Exam III Flashcards
Blood supply to individual vertebra is typically _______.
Segmental
Once inside the intervertebral foramen, the vertebral artery splits into these three branches:
Anterior Branch (Prelaminar) Posterior Branch (Postcentral) Neural branch (neurospinal)
What does the anterior branch supply blood to?
The posterior aspect of the vertebral bodies, and anterior aspect of the spinal cord and anterior ligaments inside the spinal canal
What does the posterior branch supply blood to?
The posterior arch, posterior part of the spinal cord and ligaments in the posterior spinal canal
What does the neural branch supply blood to?
The lateral aspects of the spinal cord, spinal nerve and nerve roots
The 3 main arteries that go from the head/neck downward to supply the main portion of the spinal cord:
2 Posterior spinal arteries
1 Anterior spinal artery
The 2 posterior arteries and 1 anterior spinal artery come off of the _______ arteries just before they unite to form the _______ artery
vertebral
basilar
The anterior spinal artery comes from both _____ arteries, unites in front of the _____ ____, and runs caudally through the ______ _____ ____ of the cord.
vertebral
spinal cord
ventral median fissure
A branch off the anterior spinal artery, found between T-9 and T-12
Great Radicular Artery of Adamkiewicz
What does the great radicular artery of adamkiewicz supply blood to?
The inferior thoracic vertebrae, superior lumbar vertebrae, lumbarsacral enlargement of the spinal cord
Anterior spinal artery also supplies blood to:
The lumbar segmental arteries, lateral sacral artery, and blood of the sacrum and coccyx
The posterior spinal artery arises from the ______ ____, adjacent to the ______ ______. It supplies the ______ and ______ posterior columns of the spinal cord.
vertebral artery
medulla oblongata
grey
white
The two major venous plexus (group of veins) that leave the vertebra:
Internal venous plexus
External venous plexus
Where is the internal venous plexus located?
The inside of the spinal canal
Where is the external venous plexus located?
Outside the vertebral column
The internal venous plexua is also called the (2 different names)
Epidural venous plexus or the Batson’s Plexus
Both the internal and external venous plexus have an _____ and a _______ part
anterior
posterior
Vein inside the vertebral body. Part of the anterior internal venous plexus
Basivertebral Vein
The opening in the basivertebral vein inside the vertebral body is called:
Hanh’s venous Cleft
3 Classes/types of joints within the spinal column
Fibrous
Cartilaginous
Synovial
Type of joint where 2 bones are connected by connective tissue of hyaline cartilage, with a lack of motion
Fibrous joints
Type of joint formed when 2 bony surfaces are united by cartilage or a disc. Many SLIGHT motions
Cartilaginous joint
Type of joint with an articular surface covered with articular cartilage, and connected by ligaments lined by a synovial membrane.
Synovial
What type of joint is most common in the spine and body?
Synovial joints
Subclassification of the fibrous joints in the spine is called the ________ ______. Formed when 2 bones are united by an ___________ _______.
