Unit 6, Regions of the Vertebral column (Exam 2) Flashcards
what will form the posterior boundary of a typical cervical IVF?
1) Post and Pre zygapophysis
2) Capsular ligament
3) Ligamentum Flavum
What will form the superior boundary of a typical cervical IVF?
Inferior vertebral notch/incisure
What will form the inferior boundary of a typical cervical IVF?
Superior vertebral notch/incisure
What is the unique anterior boundary of the IVF for the C4 spinal nerve?
1) Lateral groove of C3
2) Uncinate process of C4 forming the Joint of LUSHKA
What vertebral segments of the cervical are considered atypical?
C1.
C2.
C7.
What features are lacking at C1?
1) Vertebral body
2) Pedicles
3) Spinous process
4) Intervertebral disk
What is thought to represent the pedicle at C1?
Anterior Arch
What osseous modification is observed to the front of the anterior arch of C1?
Anterior tubercle
What muscle attach anterior arch of C1?
Longus Colli
What ligaments will attach to the anterior arch of C1?
1) Anterior longitudinal
2) Anterior atlanto-occipital
3) Anterior atlanto-axial
What is observed on the back of the anterior arch of C1?
Fovea dentis
What joint classifications are observed on the anterior arch?
1) Fibrous (amphiarthrosis) Syndesmosis joint
2) Synovial Pivot (diarthrosis trochoid) joint
What is the morphology of the superior articular facet of C1?
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?
BUM
Backward, Upward, Medial
What is the joint classification of the atlanto-occipital zygapophysis?
Synovial (diarthrosis) ellipsoidal joint.
What are the morphological characteristics of the inferior articular facets of C1?
Asymmetrical, Slightly concave or flattened
What is the orientation of the inferior articular facets of C1?
BMD
Backward, Medial, Downward
What is the joint classification of the atlanto-axial zygapophysis?
Synovial Plane….(Diarthrosis arthrodia) Joint
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 muscles attach to the lateral mass of C1?
1) Levator Scapulae
2) Splenius Cervicis
3) Rectus capitis anterior
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?
Male: about 50mm
Female: about 37mm
What attaches to the posterior tubercle of the posterior arch of C1?
1) Rectus Capitis posterior minor
2) Ligamentum Nuchae
What superior surface modifications of the posterior arch of C1 are present?
1) Groove/Sulcus for the vertebral artery
2) Arcuate rim
What attaches to the arcuate rim of C1?
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 7 years old.
Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?
Complete/Incomplete Ponticulus Posticus
What other name may be used to identify a Ponticulus Posticus?
Kimmerle’s anomaly
What names are given to the opening of the Ponticulus Posticus?
Arcuate foramen
Retroarticular canal
Ponticulus Posticus has been 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 incidence of a complete vs a incomplete Ponticulus Posticus?
incomplete: as high as 41%
Complete: 15 %
What are the osseous parts of the transverse process of C1?
1) Costal element
2) Posterior tubercle
3) True transverse process
What muscles attach to the transverse process of C1?
1) Rectus capitis (ANT. LATERALLIS)
2) Middle scalene
3) Levator Scapulae
4) Splenius Cervicis
5) Obliquus Capitis (SUP., INF.)
6) Intertransversarii
What suboccipital muscles are known to have fascial projections attaching to the spinal Dura?
1) Rectus Capitis posterior minor
2) Recuts Capitis posterior Major
3) 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?
Lateral mass
Transverse process of atlas
What forms of the lateral bridges are observed in the population?
Incomplete
Complete
What opening is identified when a complete lateral bridge is formed?
Retrotransverse foramen
What are the possible contents of the retrotransverse foramen?
1) vertebral artery
2) branch from the suboccipital N.
3) Veins communicating 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?
1) Vertebral A.
2) Vertebral Venous Plexus
3) Postganglionic sympathetic motor nerve fibers
What is the gender variation for measurements of the transverse diameter of C1?
Male: 78 mm
Female: 72mm
What is the distance from the posterior tubercle of the transverse process of C1 to the skin for each gender?
little over 30mm for both M and F
How many synovial joint surfaces are observed at C1?
5
What is another name given to the axis vertebra?
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?
1) Facet for fovea dentis
2) groove for the transverse atlantal ligament
3) attachment sites for the alar ligaments
4) Attachment sites for the apical-dental ligament
What is the name/classification given to the odontoid process when the tip of the dens is directed posterior?
Lordotic dens
What is the name/classification given to the odontoid process when the tip of the dens is directed anterior?
Kyphotic dens
What joint classifications are present at the vertebral body of C2?
1) fibrous (amphiarthrosis) Syndesmosis
2) Synovial Pivot (diarthrosis trochoid)
3) Modified synovial saddle (diarthrosis Sellar)
4) 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?
Membrana Tectoria
What ligament forms the anterior bouindary 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?
1) Ligamentum Flavum
2) Obliquus capitis inferior muscle
3) Posterior atlanto-axial ligament
What is the appearance of the superior articular facets of C2?
Asymmetrical
Slightly Convex
What is the facet orientation of the superior articular facets of C2?
BUL
Backward, Upward, Lateral
What is the orientation of the inferior articular facets of C2?
FoLD
Forward, Lateral, Down
What muscle attaches to the articular process of C2?
Longissimus Cervicis
What will be observed in the transverse foramen at C2?
1) Vertebral A.
2) Vertebral venous plexus
3) Postganglionic sympathetic motor N. fibers
What is the gender variation for the transverse diameter of C2?
Males: 57mm
Females: 50mm
What muscles attach to the transverse process of C2?
