Spinal 2 Flashcards
What is the classic angulation of typical cervical articular facets?
40 to 45 degrees from the coronal plane
What nerve indents the articular pillar of typical cervical vertebrae?
the medial branch of the dorsal ramus of a cervical spinal nerve
Recent work suggests what angulation for typical cervical articular facets?
55 to 60 degrees
What is the orientation of the typical cervical superior articular facet?
backward, upward, medial (BUM)
What is the orientation of the typical cervical inferior articular facet?
forward, lateral, downward (FoLD)
What muscles will attach to typical cervical articular processes?
the longissimus capitis, longissimus cervicis, semispinalis capitis, semispinalis cervicis, multifidis and rotators
What muscles blend with the capsular ligament of cervical zygapophyses?
the semispinalis capitis, multifidis and rotator longus
What is the joint classification for the typical cervical zygapophysis?
synovial plane (diarthrosis arthrodia) joint
What will influence spinal kinematics?
geometry of articular facets, mechanical properties of connective tissue, mechanical properties of muscle
The greatest range of flexion - extension among the typical cervical vertebrae occurs at which vertebral couple?
typically C5/C6
What motions are coupled in the cervical spine?
lateral bending and axial rotation
Ranges of coupled motion among the typical cervical vertebrae will begin to decrease at what cervical vertebral couple?
the C5/C6 vertebral couple
What is the usual condition for the Caucasian typical cervical spinous process?
they are bifid
What is the usual condition for the African-American typical cervical spinous process?
they are non-bifid
What muscles may attach to the typical cervical spinous process?
the spinalis cervicis, semispinalis cervicis, semispinalis thoracis, multifidis, rotators and interspinalis
What is the name of the first cervical vertebra?
atlas
What features are lacking at C1?
vertebral body, pedicles, a spinous process and the intervertebral disc
What muscle attaches to the anterior arch of C1?
longus colli
What ligaments will attach to the anterior arch of C1?
the anterior longitudinal, anterior atlanto-occipital and anterior atlanto-axial ligaments
What is observed of the back of the anterior arch of C1?
the fovea dentis
What is the morphology of the superior articular facet of C1?
they are elliptical, closer together in front and often demonstrate an elevation subdividing the facet surface into two separate surfaces
What is the orientation of the superior articular facet of C1?
backward, upward, medial (BUM)
What are the morphological characteristics of the inferior articular facet of C1?
asymmetrical, slightly concave or flattened
What is the orientation of the inferior articular facet of C1?
backward, medial, downward (BMD)
What muscles attach to the lateral mass of C1?
levator scapula, splenius cervicis and rectus capitis anterior
What is thought to represent the pedicle at C1?
the anterior arch
What is the name of the rounded elevation on the medial aspect of the lateral mass of C1?
tubercle for the transverse atlantal ligament
What is the distance from the posterior tubercle of the posterior arch to the skin in each gender?
males: ~ 50mm
females: ~ 37mm
What attaches to the posterior tubercle of the posterior arch of C1?
rectus capitis posterior minor muscle and ligamentum nuchae
What attaches to the arcuate rim of C1?
the posterior atlanto-occipital ligament
Ossification of the free margin of the posterior atlanto-occipital ligament results in which atypical bone classification?
accessory bone
What is the earliest age of development where ossification of the anterior free margin of the posterior atlanto-occipital ligament was observed?
about age 7 years old
What may be formed by ossification of the anterior free margin of the posterior atlanto-occipital ligament?
a partial ponticulus posticus or complete ponticulus posticus
What other name may be used to identify a ponticulus posticus?
Kimmerle’s anomaly
What names are given to the opening formed by the ponticulus posticus?
arcuate foramen or retroarticular cana
Ponticulus posticus has observed in what ethnic populations?
all ethnic populations studied thus far
What is the general range of incidence of ponticulus posticus in the populations studied?
1%-41%
What is the gender bias now associated with ponticulus posticus?
female
What is the location of the “zygapophysis” relative to the atlanto-occipital and atlanto-axial intervertebral foramina?
it forms part of the anterior boundary of the intervertebral foramen in both cases
What are the osseous parts of the transverse process of C1?
costal element, posterior tubercle, true transverse process
What osseous parts of the transverse process are absent at C1?
anterior tubercle and costotransverse bar
What muscles attach to the transverse process of C1?
rectus capitis anterior, rectus capitis lateralis, middle scalene, levator scapula, splenius cervicis, obliques capitis superior, obliquus capitis inferior and intertransversarii muscles
What suboccipital muscles are known to have fascial projections attaching to the spinal dura?
rectus capitis posterior minor, rectus capitis posterior major, obliquus capitis inferior
What are the connections between suboccipital muscles and the spinal dura called?
myodural bridges
What are the lateral bridges of atlas connected to?
the lateral mass and the transverse process of atlantis
What opening is identified when a complete lateral bridge is formed?
the retrotransverse foramen
What are the possible contents of the retrotransverse foramen?
the vertebral artery, a branch from the suboccipital nerve and veins communicating with the venous sinuses of the neck
Which of the ponticles (bridges) of atlas is only observed in humans?
lateral bridges
What is observed in the transverse foramen of C1?
vertebral artery, vertebral venous plexus, postganglionic sympathetic motor nerve fibers
What is the gender variation for measurements of the transverse diameter of C1?
males : 78mm
females : 72mm
What is the distance from the posterior tubercle of the transverse of the transverse process of C1 to the skin for each gender?
a little over 30mm for both males and females
What joint classifciations are observed at C1?
fibrous (amphiarthosis) syndesmosis joint, synovial (diarthrosis) ellipsoidal joint, synovial pivot (diarthrosis trochoid) joint and synovial plane (diarthrosis arthrodia) joint
How many synovial joint surfaces are observed at C1?
