Spinal Exam 2: Section VI - Lamina/Pedicle--Atypical C Vert. Flashcards
VI. Regions of the Vertebral Column (164 cards)
1
Q
What is the orientation and angulation of the pedicle of a typical cervical?
A
posterolateral , 45 degrees
2
Q
In the vertebral couple, which cervical vertebral body will contribute more toward the height of the intervertebral foramen?
A
neither, both contribute equally to the intervertebral foramen height
3
Q
Which spinal nerve will be accommodated on the superior vertebral notch of C5?
A
C5 spinal nerve
4
Q
Which spinal nerve will be accommodated on the inferior vertebral notch of C5?
A
C6 spinal nerve
5
Q
What is the direction of projection of the cervical lamina?
A
posteromedially
6
Q
What ligament attaches to the lamina of a typical cervical?
A
ligamentum flavum
7
Q
What joint classification will be associated with the ligamentum flavum and its attachment?
A
fibrous (ampiarthrosis) syndesmosis
8
Q
Ossification of the ligamentum flavum at the attachment site on the lamina will result in what feature?
A
para-articular processes
9
Q
Ossification of the ligamentum flavum at the attachment site on the lamina will be associated with which classification of bone?
A
accessory bone
10
Q
Ossification within the ligamentum flavum will be associated with which classification of bone?
A
heterotopic bone
11
Q
What is the outline of the vertebral foramen of a typical cervical vertebra?
A
heart-shaped or triangular
12
Q
Which is the greatest diameter of the vertebral foramen of typical cervicals?
A
transverse
13
Q
The greatest transverse diameter of the typical cervical vertebra occurs at__?
A
C6
14
Q
The greatest frequency of osteophytes associated with the vertebral body occurs at which typical cervical vertebral couple?
A
C5/C6
15
Q
What muscles will attach to the anterior tubercle of a typical cervical vertebra?
A
anterior scalene, longus capitis, longus colli, anterior intertransversarii
16
Q
What muscles may attach to the posterior tubercle of a typical cervical vertebra?
A
spenius cervicis, iliocostalis cervicis, longissimus cervicis, levator scapula, middle scalene, posterior scalene, rotators, and posterior intertransversarii
17
Q
What muscles will attach to the costotransverse bar?
A
middle scalene and posterior intertransversarii
18
Q
What produces the primary tension on the transverse process that will cause remodeling in the anterolateral and inferior directions?
A
cervical spine nerves as they are directed anterolaterally and inferiorly to form the cervical and brachial plexuses
19
Q
What is the orientation and angulation of a typical cervical transverse process?
A
60 degrees anterolaterally (from midsagittal plane), 15 degrees inferiorly (from the horizontal plane)
20
Q
What is the name given to the modification of the anterior tubercle of the C6 transverse process?
A
the carotid tubercle
21
Q
What will cause remodeling of the anterior tubercle at C6?
A
the common carotid artery
22
Q
What will occupy the typical cervical vertebra transverse foramen?
A
the vertebral artery, vertebral venous plexus and postganglionic sympathetic motor nerve fibers
23
Q
What is the name of the lamina-pedicle junction of typical cervical vertebrae?
A
the articular pillar
24
Q
What is the classic angulation of typical cervical articular facets?
A
40 to 45 degrees from the coronal plane
25
Recent work suggests what angulation for typical cervical articular facets?
55 to 60 degrees
26
What is the orientation of the typical cervical superior articular facet?
backward, upward, medial (BUM)
27
What is the orientation of the typical cervical inferior articular facet?
forward, lateral, downward (FoLD)
28
What muscles will attach to typical cervical articular processes?
the longissimus capitis, longissimus cervicis, semispinalis capitis, semispinalis cervicis, multifidis and rotators
29
What is the joint classification for the typical cervical zygapophysis?
synovial plane (diarthrosis arthrodia) joint
30
What modifications of the synovial joint are observed in the cervical spine?
meniscoidal folds
31
What function will meniscoidal folds provide in cervical zygapophyses?
they are assumed to distribute pressure across the joint surface
32
The greatest range of flexion - extension among the typical cervical vertebrae occurs at which vertebral couple?
typically C5/C6
33
What motions are coupled in the cervical spine?
