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OMM > L3/4: Applied Anatomy of the Spine I & II > Flashcards

L3/4: Applied Anatomy of the Spine I & II Flashcards

1
Q

What are features of the S-spine (sacrum)?

A
  • Wedge-shaped/triangular bone lies at end of spine between the ilia - Composed of five-fused vertebral segments - Four foramina on each side with sacral nerves exit - SI joint = sacroiliac joint is L-shaped - Supports entire spine and helps transmit the forces of spine to LEs and LEs to spine
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2
Q

Label the following diagram (include directionality):

A
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3
Q

What are considered the typical cervical vertebrae?

A
  • C3-C6
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4
Q

What is the ligamentum nuchae?

A
  • broad ligament from occipital bone to spinous processes of C1 to C7 supporting large size of head, also serves as area for muscular attachments
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5
Q

What are ways to decrease spinal curvature?

A
  • Trauma, degeneration (common ways) - Bedridden pt (lack of extension leading to loss of lordotic curve) - Spinal stenosis (narrowing of vertebral canal and or intervertebral foramina) leading to pain with extension and therefore loss of lordotic curve)
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6
Q

What are long restrictor muscles? Provide an example.

A
  • Long restrictor muscles move more than two vertebrae, cross more than one joint - Example: erector spinae muscles
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7
Q

Are kyphotic and lordotic curves normal? Are kyphosis and lordosis normal?

A
  • Kyphotic and lordotic curves are normal, whereas kyphosis and lordosis refer to abnormal increases to normal kyphotic and lordotic curves. –Osis signifies abnormal.
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8
Q

What is the posterior longitudinal ligament?

A
  • covers the post. Aspect of the vertebral bodies and IV discs from C2 to sacrum, not as strong as ALL, function: prevents hyperflexion, becomes thinner as it descends
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9
Q

What are the pedicles?

A
  • short pieces of bone that connect the vertebral body bilaterally to the transverse processes and are part of the vertebral arch
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10
Q

What is a functional vertebral unit?

A
  • refers to two adjacent vertebrae with their associated intervetebral disc. - Also includes arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements
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11
Q

What two anatomical structures/features form the vertebral arch?

A
  • the right and left pedicles and laminae
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12
Q

What is the ligamentum flavum?

A
  • attaches lamina to lamina, function: protect the neural elements and the spinal cord, stabilizes spine so excessive motion between bodies don’t occur, strongest of spinal ligaments
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13
Q

Explain blood supply to intervertebral discs. How does this contribute to disc degeneration?

A
  • The IV discs are avascular tissues. They have no direct blood supply. Receive nutrients through process known as imbibition (similar to diffusion). This decreases significantly by 2nd decade of life with reduction continuing throughout life, contributing to disc degeneration.
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14
Q

What are the two types of normal curves seen in the spine?

A
  • Kyphotic curve: anterior concavity of T/S spine - Lordotic curve: posterior concavity of the C/L spine
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15
Q

What is lumbar lordosis? Causes?

A
  • Characterized by an anterior rotation of the pelvis at the hip joints producing an abnormal increase in lumbar curvature. Sacral base (superior aspect) tilts forward. - Causes: weakened trunk musculature (esp. antero-lateral abd wall), pregnancy (temporary lordosis)
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16
Q

What travels through the transverse foramen?

A
  • C1-C6: contains the vertebral artery and vein - C7: contains the vertebral vein, NOT artery
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17
Q

What are the laminae?

A
  • short pieces of bone that connect the spinous process bilaterally to the transverse processes and are part of the vertebral arch
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18
Q

Explain what a disc herniation is and how it occurs. What is occurring to the intervertebral disc.

A
  • Disc herniation refers to nucleus pulposus breaking through the annulus fibrosis and impinging on the spinal cord / nerve. This is caused by excessive pressure being placed on any portion of the disc by the under/overlying vertebral bodies during excessive/rapid flexion, extension etc. Vertebral flexion causes posterior herniation, while vertebral extension causes anterior herniation.
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19
Q

What are the superficial muscles of the back?

A
  • Trapezius - Rhomboid minor and major - Latissimus dorsi
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20
Q

What are features of the L-spine?

A
  • large vertebral bodies that are kidney shaped, - largest bodies of spine with largest IV discs - intervertebral articulations/facets are facing in sagittal plane (left/right)
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21
Q

What are considered the atypical cervical vertebrae?

A
  • C1, C2 and C7
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22
Q

Does the vertebral artery pass through C7s transverse foramina?

A
  • No. Only through C1-7s.
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23
Q

What is the clinical significance of the PLL?

A
  • posterolateral disc herniations occur most frequently in the L-spine because the PLL is thin (at L1 = ½ width and L5 = ¼ width)
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24
Q

What are restrictor muscles? What are long restrictor muscles vs short restrictor muscles?

