Final Exam (new Material) Flashcards
What is the incidence of sacral sacral spondylolysis in the general population?
It’s rare
What ethnic group is associated with a high incidence of sacral spondylolysis?
The native alaskan (Inuit) population
Is sacral spondylolysis the result of congenital conditions, acquired conditions or an age-related condition?
It seems to be acquired
What activities are associated with sacral spondylolysis?
Kayaking and harpooning
What is the ethnic, gender and locational bias associated with sacral spondylolysis?
The native Alaskan (inuit) male at the S1 level
What is the definition of spondylolisthesis?
A vertebral slippage
What vertebral condition results in spondylolisthesis?
Bilateral spondylolysis
What is the direction of spondylolisthesis?
Anterior or forward displacement
What is the posterior direction of vertebral slippage called?
Retrospondylolisthesis or retrolisthesis
Identify all names given to type 1 spondylolisthesis
Dysplastic spondylolisthesis, congenital spondylolisthesis
What is the locational bias of type 1 spondylolisthesis?
L5 or upper sacral segments
What is the location of the defect associated with type 1 spondylolisthesis?
More frequently the vertebral arch
What additional conditions are linked to type 1 spondylolisthesis
Spina bifida occulta and nerve root compression of the S1 nerve
Identify all names given to type 2 spondylolisthesis
Isthmic spondylolisthesis
Which subtype of type 2 spondylolisthesis is stressed in spinal 2?
Lytic spondylolisthesis or stress fracture induced spondylolisthesis
What is the cause most frequently given for type 2 spondylolisthesis
Microfractures as the result of repetitive stress during hyper flexion and rotation
What is the age group typically associated with type 2 spondylolisthesis
Teenagers or young adults
Will spondylolysis always result in type 2 spondylolisthesis
No, particularly in cases of unilateral spondylolysis
What spinal canal dimensions are associated with type 2 spondylolisthesis
Isthmic spondylolisthesis demonstrates an increase in Sagittarius diameter of the spinal canal
What is the gender bias and locational bias associated with type 2 spondylolisthesis
Isthmic spondylolisthesis is common in men at the L5/S1 level
What conditions are often associated with type 3 spondylolisthesis
Degenerative spondylolisthesis is often associated with osteoarthritis, intervertebral disc degeneration, ligament laxity and articular facet remodeling
What is the gender bias, locational bias, and spinal canal dimension changes often associated with type 3 spondylolisthesis
Degenerative spondylolisthesis is more common in women, particularly at L4/L5, and demonstrates no change in sagittal diameter of the spinal canal
Identify all names given to type 4 spondylolisthesis
Traumatic spondylolisthesis
What causes type 4 spondylolisthesis
Fracture of the neural arch components
Is there gender, locational, or age bias associated with type 4 spondylolisthesis
No
Identify all names given to type 5 spondylolisthesis
Pathologic spondylolisthesis
What are the cause(s) associated with type 5 spondylolisthesis
Bone diseases such as pager disesase or osteogenesis imperfecta
What determines the length of the intervertebral foramen?
The width of the pedicle
What may extend the length of the intervertebral foramen?
The transverse process, muscle or ligaments
What forms the superior boundary for the typical intervertebral foramen?
The inferior vertebral notch of the pedicle above
What is the average height of the intervertebral foramen?
About 13 mm
What are the generic contents of the intervertebral foramen
Neural tissue, connective tissue, vascular tissue, lymphatic tissue
What is the percent of neural tissue in the intervertebral foramen?
From 8 to 50 percent
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 the most likely region of the thoracic spine for herniation
Below T8
What will the intervertebral veins drain into?
The external vertebral venous plexus or Batson’s plexus
What is a unique histological feature of the veins of the vertebral column
They appear to lack valves
What size lymphatic vessels lie in the intervertebral foramen
Medium sized lymphatics
What type(s) of connective tissue will be present in the intervertebral foramen
Adipose tissue and loose areolar connective tissue
What is the relationship of cervical intervertebral foramen height to nerve root size
The height increases but the nerve root size stays about the same from cranial to caudal
What parts of the cervical vertebra will modify the intervertebral foramen
The lateral groove and uncinate process
What is the relationship between aging and cervical spine nerve root characteristics
The length of the nerve root increases as it descends from its apparent origin on the spinal cord, but the cross-sectional area of the nerve root decreases
What are the specific attachment sites for a cervical spinal nerve?
The sulcus for the ventral primary ramus on the costotransverse bar and the vertebral artery
What contributes to the anterior boundary of the thoracic intervertebral foramen?
The costocentral joint
What is the amount of contribution of the intervertebral disc to the height of the lumbar intervertebral foramen?
About half
Which are the largest spinal nerves
L5 and S1 spinal nerves
What increases the length of the intervertebral foramen at L5
The lumbosacral tunnel
What forms the lumbosacral tunnel
The lumbosacral ligament, transverse process of L5 and sacral Ala
What condition is the result of encroachment on the L5 spinal nerve
The far out syndrome
What ligaments may contribute to the loss of size in the lumbar intervertebral foramen
The transforaminal ligament and corporotransverse ligament
What is unusual about the sacral intervertebral foramen compared to other intervertebral foramina
A completely osseous boundary exists
What is more likely the cause of nerve irritation at the sacral intervertebral foramen?
The tilt or position of the entire sacrum relative to the pelvis
What is unique about the relationship of spinal nerve to intervertebral foramen at S5-Co1?
There are two nerves present, S5 nerve and Co1 nerve
What are some examples of destructive lesions of the vertebral body?
Tuberculosis, hemangiomas, osteoporosis
What may reduce the impact of intervertebral disc loss of integrity on the intervertebral foramen in the cervical and thoracic spine?
The joint of Luschka in the cervcals, the costocentral joint in the thoracics
What are some examples of osteophyte formation that influence the intervertebral foramen
The bony spurs of the vertebral body and para-articular processes on the lamina
What are some examples of acquired alterations of the spinal curves identified in class?
Obesity, pregnancy and the use of heavy backpacks
What is the recommended weight of a backpack compared to individual weight for the developing spine?
Backpack weight should not exceed 10% individual body weight
What are the curvatures of the vertebral column?
Anterior, Posterior, and lateral
What is the direction of the primary curve of the vertebral column?
Posterior
Why is the posterior curve also called the primary curve?
It is the first curve to appear embryologically
What are adult remnants of primary curve along the vertebral column?
The thoracic and dorsal curve and the pelvic and sacrococcygeal curve
What are the names given to curves that form during development to reverse the direction of regions along the vertebral column
Anterior curve, secondary curve, compensatory curve
What are the names of the anterior curves, secondary curves, and compensatory curves
The cervical curve and lumbar curve
What segmental levels form the cervical curve
C2-T1
What is the earliest time of appearance of the cervical curve?
The third fetal month
What is the traditional time of appearance of the cervical curve said to be?
During the last trimester in utero
What is the time during which the “adult” cervical curve is said to appear
Within the first year after birth
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
At what age will the infant begin to hold the head erect?
Usually between the third and fourth month after birth
What is the name given to the integration of visual and motor pathways associated with holding the head erect?
The righting reflex
What is the location for the apex of the cervical curve?
Typically between C4 and C5
What is the location for the cervical kyphosis
Between occiput and C1
What is the name given to the primary cervical curve?
Cervical kyphosis
What is the vertebral relationship between the cervical curve and the cervical enlargement?
Cervical curve C2-T1; cervical enlargement C3-T1
What is the time of appearance of the lumbar curve?
Between 12 and 18 months after birth
What infant activities are associated with the development of the lumbar curve
Crawling and walking
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 the swayback of the lumbar
- Intervertebral disc height will become greater anterior compared to posterior
- Walking will further promote muscle and intervertebral disc development
What happens within the intervertebral disc to facilitate the lumbar curve development?
The nucleus purposes of L4 will shift its position within the annulus fibrosis
Which sense is a requirement for holding the head erect, standing, sitting, and walking?
