Quiz 2- Lectures 5-6 Flashcards
(104 cards)
1
Q
cervical spine (lordosis/kyphosis)
A
lordosis
2
Q
thoracic spine (lordosis/kyphosis)
A
kyphosis
3
Q
lumbar spine (lordosis/kyphosis)
A
lordosis
4
Q
sacral spine (lordosis/kyphosis)
A
kyphosis
5
Q
lordosis: define
A
normal inward CONCAVE curvature of the lumbar and cervical regions of the human spin
6
Q
kyphosis: define
A
normal outward CONVEX curvature in the thoracic and sacral regions; means “bent backward”
7
Q
fetus: spinal stage
A
primary curve; large curve
8
Q
newborn: spinal stage
A
start seeing concavity in POSTERIOR CERVICAL region and in lumbar region; when patient starts holding up their head, the curves become more pronounced
9
Q
why doesn’t it take much muscular activity to keep adult body upright?
A
line of gravity passes through curve of vertebral column
10
Q
two main segments of the typical vertebrae
A
arch and body
11
Q
orientation of facets: cervical
A
oblique/ horizontal plane
12
Q
orientation of facets: thoracic
A
coronal plane
13
Q
orientation of facets: lumbar
A
sagittal plane
14
Q
describe LUMBAR vertebrae
(shape, superior/inferior surfaces, and discs)
A
- shape: kidney bean vertebral bodies
- superior/inferior surfaces of L1-L3 are parallel**, and L4/L5 are **wedge-shaped
- Discs are wedge-shaped and contribute to most typical lumbar curve (lordosis)
15
Q
describe venous drainage of vertebrae
A
*(check)
- basivertebral veins
- anterior & posterior external vertebral venous plexus
- anterior & posterior internal (epidural) vertebral venous plexus
16
Q
basivertebral veins
A
- emerge from the foramina on the posterior surfaces of the vertebral bodies.
- communicate through small openings on the front & sides of vertebral bodies with the anterior external vertebral plexuses, and converge behind to the principal canal, and open by valved orifices into the transverse branches which unite the anterior internal vertebral plexuses
17
Q
ANTERIOR EXTERNAL vertebral venous plexus
A
- lie in front of the bodies of the vertebrae
- communicate with the basivertebral and intervertebral veins
- receive tributaries from the vertebral bodies
- In cervical region, these anastomose with the vertebral, occipital, and deep cervical veins
18
Q
POSTERIOR EXTERNAL vertebral venous plexus
A
- placed partly on the posterior surfaces of the vertebral arches and their processes, and partly between the deep dorsal muscles.
- In cervical region, these anastomose with the vertebral, occipital, and deep cervical veins
19
Q
ANTERIOR INTERNAL vertebral venous plexus
A
- consist of large veins on the posterior surfaces of vertebral bodies and IV fibrocartilages on either side of the posterior longitudinal ligament (PLL);
- under cover of PLL they are connected by transverse branches into which the basivertebral veins open
- opens into the vertebral veins and is connected above with the occipital sinus, the basilar plexus, the condyloid emissary vein, and the rete canalis hypoglossi.
20
Q
POSTERIOR INTERNAL vertebral venous plexus
A
- one on either side of the middle line in front of the vertebral arches and ligamenta flava
- anastomose by veins passing through those ligaments with the posterior external plexuses.
- opens into the vertebral veins and is connected above with the occipital sinus, the basilar plexus, the condyloid emissary vein, and the rete canalis hypoglossi.
21
Q
how many processes are there?
what if you include the mammillary processes?
A
7 processes; but 9 total if you count the mammillary processes
22
Q
what are the 7 articular processes on the vertebrae?
A
1 spinous process
2 transverse processes,
4 articular processes (=2 superior/2 inferior)
23
Q
which processes “arise from junction of pedicles & laminae, except for L5”
A
transverse process
24
Q
how do transverse processes change in the lumbar region?
A
From L1-L3:increasein size fromL1-L3, whereas
L4/L5: decrease in size of transverse processes
25
where does transverse process arise?
from the vertebral body
26
where are articular processes located?
at junction of pedicle and lamina
27
what muscle attaches to the mammillary processes?
**multifidous** muscle
* *(consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis.*
* *Very thin but importnat in stabilizing the joints within the spine.*
* *One of the transversospinales)*
28
which direction do the following face?
## Footnote
**superior articular facets**
face medially
29
which direction do the following face?
## Footnote
**inferior articular facets**
face laterally
30
in which plane do the articular facets lie?
