagen is dominant in the annulus fibrosus?

A

Type I

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57
Q

What is the organizational pattern for collagen fibers in the annulus fibrosus?

A

Parallel with one another in a single lamellus and angled

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58
Q

What is the organization of collagen fibers between lamellae?

A

Collagen fibers will be angled in the opposite direction such that a spiral - counterspiral organization is observed

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59
Q

What is the average angle of collagen fibers within the annulus fibrosus?

A

Average 50 to 60 degrees

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60
Q

What is the thickest part of the cartilage end plate?

A

Around the periphery

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61
Q

What is the principal type of collagen fiber within the cartilage end plate?

A

Type II collagen fiber

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62
Q

What is the direction of collagen fibers within the cartilage end plate?

A

Collagen fibers are aligned anterior to posterior

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63
Q

What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus?

A

Cartilaginous end plate

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64
Q

What are the types of receptor endings in the intervertebral disc?

A

Nociceptors and proprioceptors

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65
Q

What is the relationship between size of the intervertebral disc and receptor endings?

A

Larger the disc = Greater variety of receptor endings

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66
Q

What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?

A

Provide feedback during extension

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67
Q

What innervates the annulus fibrosus at the posterior part of the intervertebral disc?

A

Recurrent meningeal or sinu-vertebral or sinus vertebral notch

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68
Q

What innervates the annulus fibrosus at the anterior part of the intervertebral disc?

A

Fibers form the ventral primary ramus

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69
Q

What innervates the annulus fibrosus at the lateral part of the intervertebral disc?

A

Fibers from: Ventral primary rami,
White ramus communicans
Gray ramus communicans
Paradiscal ramus communicans

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70
Q

What is the name given to the white ramus communicans which becomes embedded within the annulus fibrosus of the intervertebral disc?

A

Paradiscal ramus communicans

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71
Q

What is the popular theory of intra-abdominal cavity pressure and the intervertebral disc response to weight bearing?

A

Increase in abdominal pressure = diminishes resistance the intervertebral disc needs to generate by 50%

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72
Q

What part of the intervertebral disc will allow distribution of weight over a maximum surface area?

A

Nucleus pulposus

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73
Q

What vertebral levels will the anterior longitudinal ligament attach to?

A

Between occiput and S3

74
Q

What is the lowest extent of the anterior longitudinal ligament based on recent studies?

A

L3

75
Q

What is the function of the anterior longitudinal ligament?

A

Brakes or limits dorsi-flexion or hyperextension of the vertebral column

76
Q

What was ossification of the anterior longitudinal ligament in the lumbar region identified as?

A

Forestier’s disease

77
Q

Anterior longitudinal ligament of ossification in the lumbar region is now identified as __?

A

DISH

Diffuse Idiopathic skeletal Hyperostosis

78
Q

What vertebral levels will the posterior longitudinal ligament attach to?

A

Between C2 and S3

79
Q

What is the innermost layer of the posterior longitudinal ligament called?

A

Perivertebral ligament

80
Q

What is the function of the posterior longitudinal ligament?

A

brakes or limits flexion of the vertebral column

81
Q

Where is ossification of the posterior longitudinal ligament most commonly identified?

A

Cervical spine with and 80% incidence

82
Q

What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?

A

A loss of hand and finger dexterity

83
Q

What is the incidence of the posterior longitudinal ligament ossification in the thoracic and lumbar spine?

A

About 10% at thoracic and Lumbar spine

84
Q

What is the clinical sign of PLL ossification in the lumbar spine?

A

Faltering gait

85
Q

What is the gender, age, and ethnic bias associated with ossification of the PLL?

A

Greater in Males >50

Higher incidence in Japanese men

86
Q

What is the acronym for ossification of the PLL?

A

OPLL

87
Q

At one time ossification of the PLL was an example of what condition?

A

DISH

Diffuse Idiopathic Skeletal Hyperostosis

88
Q

What vertebral levels will the ligamentum flavum be attached to?

A

C2-S1

89
Q

What is the relationship of the ligamentum flavum to the vertebral foramen?

A

Forms the Posterior boundary of spinal canal

90
Q

What is the histology of the ligamentum flavum?

A

Elastic fibers which are yellow

91
Q

What is the function of the ligamentum flavum?

A

Brakes or limits flexion of the vertebral column

92
Q

What is now thought to be a major function of the ligamentum flavum?

A

Early prime factor in extension of the vertebral column

93
Q

Where is ossification of the ligamentum flavum most commonly identified?

A

Thoracic spine or Thoracolumbar transition zone

94
Q

What is the acronym for ossification of the ligamentum flavum?

A

OLF

95
Q

What is the relationship between the capsular ligament and mobility?

A

More lax/loose the capsular ligament = greater motion of joint

96
Q

What regions of the column demonstrate the greatest laxity of capsular ligaments?

A

Cervical and lumbar regions

97
Q

The capsular ligament may blend with which other common ligament?

A

Ligamentum Flavum

98
Q

What muscle will blend with the capsular ligament posteriorly?

A

Multifidis

99
Q

What vertebral levels will the interpsinous ligament be attached to?

