Exam 3 Flashcards
What is the definition of spondylosis?
A vertebral condition that is acquired or age related.
What is the definition of spondylolysis?
A vertebral separation or vertebral cleavage.
What are some of the causes of spondylolysis?
Congenital, acquired during development, the result of aging, or the result of trauma
What is the location of spondylolysis that will be stressed in Spinal II?
A separation along the pars interarticularis (defect in the pars interarticularis or pars defect)
Name some characteristics of cervical spondylolysis:
More frequent in men, most common at C6 level, typically congenital
Name some characteristics of lumbar spondylolysis:
Not congenital and rare under age 5, typically affect men at L5/S1, typically affect women at L4/L5
What is the appearance of the lumbar vertebra upon oblique x-ray view?
A Scotty dog
What is the appearance of a pars defect in a lumbar vertebra upon oblique x-ray view?
A collared Scotty dog
In an oblique x-ray, spondylolysis below the superior articular process of a lumbar pars interarticularis is associated with what part of the Scotty dog?
The neck of the Scotty dog
What part of a lumbar vertebra forms the eye of a Scotty dog?
The pedicle
What part of a lumbar vertebra forms the ear of a Scotty dog?
The superior articular process
What part of a lumbar vertebra forms the nose of a Scotty dog?
The transverse process
What population has been found to have incidence of Sacral Spondylolysis (particularly of S1)?
Alaskan Inuits (young men)
What x-ray view is necessary to view the intervertebral foramen of a cervical?
An oblique view
What x-ray view is necessary to view the intervertebral foramen of a thoracic?
Lateral
What x-ray view is necessary to view the intervertebral foramen of a lumbar?
Lateral
What is the definition of spondylolisthesis?
A vertebral slippage
What vertebral condition results in spondylolisthesis?
Bilateral spondylolysis
While spondylolisthesis is typically anterior, what is it called when it is in the posterior direction?
Retrospondylolisthesis
List some characteristics of Type I spondylolisthesis (congenital)?
associated with spinal bifida; L5 but compresses S1 nerve
List some characteristics of Type II Spondylolisthesis (isthmic):
Bilateral, L5/S1, men & women who have had greater than 3 kids, increase in sagittal diameter (asymptomatic)
List some characteristics of type III spondylolisthesis (degenerative):
Known as degenerative, typically affects women and is at the L4/L5 level, no increase in sagittal diameter
List some characteristics of type IV spondylolisthesis (traumatic):
Rare, involves fracture of neural arch
List some characteristics of type V spondylolisthesis (pathological):
Associated with Paget’s/Osteogenesis imperfecta
What arteries are associated with Vertebrae C1-C6?
Ascending cervical artery, vertebral artery
What artery is associated with Vertebrae C7, T1?
Deep cervical artery
What artery is associated with T1, T2?
Superior intercostal artery
What artery is associated with Vertebrae T3-T11?
Posterior intercostal artery
What artery is associated with Vertebra T12?
Sub costal artery
What artery is associated with Vertebrae L1-L4?
Lumbar artery
What artery is associated with Vertebra L5?
Iliolumbar artery
What arteries are associated with Vertebrae L5-Co1?
Lateral sacral artery, middle sacral artery
What are the characteristics of the Artery of Adamkiewicz?
it is a left side, anterior medullary feeder artery, located in the T9/T10 intervertebral foramen, and the primary vascular supply to the lumbar enlargement
What is a unique histological feature of the veins of the vertebral column?
they appear to LACK VALVES which may contribute to the SPREAD OF MALIGNANT CELLS
What is one unique thing about facial muscles?
They do not connect two bones together (bony attachments are missing as is the case of the PROCERUS, RISORIUS, and ORBICULARIS ORIS MUSCLES
What is the most distal part of the external occipital protruberance?
The INION
What is the Ligamentum Flavum?
THE (yellow) elastic ligament
What is the annulus fibrosis derived from?
the dense sclerotomite
What is the first location of the IVD?
The intrasclerotomal fissure of Von Ebner
Name a unique feature of CN IV (Trochlear):
It is the only cranial nerve to have an apparent origin from the dorsal surface of the brain
Name a unique feature of CN IV (Trochlear):
It is the only cranial nerve to decks sate within the cranial vault from the apparent origin
How large is the Atlanto-Dental interspace:
2-3 mm in adults and 4.5 mm in children
What is the innervation of the ciliaris and sphincter pupillae muscles compared to the dilator pupillae muscle?