1) Levator Scapulae
2) Middle scalene
3) Splenius Cervicis
4) Longissimus Cervicis
5) Intertansversarii
What is the characteristic appearance of the C2 spinous process in humans?
bifid
What muscles attach to the spinous process of C2?
1) Rectus Capitis posterior Major
2) Obliquus Capitis inferior
3) Spinalis Cervicis
4) Semispinalis cervicis
5) Multifidis
6) Rotators
7) Interspinalis
What ligaments attach to the spinous process of C2?
1) Ligamentum Nuchae
2) Interspinous ligaments
What names may be given to C7?
Vertebra prominens
Vertebral Prominence
What is the name given to the topographical elevation observed at the base of the neck?
Vertebral Prominence
What name is given to C7 only?
Vertebra Prominens
In what percent of men and women does C7 become the vertebral prominence?
Male: 86 %
Female: 79 %
What is the segment and gender bias for the vertebrae other than C7 becoming the vertebral prominence?
C6 more common in Females
T1 more common in Males
How many joint surfaces are present at the vertebral body of C7?
8
What joint classifications are observed at the vertebral body of C7?
1) Fibrous (amphiarthrosis) Syndesmosis
2) Cartilaginous (amphiarthrosis) Symphysis
3) Modified synovial Saddle (diarthrosis sellar)
What muscle(s) attache(s) to the vertebral body of C7?
Longus Colli
What features are typically present in the transverse foramen of C7?
1) Vertebral venous plexus
2) Postganglionic sympathetic motor N. fibers
What muscles attach to the transverse process of C7?
1) Middle Scalene
2) Iliocostalis Thoracis
3) Longissimus cervicis
4) Semispinalis capitis
5) Rotators
6) Intertransversarii
7) Levator Costarum brevis
What is the orientation of the superior articular facet of C7?
BUM
Backward, Upward, Medial
What is the orientation of the inferior articular facet of C7?
ForMeD
Forward, Medial, downward
What muscles will attach to the articular process of C7?
1) Longissimus cervicis
2) Longissimus capitis
3) Semispinalis cervicis
4) Multifidis
What muscles attach to the spinous process of C7?
1) Trapezius
2) Rhomboid minor
3) Serratus posterior superior
4) Splenius Capitis
5) Spinalis capitis, Cervicis
6) Semispinalis thoracis
7) Multifidis
8) rotators
9) Interspinalis
What ligaments attach to the spinous process of C7?
1) Ligamentum Nuchae
2) Interspinous Ligaments
The vertebral artery on which side is typically larger?
Left Vertebral A.
What is the gender bias regarding size of the vertebral A.?
Male: Larger
What was the name of the physical exam used to determine vertebral artery patency?
Vertebrobasilar artery insufficiency test
Which side artery was tested during the course of the vertebrobasilar artery insufficiency exam?
Ipsilateral artery on the side of rotation
Typically, at what vertebral level will the vertebral artery fist become located in the transverse foramen?
C6
At what location will the vertebral artery form its first compensatory loop?
Atlanto-axial interspace
At what location will the vertebral artery form its second compensatory loop?
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?
Increase length will accommodate the greater rotation at these locations.
What happens to the vertebral artery after it enters the subarachnoid space at C1?
Vertebral artery ascends along the medulla oblongata to the pontine- medullary junction where the right and left arteries unite to form the basilar artery.
What forms the boundaries for the exit of C1 nerve form 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 anterior boundary for the C2 nerve exit from the spinal canal?
Inferior articular process of C1
Superior articular process of C2
Capsular ligament
Which suboccipital muscles attach to C1?
1) Rectus Capitis Posterior minor
2) Obliquus capitis superior
3) Obliquus capitis inferior
Which sub occipital muscles attach to C2?
1) Rectus capitis posterior major
2) Obliquus capitis inferior
Which erector spinae muscles attach to the cervical spine?
1) Iliocostalis Thoracis
2) Iliocostalis Cervicis
3) Longissimus Cervicis
4) Longissimus Capitis
5) Spinalis Cervicis
6) Spinalis Capitis
Which transversospinalis muscles attach to the cervical spine?
1) Semispinalis Cervicis
2) Semispinalis Capitis
3) Multifidis
4) Rotators
What joint classifications are present at C1?
1) Synovial (diarthrosis) Ellipsoidal
2) Synovial pivot (diarthrosis trochoid)
3) Synovial Plane (diarthrosis arthrodia)
4) Fibrous (amphiarthrosis) Syndesmosis
What joint classifications are present at C2?
1) Synovial Pivot (diarthrosis trochoid)
2) Synovial Plane (diarthrosis arthrodia)
3) Modified Synovial Saddle (diarthrosis sellar)
4) Fibrous (amphiarthrosis) Syndesmosis
5) Cartilaginous (amphiarthrosis) Symphysis
What joint classifications are present at each typical cervical?
1) Synovial Plane (diarthrosis arthrodia)
2) Modified Synovial saddle ( diarthrosis sellar)
3) Fibrous (amphiarthrosis) Syndesmosis
4) Cartilaginous (amphiarthrosis) Symphysis
What joint classifications are present at C7?
1) Synovial Plane (diarthrosis arthrodia)
2) Modified Synovial Saddle (diarthrosis sellar)
3) Fibrous (amphiarthrosis) Syndesmosis
4) Cartilaginous (amphiarthrosis) Symphysis
What forms the boundaries for the exit of the C2 nerve from the spinal canal?