A

C2-S1

100
Q

What is the classic function of the interspinous ligament?

A

Brakes or limits flexion of the vertebral column

101
Q

What is now thought to be a major function of the interspinous ligament?

A

Proprioceptive transducer for the spinal relfex

102
Q

What will ligamentum nuchae be attached to?

A

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.

103
Q

What is the name given to the superficial layer of the ligamentum nuchae?

A

Funicular layer

104
Q

What is the name given to the deep layer of the ligamentum nuchae?

A

Lamellar layer

105
Q

What are the attachment sites for the superficial layer of the ligamentum nuchae?

A

External occipital protuberance, external occipital crest, and spinous tubercle C7

106
Q

What is the histological make-up of the human ligamentum nuchae in quadrupeds?

A

Yellow elastic ligament

107
Q

What is the primary yellow elastic or elastic ligament of the spine?

A

Ligamentum flavum

108
Q

What is the histological make-up of the ligamentum nuchae?

A

Yellow elastic ligament, but has more collagen fibers than in quadrupeds.

109
Q

What is the classic function of the human ligamentum nuchae?

A

It brakes/limits flexion of the cervical spine

110
Q

What will the supraspinous ligament be attached to?

A

Spinous tubercles along the vertebral column form C7 to sacrum.

111
Q

What is the termination level inferiorly for the supraspinous ligament according to current literature?

A

Primarily at L4 (73%); between L4 and L5 (5%)

112
Q

Where is the supraspinous ligament said to be best developed?

A

Lumbar spine

113
Q

What is the classic function of the human supraspinous ligament?

A

Brakes or limits flexion of the spine

114
Q

What is now thought to be a major function of the supraspinous ligament?

A

Proprioceptive transducer for spinal reflex

115
Q

What will the intertransverse ligament be attached to?

A

C1-L5 Transvers processes to transverse tubercles

116
Q

What is the status of the cervical intertransverse ligament?

A

Paired with an anterior and a posterior intertransverse ligament.

117
Q

What is the status of the lumbar intertransverse ligament?

A

Well developed with two parts identified, ventral slip and a dorsal slip

118
Q

What part of the lumbar intertransverse ligament covers the intervertebral foramen?

A

Ventral slip

119
Q

What part of the intertransverse ligament in the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment?

A

Dorsal slip

120
Q

What are the characteristics of the capsular ligament of the atlanto-occipital joint?

A

Said to be loose, thin, and composed of collagen fibers

121
Q

What other joint space does the atlanto-occipital joint communicate with?

A

Posterior bursa of the median atlanto-axial joint

122
Q

What is the median thickening of the anterior atlanto-occipital ligament called?

A

Anterior longitudinal ligament

123
Q

What is the classic function of the anterior atlanto-occipital ligament?

A

Brakes or limits “Extension” of the skull over the cervical spine

124
Q

Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?

A

Incomplete Ponticulus Posticus or a complete Ponticulus Posticus

125
Q

What other name may be used to identify a Ponticulus Posticus?

A

Kimmerles’s anomaly

126
Q

What names are given to the opening formed by the Ponticulus Posticus?

A

Arcuate foramen or Retroarticular canal

127
Q

What is the classic function of the posterior atlanto-occipital ligament?

A

Brakes or limits axial rotation, flexion, and perhaps lateral bending of the skull on atlas

128
Q

What amount of flexion - extension is accommodated by the atlanto-occipital?

A

about 25 degrees

129
Q

What amount of axial rotation is accommodated by the atlanto-occipital joint?

A

About 3-8 degrees one side axial rotation

130
Q

What amount of lateral bending is accommodated by the atlanto-occipital joint?

A

5 degrees

131
Q

Which motion is best accommodated by the atlanto-occipital joint?

A

Flexion- extension

132
Q

Which atlanto-axial joint is identified as a synovial pivot (diarthrosis trochoid)?

A

Median atlanto-axial joint

133
Q

What are the names given to the synovial joint spaces of the median atlanto-axial joint?

A

Anterior bursa and the posterior bursa

134
Q

What are the joint surfaces of the median atlanto-axial joint at the anterior bursa?

A

Fovea dentis of C1 and the facet for fovea dentis of C2

135
Q

What ligament is formed by the transverse atlantal ligament and is perpendicular extension?

A

Cruciate ligament or cruciform ligament

136
Q

What is the function of the transverse atlantal ligament?

A

Primary stabilizer of the atlanto-axial joint restricting the distance of C2 from the anterior arch of C1.

137
Q

What is the ADI?

A

Atlanto-dental interspace, radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint.

138
Q

What is the ADI of children compared with that of adults?

A

Children: 4.5mm
Adult: 2-3mm

139
Q

What are the characteristics of the capsular ligament of the lateral atlanto-axial joint?

A

Lax or loose and demonstrates a meniscoidal fold within the joint cavity

140
Q

What are the degrees of movement facilitated at the atlanto-axial joint?

A

About 20 degrees flexion - extension
40 degrees one side axial rotation,
5 degrees of lateral bending

141
Q

The occiput-C1-C2 joint complex account for what percent of all cervical axial rotation?