The ciliaris and sphincter papillae muscles are innervated by PARASYMPATHETIC fibers of the occulomotor nerve whereas the dilator pupillae muscle is innervated by SYMPATHETIC fibers from the internal carotid plexus
What happens to the uncinate processes as we age?
They HYPERTROPHY
What is the average height of the thoracic intervertebral foramen?
13 mm
What is the average height of the lumber intervertebral foramen?
17 mm
What are the average dimensions of the cervical intervertebral foramen?
About 10mm high and 5 mm anterior to posterior
What condition is the result of encroachment on the L5 spinal nerve?
The FAR OUT SYNDROME
What activities are associated with sacral spondylolysis?
KAYAKING and HARPOONING
What will the intervertebral veins drain into?
The external vertebral venous plexus or BATSON’S PLEXUS
Which venous vessels of the vertebra will drain into the segmental veins?
BATSON’S PLEXUS (or the external vertebral venous plexus)
What types of connective tissue will be present in the intervertebral foramen and what is their function?
ADIPOSE tissue and LOOSE AREOLAR CONNECTIVE TISSUE both PROTECT NERVES
What forms the Joint of Luschka and where is it found?
The LATERAL GROOVES and the UNCINATE PROCESSES extend from underside of C2-top of C3 to C6/7 and offer PROTECTION from HERNIATED DISC
What happens to cervical nerve roots between their origin from the spinal cord and exit from the intervertebral foramen?
They DESCEND up to 8mm in the SUBARACHNIOD SPACE and then ascend to exit in the INTERVERTEBRAL FORAMEN
What are the specific attachment sites for a cervical spinal nerve?
The SULCUS FOR THE VENTRAL PRIMARY RAMUS on the costotransverse bar & THE VERTEBRAL ARTERY
Is there an intervertebral disc higher than C2?
No, and INTERVERTEBRAL DISC IS ABSENT between C1/C2 and between Occ/C1
What is the relationship between aging and cervical spine intervertebral foramen size?
the CROSS SECTIONAL AREA DIMINISHES AFTER AGE 50
What is a non-typical part of the anterior boundary in C1/Occ and C1/C2?
the ZYGAPOPHYSIS is part of the ANTERIOR BOUNDARY
What is the largest nerve in the lumbar region?
LARGEST NERVE of this region is the L5 NERVE. L5 and S1 are the LARGEST SPINAL NERVES IN THE HUMAN BODY
What increases the length of the intervertebral foramen at L5?
The LUMBOSACRAL TUNNEL
What ligament may contribute to the loss of size in the lumbar intervertebral foramen?
The TRANSFORAMINAL LIGAMENT
What ligament attaches the vertebral body to the articular processes?
the TRANSFORAMINAL LIGAMENTS
What ligament attaches the vertebral body to the transverse processes?
the CORPOROTRANSVERSE LIGAMENTS
Each intervertebral foramen is continuous with what?
Each intervertebral foramen is continuous with a DORSAL SACRAL FORAMEN and VENTRAL SACRAL FORAMEN
What is unique about the relationship of spinal nerve to intervertebral foramen at S5-Co1?
There are TWO NERVES PRESENT, S5 NERVE & Co1 NERVE
What are the two big sources off nerve compression?
DESTRUCTIVE LESIONS of the vertebral bodies and CONGENITAL OR ACQUIRED ALTERATIONS of the curvature of the spine.
What are some examples of destructive lesions of the vertebral body?
TUBERCULOSIS, HEMANGIOMAS, OSTEOPOROSIS
What are examples of acquired alterations of the spinal curves identified in class?
PREGNANCY, OBESITY, and THE USE OF HEAVY BACKPACKS (carrying 10% of body weight will alter the developing curves of the spine in children)
What is another name for demyelination?
WALLERIAN DEGENERATION
What are the adult remnants of the primary curve along the vertebral column?
The THORACIC or dorsal CURVE and the pelvic or SACROCOCCYGEAL CURVE
What are the names of the anterior curves, secondary curves, and compensatory curves?
CERVICAL CURVE AND LUMBAR CURVE
What segmental levels form the cervical curve?
C2 - T1
What segmental levels form the lumbar curve?
T12 - L5
List the PRIMARY curves of the spine:
C1/OCC, THORACIC, and SACROCOCCYGEAL CURVES
What developmental events are indicated in the formation of the adult cervical curve?