lateral bending and axial rotation
34
Ranges of coupled motion among the typical cervical vertebrae will be similar for what cervical vertebral couples?
the C2/C3, C3/C4, C4/C5 vertebral couples
35
Ranges of coupled motion among the typical cervical vertebrae will begin to decrease at what cervical vertebral couple?
the C5/C6 vertebral couple
36
What is the usual condition for the Caucasian typical cervical spinous process?
they are bifid
37
What is the usual condition for the African-American typical cervical spinous precess?
they are non-bifid
38
What muscles may attach to the typical cervical spinous process?
the spinalis cervicis, semispinalis cervicis, semispinalis thoracis, multifidis, rotators, and interspinalis
39
What ligaments will attach to the typical cervical spinous process?
the interspinous ligament and ligamentum nuchae
40
What will form the anterior boundary of a typical cervical intervertebral foramen?
the lateral groove and vertebral body of the segment above
the uncinate process and vertebral body of the segment below
the intervertebral disc and the posterior longitudinal ligament
41
What will form the posterior boundary of a typical cervical intervertebral foramen?
the inferior articular process (post-zygapophysis), the superior articular process (pre-zygapophysis), the capsular ligament and the ligamentum flavum
42
What will form the superior boundary of a typical cervical intervertebral foramen?
the inferior vertebral notch or inferior vertebral inscisure
43
What will form the inferior boundary of a typical cervical intervertebral foramen?
the superior vertebral notch or superior vertebral incisure
44
What is the unique anterior boundary of the intervertebral foramen for the C4 spinal nerve?
the lateral grooe of C3 and uncinate process of C4 forming the joint of Luschka
45
What is the name of the first cervical vertebra?
atlas
46
What features are lacking at C1?
vertebral body, pedicles, a spinous process, and the intervertebral disc
47
What is thought to represent the pedicle at C1?
the anterior arch
48
What osseous modification is observed to the front of the anterior arch of C1?
the anterior tubercle
49
What muscle attaches to the anterior arch of C1?
longus colli
50
What ligaments will attach to the anterior arch of C1?
the anterior longitudinal, anterior atlanto-occipital, and anterior atlanto-axial ligaments
51
What joint classifications are observed on the anterior arch of C1?
fibrous (amphiarthrosis) syndesmosis joint and synovial pivot (diarthrosis trochoid) joint
52
What is the morphology of the superior articular facet of C1?
they are elliptical, closer together in front and often demonstrate an elevation subdividing the facet surface into two separate sufaces
53
What is the orientation of the superior articular facet of C1?
backward, upward, medial (BUM)
54
What is the joint classification of the atlanto-occipital zygapophysis?
synovial (diarthrosis) ellipsoidal joint
55
What are the morphological characteristics of the inferior articular face of C1?
asymmetrical, slightly concave or flattened
56
What is the orientation of the inferior articular facet of C1?
backward, medial, downward (BMD)
57
What is the joint classification of the atlanto-axial zygapophysis?
synovial plane (diarthrosis arthrodia) joint
58
What muscles attach to the lateral mass of C1?
levator scapula
splenius cervicis
rectus capitis anterior
59
What is the contribution of the posterior arch to the circumference of C1?
about forty percent
60
What part of C1 represents the spinous process?
posterior tubercle of the posterior arch
61
What is the distance from the posterior tubercle of the posterior arch to the skin in each gender?
males: about fifty millimeters
females: about thirty-seven millimeters
62
What attaches to the posterior tubercle of the posterior arch of C1?
rectus capitis posterior minor muscle and ligamentum nuchae
63
What attaches to the arcuate rim of C1?
the posterior atlanto-occipital ligament
64
Ossification of the free margin of the posterior atlanto-occipital ligament results in which atypical bone classification?
accessory bone
65
What is the earliest age of development where ossification of the anterior free margin of the posterior atlanto-occipital ligament was observed?
about age 7 years old
66
Based on the amount of ossification of the anterior free margin of the posterior atlanto-occipital ligament what structures will form?
an incomplete ponticulus posticus or a complete ponticulus posticus
67
What are the attachment sites of the ponticulus posticus?
it is attached to the arcuate rim of the posterior arch of atlas and to the superior articular process of the lateral mass of atlas
68
Ponticulus posticus has observed in what ethnic population?
all ethnic population studied thus far
69
What is the general range of incidence of ponticulus posticus in the populations studied?