Sydesmodial joint
Interosseous ligaments
2 subclassifications of cartilaginous joints
Synchondrosis
Symphysis
Subclassification of cartilaginous joints. A temporary joint where the cartilage later changes into bone itself (Ex- epiphisial plates)
Synchondrosis
Subclassification of cartilaginous joints: 1 bony surfaces connected by a disc or fibrocartilage. (Ex- Pubic symphasis)
Symphysis
3 subclassifications of synovial joints
Trochoid/Pivot Joints
Condyloid Joints
Arthrodial/Gliding/Articulatio Plana joints
Subclassification synovial joint. Allows for gliding motion. (Ex- facet joints)
Arthrodial/Gliding/articulatio plana joints
Subclassification of synovial joint. Allows for rotation. Uniaxial motion. (Ex- C1-C2)
Trochoid/Pivot joints
Subclassification of synovial joints. Allows for flextion and extension. All motions except for axial rotation (Ex- C1-Occiput)
Condyloid joints
Common articulations between C-2 and S-1, between the vertebral bodies
Cartilaginous symphysis
Common articulations between C-2 and S-1, between zagapophyseal joints
Synovial arthrodial, gliding, articulation plan
Atlanto-occipital articulations
Synovial——-condyloid
Articulations of atlanto-axial
Synovial——arthrodial
Synovial——trochoid
Intersacral articulations
Cartilaginous—synchondrosis
Sacro-coccygeal articulations
Cartilaginous symphysis (fibrocartilage)
Fibrous—-syndesmodial
Intercoccygeal articulations
Cartilaginous—-synchondrosis
Common cardinal ligaments of the spine have ____ blood supply, and _____ stretch
Some
Prevent
Group 1 of the common cardinal ligaments attach to:
The vertebral bodies
Group 2 of the common cardinal ligaments attach to:
The spinous processes
Group 3 of the common cardinal ligaments attach to:
Lamina, articulations processes, and transverse processes
Common/cardinal ligaments changes name at ____ to _______ ______ _______
C2
Anterior longitudinal ligament (ALL)
Anterior longitudinal ligament covers the _____ surface of vertebral _____ and ______ from ____ to _____. The attachment is _____(weak/strong)
Anterior
Bodies and
Disc
C-2 to
Sacrum
Strong
3 layers of anterior longitudinal ligament:
Deep, middle, and superficial
Where is the anterior Longitudinal ligament most narrow? Widest?
Most narrow in cervical, widest in lumbar
What this the function of the anterior longitudinal ligament?
To limit extension of the spine.
The anterior longitudinal ligament attaches to each vertebral body _____ and ______ at the levels of the ____ ____
Superiorly and inferiorly
End plates
What is the anterior longitudinal ligament continuous with?
Anterior Atlanto-occipital membrane
Ligament working opposite to anterior longitudinal ligament
Posterior longitudinal ligament (PLL)
Posterior longitudinal ligament is the most ______ (anterior/posterior) ligament in the spinal canal.
Anterior
Where is the posterior longitudinal ligament widest? Most narrow?
Widest in cervical and over discs,
Most narrow in lumbar and over vertebral bodies
Posterior longitudinal ligament is ______ attached to the center of vertebral bodies. This is due to the ______ ____.
Loosely
Basivertebral vein
What is the function of the posterior longitudinal ligament?
Limits flexion of the vertebral bodies.
The anterior and posterior longitudinal ligaments are also called the _________ ligaments
Intercentral ligaments
Between ALL and PLL, which ligament is weaker?
PLL
What is the PLL continuous to?
Tectoral membrane (inferior)
Why are the intervertebral discs called ligaments?
They separate vertebral bodies and hold the bodies together.
How many total discs?
23- none between occiput and C-1 or C-1-2
What ligament is continuous from the tip of the spinous process of C-7 though S-1? Has 3 layers
Supraspinous ligament
What ligament is formed by the superior extension of the supraspinous and interspinous ligaments? Attaches to SP of all cervical vertebrae. Broad, triangular in shape
Ligamentum nuchae
The supraspinous ligament is a very _______ (weak/strong) band connecting the tips of contiguous spinous processes.
Weak
Where does the ligamentum nuchae run?
between occiput and C7 SP
Combination of the supraspinous and interspinous ligaments come together in the _______ spine.
Cervical
A series of ligaments that run between the SP of each motor unit. From C2/3 to L5/S1. Poorly developed in cervical spine
Interspinous Ligament (ISL)
Where does the ISL attach to? Anteriorly and posteriorly
Anteriorly to ligamentum flavum
Posterior to supraspinous ligament
The ISL connects:
Spinous processes of adjacent vertebrae
In the cervical spine, the ISL becomes part of the _______ _____.
Ligamentum nuchae
Where does the supraspinous ligament run?
Between the tips of the adjacent spines
Which ligament runs between adjacent TVP?
Intertransverse
Which ligament connects the lamina of adjacent vertebrae? Extends to the facet joint capsule.
Ligamentum Flavum
Which ligament covers the posterior lateral part of the Z-Joints?
Articular capsule/capsular ligament
What are 3 basic parts of the articular capsule?