1) Inferior Articular Process of C1
2) Superior Articular Process of C2
3) Capsular ligament
4) Inferior Vertebral Notch of C1
5) Superior Vertebral Notch of C2
6) Posterior arch of C1
7) Lamina of C2
8) Posterior atlanto-axial ligament
What forms the posterior boundary for the C2 nerve exit from the spinal canal?
1) Posterior arch of C1
2) Lamina of C2
3) Posterior atlanto-axial ligament
What forms the anterior boundary for the C3-C7 nerve exit from the spinal canal?
1) Vertebral bodies
2) Intervertebral disc
3) Posterior longitudinal Ligament
4) Uncinate process
5) Lateral groove
What forms the anterior boundary for the C8 nerve exit from the spinal canal?
1) Vertebral bodies of C7 and T1
2) Intervertebral disc
3) Posterior longitudinal ligament
4) Capsular ligament of the costocentral ligament
5) Superior costal facet of T1
6) Articular surface of the first rib
What are the superior articular facet orientations for the cervical vertebrae?
1) C1 is BMD
2) C2-C6 is FoLD
3) C7 is ForMeD
What are the inferior articular facet orientations for the cervical vertebra?
1) C1 is BMD
2) C2-C6 is FoLD
3) C7 is ForMeD
How many synovial joints are identified for each cervical vertebra?
C1= 5 C2= 8 C3-C6= 8 C7= 6
How many joints are identified at the vertebral body of each cervical vertebra?
C1= none C2= 10 C3-C6= 10 C7= 8
What features will allow discrimination between T2-T4 and T5-T8 segmental groups?
1) Vertebral body
2) Transverse process
3) Articular process
4) Spinous Process
What is the name given to the left side appearance of the vertebral body of T5-T8?
Aortic Impression
What part of the vertebral body is most influenced by the aorta at T5-T8?
Left Superior and Inferior Epiphyseal rim
What is the height pattern of the typical thoracic vertebral body?
Posterior height is GREATER than the Anterior height by 1-2 mm.
What is the principal cause of the posterior curve of the thoracic spine?
Vertebral body height differences
In terms of the anterior-posterior curves of the vertebral column, what direction will the thoracic spine face?
Posterior
What is another way of naming a posterior curve pattern?
Kyphotic Curve
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 joints are formed at the vertebral body of a typical thoracic?
Typically 10
14 if Costocentral stellate/radiate ligaments are included
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?
Superior costal demi-facet
What feature will provide assistance in maintaining the stability of the intervertebral foramen in the typical thoracics?
Costocentral joint or ribs
What is the size relationship between the articulating surface of the head of the rib and the costal demi-facet surface?
Rib surface is GREATER than the Costal demi-facet
Which muscle(s) is attached to the vertebral body of T2 or T3?
Longus Colli
Which X-ray view is used to see into the intervertebral foramen of a typical thoracic?
lateral view
Which vertebral notch or incisure is said to be prominent?
Inferior vertebral notch/Incisure
What is overlap of the lamina called in the typical thoracic region?
Shingling
In which plane will the size of the vertebral foramen of a typical thoracic be greatest?
Transverse plane
Vertebral transverse diameter
What is the distance between the transverse tubercles in the typical thoracic region?
From T2 each transverse diameter becomes shorter as the transverse processes angle more posterior
What is present on the transverse tubercle of a typical thoracic?
Transverse costal facet
What is the classification of the costotransverse joint?
Synovial plane (diarthrosis arthrodia) joint
What are the osseous parts of the costotransverse joint ?
Transverse costal facet and the articular surface of the tubercle of a rib.
What ligaments support the costotransverse joint of a typical thoracic?
1) Superior costotransverse
2) Inferior costotransverse
3) Lateral costotransverse ligament
Which muscle may attach to the transverse process of a typical thoracic?
1) Longissimus thoracis, Cervicis, Capitis
2) Semispinalis thoracis, Cervicis, Capitis
3) Multifidis
4) Rotator Longus, Brevis
5) Intertransversarii
6) Levator Costarum Longus
7) Levator Costarum Brevis
How do the transverse diameters of the articular processes compare in the T2-T4 region?
Superior articular process transverse diameter is GREATER than the Inferior articular process transverse diameter for a given segment.
How do the transverse diameters of the articular processes compare in the T5-T8 region?
Superior articular process transverse diameter is the SAME/EQUAL to the inferior articular process transverse diameter for a given segment
What is the orientation of the superior articular facet of a typical thoracic?
Backward, Upward, and Lateral
BUL
What is the orientation of the inferior articular facet of a typical thoracic?
Forward, downward, medial
ForMeD
How many synovial joints are present on a typical thoracic?
10
Identify the synovial joint surfaces present on a typical thoracic.
1) Two superior costal demi-facets
2) Two inferior costal demi-facets
3) Two Transverse costal facets
4) Two Superior articular facets
5) Two inferior articular facets
What is the name given to the overlap of the spinous processes in the thoracic region?
Imbrication
Imbrication will be more pronounced for what region of the thoracic vertebrae?
T5-T8
Which thoracic has the longest spinous process?
T8
What is the angulation of the spinous process of T2-T4?
Undersurface of T2-T4 spinous processes will angle up to 45 degrees from the horizontal plane.
What is the angulation of the spinous process of T5-T8?
Undersurface of T5-T8 spinous processes will angle up to 60 degrees from the horizontal plane.
What joint classification is associated with typical thoracic spinous process ligaments?
Fibrous (amphiarthrosis) Syndesmosis joint
Which muscles attach to the spinous process of a typical thoracic?
