Vertebral Column And Back Flashcards
1
Q
Vertebral column curvatures
A
Primary Curvatures: Thoracic and Sacral regions
Secondary Curvatures: Cervical and Lumbar regions
These curvatures increase shock absorbing resilience
2
Q
How many Vertebrae in the Cervical Region?
A
7
3
Q
How many Vertebrae in the Thoracic Region?
A
12
4
Q
How many Vertebrae in the Lumbar Region?
A
5
5
Q
How many Vertebrae in the Sacral Region?
A
5
6
Q
How many Vertebrae in the Coccyx Region?
A
4 fused vertebrae
7
Q
Abnormal curvatures of the vertebral column
A
- Excessive kyphosis: excessive thoracic curvature
- Excessive lordosis: excessive lumbar curvature
- Scoliosis: abnormal lateral curvature with rotational deformity of vertebrae
8
Q
DIAGRAM OF VERTEBRAL FEATURES
A
9
Q
Where is the Pars interarticularis located
A
- is an oblique area of bone located between the base of the superior and inferior articulate process on each side. Is a potential weak point of the vertebrae
10
Q
Clinical significance of the pars interarticularis / pars defect
A
- Spondylolysis: fracture of the pars interarticularis (mostly congenital but can occur due to repeated hyperextension of back)
- Spondylolisthesis: complete bilateral fracture of pars interarticularis causing anterior slippage of the vertebrae. (90% occurring at lumbosacral joint (l5-s1))
11
Q
What planes are each of the motions of the vertebral column?
A
Flexion/ Extension = Saggital
Lateral flexion / extension = Coronal
Rotation = transverse
12
Q
Characteristics of Cervical vertebrae
A
13
Q
Characteristics of Thoracic vertebrae
A
14
Q
Characteristics of Lumbar vertebrae
A
15
Q
Characteristics of Lumbar vertebrae
A
16
Q
Characteristics of Sacral vertebrae
A
17
Q
Characteristics of coccyx
A
18
Q
A
19
Q
What is the effect of aging on vertebrae
A
- Bone density and strength decrease with age (from the 4th decade - spondylosis)
- concave appearance due to central portion of vertebral body bowing in
- altered mechanical stresses can change bone shape leading to osteopaths (bone spores)
- Resistance exercise increases bone strength
20
Q
What are the 6 types of joints of the vertebral column?
A
- Joints of the vertebral bodies
- joints of the vertebral arches
- Craniovertebral joints
- Uncovertebral joints
- Costovertebral joints
- Sacroiliac joints
21
Q
What is a motion segment and what does it contain?
A
- A motion segment is the functional unit of the vertebral column and contains 3 joints
- Intervertebral disc (symphysis, secondary fibrocartilage): no joint space, role in shock absorption, joins bodies
- Zygapophyseal joints R & L (Synovial plane joint) between superior and inferior articulation processes of vertebrae below and above
22
Q
Movements permitted by motion segments
A
Small segmental ROM, large total ROM
- flexion, extension
- Lateral flexion
- Rotation
23
Q
3 components of an IV disc
A
- Hyaline cartilaginous end plate: confines other 2 components, provides nutrition to disc, transmits weight to adjacent bodies
- Annulus Fibrosis: Thick fibrocartilaginous rings alternating directions in each layer to withstand strain
- Nucleus Pulposis: Central gelatinous substance with high fluid content, distributes pressure throughout disc. Allows for shock absorption and keeps bodies apart, allows frictionless movement for bodies to roll over one another
24
Q
Innervation, vasculature and length of IV discs
A
- outer 1/3 annulus fibrosis innervated
- largely avascular and relies on body movement to pump nutrients and waste products in and out (diffusion)
- 25-33% of vertebral column length
- increases in thickness from superior to inferior
- thickest in cervical and lumbar regions to allow a greater ROM
25
26
IV discs of cervical region
27
IV discs of thoracic region
28
IV discs of lumbar regions
29
IV disc pathologies
Disc prolapse = penetration of the nucleus into the annulus, generally posterolaterally
Bulge = Annulus still in tact
Herniation: Nucleus breaks through pulposis
Extrusion: Nucleus breaks through pulposis and breaks of from original. Now a new foreign object within the vertebral column
- causes pain by affecting the Spinal nerve of the inferior disc
30
Anterior Longditudional Ligament
- anterior portion of vertebral bodies
- limits lumbar extension
31
Posterior Longitudinal Ligament
- posterior aspect of vertebral bodies
- limits lumbar flexion
32
Ligamentum flava
- ligament between lamina of vertebrae
- limits flexion
33
Interspinous Ligament
- ligament connecting superior spinal process to inferior articular process
- its oblique fibres control vertebral rotation throughout flexion
34
Supraspinous Ligament
- Ligament at posterior aspect of transverse processes.
