LECTURE 3- the vertebral column Flashcards
how many intervertebral disk do we have
23
how many vertebrae do we have
33
what is the “roof” to protect the SC
the lamina
what connects with the vertebra above and below
articulate process
what does the articulate processes resists
shear, compression, tensile and torsional forces
what is spondylolysis
where there is a fx to the pars interaticularis
what is spondyloloisthesis
when there is a fx and separation of the pars interarticularis
where is spondylosis and spondylolisthesis most common
L5-S1
what is the nucleus pulposus made up of
80% water
what is the annulus fibrosus made up of
60% water
what is the degrees of cervical , thoracic , and lumbar facet joints
C- 45
T- 60
L- 90
what does the anterior longitudinal ligament resist
extension
where does the anterior longitudinal ligament run
anterior surface of vertebra bodies from C2- sacrum
what do the fibers of the ALL blend with
annulus fibrosus
where is the ALL the thickest
lordotic regions
what does the anterior atlantooccipital and atlantoaxial membranes resist
extension
what does the posterior longitudinal ligament resist
flexion
where does the PLL run
posterior surface of vertebra bodies from C2- sacrum
what does the ligamentum flavum resist
flexion
where does the ligamentum flavum run
posterior surface of the SC
which ligament is in constant tension even in neutral
ligamentum flavum
what does the interspinous ligament resist
flexion
what does the interspinous ligament connect
SP to adjacent vertebra
what does the supraspinous ligament resist
flexion
what does the intertransverse ligament resist
lateral flexion
what does the alar ligaments resist
rotation
where are the alar ligaments
in teh atlas (C0-C2)
what does the alar ligaments limit ips and contra
ips- lateral flexion
contra- rotation
what does the facet joints resist
forward flexion and rotation
what is determined by the direction of motion pertaining to the vertebrae
orientation of the facets
what does the amount of motion available depend on in the spine
size of the disc
during flexion where does the vertebral body move
anterior
what happens with the facets during flexion
inferior facets slide up on superior facets
what happens with the vertebral body during extension
posterior tilt
what happens with the facets during extension
the inferior facets slides down on the superior facets
what happens during lateral flexion to the vertebral bodies
there is a ipsilateral compression and contra lateral opening
what happens with the facets with lateral flexion
the inferior facet on the ipslaterla side slides down on the superior facets and on the contralateral side the inferior facet slides up on the superior facet
what is flexion limited by
posterior outer annulus , facet capsules , post ligaments and mm
what is extension limited by
anterior outer annulus , facet capsules, ant lig, SP
what limits axial compression of the spine
discs and vertebral bodies
what limits torsional and shear forces on the spine?
torsion - resisted by annulus fibrosis and facet joints
shear - resisted by lumbar facets (prevent translation of disks)
what is considers the upper cervical spine
C0 - C2
what is considered the lower cervical spine
C3-7
what is the OA joint
C0 on C1
what is the function of the OA joint
nodding of the head
what is the AA joint
C1 - C2
what is the function of the AA joint
rotation and saying NO
what is the dens held in place by
the transverse ligament
what will get damage first the dens or the ligament
dens fx
what are the cruciate ligaments of the neck
alar ligaments
what type of joint is C0 on C1
convex on concave
during flexion of the OA joint what happens and what happens during extension
FLX: convex on concave , roll ant slide post
EXT: roll post , slide ant
what % is AA joint for cervical rotation
50
what type of joint is teh AA joint
convex on convex ( C1 inferior factions on C2)
what happens with upper cervical lateral flexion
coupled with contralateral rotation
what happens with upper cervical rotation
coupled with contralateral lateral flexion
so if you are laterally flexing your head to the right what is happening in the upper cervical region?
R lateral flexion with L rotation
where is the greatest range of flexion and extension in the cervical region
C5/6
what happens in the lower cervical region if there is lateral flexion
coupled with ipslateral rotation
what happens if there is rotation in the lower cervical region
ipsilateral lateral flexion
what articulates with the heads of ribs
demifacets
what are transitional vertebrae
t1 and t12
what is there an increase of in the thoracic spine
lateral flexion and rotation
where is the smallest intervertebral disc ratio
thoracic
what does it mean if there is a small intervebral disc ratio
increase stability over mobility
what is lateral rotation coupled with in the thoracic region
axial rotation
what does rotation of the thoracic region cause the ribs to do
shift
posterior ipsilateral rib( more concave) and anterior contralateral rib (less concave )
what ways do the ribs move if there is a right rotation of the thoracic region
the right ribs shift posteriorly and the left rights shift anteriorly
which region has the largest vertebral bodies
lumbar
what does the lumbar region support
body weight
gravity
muscle contraction
where are there mammillary processes at the superior facet for the multifidus to attach
facet joins of L 1- L4
in the lumbar region the discs are arranged in sheets called
lamellae
where does the supraspinous ligament terminate
L4
the supraspinous ligament blends with what
thoracolumbar fascia
what does the iliolumbar ligament do
prevents anterior displacement of L5 due to shear forces
what is the role for the thoracolumbar fascia
acts as mm attachment site
rentinaculum
accessory lig
what motions happen with the bodies in lumbar region during flx/ext
tilt and slide occur in same direction
what happens in the lumbar region during rotation