5
What synovial joint surfaces are observed at C1?
two superior articular facets, 2 inferior articular facets and the fovea dentis
What names are given to C2?
axis / epistropheus
What unique vertebral body modification is characteristic of C2?
dens / odontoid process
How many joint surfaces are present on the odontoid process of C2?
5
What joint surfaces are present on the odontoid process of C2?
facet for fovea dentis, groove for transverse atlantal ligament, attachment sites for the alar ligaments, attachment site for the apical-dental ligament
Which joint classifications are represented at the odontoid process of C2?
fibrous (amphiarthrosis) syndesmosis joint and synovial pivot (diarthrosis trochoid) joint
What is the name given to the odontoid process when the facet for the fovea dentis lies above the groove for the transverse atlantal ligament and the attachment sites for the apical-dental and alar ligaments appear to be directed posterior?
lordotic dens
What is the name given to the odontoid process when the facet for the fovea dentis lies below the groove for the transverse atlantal ligament and the attachment sites for the apical-dental and alar ligaments appear to be directed anterior?
kyphotic dens
What joint surfaces are present at the inferior part of the vertebral body of C2?
anterior lip, posterior lip, right and left lateral grooves and cancellous bone
How many joints are formed by the inferior part of the vertebral body of C2?
5
What joint classifications are present at the inferior part of the vertebral body of C2?
fibrous (amphiarthrosis) syndesmosis, synovial pivot (diarthrosis trochoid), modified synovial saddle (diarthrosis sellar) and cartilaginous (amphiarthrosis) symphysis
What ligament forms the anterior boundary for the spinal canal above C2?
membrana tectoria
What ligament forms the anterior boundary for the spinal canal below C2?
posterior longitudinal ligament
What lies on the upper surfaces of the pedicle of C2?
the superior articular process
What is the location of the superior vertebral notch of C2?
on the lamina-pedicle junction
What attaches to the lamina of C2?
obliquus capitis inferior muscle, posterior atlanto-axial ligament, ligamentum flavum
What is the appearance of the superior articular facets of C2?
they are asymmetrical and slightly convex
What is the facet orientation of the superior articular facet of C2?
backward, upward, and lateral (BUL)
What is the orientation of the inferior articular facets of C2?
forward, lateral, and down (FoLD)
What is the classification of the zygapophyseal joints of C2?
synovial plane (diarthrosis arthrodia) joint
What osseous parts of the typical cervical transverse process are present at C2?
costal element, posterior tubercle and true transverse process
What is the gender variation for the transverse diameter of C2?
males: 57mm
females: 50mm
What muscles attach to the transverse process at C2?
levator scapulae, middle scalene, splenius cervicis, longissimus cervicis and intertransversarii
What muscles attach to the spinous process of C2?
rectus capitis posterior major, obliquus capitis inferior, spinalis cervicis, semispinalis cervicis, multifidis, rotators and interspinalis muscles
What names may be given to C7?
vertebra prominens and vertebral prominence
What is the name given to the topographical elevation observed at the base of the neck?
vertebral prominence
What is the name given only to C7?
vertebra prominens
What is the percent of men and of women does C7 become the vertebral prominence?
men: 86%
women: 79%
What is the segment and gender bias for vertebrae other than C7 becoming the vertebral prominence?
C6 is more common in females and T1 is more common in males
How many joint surfaces are present at the vertebral body of C7?
8
What muscle attaches to the vertebral body of C7?
longus colli muscle
What are the osseous parts of the transverse process of C7?
costal element, anterior tubercle, costotransverse bar, posterior tubercle, true transverse process
What muscles attach to the transverse process of C7?
middle scalene, iliocostalis thoracis, longissimus cervicis, semispinalis capitis, rotators, intertransversarii and levator costarum brevis
What is the orientation of the superior articular facet of C7?
backward, upward, medial (BUM)
What is the orientation of the inferior articular facet of C7?
forward, medial, downward (ForMeD)
What muscles attach to the spinous process of C7?
trapezius, rhomboid minor, serratus posterior superior, splenius capitis, spinalis capitis, spinalis cervicis, semispinalis thoracis, multifidis, rotators and interspinalis
What ligaments attach to the spinous process of C7?
ligamentum nuchae and interspinous ligaments
The vertebral artery on which side is typically larger?
left vertebral artery
What is the gender bias regarding size of the vertebral artery?
men have larger vertebral arteries than women
What was the name of the physical exam used to determine vertebral artery patency?
the vertebrobasilar artery insufficiency test
Which side artery was tested during the course of the vertebrobasilar artery insufficiency exam?
the ipsilateral artery on the side of rotation
What are the symptoms of failure of the vertebral artery to compensate during the vertebrobasilar artery insufficiency exam?
dizziness, vertigo, nausea are common complaints
The vertebral artery is typically a branch of which artery?
subclavian artery
At what location will the vertebral artery form its first compensatory loop?
the atlanto-axial interspace
At what location will the vertebral artery form its second compensatory loop?
atlanto-occipital interspace
What is the purpose of the vertebral artery loops between C2, C1, and occiput?
the increased length will accommodate the greater rotation at these locations
What artery is formed by the union of the right and left vertebral arteries?
basilar artery
What forms the anterior boundary for C2 nerve exit from the spinal canal?
inferior articular process of C1, superior articular process of C2, capsular ligament
What forms the posterior boundary for the C2 nerve exit from the spinal canal?
the posterior arch of C1, lamina of C2 and posterior atlanto-axial ligament
What forms the anterior boundary for the C3-C7 nerve exit from the spinal canal?
the vertebral bodies, intervertebral disc, posterior longitudinal ligament, uncinate process, lateral groove
What are the superior articular facet orientations for the cervical vertebrae?
