Trunk

Question 1

What spinal curves are present in the different regions

Answer 1

Both the thoracic and sacral regions have a kyphosis (greatest stability with less mobility) while the lumbar and cervical have a lordosis

Question 2

What are causes of the limited mobility in the thoracic region

Answer 2

Rib cage, lowest iv disc to vertebral body height. The tall anterior part of vertebral body causing wedge causes kyphosis and limits movement

Question 3

What are the three main source of innervation for vertebral structures

Answer 3

Dorsal rami
Sympathetic trunk and grey rami communicants
Sinuvertebral nerve

Question 4

What is the FRP

Answer 4

The flexion relaxation phenomenon refers to the concept that movement in the spine revolves around an external flexion moment (gravity). Therefore during full flexion the abdominal muscle being this motion but the extensors (erector spinae) quickly being to contract, this ends at about 85% ROM where the passive structures are able resist this external force.

Question 5

What are the two main ligaments in the lumbar region and their function

Answer 5

Iliolumbar -Maintains alignment of L5 on sacrum
Lumbosacral - Resist E and contralateral LF

Question 6

What is the difference between ligament/tendons and fascia

Answer 6

Ligaments and tendons have linear alignment of collagen while fascia have collagen in multiple directions

Question 7

What are the two main muscles of the pelvic floor

Answer 7

Levator ani (pink) coccygeus (purple)

Question 8

Key ideas of vertebral motion segments

Answer 8

There are 24 vertebral bodies with 23 intervertebral disc (not one at C1/C2). The superior moves on the inferior at each motion segment .

Question 9

Where is pars interarticularis located

Answer 9

Between the two articular processes on a vertebrae

Question 10

Explain the differences in z-joint alignments in the different regions

Answer 10

Cervical (C3-7) - Almost coronal orientation as well as 46 degrees to transverse. This allows for all movement

Thoracic - Almost coronal orientation with a very tall superior articular process with 60-80 degrees to transverse (more vertical than cervical). This allows for axial rotation as well as lateral flexion)

Lumbar - Sagittal plane orientation with a vertical angle (90 degrees to transverse). This allows for flexion and extension

Question 11

What are the three main elements of the interveterbal disc

Answer 11

Annulus fibrosis - Multilayered collegen type 1 in opposite directions

Nucleus pulposis - 90% water

Vertebral edplates on superior and inferiorio vertebral bodies made from hyline cartilage

Question 12

How does the intervtebral disc contribute to weight bearing

Answer 12

During compression the NP expands outwards (due to its incompressible nature) this then exerts pressure on the AF. However, these fibers resist tension and thus it is shard betweeen NP and AF until it can be exerted onto the vertebral endplate for distribution.

Question 13

Whch region has the smallest IV disc and why

Answer 13

Thoracic region, to limit is usefulness inn movement and further resitrict flexion and extention

Question 14

Origins of the basilar artery

Answer 14

The vertebral arteries are branches from the subclavian artery which ascending through the transverse processes of the cervical vertebrae. Once reaching C1 they move transversly through a groove enclosedby fascia and then ascened to form basilar artery.

Question 15

What are the two main ligaments in upper cervical spine

Answer 15

Transverse ligament - attaches to lateral masses and resists the anterior translation of C1 on C2

Alar - Attachest to posterior aspect of the dens and the margins of foramen magnum

Question 16

What are the differences in ligaments of the upper cervical spine

Answer 16

Question 17

Actions of the sub occipital muscles

Answer 17

Bilateral - Upper cervical extension

Unilateral - Ipisilateral rotation and LF

Question 18

What are cervicogenic headaches

Answer 18

Primary afferents from topographically distinct areas converge on the same 2nd order neurons, nociceptive stimuli from 1 afferent may be perceived as originating from the other receptive area.

Question 19

Structure of the uncinate processes

Answer 19

These are secondary ossication centers that begin at around age 4 howevr, majority of ossification occurs during early teens (9-14). They are located in the sub axial cervicl spine are can be found of the lateral and posterior surfaces of the vertebral endplates.

Question 20

Functions of the uncinate processes

Answer 20

Facilitate flexion and tension by acting as a guid in AP translation. Limits extension, lateral flexion and rotation. Are one of the cuases for axial rotation/LF movement coupling.

