Exam 2 (Don’t forget to study Exam 1 cards) Flashcards
Steel’s Rule of Thirds applies to which structures of the atlas?
1/3 odontoid (anterior)
1/3 spinal cord
1/3 free space: adipose, vessels, ligaments, meninges, subarachnoid space
What are the 3 ossification centers of atlas?
anterior arch lateral masses (2)
There are 5 primary and 5 secondary ossification centers of axis, what are they?
Primary:
Body (1)
Arches (2)
Lateral base of odontoid (2)
Secondary: Tip of odontoid (1) Inferior vert body (1) TPs (2) SP (1)
There are 3 primary and 7 secondary ossification centers in C7, what are they?
Primary:
Body (1)
Secondary (2)
Secondary: TPs (2) Superior body (1) Inferior body (1) SP (1) Costal elements (2)
What ossification centers are distinctly different between typical cervical vertebrae and C7?
Separate secondary ossification centers for costal processes
Which vertebral structures have an articular facet?
Dens
Anterior arch
Superior articular process
Inferior articular process
What structures form the IVF?
Pedicles
Articular pillar
vert bodies and IVDs
Uncinate processes
Anterior and posterior roots in the cervical spine are found as part of which structure?
TPs
The atlanto-occipital joints would be considered what type of joint?
Condylar
Which part of the vertebral artery runs from C6 to C1 TP?
2nd part
What percentage of the height of the cervical spine is from the cervical disc?
25%
The EOP is found at the midpoint of which nuchal line?
Superior nuchal line
The condylar fossae are found ____ to the occipital condules?
Posterior
Which part of the vert artery runs superior of axis?
3rd part
Cervical lordotic curvature is characterized as appearing ____.
Convex anteriorly
Development of cervical curve begins when?
Around 9 weeks with initial fetal movements
Lordosis becomes more prominent when infant begins lifting head at ____.
3-4 months of age
Infant begins sitting upright around ____ months of age further establishing lordosis of c spine.
9
In males, cervical lordosis increases gradually until age ____, when a dramatic increase in lordosis occurs.
70
In females, lordosis increases gradually until age ____, before rapid increase for several years and then slowing down again.
50
Do males or females have greater lordosis throughout life?
Females
Identify the location of the upper cervical and lower cervical curve.
UC:
primary curve CO-C1, kyphotic
LC:
Secondary curve C2-C7, lordotic
How many curves are found in the cervical spine?
2 curves
During flexion of lower cervical spine, upper cervical spine moves dependently or independently?
Independently (flex/extend both possible)
Lack of a cervical lordotic curve is acceptable for what age group?
Under 17
Lack of cervical curve in adults is indicative of what?
Ligamentous injury and/or anterior neck muscle hypertonicity
Which muscles of the neck could contribute to a lack of cervical lordosis?
Hyoid muscles, longus colli (anterior hypertonicity)
What boney abnormality can contribute to lack of cervical lordosis?
Hyperplastic articular pillars
Loss of cervical curve in an adult is found often times to be a(n) ____.
Insignificant finding
The theory behind why lack of cervical lordosis is significant by some is that ____.
There is an increased pressure on the brainstem and spinal cord
Females have more rapid shortening of height during what age range?
50-60 (menopause)
Degenerative changes of the spine begin around what age range in males?
31-40
Rapid degenerative changes of the spine in females happens in what age range?
51-60
Which vertebrae are considered typical?
C3-C6
Typical cervical VBs are small, ____ shaped.
Rectangularly
Typical cervical VBs transverse diameter ____ AP diameter.
Greater
Width and height of the typical cervical VBs are present at which portion of the c spine?
Inferior portion
Which ligament attaches along ridges of the anterior VB of the typical cervical vertebrae?
ALL
Ridges of the typical cervical vertebrae create a concave or convex surface for the ALL to attach?
Concave
What boney structure creates the concave surface of the superior portion of the typical cervical VBs?
Uncinate processes
Is the inferior surface of the typical cervical VB larger or smaller than the superior surface?
Larger
Raised lips of the VB are found where on the typical cervical vertebrae?