1) Layer — Trapezius, Latissimus dorsi
2) Layer— Rhomboid Major
3) Layer— Serratus Posterior Superior
4) Layer— Spinalis thoracis, Cervicis, Capitis
5) Layer— Semispinalis Thoracis, Multifidis, rotator Longus, Rotator Brevis
Interspinalis, Splenius Cervicis, Capitis
What is the appearance of the superior surface of the vertebral body of T1?
Somewhat cup-shaped with elevations at the posterior and lateral margin.
What may the elevations on the vertebral body of T1 represent?
Uncinate processes
What is the appearance of the inferior surface of the vertebral body of T1?
Typically flat, Lacking anterior and posterior lips characteristic of the cervicals.
How many synovial joints are formed at the vertebral body of T1?
four normally
How many symphysis joints are formed with the vertebral body of T1?
2
How many syndesmosis joints are formed at the vertebral body T1?
What if you include rib articulations?
Typically 4
If ribs are included as many as 8.
How many joints are formed at the vertebral body of T1?
What if you include the rib ligaments?
Typically 10
If rib ligaments are included 14.
How many Costocentral joints are formed at the vertebral body of T1?
4
What synovial joint surfaces are present on the T1 vertebral body?
1) Right and Left superior costal facet
2) Right and Left inferior costal demi-facet
What is the rib - vertebral body combination at the intervertebral foramen for the 8th cervical nerve?
Vertebral body–T1
Rib–1
Superior costal facet of T1 will join with articular surface of the head of Rib 1.
What ligament supports the Costocentral joint of the first rib?
Costocentral stellate/radiate Ligament
What ligaments support the Costocentral joint of the second rib?
1) Costocentral stellate/radiate ligament
2) Costocentral Interarticular or intra-articular ligament
Which muscles attach to the vertebral body of T1?
Longus Colli
What ligaments support the costotransverse joint of T1?
1) Inferior costotransverse Ligament
2) Lateral costotransverse ligament
What ligament is absent at the costotransverse joint of T1?
Superior costotransverse ligament
Which costotransverse joint will the superior costotransverse ligament of T1 support?
The second rib costotransverse joint
What muscles attach to the transverse process of T1?
1) Longissimus Thoracis, Cervicis, Capitis
2) Semispinalis Cervicis, Capitis
3) Multifidis
4) Rotator Longus, Brevis
5) Intertransversarii
6) Levator Costarum Brevis
Which specific transversospinalis muscle is absent from T1?
Semispinalis Thoracis
What is the orientation of the superior articular facet of T1?
BUL
Backward, Upward, Lateral
What is the orientation of the inferior articular facet of T1>
ForMeD
Forward, Medial, Downward
What is the classification of the articular facet joint?
Synovial Plane (diarthrosis arthrodia)
How many synovial joints are present at T1?
10
Which vertebrae have been identified as forming the vertebral prominence?
C6, C7, T1
What is the gender bias associated with T1 as the vertebral prominence?
Males (9%) are more likely than females (6%) to demonstrate T1 as the vertebral prominence.
What muscles attach to the spinous process of T1?
1) Trapezius
2) Rhomboid minor
3) Serratus Posterior Superior
4) Splenius Capitis
5) Spinalis Thoracis, Cervicis, Capitis
6) Semispinalis Thoracis
7) Multifidis
8) Rotator Longus, Brevis
9) Interspinalis
What is another way of naming a posterior curve pattern?
Kyphotic Curve
Which synovial joint surfaces may be absent from the vertebral body of T9?
Inferior costal demi-facets
The Costocentral stellate/radiate ligaments will attach to what features?
Head of the Rib
Vertebral bodies of the vertebral couple
Intervertebral disc
Which muscles attach to the transverse process of T9?
1) Longissimus Thoracis
2) Semispinalis Thoracis
3) Multifidis
4) Rotator Longus
5) Rotator Brevis
6) Intertransversarii
7) Levator Costarum Longus, Brevis
Which is the last thoracic vertebra to have an inferior costal demi-facet?
T9
What muscles attach to the spinous process of T9?
1) Trapezius
2) Latissimus Dorsi
3) Multifidis
4) Rotator Longus
5) Rotator Brevis
6) Interspinalis
Which muscles are conspicuously absent at the T9 spinous process?
Spinalis and Semispinalis
How many synovial joints are formed at the vertebral body at 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.
How many joints are typically formed at the vertebral body of T10?
Typically 8.
12 if Costocentral stellate/radiate ligaments are included
Which synovial joint surface is absent from the vertebral body of T10?
inferior costal demi-facet
Para-articular processes are more commonly observed on which segment of the spine?
T10
What muscles attach to the transverse process of T10?
1) Longissimus Thoracis
2) Semispinalis thoracis
3) Multifidis
4) Rotator Longus, Brevis
5) Intertransversarii
6) Levator Costarum longus, brevis
What is the orientation of the spinous process of T10?
Posterior and slightly inferior, it will shorten and become more horizontal.
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?
1) Trapezius
2) Latissimus dorsi
3) Multifidis
4) Rotator Longus, Brevis
5) Interspinalis
What name is given to T11?
Anticlinal vertebra
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 joints are typically formed at the vertebral body of T11?
Typically 8.
12 if Costocentral stellate/radiate ligaments are included.
What part of the transverse process is absent on T11?
Transverse costal facet
Which vertebra is the last segment to demonstrate a transverse costal facet?
T10
What ligaments form the costotransverse joint of T11?
1) Superior Costotransverse Ligament
2) Slightly developed inferior costotransverse Ligament
3) Lateral costotransverse ligament
Which costotransverse joint will the superior costotransverse ligament at the transverse process of T11 support?
