Exam 2 (Don’t forget to study Exam 1 cards) Flashcards by S R

Steel’s Rule of Thirds applies to which structures of the atlas?

1/3 odontoid (anterior)
1/3 spinal cord
1/3 free space: adipose, vessels, ligaments, meninges, subarachnoid space

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What are the 3 ossification centers of atlas?

anterior arch
lateral masses (2)

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There are 5 primary and 5 secondary ossification centers of axis, what are they?

Primary:
Body (1)
Arches (2)
Lateral base of odontoid (2)

Secondary:
Tip of odontoid (1)
Inferior vert body (1)
TPs (2)
SP (1)

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There are 3 primary and 7 secondary ossification centers in C7, what are they?

Primary:
Body (1)
Secondary (2)

Secondary:
TPs (2)
Superior body (1)
Inferior body (1)
SP (1)
Costal elements (2)

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What ossification centers are distinctly different between typical cervical vertebrae and C7?

Separate secondary ossification centers for costal processes

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Which vertebral structures have an articular facet?

Dens
Anterior arch
Superior articular process
Inferior articular process

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What structures form the IVF?

Pedicles
Articular pillar
vert bodies and IVDs
Uncinate processes

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Anterior and posterior roots in the cervical spine are found as part of which structure?

TPs

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The atlanto-occipital joints would be considered what type of joint?

Condylar

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Which part of the vertebral artery runs from C6 to C1 TP?

2nd part

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What percentage of the height of the cervical spine is from the cervical disc?

25%

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The EOP is found at the midpoint of which nuchal line?

Superior nuchal line

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The condylar fossae are found ____ to the occipital condules?

Posterior

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Which part of the vert artery runs superior of axis?

3rd part

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Cervical lordotic curvature is characterized as appearing ____.

Convex anteriorly

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Development of cervical curve begins when?

Around 9 weeks with initial fetal movements

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Lordosis becomes more prominent when infant begins lifting head at ____.

3-4 months of age

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Infant begins sitting upright around ____ months of age further establishing lordosis of c spine.

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In males, cervical lordosis increases gradually until age ____, when a dramatic increase in lordosis occurs.

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In females, lordosis increases gradually until age ____, before rapid increase for several years and then slowing down again.

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Do males or females have greater lordosis throughout life?

Females

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Identify the location of the upper cervical and lower cervical curve.

UC:
primary curve CO-C1, kyphotic

LC:
Secondary curve C2-C7, lordotic

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How many curves are found in the cervical spine?

2 curves

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During flexion of lower cervical spine, upper cervical spine moves dependently or independently?

Independently (flex/extend both possible)

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Lack of a cervical lordotic curve is acceptable for what age group?

Under 17

Lack of cervical curve in adults is indicative of what?

Ligamentous injury and/or anterior neck muscle hypertonicity

Which muscles of the neck could contribute to a lack of cervical lordosis?

Hyoid muscles, longus colli (anterior hypertonicity)

What boney abnormality can contribute to lack of cervical lordosis?

Hyperplastic articular pillars

Loss of cervical curve in an adult is found often times to be a(n) ____.

Insignificant finding

The theory behind why lack of cervical lordosis is significant by some is that ____.

There is an increased pressure on the brainstem and spinal cord

Females have more rapid shortening of height during what age range?

50-60 (menopause)

Degenerative changes of the spine begin around what age range in males?

31-40

Rapid degenerative changes of the spine in females happens in what age range?

51-60

Which vertebrae are considered typical?

C3-C6

Typical cervical VBs are small, ____ shaped.

Rectangularly

Typical cervical VBs transverse diameter ____ AP diameter.

Greater

Width and height of the typical cervical VBs are present at which portion of the c spine?

Inferior portion

Which ligament attaches along ridges of the anterior VB of the typical cervical vertebrae?

ALL

Ridges of the typical cervical vertebrae create a concave or convex surface for the ALL to attach?

Concave

What boney structure creates the concave surface of the superior portion of the typical cervical VBs?