C1 is backward, upward, medial (BUM)
C2 is backward, upward, lateral (BUL)
C3-C7 is backward, upward, medial (BUM)
What are the inferior articular facet orientations for the cervical vertebrae?
C1 is backward, downward, medial (BMD)
C2-C6 is forward, downward, lateral (FoLD)
C7 is forward, downward, medial (ForMeD)
How many synovial joints are identified for each cervical vertebra?
C1 = 5 C2 = 8 C3-6 = 8 C7 = 6
How many joints are identified at the vertebral body of each cervical vertebra?
C1 = none C2 = 10 C3-6 = 10 C7 = 8
What features will allow discrimination between T2-T4 and T5-T8 segmental groups?
the vertebral body, transverse process, articular process and spinous process
What is the outline of the vertebral body of a typical thoracic from superior view?
triangular
On cranial view, what is the outline of the vertebral body for the T5-T8 group?
the left side of the vertebral body will be flattened, the right side convex
What is the name given to the left side appearance of the vertebral body of T5-T8?
the aortic impression
What part of the vertebral body is most influenced by the aorta at T5-T8?
the left side superior and inferior epiphyseal rims
What is the height pattern of the typical thoracic vertebral body?
the posterior height is greater then the anterior height by 1 to 2 mm
What is the height pattern of intervertebral discs in the typical thoracic region?
the intervertebral discs are rather planar or flat with no apparent height difference between anterior and posterior heights
What is the height principal cause of the posterior curve of the thoracic spine?
the vertebral body height differences
What is another way of naming a posterior curve pattern?
a kyphotic curve
What joint classifications are identified at the vertebral body of a typical thoracic?
fibrous (amphiarthrosis) syndesmosis, cartilaginous (amphiarthrosis) symphysis and synovial plane (diarthrosis arthrodia)
How many synovial joints are formed at the vertebral body of a typical thoracic?
4
How many symphysis joints are formed with the vertebral body of a typical thoracic?
2
How many syndesmosis joints are formed at the vertebral body of a typical thoracic?
typically 4 are identified (as many as 8 is the costocentral stellate/radiate ligaments are included)
How many joints are formed at the vertebral body of a typical thoracic?
typically 10 (14 is the costocentral stellate/radiate ligaments are included)
What is the name given to the joint formed between the vertebral body and rib?
costocentral joint
How many costocentral joints are formed at the vertebral body of a typical thoracic?
4
Which of the demi-facets on the vertebral body of a typical thoracic is larger?
the superior costal demi-facet
What feature will provide assistance in maintaining the stability of the intervertebral foramen in the typical thoracics?
the costocentral joint or ribs
What ligaments support the costocentral joint?
the costocentral stellate/ radiate ligament and the costocentral interarticular or intra-articular ligament
What does the costocentral intra-articular or interarticular ligament connect to?
the interarticular or intra-articular crest of the head of the rib and the intervertebral disc
What is the size relationship between the articulating surface of the head of the rib and the costal demi-facet surface?
the rib surface is greater than the costal demi-facet surface
Which muscle(s) is attached to the vertebral body of T2 or T3
the longus colli
What is the position and direction of the pedicle from the typical thoracic vertebral body?
the pedicle arises from the upper third of the vertebral body and projects posterior and slightly laterally
What is the angulation of the pedicle in the typical thoracic region?
10 to 15 degrees posteriolateral from the sagittal plane
Which X-ray view is used to see into the intervertebral foramen of a typical thoracic?
the lateral view
What is overlap of the lamina called in the typical thoracic region?
shingling
What is the outline of the vertebral foramen in the typical thoracic region?
oval to circular
In which plane will the size of the vertebral foramen of a typical thoracic be greatest?
the transverse plane, the vertebral transverse diameter
What are the osseous parts of the costotransverse joint?
the transverse costal facet and the articular surface of the tubercle of a rib
What ligaments support the costotransverse joint of a typical thoracic?
the superior costotransverse, inferior costotransverse, and lateral costotransverse ligaments
Which muscles may attach to the transverse process of a typical thoracic?
longissimus thoracis, longissimus cervicis, longissimus capitis, semispinalis thoracic, semispinalis cervicis, semispinalis capitis, multifidis, rotator longus, rotator brevis, intertransversarii, levator costarum longus and levator costarum brevis
How can you distinguish between a T2-T4 from T5-T8 segment using the articular process?
- at T2-T4 the width between the superior articular processes is greater than the width between the inferior articular processes of that vertebra
- at T5-T8 with width between the superior articular processes is equal to or the same as the width between the inferior articular process of that vertebra
What is the orientation of the superior articular facet of a typical thoracic?
they face backward, upward, and lateral (BUL)
What is the orientation of the inferior articular facet of a typical thoracic?
they face forward, downward, and medial (ForMeD)
How many synovial joints surfaces for ribs are present on a typical thoracic?
