Exam 2 - Regions in Spinal Column Flashcards
What are the 3 regions of the occiput?
Squamous portion
Lateral/condylar (2)
Basilar portion
Posterior part and most of the base of the cranium is formed by what
Occipital bone
What pass through foramen magnum?
Medulla oblongata
Vertebral arteries
Spinal arteries
Where the glossopharyngeal, vagus, and accessory cranial nerve exit the skull
Jugular foramen
The portion that connects to the sphenoid bone and is an area for attachment of many ligaments and muscles
Basilar portion
First _____ of flexion/extension of head and neck takes place here before any other vertebra move
50%
What are the 4 nuchal lines?
Median
Inferior
Superior
Highest
The largest part of the occiput that is posterior to the foramen magnum
Squamous portion
A typical cervical vertebra has _______ shaped bodies
Rectangular/oval
A typical cervical vertebra has _______ SP
Bifid
How many cervical lips does a typical cervical vertebra have?
3 - 2 superior lateral & 1 anterior inferior lip
in the typical cervical vertebra, the TP are _______ to the AP
Anterior
__________ ________ are ascension of the vertebral artery
Transverse foramen
What is a Costco-transverse lamella?
Groove on superior surface of the TVP for exit of the spinal nerve - typical cervical vertebra
A typical cervical vertebra has a ________ neural foramen
Triangular
Which cervical are typical
3,4,5,6
Peculiar cervical vertebra are..
1,2,7
What is the purpose of the uncinate processes?
Prevent lateral slipping of vertebra above
When does the uncinate process develop?
Between 9 and 10
A typical cervical has ___ true articulations and ___ pseudo ones
6
2
Bony elevations on the superior lateral margins of the cervical vertebrae are called what?
Uncinate processes
Uncinate processes articulate with the inferior lateral aspect of the vertebra above to form what?
Uncovertebral joint AKA Joints of Luschka AKA Luschkal Joint
What is the defining characteristics of the atlas
Lacks a body, pedicles, Laminae, spinous
Has anterior arch, posterior arch, and lateral masses, and TVPs
What is developed from the hypochondral arch that typically unites both halves of vertebral bodies
Anterior Arch
Primary center of ossification for the atlas
Anterior arch
Anterior arch fuses to lateral masses when?
Between 6 and 8
Most anterior part of the atlas
Anterior tubercle
Groove for articulation of dens on the anterior tubercle that forms a pivotal joint for rotation of C1 and C2
Fovea Dentalis
50% of rotation of the head and neck takes place in the ______ before any other vertebra moves
Anterior tubercle of anterior arch of C1
Entrance of vertebral artery and exit for 1st pair of spinal nerves
Superior Vertebral Notch (Sulcus Arteriae Vertebralis)
Exit of 2nd pair of spinal nerves
Inferior vertebral notch
Anterior inferior surface of posterior arch
Inferior vertebral notch
Lateral masses of C-1 have _____ and _____ facets
Superior
Inferior
Superior facet of C1 faces…
Superior and medial
Inferior facet of C1 faces…
Flat and inferior
Where are the longest TVP in the cervical spine?
C1
Causes of ADI abnormality
Trauma
Down’s Syndrome
Inflammatory Arthritis
C2 AKA
Axis
Epistropheus
Distinguishing characteristics of C2
Odontoid Process (dens) No superior lateral lips
What are the 5 articulations of C1?
2 with occiput
3 with C2
Atlas-Dens Interval should be….
Less than 5mm in children
Less than 3mm in adults
Which cervical has the shortest TVP
C2
Which cervical has the largest SP?
C2
What are the articulations of C2?
3 with atlas
3 with C3
What are the two ligaments of C2
Alar ligament
Apical dental ligament
Which cervical is the first palpable spinous below the EOP?
C2
2 or more motions occurring at the same time
Coupling motion
Spinous process will move to ______ side when cervical spine is laterally flexed
Opposite
The vertebral body will move to the _______ side when the cervical spine is laterally flexed
Same
The spinous process will move to the _______ side when the lumbar spine is laterally flexed
Same
The vertebral body will move to the ______ side when the lumbar spine is laterally flexed
Opposite
The coupling motion of the cervical spine occurs where?
From cervical spine to T6,7,8
The first artery off the subclavian artery
Vertebral artery
Which artery supplies the posterior 1/3 of the bran?
Vertebral artery
Which arteries supply the anterior 2/3 of the brain?
Carotid arteries
Which artery comes off the aorta?