Vision
What is the gender bias associated with lumbar curve convexity
Females have greater convexity of the lumbar curve
What is the vertebral relationship between the lumbar curve and lumbar enlargement
Lumbar curve T12-L5; lumbar enlargement T9-T12
What is the formation of the lateral curve often correlated with?
Faster development of the muscles on the side of handedness
What is the time of appearance of the lateral curves
They appear after 6 years old
What locations of lateral curves are recognized?
Cervical, thoracic or dorsal, and lumbar
Which lateral curves are best developed?
Thoracic or dorsal, and lumbar
What is the relationship between the curve direction and handedness?
A right-handed person has 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 demonstrate this
What does the suffix “osis” mean
A condition
Does “osis” infer a normal or an abnormal condition
Neither, it is non-judgemental
What generic names identified abnormal curves of the vertebral column?
Lordosis, kyphosis, scoliosis
What is the definition of lordosis
A froward bending condition
What is the definition of kyphosis
A humpback or hunchback condition
What is the definition of scoliosis
A warped or crooked condition
What is the direction of the curve deviation in scoliosis
To the side (it is a lateral curve deviation)
Is there a locational bias for the classic definition of lordosis
No, there would be an increase in the anterior direction in the cervical spine, a decrease in the posterior direction in the thoracic spine, an increase in the anterior direction in the lumbar spine and a decrease in the posterior direction in the pelvic or sacrococcygeal region
Is there a locational bias for the classic definition of kyphosis?
No, there would be a decrease in the anterior direction in the cervical spine, an increase in the posterior direction in the thoracic spine, a decrease in the anterior direction in the lumbar spine and an increase in the posterior direction in the pelvic or sacrococcygeal region
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 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 classic classification of military neck
A kyphosis
What is classic classification of humpback or hunchback
A kyphosis
What is classic classification of swayback?
A lordosis
What does the use of the term lordotic try to imply?
A normal cervical and normal lumbar anterior curve
What does the use of the term kyphotic try to imply?
A normal thoracic or dorsal and normal pelvic or sacrococcygeal posterior curve
What prefixes are used to convert abnormality in curve patterns?
Hyper and hypo
What does the term hyperlordotic infer?
An increase in the anterior curve of the cervical or lumbar region
What does the term hypolordotic infer?
A decrease in the anterior curve of the cervical or lumbar region
What does the term hyperkyphotic infer?
An increase in the posterior curve of the thoracic/dorsal or pelvic/sacroccocygeal region
What does the term hypokyphotic infer?
A decrease in the posterior curve of the thoracic/dorsal or pelvic/sacrococcygeal region
What are the curve classifications for military neck
A kyphosis or hypolordotic curve
What are the curve classifications for humpback or hunchback
A kyphosis or kyperkyphotic curve
What are the curve classifications for swayback
A lordosis or hyperlordotic curve
What is the more compelete, accepted definition of scoliosis
An abort all lateral curve coupled with axial rotation
What is the radiological test for skeletal maturity
The riser sign, an indication of bone maturity in the iliac apophysis
What are the classifications of scoliosis according the scoliosis research society
Magnitude, location, direction, etiology, structural scoliosis and non-structural scoliosis
What does magnitude of scoliosis refer to?
The length and angle of the curve deviation on x-ray
What is often used to measure the magnitude of scoliosis
The Cobb method
What does location of scoliosis infer
The location of the vertebral segment forming the apex of the curve deviation
What does direction of scoliosis mean?
The cause of the scoliosis
What is structural scoliosis
A more radical form of scoliosis, it may worsen, associated with structural deformities of the vertebra or intervertebral disc, frequently has a fixed angle of trunk rotation
What is nonstructural scoliosis
A mild form of scoliosis, unlikely to worsen, not associated with structural deformities of the vertebra or intervertebral disc and lacks a fixed angle of trunk rotation
What is the classification of scoliosis that is unique to the individual patient?
Idiopathic scoliosis
What does idiopathic scoliosis infer?
The scoliosis is unique to the individual, it has no known cause, unknown etiology
What is the incidence of idiopathic scoliosis in the population
1 to 4 percent of the population
Based on age of onset, what are the types of idiopathic scoliosis
Infantile, juvenile, and adolescent
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 adolescent 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 relationship between curve deviation, incidence, and curve worsening
The greater the deviation, the lower the incidence, and the more likely to worsen
What is the name given to segments that lie in the transition zones of the vertebral column
Transition vertebrae
What are the transition zones of the vertebral column
Occipitocervical, cervicothoracic, thoracolumbar, lumbosacral, and sacrococcygeal zones
How are specific segments within a transition one identified
By adjacent region of the segment, process of transition, and specific segment (occipitalization of C1)
What does the suffix “ization” refer to?
In the process of becoming
What are the possible transition zone - segment combinations?
Cervicalization of occiput, occipitalization of C1
Dorsalization of C7, cervicalization of T1
Lumbarization of T12, dorsalization of L1
Sacralization of L5, lumbarization of S1
Coccygealization of S5, sacralization of Co1
What is/are characteristic(s) of cericalization of occiput
An increase in occipital bone size, formation of new or larger lines on the occipital bone
What is/are the characteristic(s) of occipitalization of C1?
The atlas may be partially or completely fused to the occiput
What is another way of implying occipitalization of C1
Atlas assimilation
What is the incidence of occipitalization of C1
0.1 to 0.8%
When do the centers of ossification for the odontoid process first appear
During the last trimester in utero
When does the bilateral ossification center for the odontoid process fuse?
At or shortly after birth
What joint forms between the odontoid process ossification centers and the centrum of C2?
The sub dental synchondrosis
What joint classification is present between the C2 odontoid process and centrum?
Amphiarthrosis synchondrosis
Ossification between the odontoid process and centrum joint of C2 first appears at what age?
4 years old
A joint between the odontoid process and centrum of C2 is last identified at what age?
At 7 years old
What is the name given to the condition in which the joint formed between the odontoid process and centrum of C2 persists beyond age 7?
Os odontoideum
What is an os odontoideum
A persistence beyond age 7 of the joint formed between the centrum and odontoid process centers of ossification
What is the name given to the joint between the odontoid process and centrum of C2 which is still evident beyond age 7?
Persistent subdental synchondrosis
What is the name given to the joint formed between the tip of the dens and the odontoid process centers of ossification?
Tip of the dens synchondrosis
What is the classification of the joint formed between the tip of the dens and odontoid process centers of ossification?
Amphiarthrosis synchondrosis
At what age will the tip of the dens center of ossification appear
Sometime in early adolescence
Based on the age of appearance, how is the tip of the dens center of ossification classified?
Secondary center of ossification
At what age will the tip of the dens fuse with the odontoid process?
Before age 12
If the joint formed between the tip of the dens and odontoid process centers of ossification persists beyond age 12, what is the condition called?
Terminal ossicle
What is basilar impression
Persistence of the nonunion of the basilar and condylar parts of the chondrocranium such that the cartilage deforms due to the weight of the brain
What is basilar invagination
The upper cervical spine appears to be invaginated into the skull on x-ray analysis
What is/are the characteristic(s) of dorsalization of C7?
The addition of a rib and changes in superior articular facet orientation are typical
What is the incidence of rib-related changes following dorsalization of C7
From one-half to two and one-half percent of the population
Do patients typically present with symptoms specific for dorsalization of C7?
No, they are typically asymptomatic
What is the gender bias suggested in dorsalization of C7
Female
What alteration in C7 facet orientation may accompany dorsalization?
The superior articular facet of C7 may change from the back, upward, and medial to that of a typical thoracic facet…back, upward, and lateral; the inferior articular facet is unchanged
What alteration in C6 facet orientation may accompany dorsalization?
C6 demonstrates a change in inferior articular facet orientation from forward, lateral, and downward to forward, medial, and downward; the superior articular facet unchanged
What percent of the population may demonstrate thoracic-like features at C7
Up to 46%
What rib-related changes may accompany cervicalization of T1?