A
  • Restrictor muscles stabilize the spine to maintain postural balance against gravity and to anchor spine for movements of limbs and parts of spine - Long restrictor muscles move more than two vertebrae, cross more than one joint - Short restrictor muscles move one vertebra upon another
25
Q

Name/describe the major ligaments of the spine

A
  • Anterior longitudinal ligament (ALL): attaches on the ant. Aspect of all vertebral bodies and IV discs, stonger than PLL, function: prevents hyperextension - Posterior longitudinal ligament (PLL): covers the post. Aspect of the vertebral bodies and IV discs from C2 to sacrum, not as strong as ALL, function: prevents hyperflexion, becomes thinner as it descends - Ligamentum flavum: attaches lamina to lamina, function: protect the neural elements and the spinal cord, stabilizes spine so excessive motion between bodies don’t occur, strongest of spinal ligaments - Ligamentum nuchae: broad ligament from occipital bone to spinous processes of C1 to C7 supporting large size of head, also serves as area for muscular attachments
26
Q

Label the following diagram (include directionality):

A
27
Q

What are the articular facets?

A
  • these are surfaces present on each of the intervertebral articular processes (two superior, two inferior) that articulate or form joint with other overlying or underlying articular facets
28
Q

What are features of the T-spine?

A
  • contains additional facets (joint surfaces) on vertebral bodies/transverse processes for articulation with ribs = costal (rib) facets (superior, transverse and inferior) - vertebral bodies are heart-shaped - long, slender spinous processes - intervertebral articulations/facets are facing in coronal plane (superior/posterior)
29
Q

What is the anterior longitudinal ligament?

A
  • attaches on the ant. Aspect of all vertebral bodies and IV discs, stonger than PLL, function: prevents hyperextension
30
Q

How to evaluate for scoliosis?

A
  • Look for uneven shoulders/blades, uneven iliac crests or raised / bulge on one side of back when pt bends over
31
Q

What is the direction of rotation in the following examples?

A

a.) Movement that brings the spinous process to the right? b.) Movement that brings the right transverse process posterior? c.) Movement that brings the left superior and inferior articular processes closer to midline? - left rotation - right rotation - left rotation

32
Q

What are the 4 basic motions of the spine? What plane does each motion use?

A
  • Flexion: sagittal plane - Extension: sagittal plane - Side bending (aka lateral bending/flexion): coronal plane - Rotation: transverse/horizontal plane
33
Q

Which are considered the atypical cervical vertebrae? Why?

A
  • C1: atlas: no vertebral body, small spinous process (non-bifid), occipital bone rests on it, flexion and extension occur here, together with occiput it forms atlanto-occipital OA (“yes”) joint - C2: axis: dens/odontoid process is a modified vertebral body allows for rotation at the joint known as the atlantoaxial AA (“no”) joint - C7: vertebra promines: has longest spinous process, longest transverse process of c-spine, vertebral artery doesn’t pass through the transverse foramina here, vertebral veins pass through, transverse foramina can be septated and asymmetric
34
Q

What are common ways to decrease spinal curvature?

A
  • Trauma - Degeneration
35
Q

What are the two parts of the intervertebral discs?

A
  • Annulus fibrosus: outer layer of largely fibrocartilage - Nucleus pulposus: inner region of mucopolysaccharides (gel-like substance)
36
Q

Explain why there are functionally 10 thoracic vertebrae and 7 lumbar vertebrae? What does this mean?

A
  • Functionally there are 10 thoracic vertebrae and 7 lumbar vertebrae as T11 and T12 act like lumbar vertebrae. They are not attached anteriorly to the thoracic cage through ribs. They have floating ribs attached to them. As a result of this, they have more motion than the other thoracic vertebrae, much like the lumbar vertebrae. - In many OMM procedures, we treat the 11th and 12th T vertebrae similarly to the way we treat lumbar.
37
Q

What are the deep muscles of the back?

A
  • Semispinales - Multifudus - Rotatores - Interspinales - Intertransversarii
38
Q

What are the functions of the a.) vertebral body, b.) vertebral arch, c.) vertebral canal, d.) intervertebral foramen, e.) spinous process, f.) transverse processes, g.) intervertebral articular processes and h.) intervertebral discs?

A
  • a.) vertebral body: function is for weight bearing - b.) vertebral arch: function is to protect the spinal cord - c.) vertebral canal: comprised by the succession of vertebral foramina, the function is to house the spinal cord and meninges - d.) intervertebral foramen: function to provide outlet for spinal nerves - e.) spinous process: function as point for muscle attachment to provide movement - f.) transverse processes: function as point for muscle attachment to provide movement - g.) intervertebral articular processes: function to restrict/guide movement - h.) intervertebral discs: functions as shock absorber of the spine
39
Q

How do you describe vertebral motion?