A

About 60%

142
Q

What name is given to the occipital - C2 region of the spine?

A

Craniovertebral junction

143
Q

Embryologically, what forms the apical ligament of the dens or the apicodental ligament?

A

notochord

144
Q

What is the function of the apical ligament of the dens or the apicodental ligament?

A

It has no known function

145
Q

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?

A

alar ligament

146
Q

What is the function of the alar ligament?

A

Function to resist axial rotation

147
Q

Which ligament lies behind the alar ligaments?

A

Cruciate ligament, specifically the superior crus ligament

148
Q

What are the layers of the membrane tectoria or tectorial membrane?

A

superficial layer and deep layer identified

149
Q

The superficial layer of the membrane tectoria or tectorial membrane lies in front of what structure?

A

dura mater of the medulla oblongata and the spinal cord

150
Q

What is the function of the membrane tectoria or tectorial membrane?

A

Resists flexion and extension of the skull on the upper cervical spine

151
Q

For the cervical spine below C2, what is the range of flexion - extension?

A

about 90 degrees or about 18 degrees per couple

152
Q

For the cervical spine below C2, what is the range of one side lateral bending?

A

About 50 degrees or about 10 degrees per couple

153
Q

For the cervical spine below C2, what is the range of one side axial rotation?

A

33 degrees or about 6 degrees per couple

154
Q

Which ligaments replace the intertransverse ligament at the lumbosacral joint?

A

Iliolumbar ligament and lumbosacral ligament

155
Q

What are the attachment sites for the lumbosacral ligament?

A

Sacral ala and ventrolateral surface of sacrum attach tot he transverse process of L5

156
Q

What are the attachment sites for the iliolumbar ligament?

A

Iliac crest is attached to the transverse process of L5

157
Q

What muscle is intimately attached to the superior iliolumbar ligament?

A

quadratus lumborum

158
Q

Which of the current ligaments from the iliolumbar ligament complex represents the iliolumbar ligament of classical descriptions?

A

Superior iliolumbar ligament

159
Q

Which ligament from the iliolumbar ligament complex represents the lumbosacral ligament of classical descriptions?

A

inferior iliolumbar ligament

160
Q

Which vertebral couple of the lumbar spine has the greatest range of motion?

A

L5/S1

161
Q

Which range of motion is greatest for all lumbar vertebral couples?

A

Flexion- extension

162
Q

Which range of motion is least for L1 - L5 vertebral couples?

A

One side axial rotation

163
Q

Which range of motion is least for the L5/S1 vertebral couple?

A

One side lateral bending

164
Q

List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal canal?

A

1) Membrana tectoria
2) PLL
3) Deep posterior sacrococcygeal ligament

165
Q

List, in order, from cranial to caudal the ligaments forming the posterior boundary of the spinal canal?

A

1) Posterior atlanto-occipital ligament
2) Posterior atlanto-axial ligament
3) Ligamentum flavum
4) Superficial posterior sacrococcygeal ligament

166
Q

List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal column?

A

1) Anterior atlanto-occipital ligaments
2) Anterior atlanto-axial ligament
3) Anterior longitudinal ligament
4) Anterior sacrococcygeal ligament

167
Q

What is the auricular surface of sacrum composed of?

A

true articular cartilage

Modification of hyaline cartilage

168
Q

What is the auricular surface of the ilium composed of?

A

Articular cartilage interspersed with fibrocartilage.

169
Q

What is the superficial appearance of the auricular surfaces of the sacro-iliac joint?

A

Sacrum develops a sacral groove

Ilium develops an iliac edge

170
Q

Which gender has greater unevenness of the auricular surface of the sacro-iliac joint?

A

Males

171
Q

What pathological or age-related modifications of the sacro-iliac joint may occur?

A

1) Degenerative arthrosis

2) Ankylosis

172
Q

What does ankyloses mean?

A

condition of fibrous adhesion occurs within the joint

173
Q

What is the age and surface bias associated with degenerative arthrosis of sacro-iliac joint?

A

age: 40
surface: iliac auricular surface

174
Q

What is the age and gender bias associated with ankyloses of the sacro-iliac joint?

A

Age: 50
Gender: Males, African American

175
Q

What age and gender bias is associated with ossification of the anterior sacro-iliac ligament?

A

Age: 40
Gender: Male

176
Q

Which is the strongest of the sacro-iliac ligaments?

A

interosseous sacro-iliac lig.

177
Q

What are the attachment sites of the interosseous sacro-iliac ligament?

A

1) Sacral tuberosity

2) Iliac sulcus

178
Q

What passes between the layers of the interosseous sacro-iliac ligament?

A

Dorsal rami from the sacral spinal nerves

179
Q

What is formed by the continuation of the sacrotuberous ligament along the ischial ramus?

A

Falciform process

180
Q

What separates the greater sciatic and lesser sciatic foramina?

A

Sacrospinous ligament

181
Q

What is the function of the sacrospinous and sacrotuberous ligaments?

A

1) Oppose upward tilt of the sacral apex

2) Resist the rotation of sacrum between innominate bones.

Spinal TRI 2 (13 decks)

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