The first rib may decrease in mean relative length or become absent
What will result from fusion of a short rib to the T1 transverse process?
The transverse foramen
What is the incidence of cervicalization of T1 in the population
Up to 28% of the population
What rib-related changes may accompany dorsalization of L1
Elongated bones shaped like ribs may appear
What is the incidence of lumbar ribs in the population
Over 7% of the population demonstrates lumbar ribs
What L1 facet orientation changes may accompany dorsalization
The superior articular facet may change from concave, back upward, and medial to flat, back, upward, and lateral; the inferior articular facet is unchanged
What T12 facet orientation changes may accompany dorsalization
The inferior articular facet may change from convex, forward, lateral, and downward to flat, forward, medial, and downward; the superior articular facet is unchanged
What is the gender bias associated with dorsalization of L1
Males are two to three times more affected
What rib-related changes may accompany lumbarization of T12?
A significant shortening of the mean relative length of 113 mm of the twelfth rib or it becomes absent
What T12 facet orientation changes may accompany lumbarization
The superior articular facet may change from flat, back, upward, and lateral to concave, back, upward, and medial; the inferior articular facet is unchanged
What T11 facet orientation changes may accompany lumbarization
The inferior articular facet may change from flat, forward, medial, and downward to convex, forward, lateral, and downward; the superior articular facet is unchanged
What is characteristic of lumbarization of S1
The failure of synostosis between S1 and S2, squaring of the vertebral body of S1 and flaring of the sacral ala
What unique characteristic of lumbarization of S1 were stressed in class?
Squaring of the vertebral body of S1 and flaring of the sacral ala
What is failure of synostosis between S1 and S2?
The segments do not completely fuse together
What articular facet changes accompany lumbarization of S1?
None
What is characteristic of sacralization of L5
L5 may be partially or completely fused to the sacrum
What it is the incidence of sacralization of L5 in the population
41 to 85%
Which segment demonstrates the greatest morphological variation along the spine?
L5
What articular facet changes accompany sacralization of L5
None
What is the incidence of variation within the sacrococcygeal region in the population
Up to 14%
Which of the muscles attaching to the 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 and minor
Which muscles attaching to transverse processes represent layer two of the true back
Levator scapulae
The trapezius is innervated by what nerve?
The spinal accessory nerve
What forms the spinal accessory nerve innervations the trapezius
C1-C5 cord levels contribute to the spinal root of the spinal accessory nerve
What forms the thoracodorsal nerve innervations the latissimus dorsi
Ventral rami from C6-C8
Which of the muscles of the true back are innervated by the dorsal scapular nerve
Levator scapulae, rhomboid major, rhomboid minor
What forms the dorsal scapular nerve
The ventral ramus of C5
What part of the vertebra forms the osseous origin for the splenius muscles
The spinous process
What is the innvervation of the splenius capitis
Dorsal rami of middle cervical spinal nerves (C3-5 cord levels)
What is the innervation of the splenius cervicis
Dorsal rami of lower cervical spinal nerves (C5-C7 cord levels)
Which muscles represent the fourth layer of the true back
The erector spinal or sacrospinalis muscles
Which muscles are identified as erector spinae or sacrospinalis muscles
Iliocostalis, longissimus, Spinalis
What is the innervation of the iliocostalis lumborum
Dorsal rami of lower thoracic and all lumbar spinal nerves
What is the innervation of the iliocostalis thoracis
Dorsal rami of upper 6 thoracic spinal nerves (T1-6 cord levels)
What is the innervation of the iliocostalis cervicis
Dorsal rami of T1, T2 spinal nerves, sometimes C8 spinal nerve (C8, T1, T2 cord levels)
What muscles are classically identified as longissimus muscles
Longissimus thoracis, longissimus cervicis and longissimus capitis
What is the innervation of the longissimus thoracis
Dorsal rami of all thoracic and lumbar spinal nerves (cord levels T1-12, L1-5)
What is the innervation of the longissimus cervicis
Dorsal rami of C4-8 and T1-2 spinal nerves (C4-8 & T1-2 cord levels)
What is the innervation of the longissimus capitis
Dorsal rami of C1-3 or C4 spinal nerves, (C1-3 or C4 cord levels)
What muscles are classically identified as spinalis muscles
Spinalis thoracis, cervicis, and capitis
What is the innervation of the spinalis thoracis
Dorsal rami of all thoracic and upper lumbar nerves
What is the innervation of the spinalis cervicis
Dorsal rami of all cervical spinal nerves (C1-8 cord levels)
What is the innervation of the spinalis capitis
Dorsal rami of lower cervical and upper thoracic spinal nerves
Which muscles are identified as transversospinalis muscles
Semi spinalis, multifidis, and rotators
What is the innervation of the semi spinalis thoracis
Dorsal rami of T1-6 spinal nerves (cord levels T1-6)
What is the innervation of the semispinalis cervicis
Dorsal rami of C6-8, spinal nerves (cord levels C6-8)
What is the innervation of the semispinalis capitis
Dorsal rami of C1-6 spinal nerves (Cord levels C1-6)
What regional subdivisions are now identified with multifidis muscles?
Lumbar multifidis, thoracic multifidis and cervical multifidis
What is the innervation of the classic multifidis
Dorsal rami of C3-8, T1-12, L1-5 and S1 spinal nerves (Cord levels C3-8, T1-12, L1-5 and S1)
Contraction of the multifidis cervicis will result in what movements
Alters the zygapophyseal capsular ligament response to load distribution determines the cervical spine response to injury as evidenced by neck pain and is a significant contributor to postural control of the head and neck
What innervate the rotators
Dorsal rami at the level of insertion are believed to do so
What muscles are included in the suboccipital muscle group
Rectus capitis posterior major, rectus capitis Posterior minor, obliques capitis inferior and obliquus capitis superior
Which suboccipital muscle lacks an attachment to the skull
Obliquus capitis inferior
Which nerve will innervate all suboccipital muscles
Dorsal ramus of C1, the suboccipital nerve
Contraction of rectus capitis posterior major will result in what movements
Turns the face to the side, bilaterally acts to extend the head
Contraction of rectus capitis posterior minor will result in what movements
Extends the head
Contraction of the obliquus capitis inferior will result in what movement
Turns the face to the side
Contraction of the obliquus capitis superior will result in what movements
Lateral flexion/lateral bending of the head bilaterally acts to extend the head
An increase in the density of muscle spindles is most apparent in which suboccipital muscle?
Obliquus capitis inferior
Suboccipital muscle feedback relays to what additional locations in the brain
Extraocular nuclei of origin, primary visual cortex and vestibular nuclei
What is the result of communication between suboccipital muscles, visual centers and vestibular centers?
Coordination of head and eye position
What is the proposed function of the suboccipital muscle group?
Postural stabilizers of the Atlanto-occipital and Atlanto-axial joints
Which suboccipital muscles are known to attach to dura mater
Rectus capitis posterior major, rectus capitis posterior minor and obliquus capitis inferior
Inter spinalis is paired in which regions of the spine
Cervical and lumbar regions
At what locations will interspinalis be absent along the spine?
T3-4 down to T10-11
Based on the density of muscle spindles what is the proposed function of the interspinalis
Acts as a propioceptive transducer in conjunction with intertransversarii to coordinate the smooth movement of the spine and to maintain appropriate posture
Intertransversarii are paired in which region(s) of the spine?
Cervical and lumbar regions
In which region of the spine are intertransversarii best developed
Cervical region
Which of the cervical intertransversarii is innervated by dorsal rami of cervical spinal nerves?
Posterior medial belly, cervical intertransversarii
Which of the lumbar intertransversarii is innervated by dorsal rami of lumbar spinal nerves
Medial belly, lumbar intertransversarii
Which muscle group is innervated by both dorsal rami and ventral rami of spinal nerves?