12th rib costotransverse joint
What muscles attach to the transverse process of T11?
1) Longissimus Thoracis
2) Semispinalis Thoracis
3) Multifidis
4) Rotator Longus, Brevis
5) Intertransversarii
6) Levator Costarum Brevis
Which Levator Costarum muscle is absent at T11?
Levator Costarum longus
Which segment is the last to demonstrate an attachment for the Levator Costarum longus?
T10
What is the orientation of the superior articular facets of T11?
BUL
Backward, Upward, and Lateral
What is the orientation of the inferior articular facets of T11?
ForMeD
Forward, Medial, Downward
How many synovial joints are typically present at T11?
6
What muscles attach to the spinous process of T11?
1) Trapezius
2) Latissimus Dorsi
3) Serratus posterior inferior
4) Iliocostalis Lumborum
5) Spinalis thoracis
6) Multifidis
7) Rotator Longus, Brevis
8) Interspinalis
At which segments of the thoracic spine will the Spinalis muscle not attach?
T9, T10
Which erector spinae muscle uniquely attaches to the spinous process of T11?
Iliocostalis Lumborum
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 syndesmosis joints are formed at the vertebral body of T12?
4 typically
6 if Costocentral stellate/radiate ligaments are included.
How many joints are typically formed at the vertebral body of T12?
8 typically
10 if Costocentral stellate/radiate ligaments are included
Which muscle(s) is attached to the vertebral body of T12?
Psoas Major, Psoas Minor
What is present at the transverse process region of T12?
3 tubercles of variable size
Which tubercle on T12 represents the transverse process?
Lateral tubercle
Which tubercle on T12 represents the mammillary process of the lumbar?
Superior tubercle
Which tubercle on T12 represents the accessory process of the lumbars?
Inferior tubercle
What ligaments form the costotransverse joint of the twelfth rib?
Superior costotransverse ligament from T11 and the lumbocostal ligament from L1.
Which costotransverse ligaments are attached at T12?
None; capsular, superior, inferior, and lateral costotransverse ligaments lack an attachment of T12.
What muscles attach to the transverse process region T12?
1) Longissimus Thoracis
2) Semispinalis Thoracis
3) Multifidis
4) Rotator Longus, Brevis
5) Intertransversarii
Which segment is the last to demonstrate 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?
BUL
Backward, Upward, Lateral
Which erector spinae muscle is unique in its attachment to the T12 spinous process?
Iliocostalis lumborum
Which muscles attaching to the spinous process of T12 are not included in any muscle later of the true back?
Interspinalis
Which muscles attach to the vertebral body of thoracic vertebrae?
1) Longus Coli
2) Psoas Major
3) Psoas Minor
Which thoracic is first to demonstrate an attachment at the transverse process for the semispinalis muscle groups?
T12
Name the thoracic that is first and last to demonstrate the attachment of the levator Costarum brevis.
T1, T11
What is the generic shape of the typical lumbar vertebral body from the cranial view?
Reniform or kidney-shaped
What accounts for the direction of the lumbar curve?
Vertebral body and intervertebral disc have a GREATER ANTERIOR height.
What is the effect of aging on the vertebral body of a lumbar vertebra?
Decrease in Height
Increase in Circumference
What is the direction of the normal lumbar curve?
Anterior (Lordotic)
How many synovial joint surfaces are present on the vertebral bodies of the Lumbar vertebrae?
None
How many joint surfaces are present on the vertebral body of a typical lumbar?
6
How many fibrous (amphiarthrosis) syndesmosis joint surfaces are on a typical lumbar vertebral body?
4
What joint classifications will be observed at the vertebral body of a typical lumbar?
Cartilaginous (amphiarthrosis) symphysis joints
Fibrous (Amphiarthrosis) Syndesmosis
What muscles may attach to a typical lumbar vertebral body?
Psoas Major
Psoas Minor
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 are the attachment sites of the superior Transforaminal ligament at the L1-L2 intervertebral foramen?
L1 vertebral body—— L1 inferior articular process
What are the attachment sites of the middle Transforaminal ligament at the L1-L2 IVF?
Intervertebral disc—— L1 inferior articular process
What are the attachment sites of the inferior Transforaminal ligament at the L1-L2 IVF?
L2 vertebral body——- L2 superior articular process
What ligaments attach the vertebral body to the transverse process?
Corporotransverse ligaments
What Corporotransverse ligaments are identified?
Superior and Inferior Corporotransverse ligaments
What are the attachment sites of the superior Corporotransverse ligaments at the L1-L2 IVF?
L1 Vertebral body AND L1,L2 intervertebral disc
TO the Transverse process of L2
What are the attachment sites of the inferior Corporotransverse ligaments at the L1-L2 IVF?
L2 vertebral body AND L2,L3 intervertebral disc
TO transverse process of L2
What are the types of Hofmann Ligaments?
1) Anterior Hofmann Lig.
2) Posterior Hofmann Lig.
3) Lateral Hofmann Lig.
4) Proximal root sleeve Ligaments
Hofmann ligaments are identified in which regions along the vertebral column?
Cervical–Upper Thoracic region
Lumbar Region
Cervical–Upper thoracic Hofmann ligaments will attach what structures together?
Dura mater—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—Lower segmental levels
What is the proposed function of the lumbar Hofmann ligaments?
Resist cranial movement of the Dural sac during flexion.
What is the proposed function of the proximal root sleeve ligament?
Resist displacement of the peripheral nerve system in the intervertebral foramen.
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 part of the central nerve system is present in the lumbar spine?
