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ANATOMY > LUMBAR SPINE - ARTHROLOGY > Flashcards

LUMBAR SPINE - ARTHROLOGY Flashcards

1
Q

The vertebral column

A

Median and dorsal 33 vertebrae

🔸Cervical- 7

🔸Thoracic- 12. 🔸(24 free vertebrae)

🔸Lumbar-5

Sacral- 5 (fused together to form sacrum)

Coccygeal- 4
(Fused together to form rudimentary tail)

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2
Q

Spinal curvatures

A

Spine curves when all parts are put together

Primary and secondary curvature is which gives us our normal posture

Cervical curvature – secondary curvature
thoracic curvature – primary curvature
Lumber curvature – secondary temperature
Sacral/coccygeal curvature – primary curvature

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3
Q

Primary Curvature

A

Thoracic and sacral region primarily for protection there is little or no movement

Thoracic region help to form part of the rib cage- protects lungs

Sacral region help to form part of the pelvic ring – protects pelvic viscera

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4
Q

Secondary curvature

A

Cervical and lumbar region created by increased anterior thickness in intervertebral discs

  • more movements are more likely to be affected by degenerative changes
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5
Q

2 joints at a segment level L2–3

A

2 joints

Anteriorly :
(Invertebral body +disc)
2nd cartilagineous or Symphyseal joint (mid line of body)

Posteriorly:
Synovial plane or Zygoapophyseal or Facet joint
Superior and inferior facets

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6
Q

Synovial joint

A

Majority of joints in body

Articular surface = hyaline cartilage

Joint cavity, fibrous capsule, synovial membrane, synovial fluid

Greater reliance on strong ligament to stabilise joint

Range of movement variable

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7
Q

Symphyseal joint

A

Found in midline of the body

Articular surfaces =
hyaline cartilage

No joint cavity

Bones how together by a fibrocartilaginous plate

Some ligaments hold the bones together

Range of movement = limited degree

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8
Q

Typical lumbar vertebra

L1-4

A

There are five vertebrae in the lumbar region but L5 is a-typical

(See photo)

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9
Q

Intervertebral disc

A

24 intervertebral discs and they contribute to a 1/4 of the length of the vertebrae column reason for curvature and spine

Symphyseal joint between intervertebral body and disc

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10
Q

Lumbar discs

A

Biggest within vertebrae column

10 mm thick

Make up a 1/3 of the height of the vertebral column

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11
Q

Nucleus pulposus

A

Semi fluid or a ball bearing

Irregularly arranged collagen fibres type 2 3D lattice and a few cartilage cells dispersed in a gel of semi fluid ground substance (hold water within its makeup)

Deformable tissue- can change its shape

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12
Q

Annulus fibrosis

A

Concentric lamella ( 10–20 layers) of collagen fibres highly organised structure

Within each lamella collagen fibers line parallel to each other at 65–70° angle

Successive layers or a different inclination is to each other i.e. Axa fact provide strength + resilience copes with shearing

Elastic fibres:

1) type l collagen fibres- are in the outermost layer of annulus gives tensile strength
2) type II collagen fibers- inner most layer gives it compressive component

Structure of annulus Is important to maintain the integrity of the intervertebral disc as a whole

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13
Q

Arrangement of annulus fibrosis

Thickenings

A

Collagen lamella are thicker anteriorly and latterly

finer posteriorly

Disc most likely to fail posteriorly

  • If disc prolapse is posteriorly there is chance of spinal-cord entrapment
  • If disc prolapse is posterolatterly there is chance of nerve root entrapment
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14
Q

Vertebral End Plates

Structure

A

Layer of cartilage (0.6-1 mm thick)= hyaline and fibrocartilage

Covers the nucleus but not the entire extent of the annulus fibrosis

Plate is a mixture of hyaline and fibrocartilage:

  • Hyaline- closer to vertebral body weaker link when binding disc to body
  • Outer most fibres of the annulus fibrosis anchor the intervertebral disc to the adjacent vertebral bodies
  • inner surface of end plate is composed of fibrous tissue= inner layers of annulus fibrosis which sweep over and under nucleus fibrosis help to form inner part of vertebral end plate