1% - 41%
70
What is the gender bias now associated with ponticulus posticus?
female
71
What is the incidence of a complete ponticulus posticus versus an incomplete ponticulus posticus?
the incidence of a complete ponticulus posticus is about fifteen percent; the incidence of an incomplete ponticulus posticus may be as high as forty-one percent
72
What is observed on the under surface of the posterior arch of C1?
"inferior vertebral notch" and an attachment site for the posterior atlanto-axial ligament
73
What is the location of the "zygapophysis" relative to the atlanto-occipital and atlanto-axial intervertebral foramina?
it forms part of the anterior boundary of the intervertebral foramen in both cases
74
What are the osseous parts of the transverse process of C1?
costal element, posterior tubercle, true transverse process
75
What osseous parts of the transverse process are absent at C1?
anterior tubercle and costotransverse bar
76
What muscles attach to the transverse process of C1?
```
rectus capitis anterior,
rectus capitis lateralis,
middle scalene,
levator scapula,
splenius cervicis,
obliquus capitis superior,
obliquus capitis inferior, and
intertransversarii muscles
```
77
What suboccipital muscles are known to have fascial projections attaching to the spinal dura?
rectus capitis posterior minor,
rectus capitis posterior major, and
obliquus capitis inferior
78
What are the connections between suboccipital muscles and the spinal dura called?
myodural bridges
79
What are the lateral bridges of atlas connected to?
the lateral mass and the transverse process of atlas
80
What forms the lateral bridges are observed in the population?
incomplete lateral bridges and complete lateral bridges
81
What opening is identified when a complete lateral bridge is formed?
the retrotransverse foramen
82
What are the possible contents of the retrotransverse foramen?
the vertebral artery, a branch from the suboccipital nerve, and veins communication with the venous sinuses of the neck
83
Which of the ponticles (bridges) of atlas is most numerous?
ponticulus posticus
84
Which of the ponticles (bridges) of atlas is only observed in humans?
lateral bridges
85
What is observed in the transverse foramen of C1?
vertebral artery, vertebral venous plexus, postganglionic sympathetic motor nerve fibers
86
What is the gender variation for measurements of the transverse diameter of C1?
males: 78 millimeters
females: 72 millimeters
87
What is the distance from the posterior tubercle of the transverse process of C1 to the skin for each gender?
a little over 30 millimeters for both males and females
88
What joint classifications are observed at C1?
```
fibrous (amphiarthrosis) syndesmosis joint,
synovial (diarthrosis) ellipsoidal joint,
synovial pivot (diarthrosis trochoid) joint, and
synovial plane (diarthrosis arthrodia) joint
```
89
How many synovial joint surfaces are observed at C1?
five
90
What synovial joint surfaces are observed at C1?
two superior articular facets, two inferior articular facets, and fovea dentis
91
What names are given to C2?
axis and epistropheus
92
What unique vertebral body modification is characteristic of C2?
the dens or odontoid process
93
How many joint surfaces are present on the odontoid process of C2?
five
94
What joint surfaces are present on the odontoid process of C2?
facet for fovea dentis, groove for transverse atlantal ligament, attachment sites for the alar ligaments, attachment site for the apical-dental ligament
95
Which joint classifications are represented at the odontoid process C2?
fibrous (amphiarthrosis) syndesmosis and synovial pivot (diarthrosis trochoid) joints
96
What is the name/classifications given to the odontoid process when the tip of the dens is directed posterior?
lordotic dens
97
What is the name/classifications given to the odontoid process when the tip of the dens is directed anterior?
kyphotic dens
98
How many joints are formed by the inferior part of the vertebral body of C2?
five
99
What joint classifications are present at the inferior part of the vertebral body of C2?
fibrous (amphiarthrosis) syndesmosis, modified synovial saddle (diarthrosis sellar), and cartilaginous (amphiarthrosis) symphysis
100
How many joint surfaces are present at the vertebral body of C2?
ten
101
What joint classifications are present at the vertebral body of C2?
