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70 Cards in this Set

  • Front
  • Back
How many vertebrae does an adult vertebral column have and what are the regions?
33 vertebrae – five regions: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), 4 coccygeal (fused)
Discuss the curvature of the vertebral column in a newborn vs. adult.
Newborn: C-shaped curvature of the spine
Adult: Sinusoidal shape – thoracic and sacral curvature kyphoses (posterior convex) – cervical and lumbar curvature lordoses (anterior convex)
What are the functions of the vertebral column
1.Protection - holds the spinal cord and beginnings of the spinal nerves
2.Movement - muscles attached allow for improved ambulation
3.Support - musculoskeletal structures
5.Attachemnt - limbs are directly and indirectly attached
Describe the following landmarks:
1. Vertebra prominens
2. Scapula
3. Tuffier's line
1.Spinous process of C7 vertebra, easily palpable
2.Located between T2 and T7, used when trying to find T4 intercostal space
3.Crosses the L4-L5 junction, connects the tops of the iliac crests; since the spinal cord ends at L1 or L2 using Tuffier's line, you can access area where there is cerebrospinal fluid space and no spinal cord
What are the primary curvatures and when are they developed
Thoracic and sacral curvatures - deverloped in utero
What are the secondary curvatures and whena are they developed
Cervical and Lumbar curvatures - developed when infant raise head (cervical) and begins to walk (lumber)
What is the reason for the curvature of the cervical region? Lumbar region?
Cervical spine - intervetebral discs (IV discs) have a taller anterior
Lumbar spine - lumbar vertebrae bodies have a taller anterior
What are some abnormalities of the spine?
1. Scoliosis - extra half of a vertebra
2. Lordosis - exagerated curvature of the lumbar region (temporary in pregnant women)
3. Kyphosis - exagerated curvature of the thoracic region (humpback or Dowager's hump)
4. Spina bifida - hernial protrusion of teh meninges and maybe spinal cord
What determines our height and why do we regress to the C-shaped curve in age?
Vertebrae and IV discs determine our height. With age, IV discs desiccate and diminish causing us to shrink, regressing back to C-shape
What are the parts of a TYPICAL vertebra?
Vertebral body, vertebral arch, pedicle (attach posterior elements to the body), vertebral foramen (hole), laminae (two broad, flat plates of bone) and seven processes (2 transverse, 1 spinous, 2 superior articulate, 2 inferior articulate)
What is the zygapophysial joint?
When the superior articulate processes articulate with the inferior articulate processes
What are characteristics of the cervical vertebra?
1.Smallest vertebrae
2.Bifid spinous process
3.Transverse foramen
4.Largest vertebral foramen
5.Uncinate process forming a lateral joint
(refer to Lecture notes, outline VII A-Efor more elaboration on each)
What is the vertebral artery and its location?
Very first branch of the subclavian artery, enters the transverse foramen of C6 and runs up thru C1 entering the cranial cavity
Describe C1 (atlas).
Has no body (body migrated inferiorly and joined with the axis), has no spinous process (only anterior and posterior arches and tubercles)
Describe C2 (axis).
Has all of the characteristics of the cervical vertebra plus a dens (odontoid process)
How are the special characteristics of the atlas and axis used?
Atlas - superior articular facet accepts two convexities of the occipital bone that helps articulate here (saying "no")
Axis - odontoid articulates with the posterior surface of the anterior arch of C1, fusion of the bodies of the atlas and axis (saying "yes")
What are characteristics of the lower thoracic and lumbar regions?
1.Bulkier vertebrae
2.Hatchet shaped spinous process
3.Pars interarticularis
What is spondyolisthesis? Where is it most common?
The forward displacement of a lumbar vertebra on the one below it producing pain by compression of nerve roots. Most commone of the fifth lumbar vertebra on the first sacrum.
What are characteristics of the sacrum?
1.Remnants of superior articulate processes and spinous processes (compose the median sacral crest)
2.Sacral hiatus - canal from non-fusion of S4 and S5
3.Widen wings
4.Rudimentary IV discs
5.Articulate surface of the sacrum articulates with medial aspect of the coccyx
6.Curvature to offset weight and disperse over the ala and thru the lower extremeties
What is an intervertebral foramen?