body tilts and slides ipsilaterally
ipsilateral facet distracts
contralateral facet compresses
what happens in the lumbar region with lateral flexion
body tilts and slides ipsilaterally
ipsilaterally - infeior facet joint slides down on sup
contra- inferior facet joint slides up on sup
with forward bending lumbar flexion is followed by
anterior pelvic tilt
from forward bending to standing what happens
posterior pelvic tilt is followed by lumber extension
what vertebrae levels bears 65% of shear forces at facet joints
L4-5
how many fused vertebrae are there at the sacrum
5
what is the base of the sacrum and apex
base - S1
apex - S5
what is the symphysis pubis
pubic bones with articulate cartilage and fibrocartilage disc
what ligaments is a major bonds between sacrum and ilia which creates a fibrous union
interosseous
what ligament is ischial tuberosity to posterior spine at ilia and lateral sacrum and coccyx
sacrotuberous
what ligament is ischial spine to lateral sacrum/ coccyx
sacrospinous
what is it called when sacral base rotates anteriorly on fixed innominates
nutation
what is it called when sacral base rotates posteriorly on the fixed innominates
counternutation
in the sacrum stability is key support of what
body weight and transmission of forces
what is nutation resisted by
sacrotuberous , sacrospinous ,and anterior sacroiliac ligaments
what is nutation associated with
hip flexion and anterior pelvic til it
what is counternutaition resisted by
long posterior sacroiliac ligaments
what does the pelvic floor provide
stability to lumbopelvic ring
what are the levator ani muscles
iliococcygeus and pubococcygeus
what does the levator ani muscles do
lift pelvic floor and constrict openings
where does the ribs superior facet fit into
the inferior vertebral facet above
for example what does rib 6 articulate with
inferior facet of T5 and superior facet of T6
which ribs are considered to be “true”, “false”, and “ floating”
t- 1-7
f- 8-10
floating - 11-12
what happens to the ribs during inspiration
elevate
ribs 2-7 do what action
pump handle
ribs 8-10 do what actions
buckle handle action
primary ventilation muscles
diaphragm , intercostals , scalenes
accessory breathing muscles
SCM & traps
pec major and minor
subclavius
serratus post and inf
abdominals
how are the ribs and diaphragm in infants compared to adults
horizontal
how many degrees of flexion and extension is at the OA joint
15-25
List the joint types for AO, AA and lower cervicle
AO - convex on concave
AA - plane joint
lower cervical - saddle joint
In the lower cervical region, the discs are thicker (anterioly/posteriorly)
Anterior
When you flex your OA joint what are the kinematics? What about extension
Flexion - roll anterior and slide posterior
Extension- roll posterior slide anterior
What are the kinematics at the lower cervical spine?
Flexion - anterior tilt and slide (couples up slide of ZAJ)
Extension: posterior tilt and slide (down slide of ZAJ)
Lower cervical kinematics with later flexion vs upper cervical
Lower : lateral flex with ipsi rotations
Upper: lateral flex with contra rotation
What part of the spine has the smallest intervertebral disc ratio
Thoracic
What vertebrate experiences the most shear stress?
L5 - more with anterior pelvic tilt
The lamellae in the discs of lumbar region resist what motion
Torsional
What does the iliolumbar ligament resist??
Prevents anterior displacement on L5 due to shear forces
And all movements of L5 on S1
How does the thoracolumbar fascia translate forces
It attaches to glute max and contralateral lat, when contracted, it does transmission of forces between pelvis and trunk
In regards to lumbopelvic rythm, forward bending causes lumbar ____ and ___ pelvic tilt
While returning to erect stance causes …. ( what motions in what ORDER?)
Forward bending - lumbar flexion and anterior pelvic tilt
Returning - posterior pelvic tilt FIRST then lumbar extension
The lumbar interbody joints typically bear more weight than the facet joints. What would cause this to change? What would cause the facet joints to take on more load?
increased lumbar lordosis or internal disc distraction
The lordotic position of the lumbar spine face what forces?
Shear forces
so think tighter hip flexors = more lordosis, more shear forces
Lumbar region: increased shear loads = ___ plays a more significant role
disc
Base of sacrum at S_ and apex at S_
1
5
irregular joint surfaces (of sacrum) increase ____ but decrease ____
increase stability
decrease mobility
LoG passes ___ to the head/cervical regions, so the ___ muscles resist _____
anterior
posterior
flexion
The levator ___ the lordoditc postion of the cervical spine while the semispinalis and cervicis ___ it
resists
maintains
List the lateral and anterior muscles of the cervical region
lateral - scalenes, SCM
anterior - longus capitis and longus coli, rectus capitis anterior and lateral
Tightness in your psoas major can lead to what postural adjustment and what forces?
anterior pelvic tilt = increase compression and anterior shear forces
How does your erector spinae come into play with lifting principles
with a squat lift, the erector spinae can offset anterior shear forces
in a stoop lift, they can not, there is a shorter moment arm
what decreases the amount of load that vertebrae can hold with aging?
decrease in horizontal and vertical trabeculae
loss of proteoglycans and water content
vertebral endplates cant diffuse as well
schmorls node
nuclear material of discs prolapses into bone
Which ribs only articulate with one vertebrae
1, 10, 11 and 12
describe the movements of the upper thorax ribs vs the lower thorax and their plane of motion
pump handle action AP diameter
bucket handle action - lateral diametere
why are babies more susceptible to dying with RSV?
diagrams are less fatigue resistant (20%), failure can occur with infection
and they cant use their accessory muscles yet
the elderly have (earlier/later) recruitment of accessory muscles?
earlier
