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104 Cards in this Set
- Front
- Back
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Where is the conus medullaris found at birth vs skeletal maturity?
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L3 at birth, L1 by skeletal maturity
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How many total vertebrae in the spine?
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33: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 fused coccygeal
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Vertebral bodies generally increase in width in a cranoicaudad direction, with the exception of what?
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T1-T3
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What topographic landmark is associated with the following spinal level?
C2-C3 |
Mandible
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What topographic landmark is associated with the following spinal level?
C3 |
Hyoid Cartilage
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What topographic landmark is associated with the following spinal level?
C4-C5 |
Thyroid Cartilage
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What topographic landmark is associated with the following spinal level?
C6 |
Cricoid Cartilage
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What topographic landmark is associated with the following spinal level?
C7 |
Vertebra prominens
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What topographic landmark is associated with the following spinal level?
T3 |
Scapular Spine
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What topographic landmark is associated with the following spinal level?
T7 |
Distal tip of the scapula
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What topographic landmark is associated with the following spinal level?
L4-L5 |
Iliac Crest
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What is unique about the the shape of C1 (atlas)? How are the superior facets shaped?
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No vertebral body and no spinous process. There are 2 concave superior facets for articulation with the occipital condyles
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Where does the highest percentage of neck flexion and extension occur?
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At the occiput-c1 articulation (50% of flexion/extension comes from here)
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What 3 primary ossification centers do all vertebrae have in common?
When do these unite? What order do they unite in? |
An ossification center in the body and one cartilaginous center for each arch
Arches unite dorsally at the third month of fetal life. The arches fuse with the body during the seventh year of life. Union is in the following order: Thoracic, Cervical, Lumbar, Sacral. Failure of arch formation - spina bifida |
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What are the 5 secondary ossification centers associated with all vertebrae? When do these appear?
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2 transverse process
1 spinous process 2 body end plates These do not appear until after puberty |
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Ossification of the atlas, axis, sacral, and coccygeal vertebrae are unique. What is unique about the axis (C2)?
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The axis has 5 primary and 2 secondary ossification centers.
3 primaries are the same as for other vertebrae: 1 in the body and 1 for each arch. The apex of the odontoid process has a separate body which appears at 2 years old and fuses by 12 years old The base of the odontoid 2 centers at the base of the odontoid form at 6 months of fetal life and fuse before birth. The base of the odontoid is separated from the body by a cartilaginous disk which gradually becomes ossified around the edges by 7 years of age There is a secondary center under the surface of the body |
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Why doesn't C1 have a vertebral body?
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The dens is formed from two primary growth centers that originate from the body of C1
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The sacrum is formed from the fusion of how many spinal elements?
What is the sacral promontory? How many pairs of pelvic sacral foramina are there and what are they for? The sacral canal opens caudally into what structure? |
- The sacrum is formed from the fusion of five spinal elements.
- The sacral promontory is an anterosuperior portion that projects into the pelvis. - Four pairs of pelvic sacral foramina located both anteriorly and posteriorly transmit respective ventral and dorsal branches of the upper four sacral nerves. - The sacral canal opens caudally into the sacral hiatus. |
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How many spinal elements make up the coccyx? What attaches to the coccyx?
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The coccyx is formed from the fusion of the lowest four spinal elements.
It attaches dorsally to the gluteus maximus, the external anal sphincter, and the coccygeal muscles. |
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Why does the base of the dens narrow?
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Because of the transverse ligament
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Where does most neck rotation occur?
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Atlantoaxial articulation is responsible for the majority of neck rotation; 50% of total rotation occurs at the C1-C2 articulation.
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What is unique about the articulation of the atlantoaxial joint and what disease can lead to instability because of this feature?
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The atlantoaxial joint is diarthrodial (synovial, allowing for a great amount of movement)
Pannus in rheumatoid arthritis can affect this articulation and result in instability - clearance necessary for elective procedures |
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What is unique about the c1 vertebra?
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Has an anterior arch and no vertebral body
A branch of the vertebral artery (V3v) passes through the transverse foramen but the main vertebral artery travels across the posterior arch of the atlas through the suboccipital triangle before entering the foramen magnum. The suboccipital nerve lies between the artery and the posterior arch |
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C2-C7 have foramina in each transverse process all but 1 vertebra has a bifid spinous process, which is it?
