Back & Vertebral Column Flashcards
Where does the vertebral column extend from and to?
Cranium to the apex of the coccyx
What skeleton is the vertebral column a part of?
Axial
What are the five functions of the vertebral column?
To protect the spinal cord and spinal nerves
To support the weight of the body
To provide a site for muscle attachment
To play an important role in posture and locomotion
To provide shock absorption
How does the vertebral column support the weight of the body?
It carries and transits weight from the upper body to the lower limbs
What two structures in the vertebral column provide shock absorption?
Curvatures of the spine
IV discs
How many vertebrae are in the vertebral column?
33
What are the five different regions of the vertebral column?
Cervical
Thoracic
Lumbar
Sacral
Coccygeal
How many vertebrae are found in the cervical region of the vertebral column?
7
How many vertebrae are found in the thoracic region of the vertebral column?
12
How many vertebrae are found in the lumbar region of the vertebral column?
5
How many vertebrae are found in the sacral region of the vertebral column?
5
How many vertebrae are found in the coccygeal region of the vertebral column?
4
What do the five sacral vertebrae fuse to form?
Sacrum
What do the four coccygeal vertebrae fuse to form?
Coccyx
What happens to the size of the vertebrae as we descend the vertebral column to the sacrum?
Increases
What happens to the size of the vertebrae as we descend the vertebral column from the sacrum to the apex of the coccyx?
Decreases
Why does the size of the vertebrae change throughout the vertebral column?
Successive vertebrae bear increasing amounts of body weight
Where do the vertebrae reach the maximum size? Why?
Immediately superior to the sacrum
This is where weight is transferred to the pelvic grille at the scar-iliac joints
In which vertebrae is there significant motion? Why?
Superior 25, therefore from C1-S1
The pre-sacral vertebral column is joined by IV discs, giving it more flexibility
How is flexibility in the pre-sacral vertebral column controlled?
Synovial zygoapophysial joints, which these vertebrae articulate at
How many curvatures are there in the vertebral column?
Four
How many concave curvatures are there in the vertebral column? Which sections do they occur in? What are these curvatures referred to as? How do they curve the spine?
Two
Cervical
Lumbar
Lordoses
Posteriorly
How many convex curvatures are there in the vertebral column? Which sections do they occur in? What are these curvatures referred to as? How do they curve the spine?
Two
Thoracic
Sacral
Kyphoses
Anteriorly
What are the two primary curvatures? What does this mean?
Kyphoses
They develop during the fetal period
What curves are present in a foetus? What does this mean, in terms of the shape of the spine?
Kyphoses only
It’s convex shaped
How are primary curvatures retained throughout life?
Differences in height between the anterior and posterior parts of the vertebrae
What are the two secondary curvatures? What does this mean?
Lordoses
They develop during infancy
What results in the cervical curvature developing?
An infant beginning to hold their head erect
What results in the lumbar curvature developing?
An infant beginning to walk
What are the two roles of curvatures in the spine?
To provide additional flexibility
To provide shock absorbing resilience
What are the three abnormal curvatures?
Excessive thoracic kyphosis
Excessive lumbar lordosis
Scoliosis
What is the short name for excessive thoracic kyphosis?
Kyphosis
What is kyphosis?
When the convex curvature in the thoracic region is excessively curved
This means that the spine curves more posteriorly
What is the cause of kyphosis?
Erosion of the anterior part of one or more vertebrae
This erosion can be due to osteoporosis or age
What is the short name for excessive lumbar lordosis?
Lordosis
What is lordosis?
When the concave curvature curvature in the lumbar region is excessively curved
This means that the spine curves more anteriorly
What is the cause for lordosis?
Pregnancy
What is scoliosis?
An abnormal lateral (sideways) curvature that is accompanied by rotation of the vertebrae
With scoliosis, in what direction do the spinous processes turn?
Towards the cavity of the abnormal curvature
Who is usually affected by scoliosis?
Adolescents during puberty
What are the three causes of scoliosis?
Asymmetric weakness of the intrinsic back muscles
Failure of half of a vertebra to develop
A difference in the length of the lower limbs
What are the two main components which make up the vertebrae?
Vertebral body
Vertebral arch
Is the vertebral body at the anterior or posterior section of the vertebrae?
Anterior
What are the two functions of the vertebral bodies?