Superior aspect of VB Uncovertebral joints (Luschka’s joints, neurocentral joints) of the uncinate processes
How many uncinate processes are found on either side of the typical cervical vertebrae?
1 on each side
Which boney structure of the typical cervical vertebrae functions to allow flex/extend and limiting some lateral flexion?
Uncinate processes
Uncinate processes may help prevent IVD protrusion in which directions?
Posterior and lateral
What type of joint are the uncovertebral joints (Luschka joints, neurocentral joints)?
Synovial joints
At what age do uncovertebral joints (Lushka’s joints, neurocentral joints) form?
9-10 years of age
What pathology may encroach on the vert artery and/or spinal nerves?
Degeneration with osteophytes
Which region of the typical cervical vertebrae has the highest incidence of neural compression syndromes?
C4-C6
Which nerve roots would C4-C6 neural compression syndromes affect most often?
C5-C7
What sign may present at the typical cervical vertebrae when there has been trauma to the area?
Prevertebral soft tissue swelling
Typical cervical vertebrae pedicles project ____.
Posterolaterally
The medial border of transverse foramen is formed by which boney structure?
Pedicles
Where do the pedicles lie in relation to the superior and inferior VB endplates?
Midway
The spinal nerve runs ____ to its corresponding pedicle.
Superior
In the c spine, the spinal nerve exits ____ its corresponding vertebrae.
Above
____ of TPs of typical cervical vertebrae originate from the spine as 2 roots or bars.
Tubercles
Tubercles of typical cervical are joined by what boney structure?
Intertubercular lamella (costotransverse lamella)
Groove or gutter for the spinal nerve and anterior ramus is located ____.
Between anterior and posterior roots
Dural sleeve of the spinal nerve is adhered to ____ by fibrous tissue.
Gutter of TP
The dural sleeve of the spinal nerve is especially strong at what region of the cervical spine?
C4-C6
Dural root sleeves in the c spine has ____ sensory innervation than other regions.
More
The dural root sleeves in the c spine originate from ____ instead of recurrent meningeal nerves.
Dorsal root ganglion
Traction of nerve roots registers as ____.
Pain
Dorsal ramus leaves each ____ nerve shortly after it exits the IVF.
Spinal
Dorsal ramus courses along z joint and supplies joint with ____ innervation.
Sensory
Dorsal ramus provides what types of sensory information to cervical parts deep back muscles?
Motor, nociception, proprioception
Dorsal ramus provides information from what layers of the skin of the back?
Dermis and epidermis
What muscles attach to the anterior tubercles of the cervical TPs?
Anterior scalene
Longus colli
Longus capitis
What muscles attach to the posterior tubercles of the cervical TPs?
Splenius cervicis Longissimus cervicis Iliocostalis cervicis Levator scapulae Scalenius medius and posterior
Posterior tubercles of the TPs of the c spine extend further ____ than ____.
Laterally and inferiorly than anterior
Transverse foramen of all C spine vertebrae are bound by what structures?
Pedicle
Anterior root of TP
Posterior root of TP
Intertuberuclar lamella
After the vert artery travels through C1 transverse foramen, it loops ___ and ___ over the superior articular process to enter foramen magnum.
Superiorly and medially
Ventral rami pass ____ to vert artery.
Posterior
____ veins descend through transverse foramen.
Vertebral
Vertebral veins dump into ____ veins.
Subclavian
Vertebral veins begin in which region of the c spine?
Atlanto-occipital region
Vert artery is accompanied by plexus of ____ nerves through the transverse foramen.
Sympathetic
Cervical ribs have the following AKAs for attachment sites:
Costal elements
Costal processes
Pleurapophyses
What boney structure arises from the mesenchymal stage of vert development of the costal process?
TPs
Where in the c spine does compression of the brachial plexus or subclavian artery appear most often?
C7 ribs
The fibrous band of tissue usually connecting the tip of the cervical rib to the manubrium or the 1st true rib is seen on plain films. True/False
False
Facet joint (z joint) angles in the c spine are at what degrees?
45 degrees
What cardinal plane do the s spine facet (z) joint angles appear in?
Horizontal
Upper cervical vert are closer to what degree of facet joint angle?
35 degrees
Lower cervical vert are closer to what degree of facet joint angle?