Question 21

What is the transverse fissure (uncovertebral clefts) of the sub axial cervical spine

Answer 21

At age 8-10 these fissure appear as a response to the cervical lordosis and shear forces. At age 20 these clefts have spread mediialy. By age 45 they have completly crossed the IV disc on the posterior side.

With the anterior portion of the disc still in tact these cefts act as another point of movement. Becoming a pivot for rotation.

Question 22

Cervical vertical disc heght comapried to other regions

Answer 22

The disc height in the cervical region contributes a much greater proportion of vertebral colum length than in other region which reflects its increased mobility. Average height for these is 7 mm (+/- 1mm)

Question 23

At what are dose dehydration of the IV discs in the cervical region begin and what are the results

Answer 23

At age 30 this process begins. It causes more weight to be transfered through the uncinate processes due to the narrowing of the discs. With this increased weight beaing remodelling occurs by making them more flat, osteophytic lipping (bony spurs) can also occur lateraly

Question 24

How does z-joint alignement change throughout the cervical spine

Answer 24

C3 - more vertical sup facts allowing for stability at the transission from upper (rot) to lower (f/e)

C5- most horizontal (39.4) allowing for the most mobility

C7- Also has more vertical sup faets allowing for sability at thoracic transsion

Question 25

Name the anterior cervical muscles

Answer 25

Rectus capitus anterior

Rectus capitus lateralis

Longus coli

Longus capitus

Question 26

What nerve innervates the suboccipital muscles

Answer 26

Suboccipial nerve

Question 27

What are the 5 classifications of intrinsic back muscles

Answer 27

Suboccipital group

Segmental muscles (cross one motion segment) - Interspinales and intertransversales

Transversopinales (transvers to spinous) - rotatores, multifidis and semispinaleis

Erector spinae - illiocostalis, longissimus and spinalis

Spinotransverse - Splenius

Question 28

What regions have which transversospinales muscles

Answer 28

Semispinales prominent in cervical (capitis and colli)

Multifidus prominent in lumbar (multifidis lumborum)

Rotatores prominent in thoracic region

Question 29

Attachment point of erector spinae muscles

Answer 29

Illiocostalis, rib angles in thoracic and transverse priocesses in cervical

Longissimus - Transveres processes

Spinalis - Spinous processes

Question 30

What curve is persent in the thoracic spine and what deos this cause

Answer 30

A kyphosis is preent (, this is due to the wedged shape of the veretebral bodies (smaller anterior) casusing the COM to fall anterior and thus crete a flexion moment

Question 31

What causes a pars interarticularis fracture

Answer 31

Repetitive hyperextension and axial loading

Question 32

What is the difference between Spongylolysis and Spondylolisthesis

Answer 32

Spongylolysis = a defect in pars interarticularis

Spondylolisthesis = foreward translation of superior vertebrae relative to the inferior vertebrae

Almsot 90% of these defect occur at L5, this can lead to spondylolistheis at L5/S1

Question 33

Main features of C1 and C2 that increase moment arms

Answer 33

C1 - transverse processes

C2 - Spinous process

Question 34

Features and location of transversospinales mucles

Answer 34

Rotatores is deepest and has brevis (1 segment) and logus (2 segments), very small PSCA therefore proprioceptive, mainly in thoracic.

Multifidus have a more oblique LOA therefore more useful in LF and rot, span 3-4 motion segments, most developed in lumbar region but also seen in thoracic and lower cervical.

Semispinales are the most superficial of these and are in upper and lower cervical, main cervical extensors and span 5 motion segments

Question 35

Structure and function of multifidus lumborum

Answer 35

Just deep to ESA, 3-5 fascicles. Causes lumbar extension and also a small componet that assist in rotation. Maintains lumbar lordosis during rotation. (Int and ext obliques rotate but also flex meaning multifidus will cancel this flexion)

Question 36

Borders of the abdominopelvic cavity

Answer 36

Superior is the diaphramg, inferior is the pelvic floor, anterio is rec abdominus, anterolateral is ext/int oblique, posterior is psoasm major and quadrutus lumborum

Question 37

Innervation of abdominal muscles

Answer 37

THoracolumbar ventral rami