Intertransversarii
Which muscle group is innervated by both dorsal rami and ventral rami of spinal nerves
Intertransversarii
Based on the density of muscle spindles what is the proposed function of the intertransversarii
Acts as a propioceptive transducer in conjunction with interspinalis to coordinate the smooth movement of the spine and to maintain appropriate posture
What will innervate the longus colli
Ventral rami of C2-6 or C7 spinal nerves
Contraction of longus capitis will result in what movements
Flex the head
What will innervate the longus capitis
The ventral rami of C1-3 spinal nerves
Contraction of rectus capitis anterior will result in what movements
Flex the head
What will innervate the rectus capitis anterior
Ventral rami of C1-2 spinal nerves
What will innervate the anterior scalene
The ventral rami of C2-6 spinal nerves
What will innervate the middle scalene
The ventral rami of C3-8 spinal nerves
What will innervate the posterior scalene
The ventral rami of C6-8 spinal nerves
Which muscle is said to form the iliolumbar ligaments
Quadratus lumborum
What will innervate the quadratus lumborum
The ventral rami of T12 & L1-3 or L4 spinal nerves
What will innervate the psoas major
Primarily the ventral rami of L2 & L3, may include ventral remains of L1 & L4 spinal nerves
What is the origin of the psoas major
Vertebral bodies T12,L1
What will innervate the psoas major
The ventral ramus of L1 spinal nerve
What will innervate the iliacus
The femoral nerve, primarily the ventral rami of L2 & L3
What will innervate the levator costarum brevis
The dorsal rami of T1-12 spinal nerves
What will innervate the levator costarum longus
The dorsal rami of the lower thoracic spinal nerves
What will innervate the serratus posterior superior
The ventral rami of T2-5 spinal nerves…. intercostal nerves
What will innervate the serratus posterior inferior
The ventral rami of T9-11, the intercostal nerves & the ventral ramus of T12, the subcostal nerve
What are the characteristics of a (amphiarthrosis) symphysis
Limited motion, median plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
What are the four consistent features of synovial (diarthrosis) joints?
Articular or fibrous capsule, synovial membrane, articular cartilage and synovial fluid
What is the general function of ligaments?
Stimulate reflex contraction of muscles around the joint
What are the common characteristics of type 1 articular receptors
Located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint “at rest”
What are the characteristics of type 2 articular receptors
Located in deeper strata of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
What is the function of type 3 articular receptors
They monitor the joint during extreme motion or beyond normal range of motion
What are the characteristics of type 3 articular receptors
Present in collateral and intrinsic ligaments, resemble Golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion
What is the function of type 4 articular receptors
Nociceptive, they monitor pain
Type 4b articular receptors would be present in what locations
Accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
What are the three modifications of articular synovial membrane
(1) synovial villi, (2) articular fat pads or Haversian glands, (3) synovial menisci and intra-articular discs
What is the generic function of modifications of articular synovial membrane
Aid in spreading synovial fluid
What is the apparent function of synovial villi
Increase the surface of synovial membrane available for secretion - absorption phenomena
Articular fat pads are most numerous in what location along the vertebral column
Lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called….
Synovial menisci or intra-articular discs
Synovial menisci are a feature of what joint examples
Femur-tibia articulation, cervical zygapophyses and lumbar zygapophyses
What are the specific functions of type A synovial cells
Are phagocytic
What is the specific function of type B synovial cells
Secret proteinaceous substances and hyaluronic acid
What is the common function of type A and type B synovial cells?
Formation and absorption of synovial fluid
What are the primary constituents of articular cartilage
Water, cells, collagen type 2 fibers and a proteoglycan gel
What is the primary function of bound glycosaminoglycans in articular cartilage
Form a network for water retention
What is implied when cartilage is said to have elastic properties
Cartilage can deform and returns to original volume rapidly, a time independent property
What is implied when cartilage is said to have viscoelastic properties
Cartilage can deform but returns to original volume slowly, a time dependent property
It what are the properties of synovial fluid
It is a yellow-white, viscous, slightly alkaline and tastes salty
Identify the common ligaments of the vertebral column
The 9 common ligaments are the anterior longitudinal ligament, intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament and intertransverse ligament
What is the maximum number of common ligaments identified with a vertebral couple?
8
What is the reason that nine common ligaments are identified but only eight will be attached to any specific vertebral couple
The ligamentum nuchae and supraspinous ligaments attach to the spinous tubercles, but only one of these will be identified at a single vertebral couple
What is the cervical nucleus pulposus composed of
Fibrocartilage
What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?
Birth….88%; thirty….70%
What is the consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus
The nucleus pulposus will lose water under deformation conditions
What cell is associated with the nucleus pulposus until about age 11
Notochord cells
What cells are associated with the mature nucleus pulposus
Reticulocyte-fibroblast and chondroblast
Which type of collagen is dominant in the nucleus pulposus
Collagen type 2
What is the organizational pattern for collagen fibers in the nucleus pulposus
They are irregularly oriented and randomly scattered
What is unusual about the cervical annulus fibrosus
It lacks any lamellar or layered organization
What is the appearance of the cervical annulus fibrosus
A horse-shoe with anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
What compensates for the thinness of the posterior part of the cervical annulus fibrosus?
Posterior longitudinal ligament
What is the organization of the lumbar annulus fibrosus
It has 12-14 concentric cylindrical lamellar
What is the water concentration in the lumbar annulus fibrosus at birth and after thirty?
Birth…… 78%; thirty…… 70%
Which type of collagen is dominant in the annulus fibrosus
Collagen type 1
What is the organizational pattern for the collagen fibers in the annulus fibrosus
They are parallel with one another in a single lamellus and angled
What is the organization of collagen fibers between the lamellae
Collagen fibers will be angled in the opposite direction such that a spiral - counterspiral organization is observed
What is the average angle of collagen fibers within the annulus fibrosus
They average 50 to 60 degrees
What is the thickest part of the cartilage end plate
Around the periphery
What is the principal type of collagen fibers within the cartilage end plate?
Collagen fibers are aligned anterior to posterior
What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus
The cartilaginous end plate
What is the earliest indicator of intervertebral disc pathology or degeneration
Changes in the histology of the cartilage end plate
What part of the intervertebral disc is innervated
The outer lamellae of the annulus fibrosus
What are the types of receptor endings in the intervertebral disc
Nociceptors and proprioceptors
What is the relationship between size of the intervertebral disc and receptor endings
The larger the disc, the greater the variety of receptor endings
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc
They provide feedback during extension
What are the sources of innervation of the intervertebral disc?
The sinu-vertebral nerve (sinus vertebral nerve, reccurrent meningeal nerve), fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
What vertebral levels will the anterior longitudinal ligament attach to?
Those between occiput and S3 inclusive are traditionally indicated
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
What is the function of the anterior longitudinal ligament?
It brakes or limits dorsi-flexion or hyperextension of the vertebral column
What was ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s Disease
Anterior longitudinal ligament ossification in the lumbar region is now identified as…..?
Disuse idiopathic Skeletal hyperostosis or DISH
What is the innermost layer of the posterior longitudinal ligament called?
The perivertebral ligament
What is the function of the posterior longitudinal ligament
It brakes or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified
The cervical spine with an 80% incidence
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
A loss of hand and finger dexterity
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine
About 10% at the thoracic and 10% at the lumbar spine
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine
Faltering gait
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament
It is greater in males over 50 and has a higher incidence in the Japanese
What is the acronym for ossification of the posterior longitudinal ligament
OPLL
At one time ossification of the posterior longitudinal ligament was an example of what condition
Diffuse idiopathic skeletal hyperostosis or DISH
What is the relationship of the ligamentum flavum to the vertebral foramen?