- centers for VISION and EQUILIBRIUM will appear in the brain
- MUSCULATURE attaching the skull, cervical region, and upper thorax together DEVELOPS
- the HEAD is HELD UPRIGHT
- the INTERVERTEBRAL DISC HEIGHT becomes greater anterior than posterior
What is the name given to the integration of visual and motor pathways associated with HOLDING THE HEAD ERECT?
the RIGHTING REFLEX
What developmental events are indicated in the formation of the adult lumbar curve?
- CRAWLING will cause the abdomen to put tension on the lumbar region and pulls it forward
- MUSCLE DEVELOPMENT is promoted to COMPENSATE FOR SWAYBACK of the lumbars
- INTERVERTEBRAL DISC HEIGHT will become greater anterior compared to posterior
- WALKING will further promote muscle and intervertebral disc development
What is the GENDER BIAS associated with LUMBAR CURVE CONVEXITY?
FEMALES have a GREATER CONVEXITY of the LUMBAR CURVE
Females: 47 degrees
Males: 43 degrees
What is the relationship between the LUMBAR CURVE and LUMBAR ENLARGEMENT?
LUMBAR CURVE: T12 - L5
LUMBAR ENLARGEMENT: T9-T12
What is the time of APPEARANCE of the LATERAL CURVES?
They appear AFTER 6 YEARS OLD
What is the relationship between CURVE DIRECTION and HANDEDNESS?
A RIGHT-HANDED person has a high probability for a RIGHT THORACIC, LEFT LUMBAR curve combination
What is the incidence of a RIGHT THORACIC, LEFT LUMBAR CURVE COMBINATION in the population?
About 80% of the population demonstrates this
What does the suffix “OSIS” mean?
a CONDITION
Does “OSIS” infer a normal or abnormal condition?
NEITHER, it is non-judgemental
know it is not dependent on segment or region
What is the definition of LORDOSIS?
A FORWARD BENDING condition
What is the definition of KYPHOSIS?
A HUMPBACK or HUNCHBACK condition
What is the definition of SCOLIOSIS?
A WARPED or CROOKED condition
know it is an ABNORMAL LATERAL CURVE deviation coupled with AXIAL ROTATION
What clinical abnormal curvatures of the vertebral column were stressed in class?
MILITARY NECK, HUMPBACK or HUNCHBACK, and SWAYBACK
What is MILITARY NECK?
A DECREASED ANTERIOR CURVE in the CERVICAL REGION, a straight neck
What is HUMPBACK or HUNCHBACK?
An INCREASED POSTERIOR CURVE in the THORACIC REGION
What is SWAYBACK?
An INCREASED ANTERIOR CURVE in the LUMBAR REGION
What is a classic CLASSIFICATION of MILITARY NECK?
A KYPHOSIS
What is a classic classification of HUMPBACK or HUNCHBACK?
A KYPHOSIS
What is classic CLASSIFICATION of SWAYBACK?
a LORDOSIS
What is the RADIOLOGICAL TEST for skeletal maturity?
The RISSER SIGN, an indication of bone maturity in the ILIAC APOPHYSIS
(related to scoliosis)
What are the classifications of scoliosis according to the Scoliosis Research Society?
M: Magnitude (COBB ANGLE)
E: Etiology (cause) (IDIOPATHIC, MC ADOLESCENT FEMALE)
D: Direction (side of curve convexity)
L: Location (location of vertebra at apex of curve)
S: Structural (hardware) (can be nonstructural, POSTURE/SPASM)
What is the incidence of idiopathic scoliosis in the population
1% to 4%
Based on the age of onset, what are the types of idiopathic scoliosis?
Infantile, juvenile, and adolescent
Make sure to put full response, for example: “infantile idiopathic scoloiosis”
What is the age range for infantile idiopathic scoliosis?
From birth to 3 years old
What is the age range for juvenile idiopathic scoliosis?
From 3 years old to 10 years old
What is the age range for adolescent idiopathic scoliosis?
Over 10 years old
Identify curve direction, location, gender bias and incidence of infantile idiopathic scoliosis:
Left thoracic, male, less than 1% incidence
Identify curve direction, location, gender bias and incidence of juvenile idiopathic scoliosis:
right thoracic, females over 6 years old, and 12%-21% incidence
Identify curve direction, location, gender bias and incidence of juvenile idiopathic scoliosis:
Right thoracic or right thoracic and left lumbar, females, and 80% incidence
What is the genetic factor associated with adolescent idiopathic scoliosis?
An AUTOSOMAL DOMINANT factor that runs in families
What is the name given to the condition in which the joint formed between the odontoid process and the centrum of C2 persists beyond age 7?
Os Odontoideum
KNOW HOW TO SPELL IT
What is an os odontoideum?