fibrous (amphiarthrosis) syndesmosis,
synovial pivot (diarthrosis trochoid),
modified synovial saddle (diarthrosis sellar), and
cartilaginous (amphiarthrosis) symphysis
102
What ligament will represent the cranial continuation of the posterior longitudinal ligament?
membrana tectoria
103
What ligament forms the anterior boundary for the spinal canal above C2?
membrane tectoria
104
What ligament forms the anterior boundary for the spinal canal below C2?
posterior longitudinal ligament
105
What is the location of the superior vertebral notch of C2?
on the lamina-pedicle junction
106
What attaches to the lamina of C2?
obliquus capitis interior muscle, posterior atlanto-axial ligament, and ligamentum flavum
107
What muscles attaches to the lamina of C2?
obliquus capitis inferior
108
What is the appearance of the superior articular facets of C2?
they are asymmetrical and slightly convex
109
What is the facet orientation of the superior articular facet of C2?
backward, upward, and lateral (BUL)
110
What is the orientation of the inferior articular facets of C2?
forward, lateral, and down (FoLD)
111
What muscle attaches to the articular processes of C2?
longissimus cervicis
112
What osseous parts of the typical cervical transverse process are absent at C2?
anterior tubercle and costotransverse bar
113
What will be observed in the transverse foramen at C2?
vertebral artery, vertebral venous plexus, postganglionic sympathetic motor nerve fibers
114
What is the gender variation for the transverse diameter of C2?
males: fifty-seven millimeters (57)
females: about fifty millimeters (50)
115
What muscles attach to the transverse process of C2?
```
levator scapulae,
middle scalene,
splenius cervicis,
longissimus cervicis, and
intertransversarii
```
116
What is characteristic appearance of the C2 spinous process in humans?
bifid
117
What is the location for palpation of the spinous process of C2?
in the midline, about two inches below the external occipital protuberance
118
What muscles attach to the spinous process of C2?
```
rectus capitis posterior major,
obliquus capitis inferior,
spinalis cervicis,
semispinalis cervicis,
multifidis,
rotators, and
interspinalis muscles
```
119
What ligaments attach to the spinous process of C2?
ligamentum nuchae and interspinous ligaments
120
What names may be given to C7?
vertebra prominens and vertebral prominence
121
What is the name given to the topographical elevation observed at the base of the neck?
vertebral prominance
122
What name is given only to C7?
vertebra prominens
123
In what percent of men and of women does C7 become the vertebral prominence?
men: eighty-six percent (86%)
women: seventy-nine percent (79%)
124
What is the segment and gender bias for vertebrae other than C7 becoming the vertebral prominence?
C6 is more common in females and T1 is more common in males
125
How many joint surfaces are present at the vertebral body of C7?
eight
126
What joint classifications are observed as the vertebral body of C7?
fibrous (amphiarthrosis) syndesmosis,
cartilaginous (amphiarthrosis) symphysis, and
modified synovial saddle (diarthrosis sellar) joint
127
What synovial joint surfaces are observed at the vertebral body of C7?
two
128
What muscle(s) attaches to the vertebral body of C7?
longus colli muscle
129
What features are typically present in the transverse foramen of C7?
vertebral venous plexus and postganglionic sympathetic motor fibers
130
What muscles attach to the transverse process of C7?
```
middle scalene,
iliocostalis thoracis,
longissimus cervicis,
semispinalis capitis,
rotators,
intertransversarii, and
levator costarum brevis
```
131
What is the angulation of the articular facet of C7?
more vertical at about 63 degrees
132
What is the orientation of the superior articular facet of C7?
backward, upward, medial (BUM)
133
What is the orientation of the inferior articular facet of C7?
forward, medial, downward (ForMeD)
134
What muscles will attach to the articular process of C7?
longissimus cervicis,
longissimus capitis,
semispinalis cervicis, and
multifidis
135
What are the features of the spinous process of C7?
long, horizontal, nonbifid
136
What muscles attach to the spinous process of C7?