Subclavian artery
The vertebral artery ascends through the tansversarii of the first ____ vertebrae
6
What does it mean that the vertebral artery is fixed to adjacent structures?
It cannot slide inside the transverse foramen and will elongate then the cervical spine is rotated
The vertebral artery will elongate when the cervical spine is bent at what degree?
30-45%
Part 1 of the vertebral artery
Subclavian artery through TVP of C6
Part 2 of the vertebral artery
From C6 through C2
Part 3 of vertebral artery
C2 to C1
Moves laterally and passes through TVP of C1
Turns medially and goes through sulcus arterii vertebrialis
Part 4 of vertebral artery
Through posterior Atlanta-occipital ligament, into spinal canal then joins with fellow on opposite side to form the basilar artery
Last and largest branch of vertebral artery
PICA
Posterior inferior cerebellar artery
Basilar artery travels upward and branched into a right and left ___________
Posterior cerebral artery
The posterior cerebral artery branches and forms the _______________
Posterior communicating artery
The anterior cerebral artery unites with the _______
Anterior communicating artery
Where is the circles of Willis?
under the brain
What does the circle of Willis supply?
The base of the brain
Most common area of stroked or vascular accidents?
Circle of Willis
2 divisions of strokes
Ischemic
Hemorrhagic
Blood supple to a portion of the brain is blocked
Ischemic
Loss of blood flow due to bleeding
Hemorrhagic
90% of strokes are…
Ischemic
The type of stroke that is associated with manipulation
Ischemic
Least mobile region of the spine
Thoracic
Basic movement in the thoracic spine is _______
Rotation
There is some _______ but no _______ in the thoracic spine
Flexion
Extension
Typical thoracic vertebrae:
T2-8
Most of the thoracic vertebrae have an _______ shaped neural foramen
Oval
TVP of thoracic vertebrae are oriented…
45 degrees posterolateral
12 articulations of typical thoracic vertebra
4: Articular processes
4: Demi-facets on bodies with head of ribs
2: ribs at TVP
2: vertebral body above and below via disc
Which is the longest thoracic spinous?
T4
Which is the shortest thoracic spinous
T11
Which thoracic vertebra are peculiar
T1, T9, T10, T11, T12
T1 characteristics
2nd transitional spinal segment
Body more rectangular
Rudimentary uncinate processes
T1 Characteristics
1 pair full costal facets superior
1 Park demifacets inferior
12 articulations
T9 characteristics
1 pair demi-facets on superior
No inferior demi-facets
10 articulations
T10 characteristics
Only 1 pair of full costal facets-superior
NO costal facets on inferior
10 articulations
T11 characteristics
NO fovea costalis transversalis on TVP
1 pair full facets
8 articulations
T12 characteristics
No fovea costalis transversalis on TVP
1 pair full facets on body
3rd transitional segment in spine
Mammillary processes, accessory processes, 1 pair of interlocking articular process on inferior
Pectus carinatum
Sternum sticks outward
Ribs too short to bend backward so pushes sternum outward
Pectus carinatum
Pectus excavatum
Sternum is depressed inward
Ribs are too long and push sternum more inward
Pectus excavatum
Typical lumbar vertebra
L1-4
Typical lumbar vertebra bodies are ______ shaped
Kidney
SP of typical lumbar are..
Club-like
TVP of typical lumbar vertebra are ____ and _________
Thin
Blade like
TVPs of typical lumbar vertebra are _______ to articular process but _______ to IVF
Anterior
Posterior
Mammillary process of typical lumbar are on the _______ _________ ________ aspect of superior articular process
Posterior
Superior
Lateral
SAP of typical lumbar are convex or concave?
Concave
SAP of typical lumbar are located on inside or outside?
Outside
IAP of typical lumbar are convex or concave?
Convex
IAP of typical lumbar are on inside or outside?
Inside
Laminae of typical lumbar is _____ and _____
Broad
Short
Shape of neural foramen is _______ on typical lumbar vertebra
Triangular
Pedicles of typical lumbar have _______ inferior pedicle notch
Deep
Pedicles of typical lumbar vertebra have a ______ superior pedicle notch
Shallow
body of typical lumbars show a progressive _____ in mass
Increase
Pedicles of typical lumbar are ______ and ______ than thoracic
Longer
Wider
TVP of lumbar are _____ than in thoracic region
Smaller
SP of lumbar vertebra are _______ shaped
Square
Which lumbar is peculiar?