To give the vertebral column strength
To support the weight of the body
What happens to the size of the vertebral bodies as we move down the vertebral column? Why?
Increases
To bear the progressively greater body weight
What are the superior and inferior surfaces of the vertebral bodies covered with? How? What is its function?
Hyaline cartilage
This is remnants of the cartilaginous model from which bone develops from
To allow diffusion of fluid between the IV discs and capillaries in the vertebral body
Is the vertebral arch at the anterior or posterior section of the vertebrae?
Posterior
What are the six components which make up the vertebral arch?
Pedicles
Lamina
Vertebral foramen
Spinous process
Transverse process
Articular process
What are the pedicles?
They are short, stout processes which connect the vertebral arch to the vertebral body
How many pedicles are in each vertebrae?
Two; right and left
What are lamina?
Two broad, flat plates of bone which unite in the midline
They comment the transverse process and spinous process together
What is the vertebral foramen?
An enclosed hole within the vertebral arch
What forms the walls of the vertebral foramen?
The vertebral arch and the posterior surface of the vertebral body form the walls
What do all the vertebral foramen line up to form?
Vertebral canal, which is also referred to as the intervertebral canal
What is contained within the vertebral canal?
Spinal cord
Meninges
Fat
Spinal nerve roots
Spinal blood vessels
How many processes are contained within the vertebral arch?
Seven
What is the role of the processes?
To act as attachment sites for muscles and ligaments
What are the three types of processes?
Spinous
Transverse
Articular
How many spinous processes are in one vertebrae?
One
Where does the spinous process project from? In what direction does it project?
From the vertebral arch at the junction of the laminae
Posteriorly and usually inferiorly
How many transverse processes are in one vertebrae?
Two
Where does the transverse process project from? In what direction does it project?
From the junctions of the pedicles and laminae
Posterolaterally
What does the transverse processes in the thoracic region articulate with?
Ribs
How many articular processes are in one vertebrae?
Four; two superior and two inferior
Where does the articular process project from?
From the junctions of the pedicles and laminae
What occurs at the surface of articular process?
The processes articulate with other structures
These articulating surfaces are referred to as facets
How do deep back muscles attach to the vertebrae? What is the role of these muscles?
Spinous process
Transverse processes
To move the vertebrae
What do the articular processes articulate with?
Corresponding processes of vertebrae, superior and inferior to them
What joints occur at articular processes?
Zygoapophysial facet joints
What is the role of articular processes?
To determine the type of movements permitted and restricted between adjacent vertebrae
To keep adjacent vertebrae aligned, particularly one vertebra slipping anteriorly on the vertebrae below
Describe the three features of a cervical vertebral body
Small
Wider than it is tall
The superior surface of the body is concave, and the inferior surface is convex
Describe the features of a cervical vertebral foramen
Large and triangular
Describe the two features of a cervical transverse process
They have a hole in both of them, which is referred to as the foramina transversia
Posterior and anterior tubercles of transverse processes
What is contained within the foramina transversia?
Vertebral arteries
Vertebral veins
Nerve plexus
What is contained within the foramina transversia of C7?
Only small accessory vertebral veins
Describe the two features of a cervical articular processes
They have superior facets which are directed superoposteriorly
They have inferior facets which are directed inferoanteriorly
Describe the features of a C3-C5 spinous processes
Short
Bifibid, which means that they are split into two parts
Describe the features of a C7 spinous processes
Longest spinous process of all the spinous processes
What is the name given to C7? Why?
Vertebra prominens
Longest spinous process
What is the name given to C1?
Atlas
What is the shape of C1? Why?
Ring-like shape
It has no spinous process or vertebral body, and instead consists of two lateral masses which are connected by anterior and posterior arches
What shape are the superior articular facets of C1? What joints form here?
Concave
Atlanto-occipital joints
What shape are the inferior articular facets of C1? What joints form here?
Flat
Atlanto-axial joints
What is the name given to C2?
Axis
What is the strongest cervical vertebrae?
C2
What unique feature does C2 possess compared to other cervical vertebrae?
It has dens
What are dens?
Superior projections from the vertebral body
What is the function of dens?
To provide a pivot around which the atlas turns and carries the cranium
Describe the three features of a thoracic vertebral body
Medium-sized
Heart-shaped
Contains four demi-facets, two on each side, with one being superior and the other being inferior
What do demi-facets articulate with?