Uncinate processes

Is the inferior surface of the typical cervical VB larger or smaller than the superior surface?

Larger

Raised lips of the VB are found where on the typical cervical vertebrae?

``` Superior aspect of VB Uncovertebral joints (Luschka’s joints, neurocentral joints) of the uncinate processes ```

How many uncinate processes are found on either side of the typical cervical vertebrae?

1 on each side

Which boney structure of the typical cervical vertebrae functions to allow flex/extend and limiting some lateral flexion?

Uncinate processes

Uncinate processes may help prevent IVD protrusion in which directions?

Posterior and lateral

What type of joint are the uncovertebral joints (Luschka joints, neurocentral joints)?

Synovial joints

At what age do uncovertebral joints (Lushka’s joints, neurocentral joints) form?

9-10 years of age

What pathology may encroach on the vert artery and/or spinal nerves?

Degeneration with osteophytes

Which region of the typical cervical vertebrae has the highest incidence of neural compression syndromes?

C4-C6

Which nerve roots would C4-C6 neural compression syndromes affect most often?

C5-C7

What sign may present at the typical cervical vertebrae when there has been trauma to the area?

Prevertebral soft tissue swelling

Typical cervical vertebrae pedicles project ____.

Posterolaterally

The medial border of transverse foramen is formed by which boney structure?

Pedicles

Where do the pedicles lie in relation to the superior and inferior VB endplates?

Midway

The spinal nerve runs ____ to its corresponding pedicle.

Superior

In the c spine, the spinal nerve exits ____ its corresponding vertebrae.

Above

____ of TPs of typical cervical vertebrae originate from the spine as 2 roots or bars.

Tubercles

Tubercles of typical cervical are joined by what boney structure?

Intertubercular lamella (costotransverse lamella)

Groove or gutter for the spinal nerve and anterior ramus is located ____.

Between anterior and posterior roots

Dural sleeve of the spinal nerve is adhered to ____ by fibrous tissue.

Gutter of TP

The dural sleeve of the spinal nerve is especially strong at what region of the cervical spine?

C4-C6

Dural root sleeves in the c spine has ____ sensory innervation than other regions.

The dural root sleeves in the c spine originate from ____ instead of recurrent meningeal nerves.

Dorsal root ganglion

Traction of nerve roots registers as ____.

Pain

Dorsal ramus leaves each ____ nerve shortly after it exits the IVF.

Spinal

Dorsal ramus courses along z joint and supplies joint with ____ innervation.

Sensory

Dorsal ramus provides what types of sensory information to cervical parts deep back muscles?

Motor, nociception, proprioception

Dorsal ramus provides information from what layers of the skin of the back?

Dermis and epidermis

What muscles attach to the anterior tubercles of the cervical TPs?

Anterior scalene Longus colli Longus capitis

What muscles attach to the posterior tubercles of the cervical TPs?

``` Splenius cervicis Longissimus cervicis Iliocostalis cervicis Levator scapulae Scalenius medius and posterior ```

Posterior tubercles of the TPs of the c spine extend further ____ than ____.

Laterally and inferiorly than anterior

Transverse foramen of all C spine vertebrae are bound by what structures?

Pedicle Anterior root of TP Posterior root of TP Intertuberuclar lamella

After the vert artery travels through C1 transverse foramen, it loops ___ and ___ over the superior articular process to enter foramen magnum.

Superiorly and medially

Ventral rami pass ____ to vert artery.

Posterior

____ veins descend through transverse foramen.

Vertebral

Vertebral veins dump into ____ veins.

Subclavian

Vertebral veins begin in which region of the c spine?

Atlanto-occipital region

Vert artery is accompanied by plexus of ____ nerves through the transverse foramen.

Sympathetic

Cervical ribs have the following AKAs for attachment sites:

Costal elements Costal processes Pleurapophyses

What boney structure arises from the mesenchymal stage of vert development of the costal process?

TPs

Where in the c spine does compression of the brachial plexus or subclavian artery appear most often?