L5
L5 has a _______ shaped body
Wedge
SP of L5 tips _______
Upward
TVP of L5 arises from the _______ and not the lamina/pedicle junction
Body
4th transitional segment of the spine
L5
Flexion of lumbar spine only
60 degrees
Flexion of lumbar spine with aid of pelvis
105 degrees
Extension of the lumbars:
25 degrees
The first 15 degrees of lumbar extension are from the ______
Pelvis
Last 10 degrees of extension of the lumbar spine are from
Lumbar spine alone
Degree of lateral flexion in the lumbars:
25 degrees
Degree of rotation in the lumbars:
45 degrees
A break in the pars interarticularis without anterior slippage
Spondylolysis
Break in the pars interarticularis with anterior slippage
Spondylolisthesis
Anterolisthesis
Anterior slippage
Retrolisthesis
Posterior slippage
Spondylos 70-75% of the time occurs as ______ slips anterior on ______
L5
S1
25% of spondylos occur as _____ slips anterior on _____
L4
L5
Generally accepted cause of spondylolysis
Repeated strains
-damage lower spine over time, usually at L5
Stress fractures are associated with spondylo…..
Spondylolysis
What are the 5 types of spondylolisthesis?
Isthmic Degenerative Traumatic Pathological Dysplastic
Most common type of spondylolisthesis
Isthmic
Type of spondylolisthesis that causes fatigue or stress fracture of the pars of L5
Isthmic
Where can you find a Scotty Dog?
Oblique x-ray
Primarily posterior joint degeneration is what type of spondylolisthesis
Degenerative
Most common form of spondylolisthesis below the age of 50
Isthmic
Most common form of spondylolisthesis above the age of 50
Degenerative
No fracture or pars defect, this is caused by time (type of spondylolisthesis)
Degenerative
L5 slips on S1
Isthmic spondylolisthesis
L4 slips on L5
Degenerative
Most common spondylolisthesis in female over 40
Degenerative
Acute fracture anywhere in the posterior arch except at the pars interarticularis
Traumatic spondylolisthesis
Found secondary to pathology (type of spondylolisthesis)
Pathological
Rare congenital malformation in with L5 may not have inferior articular processes to articulate with S1 (causes anterior slide)
Dysplastic spondylolisthesis
Spondylolisthesis and spondylolysis are both _________ conditions
Acquired
Incidents of spondylolisthesis _________ with age
Increase
Congenital spondylolisthesis AKA
Dysplastic
Spondylolysis means what?
Breaking the vertebrae
95% of spondylolysis occur at which vertebrae?
L5
Spindylolysis are generally ________ in nature (bilateral or unilateral)
Bilateral
Isthmic spondylolisthesis is most often found between the ages of _____ and _____ in athletes
9
13
The majority of spondylos occur asymptomatically by the age of _____ and become symptomatic by age _____
12
13
As many as ____% of young athletes with lumbar pain for over 3 months have either spondylolisthesis and spondylolysis
50
Signs and symptoms of spondylolisthesis
- Low back pain (chronic)
- Tight hamstrings (hyperlordosis)
- Loss of flexibility
Typical x-ray views for the lumbar spine
A-P lumbar Lateral lumbar (not often)
if you suspect a spondylo, what type of x-ray view do you want?
A-P lumbar
Lateral lumbar
& obliques
2 ways to measure (or grade) the amount or degree of slippage using lateral lumbar x-ray
Ullman’s Line
Meyerding classification
Type of classification that uses posterior aspect of the vertebral bodies to measure slippage
Meyerding classification
Grade 1 meyerding classification
0-25%
Grade 2 Meyerding classification
25-50%
Grade 3 Meyerding classification
50-75%
Grade 4 Meyerding classification
75-100%
Grade 5 Meyerding classification
Vertebra has slipped totally off the segment below and anterior
Called spondyloptosis
75% of flexion of the lumbar spine is at ________
L5/S1
Least segmental motion in the lumbar spine is _______
Rotation
Greatest amount of overall motion in the lumbar spine is at _______
L4-5
Greatest amount of lateral bending in the lumbar spine occurs at _____
L3-4
Least amount of lateral bending in the lumbar spine is ______
L5/S1
What is the most common anomaly of the spine?
Trophies
“Last lumbar assumes the characteristics of the sacrum” what does this describe?
Sacralization
“1st sacral segment assumes characteristics of the lumbar” what does this describe?
Lumbarization
What are the 3 types of Baastrup’s disease?
Trophism
Sacralization
Lumbarization
51% of disc herniation occur at ______
L4/5
49% of disc herniation occur at _______
L5/S1
More mobility = ________ stability
Less
Elongated spinous process of L5 (with lordosis) and a spina bifida at S1 is referred to as what?
