Spinal Exam 2: Section VI - Lamina/Pedicle--Atypical C Vert. Flashcards
VI. Regions of the Vertebral Column
What is the orientation and angulation of the pedicle of a typical cervical?
posterolateral , 45 degrees
In the vertebral couple, which cervical vertebral body will contribute more toward the height of the intervertebral foramen?
neither, both contribute equally to the intervertebral foramen height
Which spinal nerve will be accommodated on the superior vertebral notch of C5?
C5 spinal nerve
Which spinal nerve will be accommodated on the inferior vertebral notch of C5?
C6 spinal nerve
What is the direction of projection of the cervical lamina?
posteromedially
What ligament attaches to the lamina of a typical cervical?
ligamentum flavum
What joint classification will be associated with the ligamentum flavum and its attachment?
fibrous (ampiarthrosis) syndesmosis
Ossification of the ligamentum flavum at the attachment site on the lamina will result in what feature?
para-articular processes
Ossification of the ligamentum flavum at the attachment site on the lamina will be associated with which classification of bone?
accessory bone
Ossification within the ligamentum flavum will be associated with which classification of bone?
heterotopic bone
What is the outline of the vertebral foramen of a typical cervical vertebra?
heart-shaped or triangular
Which is the greatest diameter of the vertebral foramen of typical cervicals?
transverse
The greatest transverse diameter of the typical cervical vertebra occurs at__?
C6
The greatest frequency of osteophytes associated with the vertebral body occurs at which typical cervical vertebral couple?
C5/C6
What muscles will attach to the anterior tubercle of a typical cervical vertebra?
anterior scalene, longus capitis, longus colli, anterior intertransversarii
What muscles may attach to the posterior tubercle of a typical cervical vertebra?
spenius cervicis, iliocostalis cervicis, longissimus cervicis, levator scapula, middle scalene, posterior scalene, rotators, and posterior intertransversarii
What muscles will attach to the costotransverse bar?
middle scalene and posterior intertransversarii
What produces the primary tension on the transverse process that will cause remodeling in the anterolateral and inferior directions?
cervical spine nerves as they are directed anterolaterally and inferiorly to form the cervical and brachial plexuses
What is the orientation and angulation of a typical cervical transverse process?
60 degrees anterolaterally (from midsagittal plane), 15 degrees inferiorly (from the horizontal plane)
What is the name given to the modification of the anterior tubercle of the C6 transverse process?
the carotid tubercle
What will cause remodeling of the anterior tubercle at C6?
the common carotid artery
What will occupy the typical cervical vertebra transverse foramen?
the vertebral artery, vertebral venous plexus and postganglionic sympathetic motor nerve fibers
What is the name of the lamina-pedicle junction of typical cervical vertebrae?
the articular pillar
What is the classic angulation of typical cervical articular facets?
40 to 45 degrees from the coronal plane
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 is the joint classification for the typical cervical zygapophysis?
synovial plane (diarthrosis arthrodia) joint
What modifications of the synovial joint are observed in the cervical spine?
meniscoidal folds
What function will meniscoidal folds provide in cervical zygapophyses?
they are assumed to distribute pressure across the joint surface
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 be similar for what cervical vertebral couples?
the C2/C3, C3/C4, C4/C5 vertebral couples
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 precess?
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 ligaments will attach to the typical cervical spinous process?
the interspinous ligament and ligamentum nuchae
What will form the anterior boundary of a typical cervical intervertebral foramen?
the lateral groove and vertebral body of the segment above
the uncinate process and vertebral body of the segment below
the intervertebral disc and the posterior longitudinal ligament
What will form the posterior boundary of a typical cervical intervertebral foramen?
the inferior articular process (post-zygapophysis), the superior articular process (pre-zygapophysis), the capsular ligament and the ligamentum flavum
What will form the superior boundary of a typical cervical intervertebral foramen?
the inferior vertebral notch or inferior vertebral inscisure
What will form the inferior boundary of a typical cervical intervertebral foramen?