6
Identify the synovial joint surfaces for ribs that are present on a typical thoracic?
2 superior costal demi-facets, 2 inferior costal demi-facets, 2 transverse costal facets
What is the name given to the overlap of spinous processes in the thoracic region?
imbrication
Imbrication will be more pronounced for what region of the thoracics?
T5-T8
Which thoracic has the longest spinous process?
T8
What is the angulation of the spinous process in the typical thoracic region?
- undersurface of T2-T4 spinous processes will angle up to 40degrees from the horizontal plane
- undersurface of T5-T8 spinous processes will angle up to 60degrees from the horizontal plane
Which muscles may attach to the spinous process of a typical thoracic?
trapezius, latissimus dorsi, rhomboid major, serratus posterior superior, splenius cervicis, splenius capitis, spinalis thoracis, multifidis, rotator longus, rotator brevis and interspinalis
How many joints are formed ar the vertebral body of T1?
typically 10 (14 if the rib ligaments are included)
The costocentral stellate/radiate ligament will attach to which segment(s) at the C8 spinal nerve intervertebral foramen?
the vertebral body of C7 and the vertebral body of T1
The costocentral stellate/radiate ligament will attach to which segment(s) at the T1 spinal nerve intervertebral foramen?
the vertebral body of T1 and the vertebral body of T2
What are the osseous parts of the costotransverse joint?
the transverse costal facet and the articular surface of the tubercle of a rib
What ligaments support the costotransverse joint of T1?
the inferior costotransverse and lateral costotransverse ligaments
What ligament is absent at the costotransverse joint of T1?
the superior costotransverse ligament
The superior costotransverse ligament of the transverse process of T1 will attach to which rib?
the 2nd rib
What muscles attach to the transverse process of T1?
longissimus thoracis, longissimus cervicis, longissimus capitis, semispinalis cervicis, semispinalis capitis, multifidis, rotator longus, rotator brevis, intertransversarii, levator costarum brevis
How many synovial joints are present at T1?
10
What muscles attach to the spinous process of T1?
trapezius, rhomboid minor, serratus posterior superior, splenius capitis, spinalis thoracis, spinalis cervicis, spinalis capitis, semispinalis thoracis, multifidis, rotator longus, rotator brevis, interspinalis
Which muscles attach to the transverse process of T9?
longissimus thoracis, semispinalis thoracis, multifidis, rotator longus, rotator brevis, intertransversarii, levator costarum longus and levator costarum brevis
How many synovial joints are typically present at T9?
10
How many synovial joint surfaces for ribs are typically present on T9?
6
What muscles attach to the spinous process of T9?
trapezius, latissimus dorsi, multifidis, rotator longus, rotator brevis and interspinalis
How many synovial joints are formed at the vertebral body of T10?
2
How many symphysis joints are formed with the vertebral body of T10?
2
How many syndesmosis joints are formed at the vertebral body of T10?
typically 4 are identified ( as many as 8 if the costocentral stellate/radiate ligaments are included)
Which synovial joint surface is absent from the vertebral body of T10?
inferior costal demi-facets
Para-articular processes are more commonly observed on which segment of the spine?
T10
The superior costotransverse ligament of the T10 transverse process will attach to which rib?
11th rib
What muscles attach to the transverse process of T10?
longissimus thoracis, semispinalis thoracis, multifidis, rotator longus and rotator brevis, intertransversarii, levator costarum longus and levator costarum brevis
How many synovial joints are typically present at T10?
8
How many synovial joint surfaces for ribs are typically present on T10?
4
A dimpling or depression of the skin in the thoracic region is often characteristic of the location of which segment?
T10
What muscles attach to the spinous process of T10?
trapezius, latissimus dorsi, multifidis, rotator longus, rotator brevis and interspinalis
What joint classifications are present at T10?
fibrous (amphiarthrosis) syndesmosis, cartilaginous (amphiarthrosis) symphysis and synovial plane (diarthrosis arthrodia)
How many synovial joints are formed at the vertebral body of T11?
2
How many symphysis joints are formed with the vertebral body of T11?
2
How many syndesmosis joints are typically formed at the vertebral body of T11?
4 are typically identified (as many as 8 if the costocentral stellate/radiate ligaments are included)
How many joints are typically formed at the vertebral body of T11?
typically 8 (12 is the costocentral stellate/radiate ligaments are included)
Which ligament of the costocentral joint is absent for the 11th rib?
the costocentral interarticular or intra-articular ligament
Which vertebra is the last segment to demonstrate a transverse costal facet?
T10
What ligaments form the costotransverse joint of T11?
the superior costotransverse, and slightly developed inferior costotransverse and lateral costotransverse ligaments
Which costotransverse joint will the superior costotransverse ligament at the transverse process of T11 support?
12th rib costotransverse joint
Which costotransverse ligament(s) are absent at T11?
capsular costotransverse ligament
Which joint classification is associated with the intertransverse, superior costotransverse, interior costotransverse, and lateral costotransverse ligaments?
fibrous (amphiarthrosis) syndesmosis
what muscles attach to the transverse process of T11?
longissimus thoracis, semispinalis thoracis, multifidis, rotator longus, and rotator brevis, intertransversarii and levator costarum brevis
Which levator costarum muscle is absent at T11?
levator costarum longus
Which segment will be the last to demonstrate an attachment for the levator costarum longus?
