Vertebral Column Flashcards by Sebastian Rio

What are the abnormal curvatures of the spine?

Kyphosis=excessive thoracic curvature linked to osteoporosis and Scheuermann’s disease
Lordosis=excessive lumbar curvature linked to congenital deformity, abdominal muscle weakness, poor posture, obesity, pregnancy, overtraining, lumbar hyperextension, and anterior pelvic tilt
scoliosis=abnormal lateral curvature in association with abnormal vertebral rotation

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where are the primary curvatures of the back?

Thoracic
sacral and coccygeal

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where are the secondary curvatures of the back

cervical
lumbar

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what is the function of back curvatures

shock absorbance and resilience

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what is pars interarticularis

oblique area of bone between superior and inferior articular processes of vertebra
potential weak point leading to pars defect

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what is spondylolysis?

pars defect/ pars fracture
-congenital (most common) or mechanical (repeated hyperextension with congenital susceptibility)
-can be hairline or complete fracture, unilateral or bilateral

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where is spondylolysis most common and what can it lead to?

L4 and L5
can cause slippage of another vertebral body which can compress the canal

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what is spondylolisthesis?

complete unilateral or bilateral spondylosis with anterior slippage of vertebral column
most common below lumbosacral joint (L5/S1)

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What are the characteristics of the typical cervical vertebrae?

-body short and square
-2 foramen transversarium
-spinous process short and bifid
-vertebral foramen triangular

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What are the 2 unique cervical vertebrae?

C1=atlas, flat, facet for dens
C2=axis, dens

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What are the characteristics of the thoracic vertebrae?

-superior and inferior costal facets for rib articulation (superior much larger) (allows articulation with rib at level and below)
-transverse costal facet on transverse process (articulation with own rib)
-body heart shaped
-Vertebral foramen circular
-Inferior projecting spinous process

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What are the characteristics of the lumbar vertebrae?

-body large
-transverse process thin and long (except L5)
-spinous process thick and projects straight out

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What is the effect of aging on the vertebrae?

bone density and strength decrease after 40
-central portion of body bown inward and creates concave appearance (The yossinator RAHHHHH RBC), this causes convex iv discs which narrows space between vertebrae
Osteophytes (bony spurs) likely to appear
-changes in bone shape due to altered mechanic stress, osteoarthritis, spinal stenosis, and radiculopathy

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How can we reverse the effects of aging and dip into that fountain of youth in respect to the effects of aging on vertebrae?

resistance training increases strength through mechanical loading

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What is an intervertebral disc? List the layers from most lateral to medial.

Symphysis/2ndary cartilaginous joint in between vert. bodies
Hyaline end plate, annulus fibrosis, nucleus polposus

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What is the function of the hyaline end plate?

Transmits weight to adjacent vertebral body
confines np and af
helps provide nutrition to iv disc

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What is the function of the annulus fibrosis?

collagen outer ring that limits rotation between vertebrae and holds bodies together

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What is the function of nucleus polposus?

gelatinous substance that absorbs compression forces between vertebrae
distributes pressure and absorbs shock
keeps bodies apart and lubricated to reduce friction

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Describe blood innervation of verteral discs

outer 1/3 innervated (AF) in healthy population
mostly avascular (only outer 1/3)
discs rely on body movement to pump nutrients in and waste out
limited healing capacity

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how much do vertebral discs account for total column length

25-33%
thickest in cervical and lumbar to reflect greatest ROM

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compare iv discs of children and gran grans:

child;
-water forced out during day
-np soft and gelatinous
grans;
-disc more fibrous, af and np blur
-np retains less water

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What are regional characteristcs for cervical iv discs:

af;
-anterior = thick, strong, thick
-posterior = thin, vertical fibre orientation
np;
-fibrocartilage cre with no gelatinous component
uncovertebral clefts/horizontal fissures penetrate core in puberty increase movement)

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What are regional characteristcs for thoracic iv discs:

af;
-60% of disc volume
-equal height anteriorly and posteriorly
-height of iv disc relative to vertebral body is smaller compared to cervical and lumbar region (esp. upper thoracic)
np;
-slightly posterior

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What are regional characteristcs for lumbar iv discs:

af;
-highest and widest discs
-posterior concavity
-posterior lateral position not as well reinforced
np;
-slightly posterior

what is a disc prolapse

penetration of nucleus into annulus that is posterior or posterlateral most common in cervical and lumbar

what is the difference between a bulge, herniation, and extrusion of the iv disc?