Basic, middle and inner
Which layer of the articular capsule has synovial fluid with Haluronic acid?
Inner layer
Which layer of the articular capsule is rich in nerve supply, low in blood supply?
Outer layer
Which layer of the articular capsule is highly vascularized with no nerves?
Middle layer
The articular capsule is stressed the most in _______.
Rotation
What type of joints are the Z joints?
Gliding
The ligamentum flava forms the ______ boundary of the IVF. Is highly ______. Helps restrict _______. Is thicker in the _____ region
Posterior
Elastic
Hyper flexion
Lumbar
What is the ligamentum flavum continuous with?
Posterior Atlanta-occipital membrane
The ligamentum flavum supports the anterior aspect of the _______ _____.
Z- joint
When is the intertransverse ligament stressed the most?
In contralateral bending or lateral flexion .
Narrowing of disc space results in:
Stress on facet joint
6 Ligaments of the Atlanto-occipital articulation
2 articular capsules
1 anterior atlant-occipital ligament
1 posterior Atlanto-occipital ligament
2 Lateral Atlano-occipital ligaments
3 synovial joints of the Atlanto-axial articulation
2 lateral Atlanto-axial joints
1 Median Atlanto-axial joint
How many total ligaments in the Atlanto-axial articulation?
7
50% of rotation comes from:
Atlantoaxial joint
7 ligaments of atlantoaxial articulations
TEST Q**
2 articular capsules
2 accessory ligaments
1 anterior atlantoaxial ligament
1 posterior atlantoaxial ligament
1 transverse ligament of the atlas
6 ligaments of the occipital axial complex
1 membrane tectoria
2 alar ligaments
1 apical ligament
1 crucial ligament
1 ligamentum nuchae
Superior extension of posterior longitudinal ligament
Membrana tectoria, AKA Tectorial Membrane, occipito-axial ligament
Where does the membrana tectoria attach?
from the posterior aspect of body of C-2 to anterior rim of foramen magnum of occiput
Function of the membrana tectoria
Holds other ligaments in. Limits flexion and extension of the atlas on the occiput .
Where are the alar ligaments (AKA Check Ligaments, or Odontoid ligaments) located?
Extend from posterior lateral aspect of the odontoid process to the medial surface of occipital condyles.
What is the function of the Alar Ligaments?
Limits or checks contralateral axial roration and flexion whiplash)
Damage of the Alar Ligaments will allow for _____ rotation and _____ flexion of __________ ______
increased
lateral
atlanto-occipital articulation
What type of injuries are primarily responsible for chronic whiplash symptoms, especially post-traumatic headaches
Injured Alar Ligaments.
Upper cervical ligaments:
Occipitoaxial ligament
Apical ligament
Alar ligaments
1 inch long V shaped ligament. Extends from anterior wall of foramen magnum, where it is the widest, to the superior terminal aspect of dens of C-2. Remnant of the embryonic notochord
Apical ligament
Apical ligament’s tit
TEST QUESTION
20 degrees anterior
Ligament attached to the transverse ligament. Function is to hold transverse ligament in place
Cruciate ligaments
2 parts of the cruciate ligament
1- Superior crus
2- Inferior crus
Crus anterior tip of foramen magnum
Superior crus
Crus posterior aspect of C2 body
Inferior crus
Ligaments attached to the lumbo-sacral articulation
Lumbosacral ligament
Iliolumbar ligament
Lumbosacral articulations are the same as the thoracic and lumbar ligaments, except there is no _______ _____
Intertransverse ligament
Ligament from TVP L-5 to sacral Alae and promontory
Lumbosacral ligament
Ligament from TVP L5 to crest of ilium anterior to sacro-iliac joint.