**sagittal**/median plane
31
how do **superior and inferior articular processes** differ?
* Spacing: **superior articular** proc. are **_further apart (except L5)_** than inferior articular processes
* Facet Orientation:
* Superior articular facets: face MEDIALLY
* Inferior articular facets: face LATERALLY
32
How is L5 different than the other lumbar vertebrae?
1. largest body
2. \***wedge-shaped** body
3. \*INF. ARTIC. PROC. are **_further apart_** than superior
4. **transv. proc** (TP): thick, arise partly from vertebral body; and shortest TP
5. **spinous processes**: shortest, but thickest
6. narrow lateral recesses
7. INF ART Facets (IAF): oriented in **frontal/coronal plane**, whereas the SAF are mostly oriented sagittally
\*Movement is possible at L5 due to position of facets
33
boundaries of vertebral foramen
1. formed by the anterior segment (the body),
2. and the posterior part, the vertebral arch:
* Pedicle
* Transverse process
* Laminae
* Spinous process
34
what is shape of LUMBAR vertebral foramina?
triangular in shape; often w/ sharp lateral recesses (esp. L5)
35
CC: osteoarthritic lipping around vertebral bodies posteriorly can cause...
lateral or central spinal stenosis (narrowing of vertebral canal)
## Footnote
*the contents of the vertebral canal or intervertebral foramen can be compressed*
36
**CC: Facet joint hypertropy** (facet syndrome, osteoarthritis) anteromedially can cause...
lateral spinal stenosis; and anteriorly in foraminal stenosis
## Footnote
*the contents of the vertebral canal or intervertebral foramen can be compressed*
37
**CC: Spondylosis**
| (What is it, and what are the sxs)
* any degenerative osteoarthritic change in the spine
* causes impingement upon contents of spinal canal or intervertebral foramen
38
**CC: Lumbar spondylosis w/o acute disc herniation**
how common?
nearly as common cause of lumbar nerve root encroachment as disc disease (particularly in the elderly)
39
In L3/L4, why is there a large interlaminar space between adjacent laminae?
Because laminae in the **lumbar region** are \*_not as tall as the vertebral bodies_
40
describe the lumbar spinous processes of L3/L4;
what is the clinical implication?
* lumbar spinous processes are **stout, squared off, and do not overlap; these project straight posteriorly**
* CC: these make the lumbar spine a good level to do a spinal tap or lumbar puncture
41
what are the red arrows pointing to? green arrows?
Red arrows: intervertebral foramen
Green arrow: pedicle
42
boundaries of intervertebral foramen
anterior: disc & body of vertebrae
roof/floor: pedicles
posteriorly: facet joints
43
posterior longitudinal ligament
* **Syndesmosis of vertebral body**
* Found w/in vertebral canal, extends along posterior surfaces of bodies of the vertebrae
* Prevents hyperflexion of vertebral column
* Hourglass shape: more narrow at the vertebral bodies and wider at the intervertebral disc space which is more pronounced
**CC: plays a role in spinal disc herniation**; much weaker than anterior longitudinal ligaments
44
anterior longitudinal ligament
* **Syndesmosis of vertebral body**
* a ligament that runs down the _anterior surface_ of the spine
* It traverses all of the vertebral bodies and intervertebral discs
* thick and slightly more narrow over the vertebral bodies and thinner but slightly wider over the intervertebral discs
* 3 layers: superficial, intermediate and deep
45
**CC: herniated discs**
* the disc involved with be **the disc above the vertebrae of the same name/number as the affected spinal nerve**
46
lumbar spine: movements
* primarily **flexion/extension:** bc orientation of facets limit free movement
* side bending and rotation are limited; EXCEPT between L5/S1
47
development of vertebrae: week 6
by end of 6th week, there is mesenchymal primordium and chondrification centers form --\> then it forms cartilaginous vertebrae
48
development of vertrebae: weeks 9-10
* ossification center for **neural arch**
* ossification in **costal processes**
* and ossification center for **vertrebal body (centrum)**
Based on cartilaginous model of vertebrae
49
development of vertebrae: at term
ossified: vertebral body, rib, and most of arch
\*CARTILAGINOUS SPINE remains
50
lumbar vertebrae development:
when do ossification centers for arch and body form?
Ossification center appears in 9-10th week, and vestige of notochord remains w/in body
51
when do the superior/inferior annular epiphysis of lumbar vertebrae fuse?
around age 20 y/o
52
where do neural arches begin to fuse together, and what is the order of vertebral segment?