It forms the posterior boundary of the spinal canal
What is the histology of the ligamentum flavum
It is formed primarily with elastic fibers, which are yellow in appearance
What is the name given to the ligamentum flavum based on appearance and histology
It is a yellow elastic ligament
What is the function of the ligamentum flavum
It brakes or limits flexion of the vertebral column
What is now thought to be a major function of the ligamentum flavum
It is an early prime factor in extension of the vertebral column
Where is ossification of the ligamentum flavum most commonly identified
The thoracic spine or thoracolumbar transition zone
What is the acronym for ossification of the ligamentum flavum
OLF
What is the relationship between the capsular ligament and mobility?
The more lax/loose the capsular ligament is, the greater the motion of the joint
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
The cervical and lumbar regions
The capsular ligament may blend with which other common ligament
The ligamentum flavum
What muscle will blend with capsular ligament posteriorly?
The multifidis
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its’ function
It is probably involved in propioceptive feedback to the muscle stabilizing the vertebral couple during movement
What vertebral levels will the interspinous ligament be attached to?
Those between C2 and S1 inclusive are traditionally indicated
What is now thought to be a major function of the interspinous ligament
It is more likely a propioceptive transducer for spinal reflex
What will the ligamentum nuchae be attached to?
The external occipital protuberance, external occipital crest, the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C7 inclusive are traditionally indicated
What is the name given to the superficial layer of the ligamentum nuchae?
The funicular layer or part
What are the names given to the superficial and deep layer of the ligamentum nuchae
Funicular layer and lamellar layer
What is the histological make-up of the ligamentum nuchae in quadrupeds?
It is a yellow elastic ligament
What is the histological make-up of the human ligamentum nuchae
It is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
What is the primary yellow elastic or elastic ligament of the spine
The ligamentum flavum
What is the classic function of the human ligamentum nuchae?
It brakes or limits flexion of the cervical spine
What will the supraspinous ligament be attached to
The spinous tubercles along the vertebral column from C7 to sacrum
What is the termination level inferiorly for the supraspinous ligament according to current literature?
Primarily at L4 (73%); between L4 and L5 (5%)
Where is the supraspinous ligament said to be best developed
In the lumbar spine
What is the classic function of the human supraspinous ligament
It brakes or limits flexion of the spine
Wha this now thought to be a major function for the supraspinous ligament
It is a propioceptive transducer for the spinal reflex
What is the proposed function of the suboccipital muscle group?
Postural stabilizers of the Atlanto-occipital and Atlanto-axial joints
Which suboccipital muscles are known to attach to dura mater
Rectus capitis posterior major, rectus capitis posterior minor and obliquus capitis inferior
Inter spinalis is paired in which regions of the spine
Cervical and lumbar regions
At what locations will interspinalis be absent along the spine?
T3-4 down to T10-11
Based on the density of muscle spindles what is the proposed function of the interspinalis
Acts as a propioceptive transducer in conjunction with intertransversarii to coordinate the smooth movement of the spine and to maintain appropriate posture
Intertransversarii are paired in which region(s) of the spine?
Cervical and lumbar regions
In which region of the spine are intertransversarii best developed
Cervical region
Which of the cervical intertransversarii is innervated by dorsal rami of cervical spinal nerves?
Posterior medial belly, cervical intertransversarii
Which of the lumbar intertransversarii is innervated by dorsal rami of lumbar spinal nerves
Medial belly, lumbar intertransversarii
Which muscle group is innervated by both dorsal rami and ventral rami of spinal nerves?
Intertransversarii
Which muscle group is innervated by both dorsal rami and ventral rami of spinal nerves
Intertransversarii
Based on the density of muscle spindles what is the proposed function of the intertransversarii
Acts as a propioceptive transducer in conjunction with interspinalis to coordinate the smooth movement of the spine and to maintain appropriate posture
What will innervate the longus colli
Ventral rami of C2-6 or C7 spinal nerves
Contraction of longus capitis will result in what movements
Flex the head
What will innervate the longus capitis
The ventral rami of C1-3 spinal nerves
Contraction of rectus capitis anterior will result in what movements
Flex the head
What will innervate the rectus capitis anterior
Ventral rami of C1-2 spinal nerves
What will innervate the anterior scalene
The ventral rami of C2-6 spinal nerves
What will innervate the middle scalene
The ventral rami of C3-8 spinal nerves
What will innervate the posterior scalene
The ventral rami of C6-8 spinal nerves
Which muscle is said to form the iliolumbar ligaments
Quadratus lumborum
What will innervate the quadratus lumborum
The ventral rami of T12 & L1-3 or L4 spinal nerves
What will innervate the psoas major
Primarily the ventral rami of L2 & L3, may include ventral remains of L1 & L4 spinal nerves
What will innervate the psoas major
The ventral ramus of L1 spinal nerve
What will innervate the iliacus
The femoral nerve, primarily the ventral rami of L2 & L3
What will innervate the levator costarum brevis
The dorsal rami of T1-12 spinal nerves
What will innervate the levator costarum longus
The dorsal rami of the lower thoracic spinal nerves
What will innervate the serratus posterior superior
The ventral rami of T2-5 spinal nerves…. intercostal nerves
What will innervate the serratus posterior inferior
The ventral rami of T9-11, the intercostal nerves & the ventral ramus of T12, the subcostal nerve
What are the characteristics of a (amphiarthrosis) symphysis
Limited motion, median plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
What are the four consistent features of synovial (diarthrosis) joints?
Articular or fibrous capsule, synovial membrane, articular cartilage and synovial fluid
What is the general function of ligaments?
Stimulate reflex contraction of muscles around the joint
What are the common characteristics of type 1 articular receptors
Located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint “at rest”
What are the characteristics of type 2 articular receptors
Located in deeper strata of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
What is the function of type 3 articular receptors
They monitor the joint during extreme motion or beyond normal range of motion
What are the characteristics of type 3 articular receptors
Present in collateral and intrinsic ligaments, resemble Golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion
What is the function of type 4 articular receptors
Nociceptive, they monitor pain
Type 4b articular receptors would be present in what locations
Accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
What are the three modifications of articular synovial membrane
(1) synovial villi, (2) articular fat pads or Haversian glands, (3) synovial menisci and intra-articular discs
What is the generic function of modifications of articular synovial membrane
Aid in spreading synovial fluid
What is the apparent function of synovial villi
Increase the surface of synovial membrane available for secretion - absorption phenomena
Articular fat pads are most numerous in what location along the vertebral column
Lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called….
Synovial menisci or intra-articular discs
Synovial menisci are a feature of what joint examples
Femur-tibia articulation, cervical zygapophyses and lumbar zygapophyses
What are the specific functions of type A synovial cells
Are phagocytic
What is the specific function of type B synovial cells
Secret proteinaceous substances and hyaluronic acid
What is the common function of type A and type B synovial cells?
Formation and absorption of synovial fluid
What are the primary constituents of articular cartilage
Water, cells, collagen type 2 fibers and a proteoglycan gel
What is the primary function of bound glycosaminoglycans in articular cartilage
Form a network for water retention
What is implied when cartilage is said to have elastic properties
Cartilage can deform and returns to original volume rapidly, a time independent property
What is implied when cartilage is said to have viscoelastic properties
Cartilage can deform but returns to original volume slowly, a time dependent property
It what are the properties of synovial fluid
It is a yellow-white, viscous, slightly alkaline and tastes salty
Identify the common ligaments of the vertebral column
The 9 common ligaments are the anterior longitudinal ligament, intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament and intertransverse ligament
What is the maximum number of common ligaments identified with a vertebral couple?
8
What is the reason that nine common ligaments are identified but only eight will be attached to any specific vertebral couple
The ligamentum nuchae and supraspinous ligaments attach to the spinous tubercles, but only one of these will be identified at a single vertebral couple
What is the cervical nucleus pulposus composed of
Fibrocartilage
What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?
