Trunk Flashcards
What spinal curves are present in the different regions
Both the thoracic and sacral regions have a kyphosis (greatest stability with less mobility) while the lumbar and cervical have a lordosis
What are causes of the limited mobility in the thoracic region
Rib cage, lowest iv disc to vertebral body height. The tall anterior part of vertebral body causing wedge causes kyphosis and limits movement
What are the three main source of innervation for vertebral structures
Dorsal rami
Sympathetic trunk and grey rami communicants
Sinuvertebral nerve
What is the FRP
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.
What are the two main ligaments in the lumbar region and their function
Iliolumbar -Maintains alignment of L5 on sacrum
Lumbosacral - Resist E and contralateral LF
What is the difference between ligament/tendons and fascia
Ligaments and tendons have linear alignment of collagen while fascia have collagen in multiple directions
What are the two main muscles of the pelvic floor
Levator ani (pink) coccygeus (purple)
Key ideas of vertebral motion segments
There are 24 vertebral bodies with 23 intervertebral disc (not one at C1/C2). The superior moves on the inferior at each motion segment .
Where is pars interarticularis located
Between the two articular processes on a vertebrae
Explain the differences in z-joint alignments in the different regions
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
What are the three main elements of the interveterbal disc
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
How does the intervtebral disc contribute to weight bearing
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.
Whch region has the smallest IV disc and why
Thoracic region, to limit is usefulness inn movement and further resitrict flexion and extention
Origins of the basilar artery
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.
What are the two main ligaments in upper cervical spine
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
What are the differences in ligaments of the upper cervical spine
Actions of the sub occipital muscles
Bilateral - Upper cervical extension
Unilateral - Ipisilateral rotation and LF
What are cervicogenic headaches
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.
Structure of the uncinate processes
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.
Functions of the uncinate processes
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.
What is the transverse fissure (uncovertebral clefts) of the sub axial cervical spine
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.
Cervical vertical disc heght comapried to other regions
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)
At what are dose dehydration of the IV discs in the cervical region begin and what are the results
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
How does z-joint alignement change throughout the cervical spine
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
Name the anterior cervical muscles
Rectus capitus anterior
Rectus capitus lateralis
Longus coli
Longus capitus
What nerve innervates the suboccipital muscles
Suboccipial nerve
What are the 5 classifications of intrinsic back muscles
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
What regions have which transversospinales muscles
Semispinales prominent in cervical (capitis and colli)
Multifidus prominent in lumbar (multifidis lumborum)
Rotatores prominent in thoracic region
Attachment point of erector spinae muscles
Illiocostalis, rib angles in thoracic and transverse priocesses in cervical
Longissimus - Transveres processes
Spinalis - Spinous processes
What curve is persent in the thoracic spine and what deos this cause
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
What causes a pars interarticularis fracture
Repetitive hyperextension and axial loading
What is the difference between Spongylolysis and Spondylolisthesis
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
Main features of C1 and C2 that increase moment arms
C1 - transverse processes
C2 - Spinous process
Features and location of transversospinales mucles
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
Structure and function of multifidus lumborum
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)
Borders of the abdominopelvic cavity
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
Innervation of abdominal muscles
THoracolumbar ventral rami