A PERSISTANCE BEYOND AGE 7 of the JOINT formed between the CENTRUM and ODONTOID PROCESS centers of ossification.
Ossification downward from the DENS and upward from the CENTRUM results in what?
A SUBDENTAL SYNCHONDROSIS
becomes os odontoideum if it persists beyond age 7
Between ages 4 and 7 years old, the subdental synchondrosis is typically replaced by what?
A synostosis
If the synchondrosis persists beyond age 7, the condition is called os odontoideum
The cartilage between the tip of the dens and the rest of the odontoid process is called the tip of the dens synchondrosis. While this should become a SYNOSTOSIS sometime BEFORE AGE 12, if the SYNCHONDROSIS PERSISTS it is called what?
A TERMINAL OSSICLE
What unique characteristics of lumbarization of S1 were stressed in class?
Squaring of the vertebral body of S1 and flaring of the sacral ala
What muscles are associated with the five muscle layers of the true back?
Layer 1: trapezius and latissimus dorsi
Layer 2: rhomboid major, rhomboid minor and levator scapulae
Layer 3: serratus posterior (superior and inferior)
Layer 4: erector spinae
Layer 5: transversospinalis
Which of the muscles attaching to spinous processes represent layer one of the true back?
Trapezius, latissimus dorsi
Which of the muscles attaching to spinous processes represent layer two of the true back?
rhomboid major, rhomboid minor
Which muscles attaching to transverse processes represent layer two of the true back?
Levator scapulae
Which of the muscles attaching to the scapula represent layer one of the true back?
Trapezius
Which of the muscles attaching to the scapula represent layer two of the true back?
Levator scapulae, rhomboid major, rhomboid minor
Which of the muscles attaching to the humerus represent layer one of the true back?
latissimus dorsi
Which muscles attaching to the lateral mass of C1 represent layer two of the true back?
Levator scapulae
Which muscles of the back attach to the lateral mass of C1?
Splenius Cervicis, Levator Scapulae, and Rectus Capitis Anterior
What is the origin/insertion of Iliocostalis lumborum pars lumborum?
Origin: SPINOUS PROCESSES of L1-L5, THORACOLUMBAR FASCIA
Insertion: ILIAC CREST of the inominate
What is the origin insertion of Iliocostalis Lumborum pars Thoracis?
Origin: PSIS, ILIAC CREST
Insertion: LOWER 8-9 RIBS
What is one back muscle in particular that has an effect on lordosis?
Longissimus Thoracis
The SEMISPINALIS, MULTIFIDIS, and the ROTATORS could possibly attach a single transverse process to how many vertebral spinal processes?
As many as 9
Remember MULTIFIDIS attaches spinous to MAMMILLARY
What is the origin/insertion of the SPINALIS THORACIS?
Origin: T11/12, L1-L2
Insertion: T1-T4
(mostly remember it ranges from T1-L2 and doesn’t attach to T9/T10)
What muscles are identified as transversospinalis muscles?
Multifidis, rotators, and semispinalis
Remember they are M.R.S. muscles
Transversospinalis muscles represent what layer of the true back?
Layer 5
The semispinalis capitis and spinalis cervicis may fuse to form what muscle?
Biventer Cervicis
The biventer cervicis is formed by the fusion of what muscles?
Semispinalis capitis and spinalis capitis
The thoracic rotators are replaced in the lumbar spine by what muscles?
Deep laminar fibers of the multifidis
Remember deepest layer of multifidis are the laminar fibers and they are homologous to the thoracic rotators
Which suboccipital muscle lacks attachment to the skull?
Obliquus capitis inferior
Remember this makes is NOT a TRUE CAPITIS
What is the origin/insertion of the obliques capitis inferior?
Origin: spinous process & lamina of C2
Insertion: posterior tubercle of transverse process of C1
Which suboccipital muscles are known to attach to dura mater?
Rectus capitis posterior major, Rectus capitis posterior minor & obliques capitis inferior
When muscles attach to dura what is that called and what is that structure related to?
They form MYODURAL BRIDGES and monitor dural tension. Cutting them has been shown to reduce CERVICOGENIC HEADACHE
What is the result of communication between suboccipital muscles, visual centers and vestibular centers?
Coordination of head and eye position
Of the cervical intertransversarii, which ones are innervated by the ventral ramus?
Anterior belly and the posterior belly, lateral muscle
Of the cervical intertransversarii, which are innervated by the dorsal ramus?
the posterior belly, medial muscle