Conus medullaris is typically present in the vertebral foramen of L1
What part of the peripheral nerve system is present in the lumbar spine?
Cauda Equina is typically present in the vertebral foramina of L2-L4.
Beginning with the L1 transverse process, what is the generic direction and relative length of each succeeding lumbar transverse process?
Each transverse process is directed straight lateral and increases in length from L1-L3.
L4 begins to decrease in length.
What is the name of the elevation near the origin of the lumbar transverse process?
Accessory process
Congenital elongation of the lumbar accessory process results in what feature?
Styloid Process
A styloid process occurs with what frequency and as a result of what condition?
7%
Result of congenital elongation of the lumbar accessory process
What bony part of a cervical transverse process is lacking at the lumbar transverse process?
Costotransverse bar
What ligaments will attach to the lumbar accessory process?
Mammillo-accessory ligament
What parts of a vertebra are attached via the mammillo-accessory ligament?
Mammillary process and accessory process of the same segment.
What was believed to be entrapped by the mammillo-accessory ligament?
Medial branch of the dorsal ramus of a lumbar spinal nerve.
What muscles attach to the lumbar accessory process?
Longissimus thoracis and intertransversarii
What ligament attaches the twelfth rib to the transverse process of L1?
Lumbocostal ligament
What muscles may attach to the transverse process of a typical lumbar vertebra?
1) Psoas major
2) Quadratus Lumborum
3) Longissimus Thoracis
4) Rotator Bervis, Longus
5) Intertransversarii
What ligaments attach to the transverse process of a typical lumbar vertebra?
Lumbocostal
Mammillo-accessory
Intertransverse ligaments
What are the posterior elements of the vertebrae?
Zygapophysis
Lamina and Spinous Process
What are the anterior elements of the vertebra?
Vertebral body
Pedicle
What is characteristic of the L1-L4 articular processes?
Transverse diameter between superior articular processes of an L1-L4 segment will be greater than the transverse diameter of the inferior articular processes of the same segment.
What is the orientation of the typical lumbar superior articular facet?
BUM
Backward, upward, Medial
Typically CONCAVE
What is the orientation of the typical lumbar inferior articular facet?
FoLD
Forward, Lateral, Downward
Significantly Convex
What is the name given to the projection on the lumbar superior articular process?
Mammillary process
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-L4
Zygapophysis lies in the coronal plane for L4-S1
What names are given to the condition in which one zygapophysis of a vertebral couple lies in the coronal plane and the other zygapophysis lies in the sagittal plane?
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 is Basstrup’s syndrome?
Elongation of the lumbar spinous process as a result of aging.
What muscle will attach to the typical lumbar spinous process?
1) Latissimus dorsi
2) Serratus Posterior inferior
3) Iliocostalis Lumborum
4) Longissimus Throacis
5) Spinalis thoracis
6) Multifidis
7) Rotator Longus, Brevis
8) Interspinalis
What is the appearance of the fifth lumbar vertebral body from the lateral view?
Anterior height is GREATER than Posterior Height by several mm.
Looks like a wedge on Lateral X-ray view.
How many synovial joint surfaces are present at the fifth lumbar vertebral body?
0
How many fibrous (amphiarthrosis) syndesmosis joint surfaces present on the L5 vertebral body?
6
What characteristic of L1-L4 pedicle may be used to differentiate it from the L5 segment? Be specific for each group.
Cranial view— lateral surface of the pedicle is apparent on a L1-L4 segment.
At L5 the transverse process originates from the vertebral body, pedicle and lamina-pedicle region.
How does the size of the vertebral foramen differ along the spine?
Cervicals—-Greatest size
Lumbars—- second greatest
Thoracics— Smallest
What is the generic direction and length of the fifth lumbar transverse process?
Straight lateral and is Shortest of all lumbar T.P.
What accounts for the shortness of the L5 transverse process?
Hip/innominate bones diminish the available space in the transverse plane.
What is the reported angulation and X-ray appearance of the fifth lumbar articular facets?
They lie in the vertical plane and are coronal.
What is the orientation of the fifth lumbar superior articular facet?
BUM
Backward, upward, medial
Typically concave
What is the orientation of the fifth lumbar inferior articular facet?
FoLD
Forward, lateral, downward
Significant convexity
What muscle(s) will attach to the mammillary process?
Multifidis and intertransversarii
What is the name(s) of the condition in which the L5 spinous process increases in length due to the aging process?
Baastrup’s syndrome or Kissing Spines
What is knife clasp syndrome?
Congenital condition in which the L5 spinous process is elongated, the sacrum exhibits spina bifida and dorsiflexion produces pain.
What muscles will attach to the fifth lumbar spinous process?
1) Latissimus dorsi
2) Iliocostalis Lumborum
3) Longissimus thoracis
4) Multifidis
5) Rotator Longus, Rotator brevis
6) Interspinalis
How many synovial joints are maximally observed at each lumbar vertebra?
L1-L5= four each
How many joints are traditionally observed at each lumbar vertebral body?
L1-L5= six each
What muscle(s) may attach to the first sacral vertebral body?
Psoas Major
How many joint surfaces are present on the vertebral body of the first sacral segment?
5
What is the origin of the sacral ala?
On base view, S1 transverse process and costal element appear to originate form the vertebral body and possibly the pedicle to form the sacral ala.
What part of the sacral ala is derived from the costal element?
Anterior 2/3.
What forms the median sacral crest?
Fused spinous processes and their spinous tubercles
What muscles may attach to the median sacral crest?
Latissimus Dorsi
Iliocostalis Lumborum
Longissimus thoracis
What forms the intermediate sacral crest?