T10
What is the orientation of the superior articular facets of T11?
they face backward, upward, and lateral (BUL)
What is the orientation of the inferior articular facets of T11?
the face forward, downward, and medial (ForMeD)
How many synovial joints are typically present at T11?
6
What muscles attach to the spinous process of T11?
trapezius, latissimus dorsi, serratus posterior inferior, iliocostalis lumborum, spinalis thoracis, multifidis, rotator longus, rotator brevis, and interspinalis
Which muscles of the 5 layers of the true back are present at the spinous process of T11?
the trapezius, latissimus dorsi, serratus posterior inferior, iliocostalis lumborum, spinalis thoracis, multifidis, rotator longus, rotator brevis
How many synovial joints are formed at the vertebral body of T12?
2
How many symphysis joints are formed with the vertebral body of T12?
2
How many joints are typically formed at the vertebral body of T12?
typically 8 (10 if costocentral stellate/radiate ligaments are included)
Which muscle(s) is attached to the vertebral body of T12?
psoas major and poasas minor
What does the lateral tubercle of T12 represent?
the transverse process
What does the superior tubercle of T12 represent?
the mammillary process of lumbar vertebrae
What does the inferior tubercle of T12 represent?
the accessory process of lumbar vertebrae
Which is the smallest of the tubercles at the transverse process region of T12?
inferior tubercle
What joint surface of the typical thoracic transverse process is absent on T12?
transverse costal facet
What ligaments form the costotransverse joint of the twelfth rib?
superior costotransverse ligament from the T11 and the lumbocostal ligament from l1
Which costotransverse ligament(s) are attached at T12?
none; the capsular, superior, inferior, and lateral costotransverse ligaments lack an attachment to T12
What muscles attach to the transverse process region of T12?
longissimus thoracis, semispinalis thoracis, multifidis, rotator longus, rotator brevis and intertransversarii
Which segment is the last to demostrate a levator costarum brevis attachment?
T11
Which segment is the last to demonstrate a levator costarum longus attachment?
T10
What is the orientation of the superior articular facets of T12?
face backward, upward, and lateral (BUL)
What muscles attach to the spinous process of T12?
trapezius, latissimus dorsi, serratus posterior inferior, iliocostalis lumborum, spinalis thoracis, multifidis, rotator longus, rotator brevis and interspinalis
Which muscle(s) attach to the vertebral body of thoracic vertebrae?
longus colli, psoas major, and psoas minor
Which thoracic segments will have muscles attaching to their vertebral bodies?
T1-T3, T12
Rhomboid major and rhomboid minor will attch to the spinous of which thoracic(s)?
T1 only
Which muscle(s) attach to the vertebral body of thoracic vertebrae?
longus colli, psoas major, and psoas minor
Which thoracic segments will have muscles attaching to their vertebral bodies?
T1-T3, T12
Rhomboid major and rhomboid minor will attach to the spinous process of which thoracic(s).
T1 only
What is the generic size of the typical lumbar vertebral body from the cranial view?
reniform or kidney-shaped
What accounts for the direction of the lumbar curve?
the vertebral body and intervertebral disc have a greater anterior height than posterior height
How many joint surfaces are present on the vertebral body of a typical lumbar?
6
How many synovial joint surfaces are present on the vertebral body of a typical lumbar?
0
How many cartilaginous (amphiarthrosis) symphysis joint surfaces are on a typical lumbar vertebral body?
2
How many fibrous (amphiarthrosis) syndesmosis joint surfaces are on a typical lumbar vertebral body?
4
What muscles may attach to the 1st lumbar vertebral body?
psoas major and psoas minor
What muscle(s) may attach from the second down to the 4th lumbar vertebral body?
psoas major
Psoas minor will only attach to the vertebral body of which segments?
T12, L1
What is the name given to ligaments that attach the vertebral body to articular process?
transforaminal ligaments
What ligaments attach the vertebral body to the transverse process?
corporotransverse ligaments
Hofmann ligaments are identified in which regions along the vertebral column?
cervical - upper thoracic region and lumbar region
Cervical - upper thoracic Hofmann ligaments will attach what structures together?
dura mater to segments above
What is the highest level known to demonstrate Hofmann ligaments?
C6
What is the proposed function of the cervical - upper thoracic Hofmann ligaments?
resist caudal movement of the dural sac; resist gravitational forces on the dura and cord
Lumbar Hofmann ligaments will attach what structures together?
dura mater to lower segmental levels
What is the proposed function of the lumbar Hofmann ligaments?
resist cranial movement of the dural sac during flexion
What osseous conditions of lumbar vertebrae facilitate a spinal tap in this region?
overlap of the laminae, shingling, diminishes; overlap of spinous processes, imbrication, diminishes
What is the name of the elevation near the origin of the lumbar transverse process?
accessory process
A styloid process occurs with what frequency and as a result of what condition?
7% occurrence as a result of congenital elongation of the lumbar accessory process
What muscle(s) attach to the lumbar accessory process?
longissimus thoracis and intertransversarii
What muscles may attach to the transverse process of a typical lumbar vertebra?
psoas major, quadratus lumborum, longissimus thorasis, rotator brevis, rotator longus and intertransversarii
What muscles will attach to lumbar superior articular processes?
multifidis and intertransversarii
What ligament will attach to the lumbar superior articular process and transverse process?
mammillo-accessory ligament
What was believed to be entrapped by the mammillo-accessory ligament?
the medial branch of the dorsal ramus of a lumbar spinal nerve?