```
trapezius,
rhomboid minor,
serratus posterior superior,
splenius capitis,
spinalis capitis,
spinalis cervicis,
semispinalis thoracis,
multifidis,
rotators, and
interspinalis
```
137
What ligaments attach to the spinous process of C7?
ligamentum nuchae and interspinous ligaments
138
The vertebral artery on which side is typically larger?
left vertebral artery
139
What is the gender bias regarding size of the vertebral artery?
men have larger vertebral arteries than women
140
What was the name of the physical exam used to determine vertebral artery patency?
the vertebrobasilar artery insufficiency test
141
Which side artery was tested during the course of the vertebrobasilar artery insufficiency exam?
the ipsilateral artery on the side of rotation
142
What are the symptoms of failure of the vertebral artery to compensate during the vertebrobasilar artery insufficiency exam?
dizziness, vertigo, nausea are common complaints
143
Typically, at what vertebral level will the vertebral artery first become located in the transverse foramen?
C6
144
At what location will the vertebral artery form its first compensatory loop?
the atlanto-axial interspace
145
At what location will the vertebral artery form its second compensatory loop?
the atlanto-occipital interspace
146
At what segments will the vertebral artery be firmly attached to the transverse foramen?
both C1 and C2
147
What is the purpose of the vertebral artery loops between C2, C1, and occiput?
the increased length will accommodate the greater rotation at these locations
148
What happens to the vertebral artery after it enters the subarachnoid space at C1?
the vertebral artery ascends along the medulla oblongata to the pontine- medullary junction where the right and left arteries unite to form the basilar artery
149
Which suboccipital muscles attach to C1?
rectus capitis posterior minor,
obliquus capitis superior, and
obliquus capitis inferior
150
Which suboccipital muscles attach to C2?
rectus capitis posterior major and obliquus capitis inferior
151
What joint classifications are present at C1?
synovial (diarthrosis) ellipsoidal,
synovial pivot (diarthrosis trochoid),
synovial plane (diarthrosis arthrodia), and
fibrous (amphiarthrosis) syndesmosis
152
What joint classifications are present at C2?
synovial pivot (diarthrosis trochoid),
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis joint
153
What joint classifications are present at each typical cervical?
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis
154
What joint classifications are present at C7?
synovial plane (diarthrosis arthrodia),
modified synovial saddle (diarthrosis sellar),
fibrous (amphiarthrosis) syndesmosis, and
cartilaginous (amphiarthrosis) symphysis
155
What forms the anterior boundary for the C2 nerve exit from the spinal canal?
inferior articular process of C1, superior articular process of C2, capsular ligament
156
What forms the posterior boundary for the C2 nerve exit from the spinal canal?
the posterior arch of C1, lamina of C2, and posterior atlanto-axial ligament
157
What forms the boundaries for the exit of the C1 nerve from the spinal canal?
```
occipital condyle,
superior articular process of C1,
capsular ligament,
arcuate rim,
groove for the vertebral artery,
posterior atlanto-occipital ligament
```
158
What forms the boundaries for the exit of the C2 nerve from the spinal canal?
```
inferior articular process of C1,
superior articular process of C2,
capsular ligament,
inferior vertebral notch of C1,
superior vertebral notch of C2,
posterior arch of C1,
lamina of C2,
posterior atlanto-axial ligament
```
159
What forms the anterior boundary for the C3-C7 nerve exit from the spinal canal?
```
the vertebral bodies,
intervertebral disc,
posterior longitudinal ligament,
uncinate process,
lateral groove
```
160
What forms the anterior boundary for the C8 nerve exit from the spinal canal?
```
the vertebral bodies of C7 and T1,
intervertebral disc,
posterior longitudinal ligament,
capsular ligament of the costocentral joint,
superior costal facet of T1, and
articular surface of the first rib
```
161
What are the superior articular facet orientations for the cervical vertebrae?
C1 is backward, upward, medial (BUM),
C2 is backward, upward, lateral (BUL)
C3-C7 is backward, upward, medial (BUM)
162
What are the inferior articular facet orientations for the cervical vertebrae?
C1 is backward, downward, medial (BMD)
C2-C6 is forward, downward, lateral (FoLD)
C7 is forward, downward, medial (ForMeD)
163
How many synovial joints are identified for each cervical vertebra?
```
C1 = five
C2 = eight
C3-C6 = eight
C7 = six
```
164
How many joints are identified at the vertebral body of each cervical vertebra?
```
C1 = none
C2 = ten
C3-C6 = ten
C7 = eight
```