C7 ribs

The fibrous band of tissue usually connecting the tip of the cervical rib to the manubrium or the 1st true rib is seen on plain films. True/False

False

Facet joint (z joint) angles in the c spine are at what degrees?

45 degrees

What cardinal plane do the s spine facet (z) joint angles appear in?

Horizontal

Upper cervical vert are closer to what degree of facet joint angle?

35 degrees

Lower cervical vert are closer to what degree of facet joint angle?

65 degrees

Superior articular processes and facets of c spine face what direction?

Posterior, superior and slightly medial

Articular processes become more ____ as a child reaches 10 years of age.

Vertical

Asymmetry in facet joint angles and articular process orientation is especially common in what region of the c spine?

Transition areas (C6-T1)

Height of superior articular processes of c spine ____ while width ____ from C2-C7.

Decreases and increases

Prior to what age do you maintain smooth, thick articular cartilage with regular subarticular bone?

20 years old

Subchondral bone ____ with age.

Thickens

2 signs of degeneration of facet joints/articular pillars are?

Osteophytes and sclerosis

Z joint capsules limit what movement?

Hyperextension

Which aspect of z joint capsules are thickest?

Anterolateral

Z joint capsules of s pine are thinner, longer, and looser than T spine and L spine. True/False

True

Z joint synovial folds AKA:

Menisci

Z joint synovial folds (menisci) project into the joint from what directions?

Anterior and posterior

Z joint synovial folds (menisci) cover about ____ of the articular surface?

1/3

Z joint synovial folds (menisci) cover larger area at what region of the c spine?

C1-C2

Z joint synovial folds (menisci) have ____ nerve innervation.

Sensory

Z joint synovial folds (menisci) of the c spine are most often damaged from what type of trauma?

Whiplash

Articular pillar is the column made from which boney structures?

Superior and inferior articular processes | Facet joints

What is the function of articular pillars of c spine?

Bearing weight of head

Spondylosis is rare in what boney structure of the c spine?

Articular pillar

Z joints are important for what neurological sense?

Proprioception

Z joints are innervated by what structures?

Mechanoreceptors and free nerve endings | Medial branch of dorsal rami

Z joints of the c spine are often innervated by the nerve above and below except for which segment?

C2-C3, which is innervated only C3

Cervical facets may refer neck pain to distant sites. True/False

True

Lamina narrow from what direction of the c spine?

Superior to inferior

What ligament fills the gap between lamina of adjacent vertebrae?

Ligamentum flavum

Upper border of c spine lamina is ____.

Thin

Anterior surface of inferior border roughed by attachment of what ligament?

Ligamentum flavum

Vert canal (vert foramen) is ____ shaped.

Triangular

Borders of vert canal (vert foramen) include:

Lamina lined by ligamentum flavum Pedicles VBs IVDs

What structures are present within the vert canal (vert foramen)?

Epidural adipose tissue Internal vert venous plexus Spinal cord covered by meninges and CSF Spinal nerve roots

Vert canal (vert foramen) dimensions of C1-C7 remains fairly constant at what measurement?

12-13 mm

Upper cervical vert canal (vert foramen) appear ___ superiorly than inferior

Wider

In the upper cervical vert canal (vert foramen), how much of the space is occupied by the spinal cord at C1?

Less than 50%

Narrowing of the vert canal (vert foramen) of the c spine occurs at what vert?

At what vert does the spinal cord occupy 75% of available space in the cervical vert canal?

Volume of CSF in subarachnoid space in cervical vert canal is greatest in ____ and least in ____.