b=np into af and disc does not move out h=np projects out of af surface e=np projects out of disc into canal

name the ligaments of the spinal column

anterior and posterior longitudinal ligaments ligamenta flava interspinous ligament supraspinous ligament intertransverse ligament iliolumbar ligament

describe the function and location of the anterior longitudinal ligament

-resists vertical separation of anterior vertebral bodies, limiting lumbar extension -attached superiorly to base of skull, extends inferiorly to attach to anterior surface of sacrum, runs down anterior vertebral body side

describe the function and location of the posterior longitudinal ligament

-resists separation of posterior vertebral bodies, limiting lumbar flexion -lines posterior aspect of vertebral bodies, connects c2 to base of skull (referred to as tectorial membrane)

describe the function and location of the ligamenta flava

-paired ligaments which resist laminae seperation in flexion, assist in extension in anatomical position -blends with zygapophyseal joints, goes down laminae of vertebrae

describe the function and location of the interspinous ligament

-resist seperation of posterior vertebral bodies, control vertebral location in flexion -pass between adjacent spinous process of vertebrae, blend with ligamenta flava and supraspinous ligament

describe the function and location of the supraspinous ligament

-resist seperation of spinous process, limiting excessive forward flexion -connects and passes along tips of spinous processes of c7 to sacrum, is structually distinct from c7 to base of skull (ligamentum nuchae)

describe the function and location of the intertransverse ligament

-resist seperation of transverse processes, limiting lateral flexion -inbetween transverse processes

describe the function and location of the iliolumbar ligament

-resists flexion, extension, rotation, and lateral flexion of lumbosacral joint -tip of L5 transverse process to iliac crest

what is ankylosing spondylitis

genetic condition that causes ossification of annulus fibrosis, supraspinous and interspinous ligaments causing bamboo spine

what are the uncovertebral joints

-synovial joints that develop due to uncovertebral clefts in disc -between uncinate processes below and vertebral body above -c3-c7 -increase rom of cervical region

compare the structure of c1 (atlas) and c2 (axis)

c1 is flat and has no vertebral body. c2 has odontoid process (dens) anteriorly

How many joint surfaces are there in the atlanto-axial joint? What movement is permitted?

movement = rotation of head 3 joint surfaces, 2 are the lateral synovial gliding joints and 1 is the median synovial uniaxial joint (ie. the dens)

does C2 (axis) have an uncinate process?

no, only c3-7 have an uncinate process ie. the 2 bony processes on the superior end of each vertebral body

between which level of the vertebrae does the posterior longitudinal ligament become the tectorial membrane?

from C2/axis (inclusive) up.

which ligament(s) connect the dens/odontoid process to the skull?

1x apical in the centre 2x alar more laterally

The transverse membrane is found on which vertebrae? what condition causes its weakening and what is the outcome?

found @ C1/atlas, holds c1 onto the dens of c2 weak transverse ligament = down syndrome = c1 can shift forward and cut spinal cord

what two structures does the longitudinal ligament connect?

connects the skull to c2 while joined to the transverse ligament

hyperextension would be damaged which ligament of the vertebral column?

anterior longitudinal

what ligament of vertebral column would be damaged in hyperflexion?

supra and interspinous ligaments

what level of the vertebral column does the dural sac terminate?

what level of the vertebral column does the conus medullaris terminate?

between L1-2

What level of the vertebral column does the sacral canal start and end?

starts S1 ends S4-5

What structures are within the sacral canal?

distal spinal nerves and meninges (the dural sac terminates around s2 and has all 3 layers of meninges) and within it has spinal nerves.

What is to note about the angle of the spinous processes of the thoracic region?

sharp downward angle (inhibits excessive flex/ext)

cervical

AF: posterior aspect has vertical fibres only no X over (suceptible to herniation). NP: fibrocartilage core

thoracic

AP: not as thick as lumber one NP: gelatinous nucleus + slightly posterior

lumber

AP: thickest one NP: gelatinous nucleus + slightly posterior

between C2-C6 which nerves are compressed in case of herniation? how about below C7

For **all** of the vertebral column the nerve roots of the lower vertebrae will be compressed (ie. C2/C3 will compress C3). The difference is as you move beyond C7, the reasoning changes. Above C7 the nerve root of the bottom vertebrae leaves but beyond, the nerve root of the top one leaves but the same the rule is the same is because that nerve safety exists via it's vertebraes inferior notch and the transversing nerve is hit.

cauda equina terminal location

S2-3 (same ending point as dural sac)

filum terminale terminal location

anchors at coccyx

conus medullaris terminal location

L1-2

which region of the vertebral column has mamillary processes?

lumber region - they provide muscle attachment points in particular for the multifidus muscle within the group of transversopinalis intrinsic back muscles.