65 degrees
Superior articular processes and facets of c spine face what direction?
Posterior, superior and slightly medial
Articular processes become more ____ as a child reaches 10 years of age.
Vertical
Asymmetry in facet joint angles and articular process orientation is especially common in what region of the c spine?
Transition areas (C6-T1)
Height of superior articular processes of c spine ____ while width ____ from C2-C7.
Decreases and increases
Prior to what age do you maintain smooth, thick articular cartilage with regular subarticular bone?
20 years old
Subchondral bone ____ with age.
Thickens
2 signs of degeneration of facet joints/articular pillars are?
Osteophytes and sclerosis
Z joint capsules limit what movement?
Hyperextension
Which aspect of z joint capsules are thickest?
Anterolateral
Z joint capsules of s pine are thinner, longer, and looser than T spine and L spine. True/False
True
Z joint synovial folds AKA:
Menisci
Z joint synovial folds (menisci) project into the joint from what directions?
Anterior and posterior
Z joint synovial folds (menisci) cover about ____ of the articular surface?
1/3
Z joint synovial folds (menisci) cover larger area at what region of the c spine?
C1-C2
Z joint synovial folds (menisci) have ____ nerve innervation.
Sensory
Z joint synovial folds (menisci) of the c spine are most often damaged from what type of trauma?
Whiplash
Articular pillar is the column made from which boney structures?
Superior and inferior articular processes
Facet joints
What is the function of articular pillars of c spine?
Bearing weight of head
Spondylosis is rare in what boney structure of the c spine?
Articular pillar
Z joints are important for what neurological sense?
Proprioception
Z joints are innervated by what structures?
Mechanoreceptors and free nerve endings
Medial branch of dorsal rami
Z joints of the c spine are often innervated by the nerve above and below except for which segment?
C2-C3, which is innervated only C3
Cervical facets may refer neck pain to distant sites. True/False
True
Lamina narrow from what direction of the c spine?
Superior to inferior
What ligament fills the gap between lamina of adjacent vertebrae?
Ligamentum flavum
Upper border of c spine lamina is ____.
Thin
Anterior surface of inferior border roughed by attachment of what ligament?
Ligamentum flavum
Vert canal (vert foramen) is ____ shaped.
Triangular
Borders of vert canal (vert foramen) include:
Lamina lined by ligamentum flavum
Pedicles
VBs
IVDs
What structures are present within the vert canal (vert foramen)?
Epidural adipose tissue
Internal vert venous plexus
Spinal cord covered by meninges and CSF
Spinal nerve roots
Vert canal (vert foramen) dimensions of C1-C7 remains fairly constant at what measurement?
12-13 mm
Upper cervical vert canal (vert foramen) appear ___ superiorly than inferior
Wider
In the upper cervical vert canal (vert foramen), how much of the space is occupied by the spinal cord at C1?
Less than 50%
Narrowing of the vert canal (vert foramen) of the c spine occurs at what vert?
C4
At what vert does the spinal cord occupy 75% of available space in the cervical vert canal?
C6
Volume of CSF in subarachnoid space in cervical vert canal is greatest in ____ and least in ____.
Flexion
Extension
Connective tissue attachments to the posterior spinal dural mater in the c spine vert canal are:
Foramen magnum Posterior arch of C1 SP of C2 Rectus capitis posterior minor Ligamentum nuchae Ligamentum flavum
Dura mater is held in place to prevent folding in during ____
Extension
Dura mater is held in place to prevent pressure on cord during ____.
Flexion
What is cervical myelopathy?
Pathology of c spine cord
Compression, often by narrowed vert canal
May be congenital
When A-P diameter reaches ____ mm or smaller, cervical myelopathy symptoms manifest.
12-13
Histological changes with cervical myelopathy begin with loss of ____ horn cells then to intermediate, then to lateral and posterior funiculi of white matter. Finally atrophy of entire gray matter and more severe degeneration in lateral funiculus.
Anterior
Anterior horn cells in are ____nerves which innervate upper extremities.
Motor
Clinical signs of cervical myelopathy include:
Loss of sensory input and motor function of structures supplied by the spinal cord sigment
Diffuse neck pain with neuro deficits
Mimics MS, ALS, IVD protrusion, and spinal cord tumor
What is neurapraxia of cervical nerves?