Birth….88%; thirty….70%
What is the consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus
The nucleus pulposus will lose water under deformation conditions
What cell is associated with the nucleus pulposus until about age 11
Notochord cells
What cells are associated with the mature nucleus pulposus
Reticulocyte-fibroblast and chondroblast
Which type of collagen is dominant in the nucleus pulposus
Collagen type 2
What is the organizational pattern for collagen fibers in the nucleus pulposus
They are irregularly oriented and randomly scattered
What is unusual about the cervical annulus fibrosus
It lacks any lamellar or layered organization
What is the appearance of the cervical annulus fibrosus
A horse-shoe with anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
What compensates for the thinness of the posterior part of the cervical annulus fibrosus?
Posterior longitudinal ligament
What is the organization of the lumbar annulus fibrosus
It has 12-14 concentric cylindrical lamellar
What is the water concentration in the lumbar annulus fibrosus at birth and after thirty?
Birth…… 78%; thirty…… 70%
Which type of collagen is dominant in the annulus fibrosus
Collagen type 1
What is the organizational pattern for the collagen fibers in the annulus fibrosus
They are parallel with one another in a single lamellus and angled
What is the organization of collagen fibers between the lamellae
Collagen fibers will be angled in the opposite direction such that a spiral - counterspiral organization is observed
What is the average angle of collagen fibers within the annulus fibrosus
They average 50 to 60 degrees
What is the thickest part of the cartilage end plate
Around the periphery
What is the principal type of collagen fibers within the cartilage end plate?
Collagen fibers are aligned anterior to posterior
What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus
The cartilaginous end plate
What is the earliest indicator of intervertebral disc pathology or degeneration
Changes in the histology of the cartilage end plate
What part of the intervertebral disc is innervated
The outer lamellae of the annulus fibrosus
What are the types of receptor endings in the intervertebral disc
Nociceptors and proprioceptors
What is the relationship between size of the intervertebral disc and receptor endings
The larger the disc, the greater the variety of receptor endings
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc
They provide feedback during extension
What are the sources of innervation of the intervertebral disc?
The sinu-vertebral nerve (sinus vertebral nerve, reccurrent meningeal nerve), fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
What is the function of the anterior longitudinal ligament?
It brakes or limits dorsi-flexion or hyperextension of the vertebral column
What was ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s Disease
Anterior longitudinal ligament ossification in the lumbar region is now identified as…..?
Disuse idiopathic Skeletal hyperostosis or DISH
What is the innermost layer of the posterior longitudinal ligament called?
The perivertebral ligament
What is the function of the posterior longitudinal ligament
It brakes or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified
The cervical spine with an 80% incidence
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
A loss of hand and finger dexterity
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine
About 10% at the thoracic and 10% at the lumbar spine
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine
Faltering gait
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament
It is greater in males over 50 and has a higher incidence in the Japanese
What is the acronym for ossification of the posterior longitudinal ligament
OPLL
At one time ossification of the posterior longitudinal ligament was an example of what condition
Diffuse idiopathic skeletal hyperostosis or DISH
What is the relationship of the ligamentum flavum to the vertebral foramen?
It forms the posterior boundary of the spinal canal
What is the histology of the ligamentum flavum
It is formed primarily with elastic fibers, which are yellow in appearance
What is the name given to the ligamentum flavum based on appearance and histology
It is a yellow elastic ligament
What is the function of the ligamentum flavum
It brakes or limits flexion of the vertebral column
What is now thought to be a major function of the ligamentum flavum
It is an early prime factor in extension of the vertebral column
Where is ossification of the ligamentum flavum most commonly identified
The thoracic spine or thoracolumbar transition zone
What is the acronym for ossification of the ligamentum flavum
OLF
What is the relationship between the capsular ligament and mobility?
The more lax/loose the capsular ligament is, the greater the motion of the joint
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
The cervical and lumbar regions
The capsular ligament may blend with which other common ligament
The ligamentum flavum
What muscle will blend with capsular ligament posteriorly?
The multifidis
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its’ function
It is probably involved in propioceptive feedback to the muscle stabilizing the vertebral couple during movement
What vertebral levels will the interspinous ligament be attached to?
Those between C2 and S1 inclusive are traditionally indicated
What is now thought to be a major function of the interspinous ligament
It is more likely a propioceptive transducer for spinal reflex
What will the ligamentum nuchae be attached to?
The external occipital protuberance, external occipital crest, the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C7 inclusive are traditionally indicated
What is the name given to the superficial layer of the ligamentum nuchae?
The funicular layer or part
What are the names given to the superficial and deep layer of the ligamentum nuchae
Funicular layer and lamellar layer
What is the histological make-up of the ligamentum nuchae in quadrupeds?
It is a yellow elastic ligament
What is the histological make-up of the human ligamentum nuchae
It is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
What is the primary yellow elastic or elastic ligament of the spine
The ligamentum flavum
What is the classic function of the human ligamentum nuchae?
It brakes or limits flexion of the cervical spine
What will the supraspinous ligament be attached to
The spinous tubercles along the vertebral column from C7 to sacrum
What is the termination level inferiorly for the supraspinous ligament according to current literature?
Primarily at L4 (73%); between L4 and L5 (5%)
Where is the supraspinous ligament said to be best developed
In the lumbar spine
What is the classic function of the human supraspinous ligament
It brakes or limits flexion of the spine
What is now thought to be a major function for the supraspinous ligament
It is a propioceptive transducer for the spinal reflex
What will the intertransverse ligament attached to?
The transverse tubercles and transverse processes of adjacent vertebrae along the vertebral column from C1 to L5
What is the status of the cervical intertransverse ligament
It is said to be paired with an anterior and a posterior intertransverse ligament present
What is the status of the lumbar intertransverse ligament
It is well developed with the two parts identified, a ventral slip and a dorsal slip
What is the classic function of the anterior Atlanto-occipital ligament
It brakes or limits “extension” of the skull over the cervical spine
What is the classic function of the posterior Atlanto-occipital ligament
It brakes or limits axial rotation, flexion, and perhaps lateral bending of the skull on atlas
What amount of flexion - extension is accommodated by the atlanto-occipital joint
About twenty-five degrees
What amount of axial rotation is accommodated by the Atlanto-occipital joint
About three to eight degrees one side axial rotation
What amount of lateral bending is accommodated by the Atlanto-occipital joint
About five degrees
Which motion is best accommodated by the Atlanto-occipital joint
Flexion - extension
Which Atlanto-occipital joint is identified as a synovial pivot (diarthrosis trochoid)
The median Atlanto-axial joint
What are the joint surfaces of the median Atlanto-axial joint at the anterior bursa?
The fovea dentis of C1 and the facet for fovea dentis of C2
What are the joint surfaces of the median atlanto-axial joint at the posterior bursa
The groove for the transverse Atlantal ligament of C2 and the transverse atlantal ligament
What ligament is formed by the transverse atlantal ligament and it’s perpendicular extension
The cruciate ligament or cruciform ligament
What is the function of the transverse atlantal ligament
It is the primary stabilizer of the atlanto-axial joint restricting the distance of C2 from the anterior arch of C1
What is the ADI
The atlanto-Dental interspace, a radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint
What is the ADI of children compared with that of adults?
About 4.6 mm in children; a range of 2-3 mm or about 2.5 mm in adults
What are characteristics of the capsular ligament of the lateral atlanto-axial joint
It is lax or loose and demonstrate a meniscoidal fold within the joint cavity
What are the degrees of movement facilitated at the atlanto-axial joint
About 20 degrees flexion - extension, 40 degrees one side axial rotation, and 5 degrees of lateral bending
The occiput-C1-C2 joint complex accounts for what percent of all cervical axial rotation?
About 60%
For the cervical spine below C2, what is the range of flexion - extension
About 90 degrees or about 18 degrees per couple
For the cervical spine below C2, what is the range of one side lateral bending?
About 50 degrees or about 10 degrees per couple
For the cervical spine below C2, what is the range of one side axial rotation?
