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Variation Of The Vertebral Column Flashcards

1
Q

What forms the vertebrae?

A

Sclerotome of somites

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2
Q

When the sclerotome surrounds the Spinal Cord and notochord, when does it fuse with the opposite side?

A

4th week of development

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3
Q

What is resegmentation in regards to the development of vertebrae?

A

The caudal half of one somite an the cranial half of the next somite fuse to form the resegmented sclerotome that will become a vertebra
Eg. The caudal half of the 5th somite and the cranial half of the 6th somite forms C1 (Pang and Thompson, 2011)

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4
Q

What genes regulate formation of vertebrae? Where are these genes inherited from?

A

HOX genes

Maternal mRNA

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5
Q

What cells are found between two vertebrae?

A

Mesenchymal

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6
Q

What is the reference for vertebral embryology?

A

Sadler, 2012

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7
Q

What features are fused in complete occipitalisation of the atlas?

A

Posterior arch
Anterior arch
Lateral masses

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8
Q

What is partial occipitalisation of the atlas?

A

Any osseous bridge uniting a focal areas of the atlas and occiput

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9
Q

What are the three zones in the classification of occipitalisation of the atlas? (Reference?)

A

Zone 1 = Anterior arch
Zone 2 = Lateral masses
Zone 3 = Posterior arch
(Gholve et al., 2007)

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10
Q

What is the embryological origin of occipitalisation of the atlas?

A

Sclerotome fails to differentiate into cranial and caudal parts
Caudal part of occipital sclerotome 4 and cranial part of C1 sclerotome remain fused
Lack of resegmentation between loose and dense zones of cervical sclerotome

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11
Q

What are the sequelae of occipitalisation of the atlas?

A

Anomalous vertebral arteries
Torticollis
Neck pain and stiffness
Myelopathy
Atrophy of rectum capitis posterior major
Inadequate attachment for obliquus capitis

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12
Q

What is the Thavarajah and McKenna, (2012) case study?

A

Congenital absence of anterior arch of C1
35 year old female with 4 day history of neck pain
CT showed congenital absence and non fusion of anterior arch of C1

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13
Q

What is the Khanna et al., (2014) case study?

A

Complete absence of posterior arch of C1

46 year old male with upper cervical and occipital pain

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14
Q

What is the prevalence of congenital absence of anterior arch of atlas?

A

0.1%

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15
Q

What is the prevalence of congenital absence of the posterior arch of C1?

A

4-5%

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16
Q

What are the five types of absence of posterior arch of C1? (Reference?)

A 
Type A = Two hemiarches (90%)
Type B = Unilateral cleft
Type C = Bilateral cleft
Type D = Absence of arch with tubercle
Type E = Absence of arch and tubercle
(Currarino et al., 1994)
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17
Q

What are the sequelae of congenital absence of anterior arch of C1?

A 
Instability
Torticollis
No articulation site for dens
Absence of transverse ligament of atlas
Lack of attachment for:
- Longus coli and ALL
- Atlanto-occipital membrane and anterior atlanto-occipital ligament
Subluxation and Cord compression = Quadriparesis
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18
Q

What are the sequelae of congenital absence of the posterior arch of C1?

A 
Usually stable
Generally asymptomatic
Spinal canal stenosis
Myelopathy
Neck pain
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19
Q

In what percentage of Down’s syndrome patients is atlantoaxial subluxation seen?

A

15-20%

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20
Q

What is the prevalence of accurate foramen of the atlas? (Reference?)

A

16.7%

Elliot and Tanweer, 2014

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21
Q

What environmental factors could contribute to arcane foramen of the atlas?

A

Carrying heavy objects on head

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22
Q

What is an arcade foramen of the atlas?

A

A bony bar (ponticulus) arises from the lateral masses and turns the groove for the vertebral artery into a foramen

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23
Q

Describe the pathogenesis of calcification of the posterior atlanto-occipital membrane and how it can result in an arcane foramen of the atlas?

A

Calcifies from posterior superior articular process to posterior arch of C1
Can be complete/incomplete
Can be unilateral/bilateral
Encloses the V3 portion of the vertebral artery

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24
Q

Why are ossified primitive ligaments an unlikely pathogenesis for arcuate foramen of atlas?