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C7 (vertebra prominens) does not have a bifid spinous process. C2-C6 do
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Where is the carotid tubercle (Chassaignac's tubercle) found and what is its significance?
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This is the anterior tubercle of the transverse process of C6, separating the carotid artery from the vertebral artery and against which the carotid artery may be compressed by the finger in order to treat SVT
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What is the normal diameter of the cervical spinal canal?
The cervical cord can become compromised when the diameter is reduced to less than what? |
Normal: 17mm
Compromised at less than 13mm |
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Costal facets are a unique feature of the thoracic spine. Where are these found?
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All 12 vertebral bodies and the transverse processes of T1 to T9
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What is the difference in the shape of the vertebral foramen between the thoracic spine and the rest of the spine?
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Thoracic vertebral foramina are round. Cervical and lumbar are triangular
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Lumbar vertebrae are the largest, the have short laminae and pedicales and a massive vertebral body.
What feature of the lumbar vertebrae leads to lumbar lordosis? What is the normal range of lordosis? Where is the apex of the lordosis? 66% of lordosis occurs in what region? |
Lumbar vertebrae higher anteriorly than posteriorly
Normal lordosis: 55-60 degrees Apex at L3 66% of lordosis occurs in the region from L4 to the sacrum |
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What feature of the lumbar spine has a separate ossification center that projects posteriorly from the superior articular facet?
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Mamillary processes
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What is the most common cause of back pain in children and adolescents?
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Spondylolysis is a defect in the pars interarticularis and the most common cause of back pain in children and adolescents.
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When do the 4 transverse lines that indicate fusion lines of the 5 sacral vertebra appear?
What projects inferiorly on each side of the hiatus on the inferior process of S5? |
After age 20
Sacral hornal project inferior @ S5 |
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Vertebral bodies are bound together by the anterior and posterior longitudinal ligaments. Which is stronger? Separate fibers of the ALL extend how many levels?
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The ALL is stronger. It is usually thicker at the center and thins at the periphery
Separate fibers of ALL extent from 1-5 levels |
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What motion does the ALL prevent?
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Prevents hyperextension of the vertebral spine
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How far does the PLL extend?
What space is present between the PLL and vertebral body? What is the shape of the PLL and how does this relate to ruptured discs? What motion does the PLL prevent in the spine? |
- Extends from occiput (tectorial membrane) to the posterior sacrum
- Separated from the center of the vertebral body by a space that allows passage of the dorsal branches of the spinal artery and veins - Hourglass-shaped, with the wider (yet thinner) sections located over the discs; ruptured discs tend to be lateral to these expansions - PLL prevents hyperflexion |
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What does the ligamentum flavum connect?
What are the attachments of the ligamentum flavum? Hypertrophy of ligamentum flavum can lead to what? |
- Strong, yellow, elastic ligament connecting the laminae
- Runs from the ANTERIOR SURFACE OF THE SUPERIOR LAMINA to the POSTERIOR SURFACE OF THE INFERIOR LAMINA and is constantly in tension - Hypertrophy of the ligamentum flavum is said to contribute to nerve root compression |
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How much do the intertransverse ligaments contribute to interspinous stability?
The supraspinous ligament lies _________ to the spinous processes, and interspinous ligament lies ___________ the spinous processes |
These are ligamentous capsules overlying the zygapophyseal joints; the intertransverse ligaments contribute little to interspinous stability.
Supraspinous ligament lies DORSAL to the spinous processes, and interspinous ligament lies BETWEEN the spinous processes |
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The supraspinous ligament begins at what level and is in continuity with what other structure
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The supraspinous ligament begins at C7 and is in continuity with the ligamentum nuchae (which runs from C7 to the occiput).
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The denis model of spine columns breaks the spine down into 3 columns, anterior, middle, and posterior.
What structures provide anterior stability? |
Anterior longitudinal ligament, anterior two thirds of annulus and vertebral body
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The denis model of spine columns breaks the spine down into 3 columns, anterior, middle, and posterior.
What structures provide the middle stability? |
Posterior third of body and annulus, posterior longitudinal ligament
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The denis model of spine columns breaks the spine down into 3 columns, anterior, middle, and posterior.