* start fusing together during 1st year of life
* First, LUMBAR, then thoracic, then cervical
53
when do neural arches fuse w/ centra? when is fusion is complete?
* start fusing with centra in cervical region during 3rd year
* fusion is completed by year 6
54
CC: spondylolysis of L5
5th lumbar vertebrae is **bipartite**; oblique defect through parts interarticularlis
2 elements are **held together by fibrous tissue**
55
CC: spondyloisthesis
when the anterior element of a bipartite L5 slips forward --\> can lead to significant pain and disabilities
56
CC: transitional lumbosacral vertebrae
abnormal fusion of vertebrae in which S1 vertrebrae is partly free; could also have L5 be prtly fused to sacrum
57
CC: maldeveloped sacrum
left side of sacrum is imperfectly developed
58
CC: spina bifida
"split spine"; result of nerual tube defects and problems in develpoment of spine
\*occulta = "hidden", aperta = "open
Factors include genetics and environment (deficiency of folic acid)
59
sacrum: general considerations
1. 5 fused vertebral segments, which decrease in size
2. triangular in outline
3. base at top, apex at bottom
4. forms bony pelvis (w/ os coxae + sacrum)
5. 3 surfaces: ventral, dorsal, lateral
60
sacrum: ventral (pelvic) surface
1. faces anterioinferiorly,
2. concave
3. trasnverse ridges are remnants of IV joints
4. ventral rami (S1-S4) travel through paired ventral foramina
5. lateral parts represent fused transverse processes & costal elements
61
sacrum: dorsal surface
1. faces posterosuperiorly
2. convex
3. rough/narrow
* Surface features:
* median sacral crest
* sacral groove
* sacral hiatus
* intermediate sacral crest
* lateral sacral crest
* (Dorsal sacral foramina transmit dorsal rami of S1-S4)
62
what connects the dorsal and ventral sacral foramina to the sacral canal?
intervertebral foramen
63
lateral surface features of sacrum
**auricular surface** and tuberosity
(sacroiliac joint (**auricular** surface; ear-like shape) is the articulation between the sacrum and the os coxae.
64
sacral apex: features
sacral apex is oval; and contains a **symphysis** (2nd cartilaginous joint w/ disc)
65
how many primary and secondary ossification centers have been identified in sacrum?
58 total, and 35 of which are held constant
66
coccyx ("tailbone"): characteristics
1. distal end of vertebral column (axial skeleton)
2. 3-5 segments, often fused during adulthood
3. differs from typical vertebrae
67
how does coccyx differ from typical vertebrae?
lacks true pedicles, laminae, spinous processes, and neural (Spinal) canal
68
features of 1st coccygreal segment
1. coccygeal horns that may represent rudimentary pedicles and superior articular processes
2. 2 small transverse processes
69
when does primary ossification center of 1st segment of coccyx appear?
around birth; (all others appear variably; up to age 20)
70
which small ligaments unite the coccyx and the sacrum?
intercornual and sacrococcygeal
71
CC: coccydynia
tailbone pain; can be caused by inflammation or a fall
72
os coxae
"innominate"; is the hip bone
73
pelvic girdle versus bony pelvis
* **pelvic girdle**: the 2 os coxae; does NOT include sacrum/coccyx; part of **appendicular skeleton**
* **bony pelvis**: incl sacrum and coccyx (which are parts of **axial skeleton)**
74
pelvic girdle (axial or appendicular)
appendicular skeleton
75
bony pelvis (axial or appendicular)
BOTH (bc os coxae are appendicular, and sacrum/coccyx are axial)
76
name the 3 parts of the hip bone; when do these fuse?
3 bones: ilium, ischium, pubis
Fuse during adolescence (forming synostosis)
Prior to fusion, the joints are cartilaginous (synchondroses)
77
joints between 3 parts of the hip bone
Prior to fusion, the joints are cartilaginous (**synchondroses**)
Fuse during adolescence (forming **synostosis**)
78
how to "side" the hip bone
Hold bone w/ greater sciatic notch and ischial tuberosity **facing you.** Pubis will be away from you & facing the midline. A**cebatulum will be lateral & on the right if the bone is from the right side.**
79
2 parts of ilium
1. ala (wing)
2. body (*contributes to acetabulum - lunate surface and fossa & has a pelvic part as well)*
80
2 sides of **BODY** of ilium
external (acetabular)
internal (pelvic)
81
on which bone(s) is the arcuate line of the pelvic inlet?