The heads of two different ribs
Describe the two features of a thoracic vertebral foramen
Circular
Smaller than that of the cervical and lumbar
Describe the three features of a thoracic transverse processes
Long
Strong
Extend posterolaterally
What happens to the length of transverse processes as we move from T1-T12?
Decreases
What unique feature do the transverse processes of T1-T10 have?
Costal facets
What do costal facets articulate with?
The tubercle of a rib
Describe the two features of thoracic spinous processes
Long, so long that they overlap adjacent vertebrae
Extend posteroinferiorly
Describe the two features of lumbar vertebral bodies
Largest body
Kidney/oval shaped
Describe the two features of lumbar vertebral foramen
Triangular
Larger than the thoracic vertebrae but smaller than the cervical vertebrae
Describe the three features of lumbar transverse processes
Long
Slender
There are accessory processes on the posterior surface of each process
Describe the feature of lumbar articular processes
On the superior articular facets, there mammilary processes posteriorly
Describe the two features of lumbar spinous processes
Short
Thick
What is the shape of the sacrum?
An inverted triangle, with the apex pointing inferiorly
What are the two functions of the sacrum?
To provide strength and stability to the pelvis
To transmit body weight to the pelvic gridle
What joints form between the sacrum and the pelvis?
Sacro-iliac
What forms the base of the sacrum?
The superior surface of S1
What type of joint exists between vertebral bodies?
Secondary cartilaginous, which are also referred to as symphyses
What are the two functions of secondary cartilaginous joints between vertebrae?
To provide strength
To allow weight bearing
How are articulating surfaces of vertebrae connected?
IV discs
Ligaments
What are the three functions of IV discs?
To provide shock absorption
To permit flexibility of the spine
To provide strong attachments between the vertebral bodies
What are the two components of IV discs?
Nucleus puposus
Annulus fibrosis
What is the nucleus puposus?
The central core of the IV disc
What happens to the IV disc when it is compressed?
It becomes broader
What happens to the IV disc when it is tensed or stretched?
It becomes thinner
What happens to the IV discs as we age?
They usually consist of a high water content. As we age, they becomes dehydrated and collagen starts to collect, causing it to become dry and granular
As a result, the IV discs lose their turgor, becoming thinner, stiffer and more resistant to deformation.
What is the annulus fibrosus?
A ring consisting of concentric lamellae of fibrocartilage. This forms the circumference of the IV disc, as it surrounds the nucleus puposus
What do the annuli insert into?
Epiphyseal rims on the articular surfaces of the vertebral bodies
What happens to the annulus fibrosis with age?
It thickens and often develops fissures and cavities. This means that the nucleus pulposus is no longer centred
Between which vertebrae are there no IV discs?
Atlas and axis
There are none present in the sacrum or coccyx. This means that the most inferior IV disc is between the L5 and S1 vertebrae
In which two regions are IV discs thicker?
Cervical
Lumbar
In which region are IV discs thinner?
Thoracic
Why is their differences in the thickness of IV discs in different regions?
The thickness is related to the range of movement
What is technical term for a slipped IV disc?
Herniation
What is herniation?
When the nucleus pulposus ruptures, breaking through the annulus fibrosis
In what direction does the nucleus puposus rupture?
Posterior-lateral direction
What does herniation result in? Why?
Neurological symptoms
Muscular symptoms
The nucleus puposus compresses nearby spinal nerve roots
What two ligaments cover and connect vertebral bodies?
Anterior longitudinal ligament
Posterior longitudinal ligament
What is the anterior longitudinal ligament? What does it cover and connect?
A strong, broad fibrous band
It covers and connects the anterolateral aspects of the vertebral bodies and IV discs
What is the function of the anterior longitudinal ligament?
To prevent hyperextension of the vertebral column
What is the posterior longitudinal ligament? What does it cover and connect?
A weak, narrow fibrous band
It covers and connects the posterior aspects of the vertebral bodies and IV discs. Specifically, it is attached mainly to the IV discs and less so to the posterior edges of the vertebral bodies.
What is the function of the posterior longitudinal ligament?
To prevent hyperflexion of the vertebral column
To prevent posterior herniation of the IV discs
What is the name of joints which occur between the superior and inferior articular process of adjacent vertebrae?
Zygoapophysial joints, also known as facet joints
What type of joint are zygoapophysial joints?