End-plates are strongly bond to the disks but only weakly attached the vertebral bodies

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15
Q

Vertebral End Plates

Functions

A

Protect vertebral body from pressure atrophy because the disc has to cope with pressure

Confinees the nucleus fibrosis and annulus fibrosis within their anatomical range

Acts as a semi-permeable membrane for fluid exchange via osmosis

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16
Q

End Plate+Annulus fibrosis

A

End plate+annulus fibrosis=

Ensures the nucleus fibrosis is completely contained within the intervertebral disc

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17
Q

Nutrition of the disc

A

Discs have a relatively low metabolic rate

Peripheral part of annulus is supplied by adjacent blood vessels

Majority of disk relies on DUFFUSION from blood vessels within the adjoining cancellous vertebral bodies

Diffuses through end plate and into disc

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18
Q

Intervertebral disc

Functions

A

Weight-bearing

Shock absorber

Movement

19
Q

Intervertebral disc- weight bearing

A
  • DISC LOADING– annulus+nucleus are involved in weight-bearing
  • TELEPHONE BOOK ANOLOGY– (annulus) healthy lamella will resist buckling due to the bulk of collagen fibres for a limited period of time
  • Anulus on its own is not sufficient for load bearing has to be combined effort
20
Q

Intervertebral discs – weight-bearing

Disc Looding

A

Compression increases pressure in the nucleus pulposus but due to its deformable nature it changes shape and the force is exerted radially on the annulus and tension in the annulus increases as fibres are stretches

As disc loading increases the tension in the annulus reaches maximum capacity where it can’t stretch any further

As a consequence the nucleus starts to exert pressure on vertebral end plates above and below

As the anulus can no longer stretch and the End plates are a rigid structure which prevent nucleus deforming inferiorly or superiorly = annulus therefore applies an equal and opposite force to that of the nucleus

therefore you end up with a rigid structure through which load can be transmitted

21
Q

Intervertebral disc

Shock absorber

A
  • Rapid application of forced to the disc is diverted momentarily to annulus
  • Annulus have elastic collagen fibres which stretch to absorb the shock and reduce force being passed on to adjacent vertebral bodies
22
Q

Intervertebral disc

Movement

A

Nucleus pulposus acts like a semi fluid ball bearing between adjacent vertebrae

It is able to move with in the confines of the intact annulus

23
Q

Zygoapophyseal joints

A

Synovial plane joints

Articular processes of vertebral column

LX region
•Superior concave facets face medially and posteriorly
•Inferior facets face laterally and anteriorly

Lax fibrous capsule surround to the joint with synovial membrane

Joints are stabilised by additional ligaments

24
Q

Zygoapophyseal joints

Articulations

A

inferior facets of the vertebra above articulating with the superior facets of vertebrae below = joint

Range of movement depends on the shape and orientation of facets

Lots of small movements = quite a bit of movement but still very stable

25
Q

Superior articular facets

A

concave transversely flat vertically face medially and posteriorly in direction

26
Q

Inferior particular facet

A

Reciprocally curved they are convex transversely flat vertically closer together than superior facet and face laterally and anteriorly

27
Q

Ligaments supporting vertebral column

A

1) ALL
2) PLL
3) Supraspinous ligament
4) interspinous ligament
5) ligamentum Flava
6) intertransverse ligament

28
Q

Spinal longitudinal ligament

Anterior longitudinal ligament (ALL)

A

Attaches to anterior part of bodies and discs from C1 to pelvic surface of sacrum widening inferiorly (24mm wide)

1 to 2 mm thick consisting of 3 dense layers

Superior fibres= long 7 segmental levels
Deepest= 1 segmental level

Spinal support for anterior part is vertebrae column

29
Q

Posterior longitudinal ligament (PLL)

A

Attaches to intervertebral discs and adjacent margins of vertebral column bodies with the vertebral canal