on the **ilium** and part of **pubis** bones
(\*though TECHNICALLY, the part on the pubis is called the "pectin pubis", and the arcuate line + pectin pubis is called hte **iliopectineal line)**
82
2 sides/surfaces of **ALA** of ilium
internal (pelvic)
external (gluteal)
83
auricular surface of the ilium
The anterior surface (auricular surface), so called from its resemblance in shape to the **ear**, is coated with cartilage in the fresh state, and **articulates with a similar surface on the side of the sacrum.**
84
internal (bony) structure of **ILIUM**
mostly spongy (cancellous) w/ thin cortical (compact) shell
\*arcuate line is area of thicker, cortical bone
85
Why does the arcuate line contain area of thicker, cortical bone
to support upper body weight, which is transmitted from vertebral column across arcuate line to lower extremity
86
2 key ligaments we focused on that attach to the **ILIUM?**
* sacroILIAC
* sacroTUBEROUS
87
interossesous sacroiliac ligament
* _\*\*It is the strongest ligament in the body_
* lies deep to the posterior ligament
* consists of a series of short, strong fibers connecting the **tuberosities of the sacrum and ilium**, which keeps sacrum and ilium together
* nearly horizontal direction of fibers from sacrum to ilium
88
which is strongest ligament in the body?
interosseous sacroiliac ligament
89
sacrotuberous ligament
* Situated at the lower and back part of the pelvis
* Flat, and triangular in form; narrower in the middle than at the ends
* Runs from **sacrum** to **tuberosity of the ischium** (remnant of biceps femoris muscle)
* contains the coccygeal branch of the inferior gluteal artery
90
clinical significance of sacrotuberous ligament
If the pudendal nerve becomes entrapped between this ligament and the sacrospinous ligament causing perineal pain, the sacrotuberous ligament is surgically severed to relieve the pain.
91
Which is the anteroinferior part of the os coxae?
pubis, which is fused internally and externally w/ ilium and ischium
92
pubis has 3 parts. what are they?
1. body
2. superior ramus
3. inferior ramus
93
which part of PUBIS has both ventral and dorsal sides/surfaces, in addition to internal (pelvic) and external sides?
only the **BODY** of the pubis has ventral/dorsal sides/surfaces;
but all parts of pubis have internal and external sides
94
which parts of the pubis have internal (pelvic) and external sides?
all parts of pubis
(body, superior rami, inferior rami)
95
the inferior ramus of the pubis is not unique, but what is the **ischiopubic/conjoined ramus?**
the inferior **pubic** ramus and **ischial** ramus fuse to form **conjoined/ ischiopubic ramus**
96
superior pubic ramus and landmarks
* pectin pubis (of iliopectineal line)
* pubic tubercle
* pubic crest
* obturator groove
* obturator crest
97
obturator groove (w/in membrane, contributes to obturator cana) & helps transmit
obturator nerve, artery, and vein into medial thigh
98
2 parts of ischium
1. body - *large and incl part of acetabulum and ischial tuberosity*
2. ramus - *part of conjoined ramus*
99
obturator groove is NOT obturator notch. What does the obturator NOTCH transmit?
transmits tendon of **obturator internus into gluteal region**
100
obturator groove: part of which bone, and what does it transmit
* a groove in the inferior surface of the **superior ramus of the pubis**
* converted to the obturator canal when covered over by part of the obturator membrane; and the obturator canal is patent opening that transmits obturator nerve, artery, vein, into medial thigh)
101
which parts of the ischium have internal (pelvic) and external (femoral) facing sides?
both the **BODY and the RAMUS** have the internal/external sides/surfaces
102
**acetabulum**: what is it, and which bones contribute?
* "little vinegar cup"; concave surface of a pelvis.
* the head of the femur meets with the pelvis at the acetabulum, forming the **hip joint**
* **Lunate surface (of acetabulum):** incl. ilium, ischium, and pubis (not a complete circle
* **Acetabular fossa** is surrounded by **lunate surface,** and the **acetabular notch** forms bc the lunate surface is not a complete circle
103
Development of os coxae: comparing at birth to 12-13 y/o pt
Key concepts
* Lots of bone in ilium at birth, and less bone in ischium and pubis at birth
* Week of gestation during which ossification centers develop (9th - ilium, 15th- ischium, 20th- pubis)
* Some 2º ossification centers that develop in puberty (approx 12-13 y/o) --\> usually fused by mid-20s (except for end of clavicle, which fuses a bit later)
104
adductor canal:
boundaries
anteromedial: sartorious
posterior: adductor longus & adductor magnus
laterally: vastus medialis