Synovial plane
What is the role of zygoapophysial joints?
To allow gliding movements between the articular processes
What ligament joins the laminae of adjacent vertebrae?
Ligamentum flavum
What is the colour of the ligamentum falvum?
Yellow
How does the ligamentum flavum join laminae?
It extends almost vertically from the lamina above to the lamina below
What is the function of the ligamentum flavum?
It resists separation of the vertebral laminae by preventing abrupt flexion of the vertebral column and therefore preventing injury of the IV discs
What two ligaments joint adjacent spinous processes?
Interspinous ligaments
Supraspinous ligaments
What do interspinous ligaments join?
The spinous processes
What do supraspinous ligaments join?
The tips of the spinous processes
What are the two craniovertebral joints?
Atlanto-occipital joints
Atlanto-axial joints
Where do atlanto-occipital joints occur?
Between C1 and the occipital bone of the cranium
What three movements are permitted by the atlanto-occipital joints?
Flexion
Lateral flexion
Rotation
What two movements do atlanto-occipital joints allow the head to make?
They allow nodding and sideways tilting of the head
What type of joints are atlanta-occipital joints?
Synovial joints
Where do atlanto-axis joints occur?
Between C1 and C2
What movement do atlanto-axial joints allow the head to make?
They permit the head to be turned from side to side, as occurs when rotating the head to indicate disapproval
What are costovertebral joints?
Joints between the vertebral bodies and the rib heads
What type of joints are costovertebral joints?
Synovial plane joints
What type of movement occurs at costovertebral joints?
Sliding and gliding
What are the four movements of the vertebral column?
Flexion
Extension
Lateral flexion
Rotation
In which two regions are movements of the vertebrae freer? Why?
Cervical
Lumbar
In the thoracic region, movements are additionally restricted by the attachments of ribs
What determines the type of movements in a vertebral column region?
The particular orientation of the vertebral articular facets
How are the articular facets orientated in the cervical region?
Horizontal/transverse plane
What three movements occur in the cervical region?
Flexion
Extension
Lateral flexion
Which two movements are greatest in the cervical region?
Flexion
Lateral flexion
How are the articular facets orientated in the thoracic region?
Coronal plane
What three movements occur in the thoracic region?
Rotation
Flexion
Lateral flexion
What two movements are limited in the thoracic region?
Flexion
Lateral flexion
How are the articular facets orientated in the lumbar region?
Sagittal plane
What three movements occur in the lumbar region?
Flexion
Extension
Lateral flexion
What movement does not occur in the lumbar region?
Rotation
Which two movements are greatest in the lumbar region?
Extension
Lateral flexion
Where are the spinal cord, spinal meninges and spinal nerve roots contained?
Vertebral canal
What is the spinal cord?
The major reflex centre and conduction pathway between the body and the brain
Where does the spinal cord start?
Medulla
Where does the spinal cord end?
Opposite the IV discs between L1 and L2 vertebrae
What three structures protect the spinal cord?
Vertebrae and their associated muscles and ligaments
Spinal meninges
CSF
What are meninges?
Membranes which cover the spinal cord
What are the three types of spinal meninges?
Dura
Arachnoid
Pia
What is the function of spinal meninges?
To surround, support and protect the spinal cord and the spinal nerve roots
What is the outermost membrane covering the spinal cord?
Dura
What is the thickest spinal membrane?
Dura
What is dura mater composed of?
Mainly fibrous tissue; however, it also consists of elastic tissue
What separates dura mater from the vertebrae?
Epidural space
Where is the epidural space located?
It is located between the wall of the vertebrae canal and dura mater
Where is arachnoid mater located?
Between the dura and pia mater
How thick is arachnoid mater?
It is flimsier than dura mater but thicker than pia mater
What is the shape of arachnoid mater?
Looks like a dense spider web
What is dura mater composed of?
Mainly fibrous tissue; however, it also consists of elastic tissue
What is the innermost spinal membrane layer?
Pia
Apart from the spinal cord, what does pia mater also cover?
The roots of the spinal nerves and spinal blood vessels
What is the thinnest spinal membrane?
Pia
What is the space between arachnoid and pia mater called?
Subarachnoid space
What is contained within the subarachnoid space?
CSF
What is a lumbar puncture?