Iliolumbar ligament
6 ligaments of intersacral articulations
4 Fibrocartilages
1 Anterior intersacral ligament
1 Posterior Intersacral Ligament
Ligament present between segments until segments fuse and it ossifies
Fibrocartilage ligaments
Ligament analogous to ALL. Present till segments fuse then ossify
Anterior intersacral ligament
Ligament analogous to PLL. Present till segments fuse then ossify
Posterior intersacral ligament
8 Ligaments of the sacro-coccygeal articulation
1- Intervertebral fibrocartilage
1- Anterior sacrococcygeal ligament
1- Deep posterior sacrococcygeal ligament
1- Superficial posterior sacrococcygeal ligament
2- Lateral sacrococcygeal ligaments
2- Intercornual ligaments
Ligament that is a thin fibrous extension of ALL
Anterior sacrococcygeal ligament
Ligament extension of PLL. From sacral hiatus to 1st coccygeal
Deep posterior sacrococcygeal ligament
Ligament on top of sacral hiatus. Forms roof over top. Longer than deep posterior sacococcygeal ligament
Superficial posterior sacrococcygeal ligament
Ligaments from inferior angle of sacrum to coccygeal alae. Analogous to intertransverse
Lateral Sacrococcygeal ligaments
Ligaments from sacral coruna to coccygeal cornua. Analogous to articular capsules
Intercornual ligaments
5 intercoccygeal ligaments
3 intersegmental fibrocartilages
1 anterior coccygeal ligament
1 posterior coccygeal ligament
4 cartilaginous synchondrodial joints.
Intersegmental fibrocartilages
Fibrocartilage present in coccyx ossify around age:
25-30
Fibrous extension of ALL, then ossifies
Anterior coccygeal ligament
Fibrous extension of PLL then ossifies
Posterior coccygeal ligament.
7 Ligaments of the sacro-iliac joint
1 articular capsule 1 anterior sacroiliac ligament 1 interosseous sacroiliac ligament 1 short posterior sacroiliac ligament 1 long posterior sacroiliac ligament 1 sacrotuberous ligament 1 sacrospinous ligament
Ligament from the anterior surface of sacrum (S2,3,4) to spine of ischium:
Sacrospinous ligament
What is whiplash?
Both a torn ligament (sprain) and torn muscle (strain)
Women are 40% _____ likely to be injured from a car crash, likely due to their _____ ____.
More
Smaller size
Men’s injuries are likely to be _____ severe
More
Tolerance to impact DECREASES over the age of:
40
The most common source of chronic neck pain after whiplash is the:
Cervical facet joint
How soon can symptoms of whiplash occur?
Immediately after the accident, within 12-24 hours, a few days, a few weeks, or even a few months
Whiplash victims are 10x more likely to develop ______
Spondylosis (osteoarthritis)
Signs and symptoms associated with slower recovery rate after whiplash
Neck pain upon palpation
Pain or numbness radiating from neck to arms
Headaches
Symptoms of whiplash, not including pain
Visual disturbances, dizziness, weakness, fatigue, poor concentration, difficulty sleeping, poor memory and depression
Type of pain: Deep, burning, gnawing, strapping or dull pain
Nerve pain
Type of pain: cramping or pulling pain, dulll achy, superficial
Muscle pain
Type of pain: sharp, deep boring
Fracture (bone) joint pain
Type of pain: throbbing
Vascular (pain when heart beats)
Type of pain: Stabbing, lighting like or shooting pain
Nerve root pain
4 phases of healing
1- Acute inflammatory phase
2- Tissue repair phase
3- rehabilitative/remodeling phase
4- maintenance/wellness phase
How long does acute inflammatory phase last?
48-72 hours
How long does the tissue repair phase last?
Lasts from 48 hours -12 weeks
How long does rehabilitative/remodeeling phase last?
Up to 1 year
How long does maintenance/wellness phase last?
A lifetime
Signs/symptoms of acute phase
Pain, swelling, head, redness, loss of function
There are ___ discs. __ cervical , ___ thoracic, ___ lumbar
23,
6 cervical
12 thoracic
5 lumber
IVD (intervertebral disc) is attached to:
Vertebral bodies ALL PLL Intra-articular Ligaments Ribs 2-9
Function of the disc is to maintain the ____ ___ between vertebrae, aids in ______ of the spine, and acts to properly ______ ______ _____.
Changeable space
Flexibility
Assimilate compressive loads