Fused articular processes and their facets
What features may be identified along the intermediate sacral crest?
Mammillary process of S1 and the sacral cornu of S5.
What does the sacral cornu represent?
Inferior articular process and facet of S5
What forms the lateral sacral crest?
Fused transverse processes and transverse tubercles from S1-S5
What features may be identified along the lateral sacral crest?
S1 transverse tubercle, sacral tuberosity of S2, Transverse tubercles of S3-S5
What is the name of the joint formed by the sacral tuberosity?
Accessory sacro-iliac joint.
What feature is associated with the transverse tubercle of S5?
Inferior and lateral (inferolateral) sacral angle.
What muscles may attach to the lateral sacral crest?
Multifidis
Iliocostalis Lumborum
What muscle is said to attach to the dorsal surface of sacrum?
Iliacus
What feature is identified on the lateral surface of S1-S3?
Auricular surface
What is the sacral promontory?
Bulging anterior surface of the superior epiphyseal rim of S1
What forms the posterior boundary for the fifth sacral spinal nerve IVF?
1) Sacral Cornu
2) Coccygeal Cornu
3) Superficial posterior sacrococcygeal lig
4) Intervertebral disc
What forms the anterior boundary for the fifth sacral spinal nerve IVF?
1) Vertebral body S5
2) Vertebral body Co1
3) Deep posterior sacrococcygeal ligament
4) Intervertebral disc
What is the homolog for the posterior longitudinal ligament at S5?
Deep posterior sacrococcygeal ligament
What is the homolog for the anterior longitudinal ligament at S5?
Anterior sacrococcygeal ligament
What is the homolog for the ligamentum flavum at S5?
Superficial posterior sacrococcygeal ligament
What forms the inferior boundary for the spinal canal?
Union of the superficial posterior and deep posterior sacrococcygeal ligaments.
What ligament is formed by the union of the superficial posterior sacrococcygeal and the deep posterior sacrococcygeal ligaments at Co1?
Posterior sacrococcygeal ligament
What ligament is a homolog of the intertransverse ligament at S5?
Lateral sacrococcygeal ligament
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 thenb attaches to the ischial tubersosity?
Sacrotuberous ligament
Which ligament represents a thickening of the fibrous capsule of the sacro-iliac joint?
Anterior sacro-iliac ligament.
What muscle(s) attach to the fifth lumbar accessory process?
Longissimus thoracis
What muscles may attach to the transverse process of the fifth thoracic vertebra?
Psoas Major Quadratus Lumborum Longissimus thoracis Rotator brevis, Longus Intertransversarii
What ligaments traditionally attach to the transverse process of the fifth lumbar vertebra?
Lumbosacral
Iliolumbar
Mammillo-accessory ligaments
C1, C3-C7, L1-L5, S1 have superior articular facets that face in what direction?
BUM
Backward Upward Medial
Which ligament is the strongest of the sacro-iliac ligaments and is penetrated by dorsal rami of the sacral spinal nerve
Interosseous sacro-iliac ligament
Which ligament will attach the intermediate sacral crest of S1, lateral sacral crest of S2 to the posterior superior iliac spine?
Short posterior sacro-iliac ligament
Which ligament attaches the lateral sacral crest of S3 and S4 to the posterior superior iliac spine?
Long posterior sacro-ilaic ligament
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 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 bony features are present on the coccyx?
All segments are represented by a vertebral body; Co1 has a coccygeal corny and transverse process.
What is the homolog of the superior articular process and facet and C01?
Coccygeal cornu
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 major motion and range of motion for coccyx?
Flexion–Extension
5-20 degrees
How many coccygeal nerves are present in the fetus vs the adult?
Typically 5 pairs in the fetus
Typically 1 pair in the adult
What forms the coccygeal nerve plexus?
S4,S5, Co1 nerves
What is the ganglion impar?
a midline sympathetic ganglion
What is the location of the ganglion impar?
Anywhere from the sacrococcygeal joint to upper third of coccyx.
What is the coccygeal glomus or coccygeal body?
An enlarged encapsulated arteriovenous anastomosis located near last coccyx segment.
What innervates the coccygeal glomus or coccygeal body?
Both Sympathetic and Parasympathetic fibers.
What muscles attach to the coccyx?
ischiococcygeal
Levator ani
What ligaments form the posterior boundary for the Co1 spinal nerve IVF?
Superficial posterior sacrococcygeal ligament
Intercornual ligament
What ligaments form the anterior boundary for the Co1 spinal nerve IVF?
Deep posterior sacrococcygeal ligament
Intervertebral disc
What is the superior articular facet orientation of C1?
BUM- concave
What is the inferior articular facet orientation of C1?
BMD
What is the superior articular facet orientation of C2?
BUL
What is the inferior articular facet of orientation of C2?
FLD
What is the superior articular facet orientation of C3-C6?
BUM
What is the inferior articular facet orientation of C3-C6?
FLD
What is the superior articular facet orientation of C7?
BUM
What is the inferior articular facet orientation of C7?
FMD
What is the superior articular facet orientation of T1-T11?
BUL
Which segments will have facets that are specifically shaped as “convex”?
T12, L1-L5 inferior articular facets
Which segments will have facets that are specifically shaped as “concave”?
C1, L1-L5, S1 superior articular facets
What is the definition of spondylosis?
A vertebral condition
What is the definition of spondylolysis?
A vertebral separation/cleavage
What is the definition of spondylolisthesis?
A vertebral slippage.
What is the current limited definition of spondylosis?
A vertebral condition that is acquired or age-related.
What are some of the causes of spondylolysis?