An artificial foramen formed from two bones that if too small can pinch spinal nerves - can be caused by a herniated disc or by disc degeneration
Describe the intervetebral discs.
compose 1/4 of our height, IV discs consists of anulus fibrosus (outer fibrous part) and nucleus pulposus (gelatinous central mass)
Why is it possible to herniate the IV disc?
Because the anulus fibrosus is weaker posterolaterally, nucleus pulposus can bulge out creating a hernia and causing impingement of the spinal nerve below the disc.
What are the ligaments associated with the vertebral column and its stability?
1.Anterior longitudinal ligament (ALL)
2.Posterior longitudinal ligament (PLL)
3.Supraspinous ligament
4.Infraspinous ligament
5.Cruciate (cruciform) ligament
6.Alar ligament
7.Ligamentum flavum
8.Nuchal ligament
Compare ALL and PLL.
ALL runs from the sacrum to the base of the skull along the anterior side of the vertebral column and it prevents hyperextension.
PLL runs within the vertebral canal along the posterior part of the vertebral bodies and attaches at the base of the skull, which is known as the tectorial membrane. PLL inhibits hyperflexion of the spine and prevents herniation.
Compare supraspinous ligament and interspinous ligament.
Supraspinous - runs along most posterior part of the spinous process.
Interspinous - Runs between the spinous process.
Describe ligamenta flava, location and its function.
Highly concentrated elastic tissue that extends from the lamina above to the lamina below.
Helps restore hyperextended/hyperflexed spinal columns to neutral position and forms some of the border of the intervertebral foramen.
What does the ligamentum flavum become? What is its function?
Posterior atlanto-occipital membrane - extends fromt the posterior arches of C1 to the posterior margins of the foramen magnum
How is the ligamentum flavum used during lumbar punctures?
It is felt for so that the arachnoid space is not entered when accesssing the epidural space.
What is nuchal ligament and what is its function?
Ligament composed of thickened fibroelastic tissue extending from the external occipital protuberance and posterior border of the foramen magnum to the spinous processes of the cervical vertebrae.
Because of shortness of the C3-C5 spinous processes, it substitutes for bone in providing muscular attachments.
What is the purpose of the cruciate (cruciform) and alar ligaments?
Keep C1, C2, and occipital bones firmly in place, limiting cervical motion.
How are the zygapophysial joint innervated?
By articular branches that come from the medical branches of the posterior rami of spinal nerves. Two nerves for each joint
What is the Batson's plexus?
An elaborated venous system within the vertebral foramen that is composed of valveless veins that provide a pathway fromt the pelvis to the brain.
How does the posterior vertebral column receive its arterial blood supply?
The aorta and vertebral artery.
What are the two major groups of muscles?
Extrinsic back muscles - muscles that produce and control limb (superficial) and respiratory movements (intermediate)
Intrinsic back muscles - muscles that speicifically act on the vertebral column producing its movements and maintaining posture
What are the superficial extrinsic back muscles? What are their functions
Trapezius, latissimus dorsi, lavator scapulae, and rhomboids. These muscles connect the upper limbs to the trunk
Where do the superficial extrinsic muscles receive their nerve supply?
The anterior rami of cervical nerves
What cranial nerve innervates the trapezius?
Cranial nerve XI
What are the attachments of the trapezius?
At the base of the skull to the spinous process of T12 with multiple lateral attachments (clavicle, scapula)
What is a function of the trapezius?
Shrugging shoulders amongst various other functions
What are the attachments of the latissimus dorsi?
Lower half of the thoracic vertebrae down to the sacrum and ilium with extensive attachment into the lumbodorsal fascia ending by attaching to the humerus.
What is the use of the latissimus dorsi?
Adduction, internal rotation, and extension
What nerve innervates the latissimus dorsi?
Thoracodorsal nerve branched from the brachial plexus
What is hypothesized about the extrinsic muscles such as the latissiums dorsi?
They originated near the head and neck and migrated to the back with its nerve supply
What are the intermediate extrinsic back muscles? What is their function?
Serratus posterior superior and inferior
Attaches to the ribs and help function in breathing.
What structures make up the Triangle of Petit?