A

Ossification centres not identified in that location

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25
Apart from calcification of the posterior atlanto-occipital membrane and ossified primitive ligaments, what are the other pathogeneses of arcuate foramen of the atlas?
Bony feature forming a bridge over the vertebral artery | Accessory transverse foramen of atlas
26
How can an arcuate foramen of C1 affect the vertebral artery?
Increased incidence of dissection as it is tethered: - Neck movements = Repetitive trauma Compression
27
What syndrome can result from periarterial sympathetic plexus disruption in arcuate foramen of C1? How does it present? (Reference?)
``` Barre-Lieou Syndrome: - Headache - Retro-orbital pain - Facial vasomotor disturbance - Visual disturbance - Difficulty with swallowing and phonation (Limousin, 1980) ```
28
How can arcuate foramen of the atlas affect surgery?
Mistaken for broad posterior arch - Screws inserted into arcuate foramen Complications posterior approaches
29
What is hypoplasia of the dens?
Short dens height
30
What is os odontoideum?
Failed fusion of dens to centrum
31
What is os terminale persistens?
Failed fusion of ossiculum terminale to body of dens
32
How does a bifid dens arise?
Failed/Partial fusion of the two parts of the body of the dens
33
What is pseudosubluxation of C2?
Anterior sliding of C2 on C3
34
Why is pseudosubluxation of C2 more common in the juvenile skeleton?
``` Hypermobility Lax ligaments Large head (in relation to weak neck muscles) Shallow, angled facet joints Incomplete ossification of dens ```
35
What effects does pseudosubluxation of C2 have on the juvenile skeleton?
None
36
What effects does pseudosubluxation of C2 have on the adult skeleton?
C2 dislocation | Possible Hangman's fracture
37
What syndromes is pseudosubluxation of C2 seen in?
Down's syndrome | Moquio's syndrome
38
What is the reference for pseudosubluxation of C2?
Kim, 2013
39
What is Klippel-Feil syndrome?
Abnormal congenital fusion of 2 or more cervical vertebrae
40
What is the epidemiology of Klippel-Feil syndrome?
0.71% prevalence | More common in females
41
What factors can result in Klippel-Feil syndrome?
Genetics: - Autosomal recessive or dominant Environmental: - Alcohol
42
What is the pathogenesis of Klippel-Feil syndrome?
Improper segmentation of cervical vertebrae during 3rd-8th weeks of gestation
43
What is Type 1 Klippel-Feil syndrome?
Cervical spine fusion | Many elements of many vertebrae are incorporated into a single block
44
What is Type 2 Klippel-Feil syndrome?
Cervical spine fusion Failure of complete segmentation at only 1 or 2 cervical levels May include occipito-atlantal fusion
45
What is Type 3 Klippel-Feil syndrome?
Type 1 or 2 PLUS Co-existing segmentation errors in: - Lower thoracic spine OR - Lumbar spine
46
What is the reference for types of Klippel-Feil syndrome?
Vaidyanathan et al., 2002
47
Where is the most common level of fusion in Klippel-Feil syndrome? (Reference?)
C2-C3 | Cho et al., 2014
48
What did the Yadav et al., 2014 case study see in Klippel-Feil syndrome?
C2-C3 Completely fused on both anterior and posterior aspects Foramen transversarium all present No IV discs
49
What did the Leung et al., (2011) study into Klippel-Feil syndrome at C2-C3 find?
All neck movements in a C2-C3 fused KFS spine displayed greater levels of stress compared to normal Certain movements resulted in significantly higher stress: - Neck extension - Neck lateral flexion to the right
50
What functional change can result from Klippel-Feil syndrome?
Reduced range of movement
51
What degenerative changes can arise in Klippel-Feil syndrome?
Acquired cervical stenosis -> Myelopathy Osteoarthritis -> Radiculopathy Dens fracture
52
What is the reference for functional and degenerative changes in Klippel-Feil syndrome?
Pizzutillo et al., 1994
53
In what percentage of young Klippel-Feil syndrome patients is scoliosis present? (Reference?)
53.3% | Samartzis et al. 2011
54
What results in neural arch variations?
Changes in ossification process
55
What are retrosomatic clefts?
Vertical defects in the pedicle
56
What are retroisthmic clefts?
Defects in lamina immediately dorsal to the inferior articular process
57
What is spinal dysraphism?
Failure of neural arch fusion
58
What is spinal dysraphism associated with?
Spina bifida: - Occulta - Meningocoele - Myelomeningocoele
59
What is primary spondylolysis of the axis?
Clef through C2 pars interarticularis
60