Injury to a nerve resulting in paralysis that recovers completely in a short period of time
Neurapraxia of cervical nerves usually occurs from what types of injuries and where in the c spine?
Sports (football)
C5-C6
Field AKAs stingers/burners
Typical cervical vert SPs develop from 2 ____ ossification centers.
Secondary
Typical cervical vert SPs are sites of attachment for ligament ____ along with the deep extensors of the spine.
Nuchea
Typical cervical vert SPs have ____ tubercles.
Asymmetrical
Length of cervical SPs ____ C2-C4 and ____ C4-C7.
Decreases
Increases
Which cervical vert has the shortest SPs?
C4
Borders of c spine intervertebral foramina include:
Inferior/superior notches of pedicles
Articular pillar
VBIVD
Uncinate processes
C spine intervertebral foramina face what direction?
Oblique and anterior, slightly inferior
The c spine intervertebral foramina is ____ shaped and 4-6 mm long.
Oval
C spine intervertebral increases superior to inferior diameter with what movement?
Flexion
C spine intervertebral foramina rotation to same side ____ foramen and contralateral rotation ____ foramen.
Narrows
Widens
Which spinal movement increases pressure in the IVF of c spine?
Extension
Bakody’s test shows a decrease in pressure in the IVF with what movement?
Abduction of upper limb
What structures are housed inside the IVF of c spine?
Dorsal/ventral rootlets
Spinal nerve with dural root sleeve (inferior portion)
Epidural fat and blood vessels (superior portion)
Dorsal root ganglia in small notch on anterior surface of superior articular process
IVF stenosis causes:
Bone spurs IVD protrusion Fibrous tissue/adhesions in IVF Thickened/buckled ligamentum flavum Congestion/inflammation of blood vessels in IVF
Stenosis of IVF effects:
Compression of dorsal/ventral roots
Compression of spinal nerve or dorsal root ganglion
Clinical symptoms of stenosis of IVF are:
Decreased muscle strength
Radicular pain
Most common nerve roots are C6-C8
Enlargement of IVF pathologies:
Neurofibroma Meningioma Fibroma Lipoma Chordoma Herniated meningocele Tortuous vert artery Congenital absence of pedicle with TP malformation
Squamous part of occipital bone is found on which area?
Posterior to foramen magnum
Where is the opisthion craniometric point on the squamous area of the occipital bone?
Directly posterior of foramen magnum
What muscle attaches to the EOP?
Trapezius
The outer surface of the squamous portion of the occipital bone consist of the following boney landmarks:
Opisthion EOP (inion) EO crest Supreme nuchal line Superior nuchal line Inferior nuchal line
The inner surface of the squamous portion of the occipital bone consists of the following boney landmarks:
IOP
Grooves for transverse sinus
Attachments for tentorium cerebelli (dural fold)
Lateral aspect of occipital bone consists of the following boney landmarks:
Sides of foramen magnum
L/R occipital condyles
Jugular processes
Jugular notches
Occipital condyles are located on the ____ aspect of the FM.
Anteriolateral
What is the positioning of the convex structures of the occipital condyles?
Inferior, anterior, and medial
Occipital condyles have articular facets covered with ____.
Hyaline cartilage
Atlanto-occipital articulations allow for which movements to occur?
Flex/extend, lateral flex
Jugular notch contains a ____ along the lateral margin of each side of the occiput.
Groove
The jugular process is located on what border of the jugular groove?
Lateral
The jugular process projects ____ on the lateral aspect of the jugular foramen creating the posterorlateral margin of the jugular foramen.
Anteriorly
Which muscle attaches to the jugular process?
Rectus capitis lateralis
Basilar part of occipital bone is located ____ to the foramen magnum.
Anterior
Basilar part forms what craniometric point?
Basion
Basion point on occipital bone is composed of the union between:
Basilar portion of sphenoid bone forming clivus
Sphenobasilar joint
Pharyngeal tubercle of basilar part of occipital bone is located on the ____.