A
  • Motion of one vertebra is described in relation to the vertebra below.
40
Q

In what planes do the articular facets in the L/T-spine face?

A
  • L-spine: articular facets face left/right (sagittal plane) – remember flexion/extension occurs in this plane - T-spine: articular facets face posteriorly/anteriorly (coronal plane) – remember side bending occurs in this plane
41
Q

Causes of thoracic kyphosis?

A
  • Degenerative disc disease (from old age) - Osteoporosis leading to anterior compression or wedge fracture – known as Dowager’s hump - Postural (ie. somatic dysfunction) - Scheuermann’s disease – vertebrae grow unevenly (shorter anteriorly)
42
Q

Explain the developmental spinal curves and changes.

A
  • Primary curves: kyphotic curve - Secondary curves: lordotic - At birth we have a single kyphotic curve relating to the fetal position. As we being to lift our head, we develop cervical lordotic curve. As we walk, we develop lumbar lordotic curve.
43
Q

What are the intermediate muscles of the back?

A
  • Splenius cervicis - Splenius capitis - Serratus post. sup. - Serratus post. inf. - Erector spinae (iliocostales, longissimus, spinales – lat to medial – “I love spaghetti)
44
Q

What are the types of abnormal spinal curves?

A
  • Kyphosis: abnormal increase to the kyphotic curve - Lordosis: abnormal increase to the lordotic curve (think: “Oh Lord (osis) Girl, look at your ass!”) - Scoliosis: abnormal lateral curvature of the spine
45
Q

What anatomical elements are being loaded/stretched/opened/closed during each spinal motion?

A
  • Extension: loads posterior elements, stretches anterior elements - Flexion: loads anterior elements, stretches posterior elements - Side bending: loads facet on side contralateral to motion, stretches elements ipsilateral to motion, closes intervertebral foramina on side contralateral to motion, opens faces on the side ipsilateral to motion - Rotation: no loading, stretching, opening or closing of anatomical elements
46
Q

What are features of cervical vertebrae?

A
  • smallest vertebral bodies of the spine (no body on C1, modified body C2) - bifid spinous processes C2-6 - transverse foramen in C1-7 (vertebral artery only passes through C1-6) - unique C1, C2 and C7 vertebrae (structurally and functionally)
47
Q

Describe the sections of the spine.

A
  • There are five sections of spine: - A.) cervical (neck): 7 segments - B.) thoracic (upper/middle back): 12 segments - C.) lumbar (lower back): 5 segments - D.) sacral: 5 fused segments - E.) coccygeal (tail bone): 4-5 fused segments
48
Q

What is the key feature of the T-spine?

A
  • rib facets on the vertebral bodies/transverse processes
49
Q

List other muscles that affect the spine?

A

1.) Lateral muscles: scalenes, sternocleidomastoid, quadratus lumborum, abdominals (not rectus) 2.) Anterior muscles: longus coli, longus capitis, rectus capitis anterior and laterals, external oblique, internal oblique, transversus abdominis, rectus abdominis, psoas major and minor

50
Q

Label the following diagram (include directionality:

A
51
Q

What are the 3 planes of motion in the body? What motions occur in each?

A
  • Sagittal plane (divides body into left/right): we flex and extend within this plane - Coronal plane (divides body into anterior/posterior): side bending occurs in this plane - Horizontal/transverse plane (divides body into superior/inferior): rotation occurs in this plane
52
Q

What is the pars interarticularis?

A
  • the portion of bone between the superior and inferior articular processes
53
Q

What are the four main functions of the spine?

A
  • Muscle, ligament, tendon attachment and therefore movement - Cushioning effect - Protection of spinal cord (CNS) - Support of body weight
54
Q

Do all cervical vertebra have bifid spinous processes?

A
  • No. Only C2-6
55
Q

What are short restrictor muscles? Provide an example.

A
  • Short restrictor muscles move one vertebra upon another - Example: rotatores, intertransversarii, interspinales
56
Q

How is vertebral rotation named?

A
  • Rotation is named in reference to where the vertebral body is moved in reference to the anterior-posterior axis.
57
Q

What is Scheuermann’s disease?

A
  • pathology where vertebra grow unevenly (shorter anteriorly) causing a wedge appearance that leads to kyphosis early in life
58
Q

Why do some of the cervical vertebrae have bifid spinous processes?

A
  • For more muscle attachments
59
Q

What two anatomical structures/features form the intervertebral foramen?

A
  • the superior and inferior vertebral notches

OMM (15 decks)

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