What structures provide posterior stability? |
Pedicles, facets and facet capsules, spinous processes, posterior ligaments that include interspinous and supraspinous ligaments, ligamentum flavum
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There are specialized ligaments associated with the atlanto-occpital joint:
Composed of two articular capsules (anterior and posterior) and the_____________ (a cephalad extension of the posterior longitudinal ligament) Further stabilization is provided by the ligamentous attachments to the _________ |
Composed of two articular capsules (anterior and posterior) and the TECTORIAL MEMBRANE (a cephalad extension of the posterior longitudinal ligament)
Further stabilization is provided by the ligamentous attachments to the DENS |
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There are specialized ligaments associated with the atlanto-axial joint:
What is the major stabilizer of the A-A joint? Further stabilization is provided by what 2 structures that compose the cruciate ligament? What ligaments run obliquely from the tip of the dens to the occiput? |
- The transverse ligament is the major stabilizer of the atlantoaxial joint.
This articulation is further stabilized by the apical ligament (longitudinal), which, together with the transverse axial ligament, composes the cruciate ligament. A pair of alar (“check”) ligaments runs obliquely from the tip of the dens to the occiput |
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How would disruption of the transverse axial ligament with intact alar ligaments lead to?
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The disruption of the transverse axial ligament (TAL) with intact alar ligaments results in C1-C2 instability without cord compression
That is why the alar ligaments are called the "check" ligaments |
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What atlanto-dens interval measurement and space available for the cord measurement requires stabilization prior to elective orthopedic surgery?
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An atlanto-dens interval (ADI) of more than 7 to 10 mm or a posterior space (SAC) of less than 13 mm is a relative contraindication to elective orthopaedic surgery, and the spine should be stabilized first.
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What ligament connects L5 to the sacrum? Tension can lead to what with a vertical pelvic shear fracture?
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The stout Iliolumbar ligament
Tension on this ligament in patients with unstable vertical shear pelvic fractures can lead to avulsion fractures of the transverse process. |
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What dictates the plane of motion at each relative level of the spine?
What is the sagital and coronal orientation with each spinal level? |
The orientation of the facets which varies with the spinal level
Cervical - Sagittal: 45; Coronal: Neutral Thoracic - Sagittal: 60; Coronal: 20 posterior Lumbar - Sagittal: 90; Coronal: 45 anterior **NOTE: There is a table in Miller's on p. 177 that is much much more accurate (ie picky). I say eff that |
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What is the relationship of the superior articular facet to the inferior articular facet in each spinal level? Where do the nerve roots exit?
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Cervical spine - Superior articular facet is anterior and inferior to the inferior articular process of the vertebra above. Nerve roots exit near the superior articulation
Thoracic spine - Superior articular facet is anterior and medial to the inferior articular process of vertebra above Lumbar spine: The superior articular facet is anterior and lateral to the inferior articular facets |
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Intervertebral discs account for how much of the total height of the spinal column?
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25%
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What is the difference in makeup of the annulus fibrosis and nucleus pulposus?
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Annulus: Type I collagen
Nucleus pulposis: Type II collagen; softer than annulus. High polysaccharide content and ~88% water. Aging results in loss of water and conversion to fibrocartilage |
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Intradisc pressure is position dependent. When is it the lowest and highest?
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Pressure is lowest in supine position and highest in the sitting position and flexed forward with weights on the hands
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What are the borders of the suboccipital triangle?
What is found in the suboccipital triangle? |
The superior and inferior heads of the obliquus capitis muscle and the rectus capitis posterior major muscle form this triangle.
The vertebral artery and the first cervical nerve are within this triangle, and the greater occipital nerve (C2) is superficial |
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What is the origin, insertion, action, and innervation for the following muscle?
Rectus capitis posterior major |
Origin: Spine of axis
Insertion: Inferior nuchal line Action: Extend, rotate, laterally flex Innervation: Suboccipital nerve |
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What is the origin, insertion, action, and innervation for the following muscle?
Rectus capitis posterior major |
Origin: Posterior tubercle of atlas
Insertion: Occipital bone Action: Extend, laterally flex Innervation: Suboccipital nerve |
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What is the origin, insertion, action, and innervation for the following muscle?
Obliquus capitis superior |
Origin: Atlas transverse process
Insertion: Occipital bone Action: Extend, rotate, laterally flex Innervation: Suboccipital nerve |
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What is the origin, insertion, action, and innervation for the following muscle?
