VERTEBRAL COLUMN 3 Flashcards

1
Q

Thoracic region

A

Wedge shaped vertebrae = primary cause of thoracic kyphosis - ANTERIOR HEIGHT OF VB IS LESS THAN POSTERIOR WHICH GIVES A WEDGED SHAPED
Low disc: vertebral body height
Tall, coronal superior articular processes limit flexion - TALL AND VERTICAL IN CORONAL PLANE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Coupling of movements in the thoracic spine:

A

Upper thoracic: lateral flexion & ipsilateral rotation coupling
When the inferior articular process of the superior vertebrae slides inferiorly it also moves
posteriorly (like mid & lower Csp (C3-7))
Mid & lower thoracic: variable
Rotation refers to the direction that the anterior vertebral body turns toward
C3-7 SIMILAR TO THORACIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Lumbar vertebral column

A

Flat superior & inferior ends of vertebral bodies
Almost sagittal orientation of zygapophysial joints
(curved anteriorly)
6. Mammillary process: Located on the superior articular process
1. Accessory process: Located on the dorsal, medial aspect of the transverse process
L1-4 PARALLEL VB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lumbar vertebral column - 2

A

Almost sagittal orientation of zygapophysial joints favour movements in the sagittal plane (F/E)
Changes to coronal by L5 to help prevent forward slipping of L5 on S1
L4 TRANSITION STAGE
L5-SUP. ARTICULAR PROCESS IS NOW MAJORITY IN CORONAL PLANE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The lumbar lordosis

A
• 1. sacrum is tilted anteriorly
• 2. L5/S1 iv disc is wedge shaped
(taller anteriorly)
• 3. L5 vertebra similarly wedge shaped
• 4. superior vertebrae incline slightly
backwards
• 5. L1 aligned vertically over S1
Flexion of the lumbar spine = decrease of the lordosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Iliolumbar ligament:

A
  • Transverse processes of L5 to ilium
  • Resists L5 slipping anteriorly off the sacrum
  • Resists all directions of movement of L5 on the sacrum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Movements of the Lumbar vertebral column

FLEXION limited by:

A
FLEXION limited by:
1. impaction of articular processes
2. tension in:
• Zygapophysial joint capsules
• Supraspinous ligament
• Interspinous ligament
• Ligamentum flavum
• Posterior annulus fibrosus
3. compression of:
• Anterior annulus fibrosus
  • flx - lifting inf. articular processes up = allows a bit of rotation b4 impact, therefore transfer load on ligaments, disc and AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Movements of the Lumbar vertebral column

AXIAL ROTATION limited by:

A

AXIAL ROTATION limited by:

  1. Impaction of zygapophysial joints
  2. Tension in posterior ligaments
  3. Tension in annulus fibrosus
    * more rotation range in flexion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Movements of the Lumbar vertebral column

EXTENSION limited by:

A
  1. impaction of spinous processes or inferior articular process with lamina below
  2. Tension in anterior AF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Scoliosis

A
“3D torsional deformity of the spine & trunk” lateral curvature + axial rotation + disturbance of sagittal curves structural (true) v’s functional (extrinsic cause)
Structural: 80% idiopathic
Classification: age of onset
Cobb angle: 100; 300; 500
location of frontal plane deformity
   R thoracic scoliosis R rib hump
Rotation of the vertebra moves the ribs
  • flattening of lordosis or kyphosis
    lft lat flexion = R lat rotation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Segmental muscles

A

Interspinales (Cx / Lx) / medial intertransversarii (Cx)
Small PCSA
Small moment arms
= small force production Proprioceptive function?
“all unisegmental muscles of the vertebral column have between 2 to 6 times the density of muscle spindles found in the longer polysegmental muscles”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Note

A

intertransversarii (lateral) are not intrinsic back muscles – they are innervated by ventral rami

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

transversospinales

A

attach to inferior transverse processes & superior spinous processes
Rotatores:
brevis & longus
most developed in Tx region but still very small PCSA = proprioceptive?
Multifidus:
more oblique alignment in Tx … better line of action for segmental rotation & lateral flexion than in lumbar region
most developed in lumbar spine
Semispinalis:
most developed in cervical & capitis regions
= main cervical extensors
(semispinalis thoracis spinous attachment C7 – T4)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Multifidus:

A

• View it as arising from the caudal edge of a lamina / spinous process
• 3 to 5 fascicles diverge inferiorly & attach to:
• superior articular process Cx
• base of transverse process Tx
• mammillary processes Lx, iliac crest & sacrum (depending on the region)
* fascicles diverge
* don’t consider as rotator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Action of multifidus: Acts over few segments