About 33 degrees or about six degrees per couple
At what rib will the superior costotransverse ligament be absent
The first rib
Which ribs will have an attachment for the inferior costotransverse ligament
Rib 1 - rib 11
Which vertebra will lack an attachment for the lateral costotransverse ligament
T12
Which vertebral couples of the thoracic spine have the greatest motion
T11/T12 and T12/L1
Which range of motion is the greatest for lower thoracic vertebral couples
Flexion - extension
Which range of motion is the least for the lower thoracic vertebral couples
One side axial rotation
Which ligaments replace the intertransverse ligament at the lumbosacral joint
The iliolumbar ligament and lumbosacral ligament
Which of the current ligaments from the iliolumbar ligament complex represents the iliolumbar ligament of classical descriptions
The superior iliolumbar ligament
Which ligament from the iliolumbar ligament complex represents the lumbosacral ligament of classical descriptions
The inferior iliolumbar ligament
Which vertebral couple of the lumbar spine has the greatest range of motion
L5/S1
Which range of motion is greatest for all lumbar vertebral couples
Flexion - extension
Which range of motion is least for L1-L5 vertebral couples
One side axial rotation
Which range of motion is least for the L5/S1 vertebral couple
One side lateral bending
List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal column
The anterior atlanto-occipital ligament, the anterior atlanto-axial ligament, anterior longitudinal ligament and the anterior sacrococcygeal ligament
List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal canal
The membrana tectoria, Posterior longitudinal ligament and deep posterior sacrococcygeal ligament
List, in order, from cranial to caudal the ligaments forming the posterior boundary of the spinal canal
The posterior atlanto-occipital ligament, posterior atlanto-axial ligament, ligamentum flavum and the superficial posterior sacrococcygeal ligament
What is the auricular surface of the sacrum composed of?
True articular cartilage, a modification of hyaline cartilage
What is the auricular surface of the ilium composed of?
Articular cartilage, interspersed with fibrocartilage
What is the superficial appearance of the auricular surfaces of the sacro-iliac joint by age 15?
The sacrum develops a sacral groove while the ilium develops an iliac ridge
Which gender has greater unevenness of the auricular surface of the sacro-iliac joint?
Males
What pathological or age-related modifications of the sacro-iliac joint may occur?
Degenerative arthrosis and ankylosis
What does ankylosis mean?
A condition of fibrous adhesion occurs within the joint
What is the age and surface bias associated with degenerative arthrosis of the sacro-iliac joint?
Age 40, the iliac auricular surface
What is the age and gender bias associated with ankylosis of the sacro-iliac joint/
Age 50 and male bias particularly in African American males
What age and gender bias is associated with ossification of the anterior sacro-iliac ligament?
Age 40 and male bias
Which is the strongest of the sacro-iliac ligaments?
The interosseous sacro-iliac ligament
What are the attachment sites of the interosseous sacroiliac ligament?
At the sacral tuberosity and the iliac sulcus
What passes between the layers of the interosseous sacro-iliac ligament?
Dorsal rami from the sacral spinal nerves
What accessory sacro-iliac joint ligaments connect to the ischium?
The sacrotuberous ligament and the sacrospinous ligament
What is formed by the continuation of the sacrotuberous ligament along the ischial ramus?
The falciform process
What separates the greater sciatic and lesser sciatic foramina
The sacrospinous ligament
What is the function of the sacrospinous and sacrotuberous ligaments?
They oppose the upward tilt of the sacral apex and resist the rotation of sacrum between the innominate bones
What vertebral levels correspond to the position of the manubrium sterni?
T3-T4
Which ribs will articulate with the manubrium sterni?
The first and second ribs
What vertebral levels correspond to the position of the corpus sterni
T5-T9
How many sternabrae form the corpus sterni
4 sternabrae
What ribs will joint with the corpus sterni via costal cartilage
Ribs 2-7
What feature of the corpus sterni is present in 4-7% of the population
A sternal foramen
Which ribs are classified as typical ribs, true ribs, costa verae, and vertebrosternal ribs in the typical adult skeleton?
Ribs 3 - 7
Which ribs are classified as atypical ribs, true ribs, costa verae, and vertebrosternal ribs in the typical adult skeleton
Ribs 1 and 2
Which ribs are classified as typical ribs, false ribs, costa spuriae, and vertebrochondral ribs in the typical adult skeleton
Ribs 8 and 9
Which ribs are classified as atypical ribs, false ribs, costa spuriae, and vertebrochondral ribs in the typical adult skeleton
Rib 10
Which ribs are classified as atypical ribs, false ribs, costa spuriae, and vertebral ribs in the typical adult skeleton
Ribs 11 and 12
What joint classification is now given to the joint between the sternum, clavicle and first rib?
Synovial saddle (diarthrosis stellar) joint
What ribs will participate in the sternocostal or sternochondral joint
Rib 1 to rib 7
What is the classic classification of the first stenocostal or sternochondral joint
Cartilaginous (amphiarthrosis) synchondrosis
What is the classification of the second - seventh sternocostal or sternochondral joint?
Synovial plane (diarthrosis arthrodia)
What is the name given to the segments of the sternum?
Sternabrae (for sternal bodies)
How many primary centers of ossification appear in the manubrium
1-3 centers have been identified
How many primary centers of ossification appear in the corpus sterni?
Typically 6
In what part of the sternum will a secondary center of ossification appear?
The xiphoid process
When does the xiphoid process first demonstrate a center of ossification
Sometime during or after 3 years old
In what part of the rib will primary centers of ossification appear
The body (corpus, shaft)
In what parts of the true rib will secondary centers of ossification appear?
The head, articular surface of the tubercle and the non-articular surface of the tubercle
Which ribs will demonstrate primary centers of ossification for the body (corpus or shaft)
All ribs; ribs 1-12
Which ribs will demonstrate secondary centers of ossification
Ribs 1-10
What are the four subclassifications of synarthrosis joints based on Latin groupings?
Suture, gomphosis, schindlyesis and syndesmosis
What are the characteristics of suture Vera (true sutures)
Sutures demonstrating interlocking of the adjacent bone surfaces; typically formed by the intramembranous ossification
What are the characteristics of suture notha (false sutures)
Sutures lacking interlocking of adjacent bone surfaces; typically formed by endochondral ossification
What is the classification of a joint with a “nail-like” condition?
Gomphosis
What is the classification of a joint with a “fissure-like” condition?
Schindylesis
What is the tip of the external occipital protuberance called?
The inion
What is the appearance of suture intersections just above the zygomatic arch called?
The pterion
What is the appearance of suture intersections just above the mastoid process called?
The asterion
What points on the skull are used to measure the skull size?
The nation, vertex, inion and gnathion
What points on the skull are used to measure cranial vault capacity?
The nation, vertex and inion
What are the contents of the optic canal?
The optic nerve and ophthalmic artery
What are the contents of the superior orbital fissure?
The ophthalmic veins, the oculomotor nerve, the trochlear nerve, the ophthalmic division of the trigeminal nerve, and the abducent nerve
The maxillary division of the trigeminal nerve exits the middle cranial fossa via which opening?
The foramen rotundum
What are the contents of the foramen ovale?
The mandibular division of the trigeminal nerve (Vc) and the lesser petrosal branch of the glossopharyngeal nerve
What opening allows a branch of cranial nerve Vc to enter the middle cranial fossa from the infratemporal region
The foramen spinosum
Which vessel is located within the foramen spinosum
The middle meningeal artery
What part of the cerebrum occupies the posterior cranial fossa?
None; the tentorium cerebellum separates the cerebrum into a space above the posterior cranial fossa
What bony feature is prominent in the median plane of the posterior cranial fossa?
The clivus or basilar part of the occipital bone
Which cranial nerves exit posterior cranial fossa Ostia?
Cranial nerve VII (facial), VIII (vestibulocochlear/auditory), IX (glossopharyngeal), X (vagus), XI (spinal accessory) and XII (hypoglossal)
What can the five layers of the scalp spell?