What is the joint classification for the typical lumbar zygapophysis?
synovial plane (diarthrosis arthrodia)
How many synovial joints are present on a typical lumbar vertebra?
4
What is the position of the lumbar zygapophysis in children?
zygapophysis lies in the coronal plane
What is the position of the lumbar zygapophysis in adults?
zygapophysis lies in the sagittal plane for L1/L2, L2/L3 and L3/L4
zygapophysis lies in the coronal plane for L4/L5 and L5/S1
What name is given to zygapophysis between vertebral couples that lie in the same plane?
joint symmetry
What names are given to the condition in which one zygapophysis of a vertebral couple lies in the coronal plane or position and the other zygapophysis lies in the sagittal plane or position?
joint asymmetry or joint tropism
What is the name(s) of the condition in which the typical lumbar spinous process increases in length due to the aging process?
Baastrup’s syndrome or “kissing spines”
What muscles will attach to the typical lumbar spinous process?
latissimus dorsi, serratus posterior inferior, iliocostalis lumborum, longissimus thoracis, spinalis thoracis, multifidis, rotator longus, rotator brevis and interspinalis
What is the appearance of the fifth lumbar vertebral body from the lateral view?
anterior height is greater than posterior height by several millimeters; it appears to form a wedge on a lateral X-ray view
How many joint surfaces are present on the vertebral body of the 5th lumbar?
6
How many synovial joint surfaces are present on the vertebral body of the 5th lumbar?
none
How many cartilaginous (amphiarthrosis) symphysis joint surfaces are present on the vertebral body of L5?
2
How many fibrous (amphiarthrosis) syndesmosis joint surfaces are present on the vertebral body of L5?
4
What muscle(s) attach to the 5th lumbar vertebral body?
psoas major
What is the orientation of the 5th lumbar superior articular facet?
backward, upward, medial (BUM); typically concave
What is the orientation of the 5th lumbar inferior articular facet?
forward, lateral, downward (FoLD); significant convexity
What is the name given to the congenital condition in which the 5th lumbar spinous process is elongated, the sacrum exhibits spina bifida, and dorsiflexion produces pain?
Knife Clasp Syndrome
What muscle groups constitute the erector spinae?
iliocostalis, longissimus, spinalis
How many synovial joints are maximally observed at each lumbar vertebra?
L1-L5 = 4 each
How many joints are traditionally observed at each lumbar vertebral body?
L1-L5 = 6 each
What is the inferior articular facet orientation at each lumbar vertebra?
L1-L5 = forward, downward, lateral (FoLD)
What part of the sacral ala is derived from the costal element?
anterior 2/3
What part of the sacral ala is derived from the true transverse process?
posterior 3rd
How many fibrous (amphiarthrosis) syndesmosis joint surfaces are present on the S1 vertebral body?
4
How many joint surfaces are present are present on the vertebral body of the 1st sacral segment?
5
How many cartilaginous (amphiarthrosis) symphysis joint surfaces are present on the S1 vertebral body?
1
How many fibrous (amphiarthrosis) syndesmosis joint surfaces are present on the S1 vertebral body?
4
what muscle(s) may attach to the 1st sacral vertebral body?
psoas major
What is the position of the sacral zygapophysis in adults?
zygapophysis lies in the coronal plane for L5/S1
What is the orientation of the 1st sacral superior articular facet?
backward, upward, medial (BUM); typically concave
What is the name given to the projection on the 1st sacral superior articular process?
mammillary process
What muscles will attach to the sacral mammillary processes?
multifidis
What is the usual condition for the 1st sacral spinous process?
it is non-bifid and short
An imaginary line drawn along the dorsal midline of sacrum is identified as the ___.
median sacral crest
What is the name given to the congenital condition in which the 5th lumbar spinous process is elongated, the sacrum exhibits spina bifida, and dorsiflexion produces pain?
Knife Clasp Syndrome
An imaginary line drawn from the superior articular process of S1 to the sacral cornu will form what feature?
intermediate sacral crest
What feature may be identified along the intermediate sacral crest?
the mammillary process of S1 and the sacral cornu of S5
What does the sacral cornu represent?
inferior articular process and facet of S5
What is the name of the inferior opening of the sacral spinal canal?
sacral hiatus
An imaginary line drawn from the transverse process of S1 to the inferior lateral sacral angle will form what feature?
lateral sacral crest
What is the sacral tuberosity?
enlarged transverse tubercle of S2
What is the name of the joint formed by the sacral tuberosity?
accessory sacro-iliac joint
What feature is identified on the lateral surface of S1-S3?
auricular surface
What feature does the anterior surface of the superior epiphyseal rin of S1 form?
sacral promontory
What feature is identified on the lateral surface of S1-S3?
auricular surface
The continuation of the posterior longitudinal ligament below S3 forms what ligament?
the deep posterior sacrococcygeal ligament
What forms the posterior boundary for the 5th sacral spinal nerve intervertebral forament?
sacral cornu, coccygeal cornu, superficial posterior sacrococcygeal ligament and intercornual ligament
What forms the anterior boundary for the 5th sacral spinal nerve intervertebral foramen?