Lateral view:

A

• Vertical line of action & posterior position to axis = posterior sagittal rotation i.e. extension
(& maintains the lumbar lordosis)
= no translation results from contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Action of multifidus:

Posterior view:

A

• small horizontal component that could assist rotation (in Tx)
• The primary rotators of the lumbar spine are the oblique abdominals
The abdominals are anterolateral muscles… SO… they produce flexion + rotation
If the flexion component is not desired - recruit multifidus to produce extension moment F & E cancel to produce pure rotation of the trunk
- small horizontal component

17
Q

Erector spinae

A

Use bony landmarks: 1. Spinalis
2. Longissimus over transverse processes
3. Iliocostalis over angle of ribs
2nd part of name usually indicates the superior attachment

18
Q

Erector spinae aponeurosis

A

formed by the pars thoracis of:
• longissimus thoracis
• iliocostalis lumborum

19
Q

Longissimus thoracis pars thoracis

A

Lx sp processes;sacrum&psis to Tx transverse processes/medial ribs

20
Q

Iliocostalis lumborum pars thoracis

A

ilium&sacrum to lower 8 rib angles

- more lateral and can derotate thorax

21
Q

Iliocostalis lumborum pars thoracis and Longissimus thoracis pars thoracis

A

Unilateral action = ipsil. LF
Bilateral action = E
The prime extensors of the thoracolumbar spine (trunk)
Most powerful extensors of the lumbar spine:
Vertical line of action
Large PCSA
Large posterior moment arm
* thoracic parts - large, long superficial

22
Q

LIA = lumbar intermuscular aponeurosis

A

is formed by the caudal tendons of longissimus

23
Q

Longissimus thoracis pars lumborum

A

5 fascicles: Medial end of each lumbar transverse process to psis area

24
Q

Iliocostalis lumborum pars lumborum

A

4 fascicles: Tips of L1-4 transverse processes to medial iliac crest

25
Q

Longissimus thoracis pars lumborum and Iliocostalis lumborum pars lumborum

A

Unilateral action: vertical line of action lateral to the axis = Lateral Flexor
Bilateral action: vertical line of action posterior to the axis
• posterior sagittal rotation i.e. extension
horizontal line of action
• + simultaneous posterior shear (or resist anterior shear)
* have more ant. > post. direction

26
Q

Anterior & posterior shear forces on the lumbar spine

A

When lumbar spine flexes, the superior body weight exerts compressive and anterior shear force on the intervertebral joints.
Mechanisms to stabilise the motion segment:
1. Zygapophysial joints / articular processes
2. Intervertebral disc sagittal view 3. Ligaments
4. Muscles
* flx = straightening of lordosis

27
Q

Anterior & posterior shear forces on the lumbar spine

A

multifidus and pars thoracis - vertical downwards pull

pars lumborum = horizontal downwards pull

28
Q

Innervation of vertebral structures

A

Dorsal Rami:
medial branch
zygapophysial joint above & below
all muscles arising from spinous process / lamina
of that vertebra
= interspinales, rotatores, multifidus & semispinales + cutaneous branches in Cx & upper Tx
intermediate branch in lumbar spine longissimus
lateral branch erector spinae
+ cutaneous branches in lower Tx & Lx
* anterior innervates anterior

29
Q

sinuvertebral nerves, sympathetic trunks & grey rami

A

branches from the sympathetic trunks & grey rami form an anterior plexus (anterior to vertebral bodies & iv discs)
branches from sinuvertebral nerve form a posterior plexus (posterior to vertebral bodies & iv discs)

30
Q

Sympathetic trunk grey rami

communicantes

A

Nerve structure: Anterior plexus

Innervated structures: Anterior outer annulus fibrosus, ALL, anterior vertebral periosteum & vertebra, blood vessels

31
Q

Ventral rami via sinuvertebral nerve

A

Nerve structure: Posterior plexus
Innervated structures: Posterior outer annulus fibrosus, PLL, anterior & ventral/lateral dura & nerve root sleeves, posterior vertebral periosteum & vertebra, blood vessels

32
Q

Dorsal rami

A

Nerve structure: Medial branch
Innervated structures: - Zygapophysial joint above & below
- interspinales, rotatores, multifidus & semispinales

Nerve structure: Intermediate branch (in lumbar region only)
Innervated structures: longissimus

Nerve structure:Lateral branch
Innervated structures: erector spinae (except longissimus in Lx)