Midline
Superior pharyngeal constrictor
Longus capitus
Superior band of cruciate ligament attaches to the surface of what boney structure on the basilar part of occiput?
Clivus, beneath the tectoral membrane
Anterior atlanto-occipital membrane attaches ____ to the FM.
Anterior
Apical ligament of odontoid attaches to ____ rim of FM.
Anterior
Incomplete incorporation of superior sclerotome leaves remnants of ____ vertebrae congenitally.
Occipital
Which structures are congenital anomalies found in the occiput?
Paracondylar process Epitransverse process Hypocondylar arch 3rd occipital condyle Accesory ossicles
Assimilation or fusion of atlas to occiput occurs when there is ____ segmentation of occipital and upper cervical somites.
Lack of
Assimilation of atlas to occiput usually occurs with ____ fusion of one lateral mass to the adjacent occipital condyle
Asymmetrical
Both lateral masses and the ____ arch of C1 may fuse with the occiput during AO assimilation.
Anterior
The posterior does not fuse in AO assimilation for ____ artery to enter the foramen magnum.
Vertebral
What boney structure may extend up into FM with the occurrence of AO assimilation?
Odontoid process
The cerebellum and lower cranial nerves may be affected with an AO assimilation due to invagination of which surface of the occiput?
Basilar area (superior deviation of inferior aspect of occiput)
Upper cervical anomalies are often accompanied by anomalies of which other body structures?
Face
Ears
Mid-lower cervical vertebrae
Atlas contains how many primary centers of ossification?
1 in each LM (7th week of gestation) close to complete posterior arch at 4yrs old
1 in anterior arch
The hypochordal arch is found on which arch of the atlas?
Anterior arch
Hypochordal arch is located where on the anterior arch of the atlas?
Between lateral masses of atlas in embryo
Primary center of ossification appears around 1 year of age in atlas and fuses with L/R LM between what ages?
7 and 9 years of age
Which arch of atlas is smaller?
Anterior arch
Which ligament attaches to anterior tubercle of anterior arch of atlas?
ALL and longus colli muscles
What type of joint is the atlas facet dens articulation?
Diarthrodial joint (synovial pivot)
Posterior arch of atlas forms ___ of the ring.
2/3
Which ligament connects at the posterior tubercle of the posterior arch of the atlas?
Ligamentum nuchae
Rectus posterior minor muscle
Which ligament attaches at the lower border of the posterior arch of atlas?
R/L ligamentum flava
What structure rest in the grooves on either side of the posterior arch of atlas?
VAN
Which nerve travels between vertebral artery and posterior arch of atlas?
Sub-occipital nerve (dorsal rami of C1)
Foramen structure for the groove of vertebral artery is called what?
Arcuate foramen
What soft tissue structure attaches to either side of the groove of the vertebral artery which when ossified creates a posterior ponticus?
Posterior AO membrane
What percentage of the population as a posterior ponticus?
25% partial
8% both
Ossification laterally between what structures creates a lateral ponticus?
Superior articular process of atlas and atlas TP
Lateral ponticus is ____ more common on right side.
4%
Lateral masses of atlas are composed of which boney structures?
Superior articular process
Inferior articular process
TP
Superior articular process of atlas’ anterior aspect is positioned how?
More medially than posterior
The superior articular process surface is ____ shaped.
Concavely
The rectus capitis anterior attaches on what aspect of the lateral masses of the atlas?
Anterior aspect
Which ligament attaches on the tubercle of the medial surface of the lateral masses of atlas?
Transverse atlantal ligament (colliculus atlantis)
At what age does the transverse atlantal ligament (colliculus atlantis) form?
13 years of age
Typical thoracic vertebrae:
T2-T8
Typical thoracic VBs size ____ as they descend down the spine to accommodate increased load bearing.
Increases
Prominent kyphosis in T-spine extends what region?
T2-T12
Posterior vertebral height is ____ than anterior from T2-T12.
Greater
Average kyphosis in T-spine is ____ degrees (10-40 range).
25 degrees
Straight back means ____ A to P diameter, decreasing room for heart and lungs.
Narrower
Heart is pushed where kinking great vessels with straight back syndrome?
To the left
Schueermann’s disease is found in what percentage of adolescents?