the superior vertebral notch or superior vertebral incisure
What is the unique anterior boundary of the intervertebral foramen for the C4 spinal nerve?
the lateral grooe of C3 and uncinate process of C4 forming the joint of Luschka
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 is thought to represent the pedicle at C1?
the anterior arch
What osseous modification is observed to the front of the anterior arch of C1?
the anterior tubercle
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 joint classifications are observed on the anterior arch of C1?
fibrous (amphiarthrosis) syndesmosis joint and synovial pivot (diarthrosis trochoid) joint
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 sufaces
What is the orientation of the superior articular facet of C1?
backward, upward, medial (BUM)
What is the joint classification of the atlanto-occipital zygapophysis?
synovial (diarthrosis) ellipsoidal joint
What are the morphological characteristics of the inferior articular face of C1?
asymmetrical, slightly concave or flattened
What is the orientation of the inferior articular facet of C1?
backward, medial, downward (BMD)
What is the joint classification of the atlanto-axial zygapophysis?
synovial plane (diarthrosis arthrodia) joint
What muscles attach to the lateral mass of C1?
levator scapula
splenius cervicis
rectus capitis anterior
What is the contribution of the posterior arch to the circumference of C1?
about forty percent
What part of C1 represents the spinous process?
posterior tubercle of the posterior arch
What is the distance from the posterior tubercle of the posterior arch to the skin in each gender?
males: about fifty millimeters
females: about thirty-seven millimeters
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
Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?
an incomplete ponticulus posticus or a complete ponticulus posticus
What are the attachment sites of the ponticulus posticus?
it is attached to the arcuate rim of the posterior arch of atlas and to the superior articular process of the lateral mass of atlas
Ponticulus posticus has observed in what ethnic population?
all ethnic population 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 incidence of a complete ponticulus posticus versus an incomplete ponticulus posticus?
the incidence of a complete ponticulus posticus is about fifteen percent; the incidence of an incomplete ponticulus posticus may be as high as forty-one percent
What is observed on the under surface of the posterior arch of C1?
“inferior vertebral notch” and an attachment site for the posterior atlanto-axial ligament
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, obliquus 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, and
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 atlas
What forms the lateral bridges are observed in the population?
incomplete lateral bridges and complete lateral bridges
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 communication with the venous sinuses of the neck
Which of the ponticles (bridges) of atlas is most numerous?
ponticulus posticus
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: 78 millimeters
females: 72 millimeters
What is the distance from the posterior tubercle of the transverse process of C1 to the skin for each gender?
a little over 30 millimeters for both males and females
What joint classifications are observed at C1?
fibrous (amphiarthrosis) 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?
five
What synovial joint surfaces are observed at C1?
two superior articular facets, two inferior articular facets, and fovea dentis
What names are given to C2?
axis and epistropheus
What unique vertebral body modification is characteristic of C2?
the dens or odontoid process
How many joint surfaces are present on the odontoid process of C2?
five
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 C2?
fibrous (amphiarthrosis) syndesmosis and synovial pivot (diarthrosis trochoid) joints
What is the name/classifications given to the odontoid process when the tip of the dens is directed posterior?
lordotic dens
What is the name/classifications given to the odontoid process when the tip of the dens is directed anterior?
kyphotic dens
How many joints are formed by the inferior part of the vertebral body of C2?
five
What joint classifications are present at the inferior part of the vertebral body of C2?
fibrous (amphiarthrosis) syndesmosis, modified synovial saddle (diarthrosis sellar), and cartilaginous (amphiarthrosis) symphysis
How many joint surfaces are present at the vertebral body of C2?
ten
What joint classifications are present at the vertebral body of C2?
fibrous (amphiarthrosis) syndesmosis,
synovial pivot (diarthrosis trochoid),
modified synovial saddle (diarthrosis sellar), and
cartilaginous (amphiarthrosis) symphysis
What ligament will represent the cranial continuation of the posterior longitudinal ligament?
membrana tectoria
What ligament forms the anterior boundary for the spinal canal above C2?
membrane tectoria
What ligament forms the anterior boundary for the spinal canal below C2?