What is the reference for neural arch variations?
Mellado et al. 2011a and 2011b
61
Where is spinal canal stenosis commonest?
Lumbar or cervical regions
62
What are the symptoms of cervical spinal stenosis?
Gait disturbance Partial paralysis of lower limbs Limited Flexion of neck
63
What are the symptoms of lumbar spinal stenosis?
``` Pain in: - Hips - Groin - Buttocks Numbness/Weakness in lower limbs and lower back ```
64
What can cause spinal canal stenosis?
Degenerative disc bulging Hypertrophied ligamentum flavum Degenerative facet joint changes
65
Why do symptoms arise in spinal stenosis?
Spinal cord compression
66
What is the gold standard for classification of (lumbar) canal stenosis?
There is none
67
What are the references for spinal canal stenosis?
Azimi et al., 2015; ManfrÃ, 2016
68
What is the incidence of spina bifida?
0.5-0.8/1000 live births
69
What is the pathogenesis of spina bifida? (Reference?)
``` Failure of neural tube closure during week 4 of development Vertebral arch is either: - Incomplete - Absent (Copp et al., 2015) ```
70
What is spina bifida occulta?
Absence of spinous process | Variable amount of laminae
71
What is meningiocele?
Herniation of meningeal tissue and CSF
72
What is myelomeningiocele?
Herniation of meningeal tissue, CSF and CNS tissue
73
What is the prevalence of spina bifida occulta in the general population?
10-15%
74
How can meningiocele present?
Usually asymptomatic so incidental finding | Low incidence of hydrocephalus
75
What is the pathogenesis of the sensory and motor defects in myelomeingiocele?
Prolonged exposure of open neural tube to amniotic fluid Neuronal differentiation occurs, even below lesion Toxicity of amniotic fluid causes haemorrhage and neuronal death
76
What is myelomeningiocele associated with?
Urinary and faecal incontinence 65-85% associated hydrocephalus Type II Chiari malformation
77
What is the reference for types of spina bifida?
Copp et al., 2015
78
How does Butterfly vertebra present?
Usually asymptomatic
79
When does butterfly vertebra arise?
Between weeks 3-6 of gestation
80
What is the pathogenesis of butterfly vertebra?
Symmetric fusion defect -> 'Split' vertebra | Both chondrification centres fail to develop (related to hemivertebrae)
81
What can butterfly vertebra be confused with?
Compression fracture if trapezoidal or cuneiform anterior wedging
82
What does the Ozaras et al., (2015) case study on butterfly vertebra show?
``` 38 year old male with lower back pain: - Worse when standing and walking PMHx of Behçet's disease Coronal CT showed butterfly vertebrae at: - L3 - T9 ```
83
What syndromes is butterfly vertebra associated with?
Pfeiffer syndrome Jarcho-Levin syndrome Crouzon syndrome Alagille syndrome
84
What other spinal anomalies is butterfly vertebra associated with?
Kyphoscoliosis Hemivertebrae Spina bifida
85
When does hemivertebrae arise?
During weeks 4-6 of development
86
What is the pathogenesis of hemivertebrae?
One chondrification centre fails to develop -> Wedge of bone: - Half of a vertebral body - 1 pedicle - Hemilamina
87
In what region(s) are hemivertebrae most common?
Thoracic | Lumbar
88
What spinal deformity do hemivertebrae result in?
Congenital scoliosis
89
What is a fully segmented hemivertebra?
Has no attachment to other vertebrae
90
What is a semisegmented hemivertebra?
Half is fused with vertebra above or below | No IV disc
91
What is an incarcerated hemivertebra?
Joined by pedicles to vertebrae above and below
92
What is a non-segmented hemivertebra?
Connected to vertebrae above and/or below
93
What is the most concerning type of hemivertebra?
Fully segmented
94
What conditions are associated with hemivertebrae?
VATER syndrome VACTERL syndrome Jarcho-Levin syndrome Klippel-Feil syndrome
95
What are the references for hemivertebrae?
Johal et al., 2016 Ozaras et al., 2015 Weerakkody, 2017
96
In regards to block vertebrae, what does Leviseth et al., (2005) show?
Causally adjacent disk height is significantly less | Discs not affected cranially
97
In regards to block vertebrae, what did Guille et al., (1995) show?
59% of Klippel-Feil syndrome patients had degeneration adjacent to block vertebrae
98
In regards to block vertebrae, what did Karuppal et al., (2013) show?
1st rib fracture associated with type 1 cervical block vertebra
99
What can lumbar block vertebrae be associated with?
Weakness in muscles: - Abdominals - Hip flexor - Quadriceps

Vertebral Column (14 decks)

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