Knife clasp syndrome
In ________, joints are faced different and only move with great stress.
Tropism
A pathological stimulation of new bone formation at the attachments of the longitudinal ligaments
Spondylosis
What are the 2 types of spondylosis?
Syndesmophyte
Spondylophyte
Vertical spurs - calcification of the longitudinal ligaments
What type of spondylosis does this describe
Spondesmophyte
Horizontal spurs off the vertebra - may end up with fusion
What type of spondylosis does this describe?
Spondylophyte
What is a spur found on the bone called?
Osteophyte
What are the 3 types of fusion?
Arthrodesis
Ankylosis
Synostosis
Surgical fusion
Arthrodesis
Pathological fusion
Ankylosis
Congenital fusion
Synostosis
Base of the sacrum is body of ______
S1
Sacral Alae AKA
Lateral sacral masses
Superior articular process of the sacrum articulates with what?
Last lumbar segment
Facets in the sacrum face more ______ than ______
Coronally than sagittally
Women sacrum is _______(short or tall), _______ (thin or wide), and _______ curved
Shorter
Wider
More curved
Sacral vertebrae connects the spine to the pelvic girdle at the _______________
Sacroiliac joint
Sacral promontory is on the _____ surface of the sacrum
Anterior
How many pair of anterior pelvis sacral foramen are there?
4
What is the articular surface on the lateral surface of the sacrum?
SI joint
Lateral sacral crest is analogous to _____
TVP
The only normally occurring spina bifida in vertebral column is what?
Sacral hiatus
What is the last pair of articular processes?
Sacral cornua
Male sacrum is more _____ than the females (narrow or wide)
Narrow
Male sacrum is ________ than females (short or long)
Longer
Male sacrum is oriented more ________
Vertically
Female sacrum is oriented more _________
Horizontally
Male lumbosacral angle is _________
Decreased
Female lumbosacral angle _________
Increased
Female anterior surface of the sacrum is more or less curved
More
What is a females Q-angle?
18 degrees
What is a males Q-angle?
13 degrees
Coccyx is formed by ___ segments fused together
4
Each segment of the coccyx develop as what?
Primary center of ossification
Coccyx will develop every ____ to ____ years
1-5
Segments of the coccyx are completely fused between ages _____ and ____
25 - 30
Normal lumbar spine is about _____ degrees from sacrum
37
Nerve supply for SI joint is from
SI and S2 segments
Sacroiliac joint moves about _____ degrees
2
Articular capsule on anterior surface of sacrum
Sacroiliac joint
What 5 typed of joints are in the pelvic ring?
Syphysis pubis (1) SI joints (2) Coxal joint (2) Anterior LS joint (1) Lumbosacral zagapophyseal joints (2)
Total number of joints in the pelvic ring?
8
Pelvic girdle is more flexible in _____
Females
Forward movement of the sacral base with relationship to the ilium
Nutation
Sacral base moves posterior in relation to the ilium
Counter nutation
When the ilium comes tougher is posterior and widens in front, what type of motion is it?
Nutation
When the ilium opens in the back and comes together in the front, what type of motion is it?
Counter nutation
What three types of movement are associated with the SI joint
Rotatory
Nutation
Counter nutation
By the _____ generation of life, degeneration begins and mobility decreases
4th
By the _____ decade, total fibrous degeneration occurs and movement is changed
8th
_______ are more susceptible to SI joint issues than ______
Females
Males
3 joints of uncinate processes
Joints of Von Luschka
Unco-vertebral joint
Co-vertebral joint
False or pseudo joint is called
Joint of Von Luschka
AKA
Luschka Joint
Transverse ridges of the sacrum are analogous to ______
Discs
Sacrospinous ligament seperates _______________ and _____________
Greater sciatic notch and foramen
Lesser sciatic notch and foramen
Who has larger lordosis, males or females?
Females
Atlas can move _______ left or right just from the C1/C2
40-45
2/5th the body ring is part of the ______ arch of C1
Posterior
Most posterior part of C1
Is analogous to SP
Posterior tubercle
Entrance of vertebral artery and exit of 1st pair spinal nerves through
Sulcus arteriae vertebraialis
Ponticus posticus AKA
Posterior Atlanto-occipital ligament
Calcification of the sulcus arteriae vertebrialis
Ponticus posticus
Exit of 2nd pair of spinal nerves
Inferior vertebral notch