Flexion | Extension

Connective tissue attachments to the posterior spinal dural mater in the c spine vert canal are:

``` Foramen magnum Posterior arch of C1 SP of C2 Rectus capitis posterior minor Ligamentum nuchae Ligamentum flavum ```

Dura mater is held in place to prevent folding in during ____

Extension

Dura mater is held in place to prevent pressure on cord during ____.

Flexion

What is cervical myelopathy?

Pathology of c spine cord Compression, often by narrowed vert canal May be congenital

When A-P diameter reaches ____ mm or smaller, cervical myelopathy symptoms manifest.

12-13

Histological changes with cervical myelopathy begin with loss of ____ horn cells then to intermediate, then to lateral and posterior funiculi of white matter. Finally atrophy of entire gray matter and more severe degeneration in lateral funiculus.

Anterior horn cells in are ____nerves which innervate upper extremities.

Motor

Clinical signs of cervical myelopathy include:

Loss of sensory input and motor function of structures supplied by the spinal cord sigment Diffuse neck pain with neuro deficits Mimics MS, ALS, IVD protrusion, and spinal cord tumor

What is neurapraxia of cervical nerves?

Injury to a nerve resulting in paralysis that recovers completely in a short period of time

Neurapraxia of cervical nerves usually occurs from what types of injuries and where in the c spine?

Sports (football) C5-C6 Field AKAs stingers/burners

Typical cervical vert SPs develop from 2 ____ ossification centers.

Secondary

Typical cervical vert SPs are sites of attachment for ligament ____ along with the deep extensors of the spine.

Nuchea

Typical cervical vert SPs have ____ tubercles.

Asymmetrical

Length of cervical SPs ____ C2-C4 and ____ C4-C7.

Decreases Increases

Which cervical vert has the shortest SPs?

Borders of c spine intervertebral foramina include:

Inferior/superior notches of pedicles Articular pillar VBIVD Uncinate processes

C spine intervertebral foramina face what direction?

Oblique and anterior, slightly inferior

The c spine intervertebral foramina is ____ shaped and 4-6 mm long.

Oval

C spine intervertebral increases superior to inferior diameter with what movement?

Flexion

C spine intervertebral foramina rotation to same side ____ foramen and contralateral rotation ____ foramen.

Narrows Widens

Which spinal movement increases pressure in the IVF of c spine?

Extension

Bakody’s test shows a decrease in pressure in the IVF with what movement?

Abduction of upper limb

What structures are housed inside the IVF of c spine?

Dorsal/ventral rootlets Spinal nerve with dural root sleeve (inferior portion) Epidural fat and blood vessels (superior portion) Dorsal root ganglia in small notch on anterior surface of superior articular process

IVF stenosis causes:

``` Bone spurs IVD protrusion Fibrous tissue/adhesions in IVF Thickened/buckled ligamentum flavum Congestion/inflammation of blood vessels in IVF ```

Stenosis of IVF effects:

Compression of dorsal/ventral roots | Compression of spinal nerve or dorsal root ganglion

Clinical symptoms of stenosis of IVF are:

Decreased muscle strength Radicular pain Most common nerve roots are C6-C8

Enlargement of IVF pathologies:

``` Neurofibroma Meningioma Fibroma Lipoma Chordoma Herniated meningocele Tortuous vert artery Congenital absence of pedicle with TP malformation ```

Squamous part of occipital bone is found on which area?

Posterior to foramen magnum

Where is the opisthion craniometric point on the squamous area of the occipital bone?

Directly posterior of foramen magnum

What muscle attaches to the EOP?

Trapezius

The outer surface of the squamous portion of the occipital bone consist of the following boney landmarks:

``` Opisthion EOP (inion) EO crest Supreme nuchal line Superior nuchal line Inferior nuchal line ```

The inner surface of the squamous portion of the occipital bone consists of the following boney landmarks:

IOP Grooves for transverse sinus Attachments for tentorium cerebelli (dural fold)

Lateral aspect of occipital bone consists of the following boney landmarks:

Sides of foramen magnum L/R occipital condyles Jugular processes Jugular notches

Occipital condyles are located on the ____ aspect of the FM.

Anteriolateral

What is the positioning of the convex structures of the occipital condyles?

Inferior, anterior, and medial

Occipital condyles have articular facets covered with ____.

Hyaline cartilage

Atlanto-occipital articulations allow for which movements to occur?