Skin, connective tissue, Aponeurosis, loose connective tissue, periosteum… SCALP
What are the principal sources of blood to the scalp?
Internal carotid and external carotid artery branches
What veins drain the scalp?
Superficial temporal, posterior auricular, occipital, & ophthalmic veins
Which divisions of the trigeminal nerve receive sensory information from the scalp?
All 3 divisions: ophthalmic nerve, maxillary nerve, & mandibular nerve
What is unusual/unique about the muscles of the face?
They do not act as lever muscles; they do not attach to bone at both origin & insertion
Which muscles lack any attachment to bone?
Obicularis oris, procerus & risorius
What type of motor fibers to skeletal muscle are given off by the facial nerve?
Branchial efferent (BE)
What opening(s) are located along the superior wall of the orbit?
Optic canal
What is the name given to the medial wall of the orbit
Lamina papyracea
What opening(s) are located along the lateral wall of the orbit?
Superior orbital fissure
What opening(s) are located along the inferior wall of the orbit?
Inferior orbital fissure
What is contained in the inferior orbital fissure?
Maxillary division of trigeminal nerve
What are the layers of the eyelid?
Palpebra
What are the names given to the modified sebaceous gland in the tarsus of the eyelid?
Tarsal or Meibomian gland
What is the function of the Meibomian gland?
Produces a thick, hydrophobic substance that presents tears from overflowing onto the cheeks along the margin of the eyelid
What is the name of the gland located at the base of the eyelash?
Ciliary gland
What are the names given to the modified sebaceous glands of the palpebra?
Tarsal gland or Meibomian gland and ciliary gland
Which cranial nerves are involved in the Visceral Efferent (VE) parasympathetic pathway to the lacrimal gland?
Facial and trigeminal (maxillary and ophthalmic divisions/branches)
What are the names of the ganglion of synapse in the efferent pathway to the lacrimal gland?
Pterygopalatine ganglion, sphenopalatine ganglion, Meckel’s ganglion
Parasympathetic stimulation of blood vessels in the lacrimal gland will result in what events?
Vasodilation of blood vessels, increased availability of water to secretory units, thinner or more watery product in lumen;
Sympathetic fibers synapse in which ganglion in the pathway to the lacrimal gland
The superior cervical ganglion
Sympathetic stimulation of the lacrimal gland will result in what events?
Vasoconstriction of blood vessels, limited availability of water to secretory units, more viscous or thicker product formed in glandular lumen
What cells of the lacrimal gland will cause the product to be released from the secretory unit?
Myoepithelial cells
What are the names of the layers of the eyeball?
Fibrous tunic, uveal tract & retina
What are the parts of the fibrous tunic of the eyeball?
Cornea and sclera
What are the parts of the uveal tract of the eyeball?
Iris, ciliary body, choroid & pupil
What muscles are present in the iris?
Sphincter papillae and dilator papillae
What is the innervation of the ciliaris muscle?
Oculomotor nerve, parasympathetic pathway
What is the innervation of the dilator pupillae?
Internal carotid artery plexus, sympathetic pathway
What are the chambers of the eyeball in front of the lens?
Anterior chamber and posterior chamber
What separates the anterior chamber and posterior chamber in the eyeball?
Iris
What is contained in the anterior chamber of the eyeball?
Aqueous humor
What is the primary cause of glaucoma
Excess aqueous humor in the chambers in front of the lens
What is the name given to the chamber behind the lens?
Vitreous chamber
What fills the vitreous chamber?
Vitreous body
What are the functions of the vitreous body?
Maintain retinal curvature; allow minimal light distortion form lens to retina
What are the common characteristics in origin and insertion of all rectus extraocular muscles?
They all originate from a common annular tendon in the orbit
They all insert into the sclera in front of the coronal equator of the eyeball
What is the common characteristic regarding the insertion of both oblique extraocular muscles?
Both insert onto sclera on the lateral margin of the eyeball behind the the coronal equator
What are the two unique features of the fourth cranial nerve
It is the only cranial nerve with an apparent origin from the brains’ dorsal surface; it is the only cranial efferent nerve to decussate within the midbrain from its nucleus
Intrinsic muscles of the eyeball are innervated by which Visceral Efferent (VE) pathways?
Ciliaris and sphincter pupillae are innervated by parasympathetic; dilator pupillae is innervated by the sympathetics
Which branch of the trigeminal nerve receives sensory information from the auricle?
Auriculotemporal nerve (mandibular division, trigeminal)
What part of the external acoustic meatus is protected by cartilage?
Lateral one third
The medial part of the external acoustic meatus is protected by___?
The temporal bone
Skin lining external acoustic meatus contains what modified sebaceous glands?
Ceruminous glands
Vascularization of the external acoustic meatus is derived from which branch(es) of the external carotid artery?
Posterior auricular artery, internal maxillary artery, superficial temporal artery… PIS
The external acoustic meatus transmits sensory innervation via which specific cranial nerve branches?
Auriculotemporal nerve (mandibular division, trigeminal) Auricular nerve (vagus)
What vein is formed within the parotid gland?
The retromandibular vein
Within the parotid gland what branches of the facial nerve are given off?
Posterior auricular, digastric, stylohyoid and forms the facial nerve plexus
What branch of the facial nerve penetrates the parotid gland, but is not given off within it?
The chorda tympani nerve
What branches of the mandibular division of the trigeminal nerve are given off within the parotid gland?
The auriculotemporal and lingual nerves
What forms the lateral boundary of the infratemporal region?
Ramus of the mandible
What are the contents of the infratemporal region?
Medial and lateral pterygoid muscles, internal maxillary artery and branches, pterygoid venous plexus, internal maxillary vein, branches of the trigeminal & facial nerves & the otic ganglion
What are the attachment sites of the stylomandibular ligament?
Styloid process of the temporal bone to the angle of the mandible
What are the attachment sites of the sphenomandibular ligament?
The spine of the sphenoid bone to the lingual of the mandible
What muscles act to depress the mandible or open the mouth?
Lateral pterygoid along with the suprahyoid and infrahyoid muscles
What muscles act to retract the mandible or pull the chin back?
Temporalis
What openings are associated with the pterygopalatine region?
Inferior orbital fissure, pterygomaxillary fissure, sphenopalatine foramen and foramen rotundum
Which ganglion is located within the pterygopalatine region?
The ptyergopalatine or Meckel’s ganglion
What neural pathway is the pterygopalatine associated with?
Parasympathetic innervation of the lacrimal gland
Which cranial nerves are associated with the parasympathetic pathway to the lacrimal gland?
The facial and trigeminal cranial nerves
What divisions of the trigeminal nerve will be associated with the parasympathetic pathway to the lacrimal gland
The ophthalmic and maxillary divisions of the trigeminal nerve
Which of the larger nasal cartilages lacks any attachment to the bone?
The major alar cartilage
Which branch(es) of the external carotid artery will vascularize the external nose?
The facial and internal maxillary arteries
Which branch(es) of the internal carotid artery will vascularize the external nose
The ophthalmic artery
What nerves provide cutaneous sensation for the skin of external nose?
The ophthalmic and maxillary divisions of the trigeminal nerve
What is the vermillion border?
The name given to the junction between the skin and the red region of the lip
What is the name given to the red region of the lip
The vermillion zone
What is unique about the human lip
The natural red color
What it’s he name given to the median depression of the upper lip
The Phil trump
What is the name given to the depression extending from the nasal ala to the corner of the upper lip?
The nasolabial groove or the nasolabial sulcus
What is the name given to the attaching material in the median plane from the lip to the gingiva proper
The superior labial frenulum or the inferior labial frenulum
What forms the layers of the cheek from the external to internal?
The skin, corpus adiposum, buccinator muscle, buccal salivary glands and the mucous membrane of the cheek
What is the location for the release of saliva from the parotid duct?
The buccal vestibule near the second maxillary molar