- limits excessove forward flexion
35
Intertransverse Ligament
- ligament connecting transverse processes
36
Iliolumbar Ligament
resists flexion/ extension, rotation & lateral flexion at the L/S joint
37
Ankylosing Spondylitis
' Bamboo Spine'
- Ossification of annulus fibrosis as well as ossification of supraspinous and intraspinous ligament
- vertebrae fuse together, very limited movement
38
Angle of Cervical vertebrae and allowed movements
39
Angle of Thoracic vertebrae and allowed movements
40
Angle of Lumbar vertebrae and allowed movements
41
What are the 2 categories of Cervical Vertebrae
1. Craniovertebral: No IV disc
- Atlantooccipital and Atlanto - axial
42
Properties of Atlantooccipital joint
Between atlas and occipital bone. is synovial biaxial producing Flexion, extension and lateral flexion
43
Properties of Atlantoaxial joint
Between atlas and axis. Contains 2 lateral synovial gliding joints and 1 median synovial uniaxial pivot joint allowing 30 degree rotation
- allows 'no' movement
44
Properties of Uncovertebral joints
Found from vertebrae c3-c7. Synovial joints that DEVELOP (not born with it) between uncovertebral clefts in IV discs. is an articulation between the inferior uncinate process (superolaterally) and the superior vertebral body (inferolateral)
Purpose is to increase ROM
45
Post. Longitudional ligament changes name to ____ at ___ level
Post. Longitudional ligament changes name to the tectoral membrane at C2 level
NOTE: PLL reinforces vertebral bodies posteriorly that are missing cervical IV disc rings
46
Middle layer of cervical ligaments
Cruciform (transverse & longitudional)
- Transverse ligament stronger than the dens (C2), dens will fracture/breal before the ligament does
47
Deep layer of cervical ligaments
2x Alar ligaments (lateral)
1x apical ligament (medial)
48
Properties of X-Rays
- density of tissues provide contrast
- 2D view
- Excellent visibility of bone but muscle and nerve not visible
- fast scan time (<1s)
- low radiation dose
- cheap, readily available
49
Properties of CTs
- Density of tissues provide contrast
- 3D volume image created from multiple 2D cross sections
- Good visibility of bone (w/o superimposed shadows) and muscle but spinal cord/nerves barely visible
- Fast scan time (<10s)
- high radiation dose
- readily available unless remote
50
Properties of MRIs
- T1 relaxation and T2 decay provide constrast for image
- can give a 2D cross section or a 3D volume
- excellent view of muscle and spinal cord/nerves as well as a good view of bone
- Slow scan time (up to 1hr)
- No radiation dose
- Expensive
51
Properties of ultrasounds
- Density provides contrast for image
- Field of view is limited & 2D
- poor visibility of bone and good visibility of muscle as well as superficial nerves
- Quick scan time (real time)
- No radiation dose
- cheap, readily available
- often used in babies when bone is still primarily cartilage
52
isometric contraction
no muscle length change. force of gravity = force of contraction
53
concentric contraction
muscle shortening. force generated by muscle > force of gravity
54
eccentric contraction
muscle lengthening. force of gravity/load > force generated by muscle
55
What is an agonist
is the prime mover. main muscle for producing a movement
56
What is an antagonist
relaxes or lengthens progressively in coordination with prime mover
57
What is a fixator/ stabiliser/
steadies the proximal part of a limb via isometric contraction while movement ocurs in distal parts
58
What is a synergist?