1) Congenital
2) Acquired during development
3) result of Aging
4) Trauma
What is the location of spondylolysis that will be stressed in spinal II?
Separation along the PARS Interarticularis. (defect in PI or pars defect)
What specific parts of a vertebra are separated as a result of a pars defect?
Vertebral body, pedicle, and articular process from the other articular process, lamina, spinous process
What is the incidence of spondylolysis I the general population?
2.6%-10%
What is the incidence of spondylolysis in the native Alaskan population?
52.6%
What is the geographic or ethnic bias for a higher incidence of spondylolysis?
Native Alaskan (Inuit) People
What characteristics are associated with cervical spondylolysis?
Rare
Gender biased to MEN, Commonly at C6
Linked to spondylolisthesis and Spina Bifida
Lumbar spondylolysis has not been reported in what groups of individuals?
1) Fetuses
2) Newborns
3) Rarely in children under 5 years old
4) Patients who have never walked
5) Non-erect species
Lumbar spondylolysis only been reported in what types of species?
Species that walk erect; Humans
Lumbar spondylolysis is associated with what characteristics?
1) Familial association
2) Spina Bifida occulta
3) Racial/Ethic disparities
4) Gender and Location bias
5) Youthful incidences
6) Activities with repetitive stress on spine
What is the gender bias and location bias associated with lumbar spondylolysis?
Men—L5/S1
Women—-L4/L5
What is the age range typically associated with lumbar spondylolysis?
10-20 years olds
What activities are particularly stressful at the pars Interarticularis of lumbar vertebrae?
Gymnastics, Dance, Soccer
What motion(s) is particularly associated with lumbar spondylolysis?
Hyperextension coupled with Rotation
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?
1) Nociception
2) Neuromodulation
3) Autonomic function
What is the appearance of the lumbar vertebra upon oblique x-ray view?
a Scotty Dog
What is the appearance of a pars defect in a lumbar vertebra upon oblique x-ray view?
Collared Scotty Dog
What is the appearance of a spondylolysis in a lumbar vertebra upon oblique x-ray view?
Collared Scotty dog
In an oblique x-ray, spondylolysis below the superior articular process of a lumbar pars Interarticularis is associated with what part of the scotty dog?
Neck of the Scotty Dog
What part of a lumbar vertebra forms the eye of a Scotty dog?
Pedicle
What part of a lumbar vertebra forms the ear of a scotty dog?
Superior articular facet
What part of a lumbar vertebra forms the nose of a scotty dog?
Transverse process
What is the incidence of sacral spondylolysis in the general population?
It’s Rare
What ethnic group is associated with a high incidence of sacral spondylolysis?
Native Alaskan population
Is sacral spondylolysis the result of congenital conditions, acquired conditions or an age -related conditions?
Seems to be Acquired.
What activities are associated with sacral spondylolysis?
Kayaking, Harpooning
What is the ethnic, gender, and locational bias associated with sacral spondylolysis?
Male, Native Alaskan, S1
What is the direction of spondylolisthesis?
Anterior or Forward displacement
What is the posterior direction of vertebral slippage called?
Retrospondylolisthesis or retrolisthesis
What are the types/classifications of spondylolisthesis?
Type 1--- Dysplastic spondylolisthesis, Congenital Spondylolisthesis. Type 2--- Isthmic spondylolisthesis Type 3--- Degenerative spondylolisthesis Type 4---Traumatic spondylolisthesis Type 5--- Pathologic Spondylolisthesis
Identify all names given to type 1 spondylolisthesis?
Congenital or Dysplastic spondylolisthesis
What is the locational bias of Type 1 spondylolisthesis?
L5 or upper sacral segments
What is the location of the defect associated with type 1 spondylolisthesis?
Frequ. the vertebral arch.
What additional conditions are linked to type 1 spondylolisthesis?
1) Spina bifida occulta
2) Nerve root compression of the S1 nerve
Identify all names given to Type II spondylolisthesis?
Isthmic Spondylolisthesis
Which subtype of type II spondylolisthesis is stressed in spinal II?
Lytic spondylolisthesis or Stress fracture induced spondylolisthesis
what is the cause most frequently given for type II spondylolisthesis?
microfractures as the result of repetitive stress during hyperflexion and rotation
What is the age group typically associated with type II spondylolisthesis?
Teenage or young adults
Will spondylolysis always result in type II spondylolisthesis?
No, not in unilateral spondylolysis.
What spinal canal dimensions are associated with the Type II spondylolisthesis?
Isthmic demonstrates an increase in Sagittal diameter of spinal canal.
What is the gender bias and locational bias associated with Type II spondylolisthesis?
Isthmic is common in MEN @ L5/S1 level.
What conditions are often associated with type III spondylolisthesis?
1) Osteoarthritis
2) Intervertebral disc degeneration
3) Ligament laxity
4) Articulate facet remodeling
What is the gender bias, locational bias, and spinal canal dimension changes often associated with type III spondylolisthesis?
Women >, @ L4/L5
No change in sagittal diameter of spinal canal
Identify all names given to type IV spondylolisthesis?
Traumatic spondylolisthesis
What causes type IV spondylolisthesis?
Fracture of Neural Arch components
Is there a gender, locational, or age bias associated with type IV spondylolisthesis?
No
Identify all names given to Type V spondylolisthesis?
Pathologic spondylolisthesis
What are the cause(s) associated with type V spondylolisthesis?
1) Bone diseases—–Paget disease or Osteogenesis imperfecta
What is the result of type V spondylolisthesis?
Bone of neural arch is lengthened thus listhesis occurs.