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Vertebral Column > Development of the Vertebral Column > Flashcards

Development of the Vertebral Column Flashcards

1
Q

What do the curves of the spine act like to confer?

A

Act like springs to confer:

  • Flexibility
  • Resilience
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2
Q

Describe the primary curvatures of the spine

A

Concave anteriorly:

  • Thoracic
  • Sacral/Coccygeal
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3
Q

When do the primary curvatures develop and how are they maintained?

A

Established in fetal development

Maintained through vertebral shape

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4
Q

Describe the secondary curvatures of the spine?

A

Convex anteriorly:

  • Cervical
  • Lumb
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5
Q

When do the secondary curvatures develop and how are they maintained?

A

Develop during infancy:
- Cervical at 2-3 months when child holds up head
- Lumbar at 6-8 months when child sits unaided
Both result in IV disc becoming thicker anteriorly, due to loading, changing the curvature

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6
Q

What does IV disc degeneration result in?

A

Spine returning to an overall primary curvature (kyphosis)

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7
Q

In what physiological state is lordosis often seen? Why?

A

Pregnancy:

  • Forward pelvic tilt
  • Bulk of mass over pelvis
  • More efficient walking gait
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8
Q

What is scoliosis?

A

Lateral deviation >10 degrees

Often accompanied by a rotational defect

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9
Q

How can scoliosis arise?

A

Congenital
Idiopathic
Secondary to a primary neuromuscular condtion

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10
Q

What is the adult vertebral body derived from?

A

Juvenile centrum
PLUS
Small portion of neural arch:
- Boutons of the pedicles

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11
Q

Where does ossification of the centra initiate?

A

Dorsal to notochord

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12
Q

What type of ossification is that of the centra?

A

True endochondral

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13
Q

Describe the ossification process of the centra?

A 
Mesenchymal template
Tissue is hyaline cartilage first:
- Chondrification
- An avascular model
Cartilage starts to ossify
Bone forms on surface
Core of cartilage starts to die:
- Usually receives nutrients from surface via diffusion
- Sends angiogenic signals
- Blood vessels to core form
- Vessels bring osteogenic cells
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14
Q

What factor does the notochord contain? What does this do?

A

Angiogenic inhibiting factor:

- Delays vascular penetration so bone does not invade it initially

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15
Q

What does the release of the factor from the notochord cause?

A

Axial avascular area around notochord

Results in ring-shaped area of ossification

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16
Q

Where does ossification of the neural arches commence?

A

Inner surface of each hemi-arch

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17
Q

What is the method of ossification of the neural arches?

A

Intramembranous following by endochondral

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18
Q

Where does the first ossification centre for the neural arches appear and when?

A

Lower cervical and upper thoracic regions

2nd foetal month

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19
Q

What initiates neural arch ossification in the cervical/thoracic region?

A

Gasp reflex = Muscle contraction

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20
Q

Once the first ossification centre for the neural arches appears, where does it spread?

A

Cranially and caudally

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21
Q

Where and when does a second group of ossification centres appear for the neural arches?

A

Lower thoracic and upper lumbar regions

3rd fetal month

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22
Q

What initiates neural arch ossification in the thoracic/lumbar region?

A

Lower limb movement = Muscle contraction

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23
Q

Once the second ossification centre for the neural arches appears, where does it spread?

A

Cranially and caudally

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24
Q

What part of the neural arches fuses first?

A

Fusion starts posteriorly at spinous processes

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25
Q

When does neural arch fusion commence?

A

During the 1st year

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26
Q

In what region does neural arch fusion begin and what direction(s) does it spread?

A

Lower thoracic and upper lumbar regions

Spreads cranially and caudally

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27
Q

By what ages have the neural arches in each region fused?

A

Lower cervical arches = Year 2
Very upper cervical arches = Year 3
Lowest lumbar arches = Year 5 (end of)

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28
Q

What is the implication of neural arches not fusing until a few years into life?

A

If a child is <6 years old, expect some degree of arch non-fusion on imaging

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29
Q

What is the fusion at the posterior aspect of the neural arches?

A

A synchondrosis:

  • Primary cartilaginous
  • Hyaline cartilage so it ossifies
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30
Q

At what part of the vertebra does neurocentral fusion occur?

A

Ventral to pedicles at neurocentral junction

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31
Q

At what ages does neurocentral fusion occur?

A

2-5 years

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32
Q

Regarding neurocentral fusion, what parts of the developing vertebrae involved articulate with the costal processes

A

Only the boutons of the pedicles

NOT the centrum

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33
Q

Until what age is evidence of the neurocentral junction maintained?

A

Evidence maintained throughout life

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34
Q

Where does neurocentral fusion occur first, second and third and at what ages?

A 
First = (Lower) lumbar at 2-4 years
Second = Cervical at 3-4 years
Third = (Lower) thoracic at 4-5 years
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35
Q

What are the ossification centres for the atlas? When do they appear?