- directly assists prime mover through aiding with the same movement
OR
- Indirectly assisting through being a fixator at an interventing joint when a prime mover crosser over MORE THAN ONE joint
59
Proximal vs Distal attachments
Proximal is closer to the midline and is typically origin
Distal is more lateral and is typically insertion
60
What are the muscles found in the 3 layers of the extrinsic back muscles? (from superficial to deep)
1. Trapezius and Levator Scapulae
2. Rhomboids major & minor, levator scapulae
3. Serratus posterior superior and inferior
61
Innervation of the extrinsic back muscles
all supplied by ventral rami apart from the trapezius which is supplied by the cranial accessory nerve
62
What are the three groups of intrinsic back muscles (from superficial to deep)
1. erector spinae. spans many vertebral segments, allows quicker & broader movements but actions not as stable
2. transversospinalis: spans some segments
3. uni-segmental group. spans from 1 vertebrae to another
63
3 groups of erector spinae (medial to lateral)
1. spinalis (thoracis, cervicis & captis) concentrically extends trunk
2. longissimus (thoracic, cervicis & capitis) extends trunk, head and neck
3. iliocostalis (lumorum, thoracis & cervicis) extends and ipsilaterally laterally flexes the trunk and neck
64
3 groups of transversospinalis (superficial to deep)
1. Semispinalis (thoracis, cervicis, capitis) spans 5-7 vertebral segments. Extends and contralaterally rotates trunk, neck & head
2. Multifidus. spans 2-5 vertebral segments. extends, contralaterally rotates and ipsilaterally laterally flexes trunk and neck
3. Rotatores: spans 1 vertebral segment (long & short fibres in THORACIC region). acts as a stabaliser and permits local extension and rotation
65
3 groups of the uni-segmental group
1. Intertransversarii: between transverse processes of adjacent vertebrae
2. Interspinales: between ligaments
3. levatores costarum: from inferior rib to superior stansverse process
66
What are the 4 layers of the extensor muscles of the head & neck? (superficial to deep)
Layer 1: Trapezius
Layer 2: Splenius & Levator Scapulae
Layer 3: Semispinalis (part of transversospinalis)
Layer 4: 4x Suboccipital muscles
67
What muscles make up the suboccipital triangle
medial border: Rectus capitis posterior major and minor
lateral border: obliquus capitis superior
inferior border: obliquus capitis inferior
68
Properties and contents of the suboccipital triangle
contains vertebral artery and suboccipital nerve (C1 post. ramus - motor) as well as the greater occipital nerve (C2 post. ramus - sensory)
muscle spindle of the suboccipital muscles are full of propriceptive fibres and thus play a large role in holding up the head
69
Purpose of thoracolumbar fascia and where is it found?
- Purpose is to provide dynamic stability of lumbar spine and sacroiliac joint through wrapping around intrinsic back muscles
- Provides a connection between the vertebral column, abdominal muscles and U&L limbs
70
What provides lumbopelvic stability?
intraabdominal pressure inside the abdominal cavity helps to stiffen the lumbar spine and prevent it from buckling under compressive loads
71
borders of the abdominal cavity
Superior: Diaphragm
Inferior: Pelvic floor & hip girdle
Anterolateral: Abdominal muscles
Posterior: paraspinal and gluteal muscles
72
Innervation of the extrinsic back muscles
nerves coming from the ventral rami
73
Nerves supplying the intrinsic back muscles
All come from dorsal rami:
- Lateral branch: iliocostalis & longissimus (both erector spinae)
- Medial branch: spinalis, transversospinalis & unisegmental muscles.
74
What else (other than intrinsic back muscles) does the medial branch of the dorsal rami innervate
also innervates zygapophyseal joints and the overlying skin
75
How does the vertebral column recieve its blood supply?
- 1x anterior spinal artery
- 2x posterior spinal arteries
These arteries are reinforced by other arteries throughout the body to ensure adequte blood supply
76
Segmental spinal arteries
Branch from named aortic artery and depends on region. exists at each spinal level
77
Anterior and posterior radicular arteries
branch from the segmental spinal artery and thus also occur at each vertebral level
supply nerve roots
78
Segmental medullary arteries
branch from segmental spinal arteries and only occur at some vertebral levels.
These arteries reinforce the spinal arteries to supply the spinal cord
79
How is blood drained in the vertebral column?
- external vertebral plexus: ouside vertebrae
- internal vertebral plexus: within vertebral canal/foramen
- contains ant. & post. segmental medullary/ radicular vein
- also has an anterior and a posterior spinal vein
- IV veins drain into vertebral posterior intercostal and lumbar veins which drain into the IVC or SVC
- post. intercostal veins drain into the azygous system and then the SVC
80