vertebral body S5, vertebral body Co1, deep posterior sacrococcygeal ligament and intervertebral disc
What is the homolog for the inferior articular process and facet at S5?
sacral cornu
What is the homolog for the superior articular process and facet at Co1?
coccygeal cornu
What forms the inferior boundary for the spinal canal?
the union of the superficial posterior and deep posterior sacrococcygeal ligaments
What ligament divides the sciatic foramen into the greater and lesser sciatic foramina?
sacrospinous ligament
Which ligament has a broad attachment along the lateral margin of sacrum and coccyx and then attaches to the ischial tuberosity?
sacrotuberous ligament
Which ligament is the strongest of the sacro-iliac ligaments and is penetrated by dorsal rami of the sacral spinal nerves?
interosseous sacro-iliac ligament
What is the homolog for the capsular ligament at S5?
intercornual ligament
What is the number of coccygeal somites?
10
What is the typical number of segments that unite to form the adult coccyx?
4 segments
When is ossification of coccyx completed?
about age 30
What is the direction of fusion of coccygeal segments?
from caudal to cranial, the last segments to fuse together are Co1 and Co2
What is the direction of the coccygeal curve?
posterior (kyphotic)
What is the major motion and range of motion for coccyx?
flexion - extension, 5-20 degrees
How many coccygeal nerves are present in the fetus?
typically 5 pairs of coccygeal nerves are present
What forms the coccygeal nerve plexus?
S4, S5 and Co1 nerves
What is the ganglion impar?
a midline sympathetic ganglion
What is the ganglion impar?
a midline sympathetic ganglion
What is the coccygeal glomus or coccygeal body?
an enlarged encapsulated arteriovenous anastomosis located near the last segment of coccyx
Superior articular facets of which vertebrae will be oriented backward, upward, and medial?
C1, C3-C7, L1-L5, S1
Superior articular facets of which segments will be oriented backward, upward, and lateral?
C2, T1-T12
Inferior articular facets of which segments will be oriented backward, medial, and downward?
C1
Inferior articular facets of which segments will be oriented forward, lateral, and downward?
C2-C6, T12, L1-L5
Inferior articular facets of which segments will be oriented forward, medial, and downward?
C7, T1-T11
Which segment has the only inferior articular facet to face backward?
C1
What is the definition of spondylosis?
a vertebral condition
What is the definition of spondylolysis?
a vertebral separation or vertebral cleavage
What is the definition of spondylolisthesis?
a vertebral slippage
What is the location of spondylolysis that will be stressed in Spinal II?
a separation along the pars interarticularis (defect in the pars interarticularis or pars defect)
What is the incidence of spondylolysis in the general population?
range of 2.6% to 10%
What is the geographic or ethnic bias for a higher incidence of spondylolysis?
the native Alaskan (Inuit) population
What does lumbar spondylolysis appear to be related to?
uniquely human upright stance or erect posture
Lumbar spondylolysis is associated with what characteristics?
familial association, spina bifida occulta, racial/ethnic disparities, gender and locational bias, youthful incidence and activities requiring repetitive stress on the spine
What is the age range typically associated with lumbar spondylolysis?
10-20 yr olds
What activities are particularly stressful at the pars interarticularis of lumbar vertebrae?
gymnastics, dance, soccer
What fills the space in a lumbar spondylolysis?
fibrocartilagenous material
What name has been given to the material filling the space in a lumbar spondylolysis?
spondylolysis ligament
What types of neural function(s) have been associated with the spondylolysis ligament?
nociception, neuromodulation and autonomic function
What is the appearance of the lumbar vertebra upon oblique x-ray view?
a Scotty dog
What is the appearance of a spondylolysis in a lumbar vertebrae upon oblique x-ray view?
a collared Scotty dog
In an oblique x-ray, spodylolysis below the superior articular process of a lumbar pars interarticularis is associated with what part of the Scotty dog?
the neck of the Scotty dog
What part of a lumbar vertebra forms the ear of a Scotty dog?
the pedicle
What part of a lumbar vertebra forms the ear of a Scotty dog?
the superior articular process
What part of a lumbar vertebrae forms the nose of a Scotty dog?
the transverse process
What characteristic are associated with cervical spondylolysis?
rare, congenital, gender biased toward men, most common at C6 and linked to spondylolisthesis and spina bifida
What characteristics are associated with sacral spondylolysis?
rare in general population, within typical percents in the native Alaskan (Inuit) population, seems to be acquired, gender biased toward men, most common at S1 and linked to activities such as kayaking and harpooning
Identify all names given to type I spondylolisthesis?
dysplastic spondylolisthesis, congenital spondylolisthesis
What is the locational bias of type I spondylolisthesis?
L5 or upper sacral segments
What additional conditions are linked to type I spondylolisthesis?
spina bifida occulta and nerve root compression of the S1 nerve
What gender bias, locational bias, and spinal canal demensions are associated with type II spondylolisthesis?
isthmis spondylolisthesis is common in men, located at the L5/S1 level and demonstrates an increase in sagittal diameter of the spinal canal
What is the gender bias, locational bias, and spinal canal dimension changes often associated with type III spondylolisthesis?
degenerative spondylolisthesis is more common in women, particularly at L4/L5, and demonstrates no change in sagittal diameter of the spinal canal
What causes type IV spondylolisthesis?
fracture of the neural arch components
What are the cause(s) associated with type V spondylolisthesis?
bone diseases such as Paget disease or osteogenesis imperfecta
What determines the length of the intervertebral foramen?
the width of the pedicle
What is the average height of the intervertebral foramen?
about 13 mm
What percent of total vertebral column length does “true” intervertebral foramina height from C2-S1 equal?