A

Three primary centres:

  • One for each lateral mass posterior to articular pillar which appear in 7th foetal week
  • Anterior arch centre appears in 1st or 2nd year
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36
Q

How can the anterior arch of atlas ossification centre appear?

A

Single nodule OR
Paired nodules OR
Multifocal nodules OR

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37
Q

How can the anterior arch ossify if its ossification centre does not appear?

A

Ossification bars can extend from lateral masses

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38
Q

How does C1 appear at birth?

A

Two bony masses:

  • Large concave articular facets on upper surface
  • Smaller facets on lower surface
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39
Q

How does the morphology of the atlas change?

A

Unchanged throughout 1st year

Increases in size

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40
Q

When does the posterior arch of the atlas fuse?

A

Years 4-5 (synchondrosis)

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41
Q

What happens if the posterior arch of the atlas does not fuse? How does this make the arch appear?

A

Spina bifida atlantis:

- Ends of each neural arch appears pointed instead of flat (flat = unfused but will fuse)

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42
Q

What is the incidence of failure of posterior arch of atlas fusion?

A

1%

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43
Q

What are the anterior neurocentral junctions of the atlas between?

A

Each lateral arch and the anterior arch (x2)

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44
Q

When do the anterior neurocentral junctions of the atlas fuse?

A

5-6 years

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45
Q

Where does the fusion line of the anterior neurocentral junctions of the atlas lie and what is its clinical implication?

A

Union line passes across anterior portions of superior articular facet
Can be a fracture point

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46
Q

Endochondral growth occurs at all junctions of the atlas prior to fusion. What does this cause?

A

Integrated expansion of vertebral canal as 3 units grwo away from one another

47
Q

When does the atlas reach adult size?

A

Age 4-6 years

48
Q

What does the adult size of the atlas act as?

A

Early limit to vertebral canal size:

- Indicates precocious CNS maturation

49
Q

What are the primary ossification centres of the axis?

A

Five primary centres:

  • One for each half of neural arch
  • One for true centrum
  • One for each half of body of dens
50
Q

When do the ossification centres for the neural arches of C2 appear?

A

7-8 foetal weeks

51
Q

When does the true centrum ossification centre for C2 appear?

A

4-5 foetal months

52
Q

When do the odontoid centreas appear?

A

4-6 foetal months

53
Q

When do the two halves of the dens fuse?

A

Intradental synchondrosis formed by birth

54
Q

How does the dens appear at birth?

A

Forked:

- Due to intradental sulcus

55
Q

When does the posterior synchondrosis (between neural arches) of C2 fuse?

A

3-4 years

56
Q

When does the dens fuse laterally to the neural arches? What is this joint called?

A

3-4 years

Dentoneural synchondrosis

57
Q

Where does the fusion line between the dens and the neural arches lie?

A

Passes across superior articular facet:

  • Medial 1/3 of facet is formed by dens
  • Lateral 2/3 of facet is formed by neural arch
58
Q

What part of C2 forms the inferior articular facet?

A

Neural arch

59
Q

What does fusion of C2 halt?

A

Increase in dimensions of vertebral canal

60
Q

When is fusion of the foramen transversarium complete?

A

3-5 years

61
Q

When do the dentocentral and paired neurocentral junctions fuse?

A

4-6 years

62
Q

When do lines of fusion within C2 disappear?

A

9-10 years

63
Q

What line of fusion may remain in C2? Clinical implication?

A

Small horizontal crevice in region of posterior dentocentral junction:
- Fracture weakness

64
Q

When does the ossiculum terminale appear?

A

~2 years

65
Q

What is the ossiculum terminale?

A

A small ossific nodule

66
Q

Where does the ossiculum terminale appear?

A

In cartilage plug that fills apical cleft of dens

67
Q

When does the ossiculum terminale fuse with the dens?

A

~12 years

68
Q

What are the secondary ossification centres of C2?

A

Five secondary centres:
- Two ‘flake-like’ epiphyses for transverse processes
- Two ‘plate-like’ epiphyses for bifid spinous process
- Inferior annular ring (C2 has no superior oe due to os terminale)
Sometimes considered to be 6 secondary centres if os terminale considered epiphyseal

69
Q

What does a small tongue of bone progressing up posterior surface of dens fill?

A

Interdental groove

70
Q

What are the typical cervical vertebrae primary ossification centres and when do they appear?

A

3 primary centres:

  • Centrum = 3-4 foetal months
  • Two neural arches = 2-3 foetal months
71
Q

When do the cervical laminae unite posteriorly?

A

In 2nd year

72
Q

When is cervical neurocentral fusion complete?

A

3-4 years

73
Q

What structures form following neurocentral fusion of the cervical vertebrae?

A

Synovial uncovertebral joints of Luschka

74
Q

When is a typical cervical vertebra fully fused?