A procedure performed to obtain a sample of CSF for analysis
Where is the needle inserted for a lumbar puncture? Why?
Between L3 and L4
In an adult the spinal cord ends at L2 so this prevents injury to the spinal cord
In the lumbar region the interspinous distance is greater compared to the thoracic region, and the spinous processes point straight rather than down
Where is the needle inserted for a lumbar puncture in kids?
Between L4 and L5
Why do we ask patients to flex their lumbar spine during a lumbar puncture?
This widens this space between the vertebrae, making it easier for the needle to access the subarachnoid space without damage
What are the two major groups of muscles in the back?
Extrinsic back muscles
Intrinsic back muscles
What are the two subcategories of extrinsic back muscles?
Superficial
Intermediate
What is the role of superficial extrinsic back muscles?
To produce and control limb movements
What do the superficial extrinsic muscles connect?
The upper limbs to the trunk
Name three superficial extrinsic muscles
Trapezius
Latissimus dorsi
Rhomboids
What is the role of intermediate extrinsic back muscles?
To produce and control respiratory movements
Name three intermediate extrinsic muscles
Serratus posterior
Serratus superior
Serratus inferior.
What is deeper intrinsic or extrinsic back muscles?
Intrinsic
What are intrinsic back muscles attached to?
The back only, as they are only attached to the spine
What are the two functions of the intrinsic back muscles?
To maintain posture
To control movements of the vertebral column
Where do intrinsic muscles extend from?
The pelvis to the cranium
What are the three layers of intrinsic back muscles?
Superficial
Intermediate
Deep
What muscles are in the superficial intrinsic muscle layer?
Splenius
Where are splenius muscles located?
The posterior and lateral aspects of the neck and upper part of the thorax
What is the function of the splenius muscles?
To extend the head and neck
What three muscles are in the intermediate intrinsic muscle layer?
The iliocostalis (lateral)
Longissimus (intermediate)
Spinalis (medial)
What do the three intermediate intrinsic muscle layers form?
Erector spinae muscle
Where is the erector spinae located?
Posterolaterally, between the vertebral spinous processes and the costal angles of the ribs
What group of muscles are located in the deep intrinsic muscle layer?
Transversospinales
What are transversospinales muscles?
They are a group of short muscles, which originate from transverse processes of vertebrae and pass to spinous processes of more superior vertebrae
What are the three muscles that make up the transversospinales muscle group?
The semispinalis
The multifidus
The rotatores
What muscles act on the vertebral column?
Back
Abdominal
Sternocleidomastoid
What three abdominal muscles act on the vertebral column?
Obliques
Transverse abdominis
Rectus abdominis
What are the two main anterior muscles which act in the vertebral column?
Abdominal
Sternocloidmastoid
What are the main posterior muscles which act in the vertebral column?
Erector spinae
Which six vertebrae can easily be identified when palpating the back?
C7
C1
T4
T3
T7
L4
Why is C7 palpable?
Its spinous process is slightly longer than other cervical processes
Where can we feel C1?
It can be felt midway between the angle of the mandible and the mastoid process, which in other words is behind the ear
Why is T4 an important landmark?
it is the level at which a number of important structures in the thorax are normally located
Where can T3 be palpated?
The spine of the scapula
Where can T7 be palpated?
The inferior angle fo the scapula
Where can L4 be palpated?
The top of the iliac crests in the pelvis
Why is L4 an important landmark?
Above or below which lumbar puncture may be performed
What three changes occur in the vertebral column as you age?
Dehydration of IV discs
Osteoarthritis
Ostoporosis
What is osteoarthritis?
This is when there is pain and stiffness of joints
What two joints are commonly affected by osteoarthritis?
Vertebral body joints (secondary cartilaginous)
Facet joints (synovial plane)
What is the cause of osteoarthritis?
When the articular cartilage at each end of the bones weals down over time
What is osteoporosis?
A bone disease that occurs as a result of more bone resorption occurring than formation. This means that the trabeculae in the spongy bone tissue that are usually well organised and support the bone well, become thin or missing
What does osteoporosis result in?
Bones becoming weaker and more prone to fracture
What type of fractures are likely to occur as a result of osteoporosis?
These are fractions which alterthe curvature of the spine, specifically resulting in excessive kyphosis.
What type of position is good for taking x-rays?
Lateral
What type of scan is good for assessing IV disc disorders?
MRI