Extending from C2 to sacrum

1- 1.4 mm thick consisting of 2 dense layers

Superior fibres extensive
Deep fibres short

30
Q

Difference between ALL and PLL

A

Not as strong as ALL

PLL attaches to the intervertebral disc and the adjacent margins of the vertebral bodies but it doesn’t attach to the backs of the whole of the vertebral body because it needs to allow space for vertebral vein to pass through to supply nutrition for intervertebral disc

31
Q

Supraspinous ligament

A

Most posterior

Band of longitudinal fibres extending over and connecting the tips of spinous processes from C7 to sacrum

Superficial fibres are extensive
Deep fibres are shorter

Continuous with the posterior edge of the interspinous ligament anterior to supraspinous ligament

32
Q

Interspinous ligament

A

Thin and membranous

Relatively weak best developed in lumbar region

Fibres passed between and unite adjacent vertebral ptocesses

Particularly well-developed in the Lx region

33
Q

Ligamentum Flava

A

Passing between both laminae of adjacent vertebrae from C1 to L5

Attaches is to lower border of lamina above the upper border of vertebra below

Medial borders of each ligament me at the root of the spine

Yellowish a parent due to lots of elastin fibres permits separation of lamina during flexion to allow for a good range of movement but during extension it prevents it + stability

34
Q

Intertansverse ligament

A

Generally insignificant bands of fibres

connecting adjacent transverse processes lower broader of T.p above and superior boarder of T.p below

Best developed in the Lx region

Absent in the CX region

35
Q

Flexion of vertebral column

A

ROM: freely moving

Effect on intervertebral discs:
•Compression of the anterior part of disc
•stretching of the posterior part of disc
•nucleus moves backwards

Effect of facet joints:
•inferior articular facet glide upwards on adjacent superior facets

Effect on soft tissue :
•laminae move apart

Limiting factors: increase tension in
•Supraspinous Lig
•Interspinous ligament 
•Ligament Flava
•PLL
•extensor muscles
36
Q

Extension of vertebral column

A

ROM: limited fairly free

Effect on intervertebral discs:
Compression of posterior part of disc
Nucleus moves forwards
stretching of anterior part of disc

Effect of facet joints:
Inferior articular facets glide downwards on the adjacent superior facets = CLOSE PACK POSITION (maximum congruency of articulating surfaces)

Effect on soft tissue
Spinous processes and laminae move closer together

Limiting factors: Increased tension in
•ALL
•Flexor muscles

37
Q

Lateral flexion of vertebral colum

A

ROM: free in lumbar region but less than CX region

Effect on 6 discs:
Six disc compression with some degree of torsion

Effect of facet joints:
Inferior articular facet glides downwards on adjacent superior articular facet

Effect on soft tissue:
Laminae move closer together

Limiting factors: tension in
•Ligaments on the opposite side to the movement
•i.e. intertransverse ligament and ligament flava
•Opposite muscles

38
Q

Rotation

A

ROM: very limited = shape and orientation of facets

Effect on intervertebral discs:
Torsional affect on desk (windeing up)
50% fibrous will be taught in each direction due to the arrangement of them

Same side laminae move closer together

Opposite side laminae move further apart

Limiting factors: increased tension in
•Ligaments on both sides
•Muscles on opposite side of movement

39
Q

Intervertebral Foreman

A

Boundaries

Superior and inferiorly by pedicles of adjacent vertebrae

Anteriorly by vertebral bodies and intervening discs

Posteriorly by articular processes and facet joints

40
Q

Intervertebral compression

A

Any reduction in the transverse dimension of the foramen will result in nerve compression

41
Q

Boundaries of intervertebral foreman

A

Slightly elongated in the vertical plane

Anterior wall: posterior boarder VB

Posterior wall: anterior part facet joints

Roof: inferior notch of the vertebrae above

Floor: superior notch of the vertebrae below

42
Q

What passes through the intervertebral foreman

A

Spinal nerve root

Dorsal root ganglion

Segmental spinal artery

Spinal communicating veins

43
Q

protection of Vertebral canal

A

Protected by PLL anteriorly and Lig flava poseriorly

ANATOMY (11 decks)

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