0.4-8.3
Classic Scheurmann’s disease affects T-spine how often?
2/3 of the time
Classic Scheuermann’s disease affects L-spine how often?
1/3 of the time
Disruption of cartilaginous endplates and fragmentation of annular apophysis and bony endplate is what pathology?
Affects many adjacent segments.
Scheuermann’s disease
Scheuermann’s disease begins insidiously around ____ years of age.
10-12
At what age range does Scheuermann’s disease become painful?
12-15 years old (changes seen on film)
When does Scheuermann’s disease stop progressing?
25 years of age after vertebral growth is complete
Clinical signs of VBs becoming wedge shaped, more shorter anteriorly than posteriorly increasing kyphosis (apex T*) mid and low back aching pain comes and goes in adolescence.
Scheuermann’s disease
Initial irregularity and fragmentation of bony endplates
1+ vertebra with wedging of greater than 5 degrees
Multiple Schmorl’s nodes
Narrowed IVD space
Kyphosis greater than 45 degrees
Radiographical findings of Scheuermann’s disease
Complications of Scheuermann’s disease include:
Severe cases: compression of spinal cord (melopathy) at apex of kyphosis
Treatment of Scheuermann’s disease includes:
Bracing spine in extension, exercise, palliative pain management
T-spine VBs are ____ shaped when viewed from above do to concavity in posterior region abutting VF.
Heart
Upper thoracic VBs may have some remnants of cervical ____.
Uncinate processes
T-spine VBs are more flattened on anterior ____ side due to pressure from thoracic aorta.
Left
Which typical vertebrae are wedge shaped with shorter S to I height anteriorly and larger height posteriorly?
Thoracic vertebrae
Slight, sporadic left lateral wedging of VBs, compensated for by IVDs is seen in which typical vertebrae?
Thoracic vertebrae
Which thoracic vertebrae is the smallest?
T3
T5-T8 are more ____ shaped due to more prominent posterior concavity.
Heart
Which thoracic VBs resemble lumbars, enlarging more transversely/laterally?
T9-T12
What is neurocentral synchondrosis?
Where neural arches fuse to centra
Where does the neurocentral synchondrosis fuse last at?
Thoracics (may not complete until adulthood)
Osteophytes most common/prominent at what region of the T-spine?
T9-T10
The ____ side of T9-T10 is more likely to develop osteophytes because the aorta sits on the other side keeping it smoothed off.
Right
There are how many costal demifacets on the typical T-spine?
4 (2 on each side)
Costal demifacets form what kind of joint articulating with rib heads.
Synovial joint
Intraarticular ligament attaches to the IVD from what portion of the rib?
Ridge of rib head
Which ligament extends from head of each rib to adjoining VBs and surface of IVDs?
Radiate
Which muscle originates on the anterior surface of T1-T3?
Longus colli muscle
Which muscle attaches to the lateral surface of T12?
Psoas major and minor
T-spine pedicle characteristics include:
Long/stout
Predominately cancellous bone (C-spine, cortical)
Attach very high on VB, inferior notch is deep and no superior notch
Which direction do the T-spine TPs project?
Obliquely posterior
More posterior than C-spine and L-spine
T-spine TPs get ____ from top to bottom.
Smaller
Which T-spine TP is often longer than the other?
Left
What is the tubercle called on the T-spine TP that articulates with the transverse costal facet?
Articular tubercle
Costal facets are concave, facing anterior and slightly lateral for which region of T-spine?
T1-T6
Which T-spine region facets are more flat (planar) and face anterior, lateral and superior?
T7 down
What attaches on anterior surface of thoracic TPs?
Costotransverse ligament (medial to transverse costal facet)
What attaches to the apex surface of thoracic TPs?
Lateral costotransverse ligament
What attaches to posterior apex surface of thoracic TPs?
Levator costorum muscle
What attaches to inferior surface of thoracic TPs?
Superior costotransverse ligament
What attaches to the superior border of thoracic TPs?
Intertransversarii muscle and ligament
What attaches to posterior surface of thoracic TPs?
Deep back muscles (longissimus thoracis, semispinalis thoracis and cervicis, multifius thoracis, rotators longus and brevus)