Flex/extend, lateral flex

Jugular notch contains a ____ along the lateral margin of each side of the occiput.

Groove

The jugular process is located on what border of the jugular groove?

Lateral

The jugular process projects ____ on the lateral aspect of the jugular foramen creating the posterorlateral margin of the jugular foramen.

Anteriorly

Which muscle attaches to the jugular process?

Rectus capitis lateralis

Basilar part of occipital bone is located ____ to the foramen magnum.

Basilar part forms what craniometric point?

Basion

Basion point on occipital bone is composed of the union between:

Basilar portion of sphenoid bone forming clivus | Sphenobasilar joint

Pharyngeal tubercle of basilar part of occipital bone is located on the ____.

Midline Superior pharyngeal constrictor Longus capitus

Superior band of cruciate ligament attaches to the surface of what boney structure on the basilar part of occiput?

Clivus, beneath the tectoral membrane

Anterior atlanto-occipital membrane attaches ____ to the FM.

Apical ligament of odontoid attaches to ____ rim of FM.

Incomplete incorporation of superior sclerotome leaves remnants of ____ vertebrae congenitally.

Occipital

Which structures are congenital anomalies found in the occiput?

``` Paracondylar process Epitransverse process Hypocondylar arch 3rd occipital condyle Accesory ossicles ```

Assimilation or fusion of atlas to occiput occurs when there is ____ segmentation of occipital and upper cervical somites.

Lack of

Assimilation of atlas to occiput usually occurs with ____ fusion of one lateral mass to the adjacent occipital condyle

Asymmetrical

Both lateral masses and the ____ arch of C1 may fuse with the occiput during AO assimilation.

The posterior does not fuse in AO assimilation for ____ artery to enter the foramen magnum.

Vertebral

What boney structure may extend up into FM with the occurrence of AO assimilation?

Odontoid process

The cerebellum and lower cranial nerves may be affected with an AO assimilation due to invagination of which surface of the occiput?

Basilar area (superior deviation of inferior aspect of occiput)

Upper cervical anomalies are often accompanied by anomalies of which other body structures?

Face Ears Mid-lower cervical vertebrae

Atlas contains how many primary centers of ossification?

1 in each LM (7th week of gestation) close to complete posterior arch at 4yrs old 1 in anterior arch

The hypochordal arch is found on which arch of the atlas?

Anterior arch

Hypochordal arch is located where on the anterior arch of the atlas?

Between lateral masses of atlas in embryo

Primary center of ossification appears around 1 year of age in atlas and fuses with L/R LM between what ages?

7 and 9 years of age

Which arch of atlas is smaller?

Anterior arch

Which ligament attaches to anterior tubercle of anterior arch of atlas?

ALL and longus colli muscles

What type of joint is the atlas facet dens articulation?

Diarthrodial joint (synovial pivot)

Posterior arch of atlas forms ___ of the ring.

2/3

Which ligament connects at the posterior tubercle of the posterior arch of the atlas?

Ligamentum nuchae | Rectus posterior minor muscle

Which ligament attaches at the lower border of the posterior arch of atlas?

R/L ligamentum flava

What structure rest in the grooves on either side of the posterior arch of atlas?

VAN

Which nerve travels between vertebral artery and posterior arch of atlas?

Sub-occipital nerve (dorsal rami of C1)

Foramen structure for the groove of vertebral artery is called what?

Arcuate foramen

What soft tissue structure attaches to either side of the groove of the vertebral artery which when ossified creates a posterior ponticus?

Posterior AO membrane

What percentage of the population as a posterior ponticus?

25% partial | 8% both

Ossification laterally between what structures creates a lateral ponticus?

Superior articular process of atlas and atlas TP

Lateral ponticus is ____ more common on right side.

Lateral masses of atlas are composed of which boney structures?

Superior articular process Inferior articular process TP

Superior articular process of atlas’ anterior aspect is positioned how?

Exam 2 (Don’t forget to study Exam 1 cards) Flashcards

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