A

~4 years

75
Q

What are the 6 secondary ossification centres of typical cervical vertebrae?

A

2x transverse processes
2x spinous processes
1x superior annular ring
1x inferior annular ring

76
Q

When do the secondary ossification centres appear in the typical cervical vertebrae?

A

Beginning of puberty

77
Q

When do the secondary ossification centres of cervical vertebrae begin and finish fusing?

A

Begin at end of puberty (18+ years)

Complete by 24 years

78
Q

When do all 3 ossification centres in the thoracic and lumbar vertebrae appear?

A

By end of 3rd foetal month

Identifiable by 4th foetal month

79
Q

What are the 5 secondary ossification centres of both thoracic and lumbar vertebrae?

A 
Annular rings:
- 1x Superior
- 1x Inferior
1x Spinous process
2x Transverse processes
80
Q

What are the 6th and 7th secondary ossification centres of thoracic vertebrae?

A

A costal articular surface on each transverse process

81
Q

What are the 6th and 7th secondary ossification centres of lumbar vertebrae?

A

Mamillary processes:

- Part of superior articular surface

82
Q

How many primary ossification centres does the sacrum have?

A

21

83
Q

What is each sacral vertebra represented by in regards to primary ossification centres?

A

3 typical primary ossification centres:

  • 1x centrum
  • 2x neural arches
84
Q

What additional primary ossification centres do S1-S3 (sometimes S4) have? What do these form?

A

Paired lateral elements:

  • Form ventral aspect of alae
  • Site of SIJ
85
Q

What sacral primary ossification centres appear in the 3rd foetal month?

A

S1 and S2 centra

86
Q

What sacral primary ossification centres appear in the 4th foetal month?

A

S3 and S4 centra

S1-S3 neural arches

87
Q

What sacral primary ossification centres appear in the 5th foetal month?

A

S5 centrum

S4-S5 neural arches

88
Q

What sacral primary ossification centres appear in the 6th-8th foetal months?

A

S1-S3 paired costal elements

89
Q

When do the neural arches fuse to the lateral elements in the sacrum?

A

2-5 years

90
Q

When does each united neural arch-lateral element component fuse to the centrum in the sacrum?

A

2-6 years

91
Q

By what age have all primary centres (except one) fused within the sacrum? What is the exception?

A

6 years
Except posteriorly at spinous process:
- Fuses between 7-15 years

92
Q

When do the sacral vertebrae fuse to form the fused sacrum? What is the pattern of this fusion

A

Puberty:

  • Lateral elements commence fusion
  • Fusion is caudocranially directed
93
Q

How many constant secondary ossification centres are there in the sacrum?

A

14:

  • 10x annular rings
  • 2x auricular epiphyses
  • 2x lateral margin epiphyses
94
Q

Where are the variable small secondary ossification centres in the sacrum?

A

Flake-like epiphyses:

  • Spinous processes
  • Median sacral crest
  • Lateral sacral crest
  • Between sacral vertebrae
95
Q

What age is a skeleton if there are still spaces between sacral vertebral bodies?

A

<20 years

96
Q

What age is a skeleton if there is still a space between S1-S2 vertebral bodies?

A

<27 years

97
Q

When is there complete union of the sacrum?

A

25+ years

98
Q

When do the several ossific nodules for the SIJ appear?

A

15-16 years

99
Q

When do the ossific nodules of the SIJ fuse?

A

18 years

100
Q

What epiphyses of the sacrum follow the same pattern as the SIJ secondary ossification nodules?

A

Lateral margin epiphyses

101
Q

When does the SIJ form and by what action?

A

2nd fetal month

Cavitating

102
Q

When is the SIJ joint complete?

A

7th fetal month

103
Q

What is the shape of the SIJ at birth?

A

Straight
Parallel to vertebral column:
- Reflects quadripedal form

104
Q

What do mechanical forces due to growth and bipedalism cause the SIJ to do?

A

Curve caudodorsally:

105
Q

How does the surface area of the SIJ change with milestones?

A

Increases

106
Q

How do we know that the SIJ is non-weight bearing?

A

No dense lines in trabeculae to indicate stress

107
Q

How do we know there is no sexual dimorphism of the SIJ?

A

It is not smaller in females:

- Weight bearing joints often smaller in females

108
Q

Which coccygeal element may appear from multiple primary centres instead of a single centre as they usually do?

A

Co1

109
Q

When does the Co1 primary ossification centre appear?

A

Late foetal period to early life

110
Q

When does the Co2 primary ossification centre appear?

A

3-6 years

111
Q

When does the Co3 primary ossification centre appear?

A

10 years

112
Q

When does the Co4 primary ossification centre appear?

A

Puberty

113
Q

When is the coccyx fully recognisable?

A

By puberty

Vertebral Column (14 decks)

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