Latissimus dorsi, iliac crest, external abdominal oblique muscles
What is unique about the Triangle of Petit?
It is a weak area, where herniation is likely to occur
What structures make up the Triangle of Auscultation?
Trapezius, latissimus dorsi, scapula or rhomboid muscles
What is unique about the Triangle of Auscultation?
This area has less muscle so one can hear the thorax better.
How are the native intrinsic back muscles (deep back muscles) categorized?
According to their layers: superficial, intermediate, and deep
How are the intrinsic back muscles innervated? What are their functions?
By the posterior rami of spinal nerves.
Act to maintain posture and control movements of the vertebral column
What group of muscles fall into each category of superficial, intermediate, and deep intrinsic back muscles?
1.Superficial - splenius muscles
2.Intermediate - erector spinae muscles
3.Deep - transversospinalis muscle group
What are the splenius muscles? See Table 4.6A for origin, insertion, nerve supply, and main action.
Splenius capitis and splenius cervicis
What are the columns of erector spinae muscles and their location relative to the spine? See Table 4.6A for origin, insertion, nerve supply, and main action.
1.Most lateral group - iliocostalis column (iliocostalis lumborum, thoracis, cervicis)
2.Intermdiate group - longissimus column (longissimus lumborum, thoracis, cervicis)
3.Most medial group - Spinalis column (spinalis lumborum, thoracis, cervicis)
What are the OVERALL functions of the erector spinae muscles?
Help us remain erect, provide stability, and give strength to the vertebral column
Where do the erector spinae muscles receive their blood supply?
A branch of the intercostals (segmented arteries off the descending aorta) called the posterior intercostal artery
What muscles make up the transversospinal muscle group and what are their locations? See Table 4.6B for the origin, insertion, nerve supply, and main action of these muscles.
Superficial - Semispinalis
Deeper- multifidus
Deepest - rotatores
How many segments does each transversospinal muscle span?
Semispanalis: 4-6
Multifidus: 2-4
Rotatores: 1-2
Where do the transversospinal muscles run?
Run from transverse processes to the spine as a group
What are the three parts of the semispinalis? Which is the largest?
The parts are semispinalis capitis, thoracis, cervicis. The largest is the semispinalis capitis.
What are multifidus?
Short, triangular muscular bundles that attach along the whole length of the spinous process of the adjacent superior vertebra
What are rotatores?
Best developed muscles in the thoracic region, arise from the transverse process of one vertebra and insert into the root of the spinous processes of the next one or two vertebrae
What muscles are the smallest of the deep back muscles?
Interspinales, intertransversarii, levatores costarum
Where is the suboccipital triangel and what is its function?
Deep to the trapezius and semispinalis capitis muscles.
It helps stabilize the axis and the atlas to the occipital bone.
What muscles define the borders of the suboccipital triangle?
1.Inferior oblique muscle - from the spinous process of C2 extending laterally to the transverse process of C1 (defining the inferior border)
2.Superior oblique muscle - from the transverse process C1 to the occipital bone below the inferior nuchal line
3.Rectus capitis major - medically from the spinous process of C2 superiorly to the occipital bone and below the inferior nuchal line
What muscle is lateral to the rectus capitis major?
Rectus capitis minor
What is the function of the inferior/superior obliques and the rectus capitis posterior major/minor?
Obliques - Lateral rotation of the atlas on the axis
Rectus capitis - extension posteriorly of the nexk and the head
What are the nerves emerging in this area and the location each emerge from?
1.Suboccipital nerve (posterior ramus of C1)- emerges thru the suboccipital triangle
2.Greater occipital nerve (posterior ramus of C2) - emerges just below the triangle and passes superiorly onto the base of the skull
3.Lesser occipital nerve (posterior ramus of C3) - emerges a little distance below the triangle, laterally coming down and swinging up
The four small muscles in the suboccipital region are innervated by what nerve?
Suboccipital nerve (ramus of C1)
What is unique about the C1 nerve?
It has no dorsal root ganglion, so it only supplies the muscles of this area with a motor component (not a sensory)
Since all muscles have a motor and sensory innervation what nerve provides the sensory innervation to these muscles of the suboccipital region?
Greater occipital nerve (ramus of C2)