40%
What percent of total vertebral column length does all intervertebral foramina height from occiput - Co1 equal?
53%
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 - 50%
What are medullary feeder arteries?
enlarged radicular arteries which join the arterial vasa corona to provide blood for the spinal cord
What is the name of the largest medullary feeder artery?
the artery of Adamkiewicz or the arteria radicalis magna anterior
What are the characteristics of the Artery of Adamkiewicz?
it is a left side, anterior medullary feeder artery, located in the t9/T10
What is the name of the largest medullary feeder artery?
the artery of Adamkiewicz or the arteria radicalis magna anterior
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 ligament lies next to the anterior internal vertebral venous plexus?
the posterior lingitudinal ligament
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 parts of the cervical vertebra will modify the intervertebral foramen?
the lateral groove and uncinate process
What happens to cervical nerve roots between their origin from the spinal cord and exit from the intervertebral foramen?
they descend along the spinal cord
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 is the relationship between aging and cervical spine intervertebral foramen size?
the cross-sectional area diminishes after age 50
What are the spicific attachment sites for a cervical spinal nerve?
the sulcus for the ventral primary ramus on the costotransverse bar & the vertebral artery
What contributes to the anterior boundary of the thoracic intervertebral foramen?
the costocentral joint
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 enchroachment on the L5 spinal nerve?
the far out syndrome
What is the name of the largest medullary feeder artery?
the artery of Adamkiewicz or the arteria radicalis magna anterior
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 ligament lies next to the anterior internal vertebral venous plexus?
the posterior lingitudinal ligament
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 parts of the cervical vertebra will modify the intervertebral foramen?
the lateral groove and uncinate process
What happens to cervical nerve roots between their origin from the spinal cord and exit from the intervertebral foramen?
they descend along the spinal cord
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 is the relationship between aging and cervical spine intervertebral foramen size?
the cross-sectional area diminishes after age 50
What are the spicific attachment sites for a cervical spinal nerve?
the sulcus for the ventral primary ramus on the costotransverse bar & the vertebral artery
What contributes to the anterior boundary of the thoracic intervertebral foramen?
the costocentral joint
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 enchroachment on the L5 spinal nerve?
the far out syndrome
What is the relationship between intervertebral disc herniation and lumbar spinal nerves?
the intervertebral disc above the intervertebral foramen is usually the source of damage
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 the relationship of lumbar nerve root size to intervertebral foramen size above L4?
the nerve root size will account for less than 22% of the available size
What is unique about the relationship of spinal nerve to intervertebral foramen at S5-Co1?
there are 2 nerves present, S5 nerve & Co1 nerve
What are some examples of destruction lesions of the vertebral body?
tuberculosis, hemangiomas, osteoporosis
What may reduce the impact of intervertebral disc loss of integrity of the intervertebral foramen in the cervical and thoracic spine?
the joint of Luschka in the cervicals, the costocentral joint in the thoracics
What are 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 examples of acquired alterations of the spinal curves identified in class?
obesity, pregnancy and the use of heave 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 embryonic event causes the direction of the posterior curve of the vertebral column?
the embryonic disc will undergo flexion in a cranial to caudal direction
Why is the posterior curve also called the primary curve?
it is the 1st curve to appear embryologically
What are the adult remnants of the primary curve along the vertebral column?
the thoracic or dorsal curve and the pelvic or 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 surve, compensatory curve
What are the names of the anterior curves, secondary curves, and compensatory curves?
cervical curve and lumbar curve
What segmental levels form the cervical curve?
C2-T1
What segmental levels form the lumbar curve?
T12-L5
What is the earliest time of appearance of the cervical curve?
3rd 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 1st yr 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 hwat age will the infant begin to hold the head erect?
usually between the 3rd and 4th 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 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 developmental 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 lumbars
- intervertebral disc height will become greater anterior compared to posterior
- walking will further promote muscle and intervertebral disc development
Which sense is a requirement for holding the head erect, standing, sitting, and walking?
vision
What is the gender bias associated with the lumbar curve convexity?
females have a greater convexity of the lumbar curve
What is the vertebral relationship between the lumbar curve and the 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?
the appear after 6yrs old
Which lateral curves are best developed?
thoracic or dorsal, and lumbar
What is the relationship between curve direction and handedness?
a right-handed person has a 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 demonstrates this
What names are given to conditions associated with abnormal curves of the vertebral column?
lordosis, kyphosis, scoliosis
What is the definition of lordosis?
a forward bending condition
What is the definition of kyphosis?
a humpback of hunchback condition
What is the definition of scoliosis?
a warped or crooked condition
What is the direction of the curve deviation in lordosis?
to the anterior
What is the direction of the curve deviation in kyphosis?
to the posterior
What clinical examples of abnormal curvatures along the vertebral column were stressed in class?
military neck, humpback or hunchback, and swayback
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 hyperkyphotic curve
What are the curve classifications for swayback?
a lordosis or hyperlordotic curve
What is a more complete, accepted definition of scoliosis?
an abnormal lateral curve coupled with axial rotation
What are the classifications of scoliosis according to the Scoliosis Research Society?
magnitude, location, direction, etiology, structural scoliosis and non-structural scoliosis