posterior longitudinal ligament
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 interior muscle, posterior atlanto-axial ligament, and ligamentum flavum
What muscles attaches to the lamina of C2?
obliquus capitis inferior
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 muscle attaches to the articular processes of C2?
longissimus cervicis
What osseous parts of the typical cervical transverse process are absent at C2?
anterior tubercle and costotransverse bar
What will be observed in the transverse foramen at C2?
vertebral artery, vertebral venous plexus, postganglionic sympathetic motor nerve fibers
What is the gender variation for the transverse diameter of C2?
males: fifty-seven millimeters (57)
females: about fifty millimeters (50)
What muscles attach to the transverse process of C2?
levator scapulae, middle scalene, splenius cervicis, longissimus cervicis, and intertransversarii
What is characteristic appearance of the C2 spinous process in humans?
bifid
What is the location for palpation of the spinous process of C2?
in the midline, about two inches below the external occipital protuberance
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 ligaments attach to the spinous process of C2?
ligamentum nuchae and interspinous ligaments
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 prominance
What name is given only to C7?
vertebra prominens
In what percent of men and of women does C7 become the vertebral prominence?
men: eighty-six percent (86%)
women: seventy-nine percent (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?
eight
What joint classifications are observed as the vertebral body of C7?
fibrous (amphiarthrosis) syndesmosis,
cartilaginous (amphiarthrosis) symphysis, and
modified synovial saddle (diarthrosis sellar) joint
What synovial joint surfaces are observed at the vertebral body of C7?
two
What muscle(s) attaches to the vertebral body of C7?
longus colli muscle
What features are typically present in the transverse foramen of C7?
vertebral venous plexus and postganglionic sympathetic motor fibers
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 angulation of the articular facet of C7?
more vertical at about 63 degrees
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 will attach to the articular process of C7?
longissimus cervicis,
longissimus capitis,
semispinalis cervicis, and
multifidis
What are the features of the spinous process of C7?
long, horizontal, nonbifid
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
Typically, at what vertebral level will the vertebral artery first become located in the transverse foramen?
C6
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?
the atlanto-occipital interspace
At what segments will the vertebral artery be firmly attached to the transverse foramen?
both C1 and C2
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 happens to the vertebral artery after it enters the subarachnoid space at C1?
the vertebral artery ascends along the medulla oblongata to the pontine- medullary junction where the right and left arteries unite to form the basilar artery
Which suboccipital muscles attach to C1?
rectus capitis posterior minor,
obliquus capitis superior, and
obliquus capitis inferior
Which suboccipital muscles attach to C2?
rectus capitis posterior major and obliquus capitis inferior
What joint classifications are present at C1?
synovial (diarthrosis) ellipsoidal,
synovial pivot (diarthrosis trochoid),
synovial plane (diarthrosis arthrodia), and
fibrous (amphiarthrosis) syndesmosis
What joint classifications are present at C2?
synovial pivot (diarthrosis trochoid),
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis joint
What joint classifications are present at each typical cervical?
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis
What joint classifications are present at C7?
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis
What forms the anterior boundary for the 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 boundaries for the exit of the C1 nerve from the spinal canal?
occipital condyle, superior articular process of C1, capsular ligament, arcuate rim, groove for the vertebral artery, posterior atlanto-occipital ligament
What forms the boundaries for the exit of the C2 nerve from the spinal canal?
inferior articular process of C1, superior articular process of C2, capsular ligament, inferior vertebral notch of C1, superior vertebral notch of C2, posterior arch of C1, lamina of C2, 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 forms the anterior boundary for the C8 nerve exit from the spinal canal?
the vertebral bodies of C7 and T1, intervertebral disc, posterior longitudinal ligament, capsular ligament of the costocentral joint, superior costal facet of T1, and articular surface of the first rib
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 = five C2 = eight C3-C6 = eight C7 = six
How many joints are identified at the vertebral body of each cervical vertebra?
C1 = none C2 = ten C3-C6 = ten C7 = eight