Obliquus capitis inferior |
Origin: Spine of axis
Insertion: Atlast transverse process Action: Extend, laterally rotate Innervation: Suboccipital nerve |
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What is the origin, insertion, action, and innervation for the following muscle?
Serratus posterior superior |
Origin: Spinous process C7-T3
Insertion: Ribs 2-5 (upper border) Action: Elevate ribs Innervation: Intercostal nerve (T1-4) |
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What is the origin, insertion, action, and innervation for the following muscle?
Serratus posterior inferior |
Origin: Spinous process T11-L3
Insertion: Ribs 9-12 (lower border) Action: Depress ribs Innervation: Intercostal nerve (T9-12) |
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What is the origin, insertion, action, and innervation for the following muscle?
Splenius capitis |
Origin: Ligamentum nuchae
Insertion: Mastoid & nuchal line Action: Both: laterally flex & rotate neck to same side Innervation: Dorsal rami of inferior cervical nerves |
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What is the origin, insertion, action, and innervation for the following muscle?
Splenius cervicis |
Origin: Spinous process T3-6
Insertion: Transverse process C1-3 Action: Bilaterally: Extend the head & neck, Unilaterally: Lateral flexion to the same side, Rotation to the same side. Innervation: Posterior rami of the lower Cervical spinal nerves |
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What is the origin, insertion, action, and innervation for the following muscle?
Ilioicostalis |
Origin: Sacrum/Illiac Crest/Spinous Processes of lower lumbar/thoracic vertebrae
Insertion: Ribs Action: Laterally: Flex the head and neck to the same side. Bilaterally: Extend the vertebral column. Innervation: Dorsal rami of spinal nerves |
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What is the origin, insertion, action, and innervation for the following muscle?
Longissimus |
Origin: Common origin: Sacrum, iliac crest, and lumbar spinous process.
Insertion: T&C spinous process, mastoid process Action: Laterally: Flex the head and neck to the same side. Bilaterally: Extend the vertebral column. Innervation: Dorsal rami of spinal nerves |
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What is the origin, insertion, action, and innervation for the following muscle?
Spinalis |
Origin: Common origin: Sacrum, iliac crest, and lumbar spinous process.
Insertion: T-spine: spinous process Action: Laterally: Flex the head and neck to the same side. Bilaterally: Extend the vertebral column. Innervation: Dorsal rami of spinal nerves |
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What is the origin, insertion, action, and innervation for the following muscle?
Semispinalis (C&T) |
Origin: Transverse processes of the upper five or six thoracic vertebræ
Insertion: Cervical spinous processes, from the axis to the fifth cervical vertebra Action: Extend, rotate opposite side Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Semispinalis capitis |
Origin: Transverse processes of lower cervical and higher thoracic column
Insertion: Area between superior and inferior nuchal line Action: Extends the head Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Multifidus (C2-S4) |
Origin: Transverse process
Insertion: Spinous process Action: Flex, laterally rotate opposite Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Rotatores |
Origin: Transverse process
Insertion: Spinous process + 1 Action: Rotate superior vertebrae opposite Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Levator costarum |
Origin: Transverse Process
Insertion: Brevis: Rib 1; Longus: Rib 2 Action: Elevate rib during inspiration Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Interspinales |
The Interspinales are short muscular fasciculi, placed in pairs between the spinous processes of the contiguous vertebræ, one on either side of the interspinal ligament.
Origin: Spinous process Insertion: Spinous process + 1 Action: Extend column Innervation: Dorsal primary rami |
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What is the origin, insertion, action, and innervation for the following muscle?
Intertransversarii |
Origin: Transverse process
Insertion: Transverse process + 1 Action: Laterally flex column Innervation: Dorsal primary rami |
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The space for the cord is greatest in what area of the spine?
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Cervical spine
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The following spinal cord tract is responsible for what?
Dorsal columns Lateral spinothalamic Anterior spinothalamic Lateral corticospinal Anterior corticospinal |
Dorsal columns: Deep touch, proprioception, vibration
Lateral spinothalamic: Pain and temperature Anterior spinothalamic: Light touch Anterior/Lateral corticospinal: Voluntary motor |
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Why does central cord syndrome affect the upper extremities more than the lower?
What is the prognosis of this? |
Sacral structures are the most peripheral in the lateral corticospinal tracts, cervical structures are more medial
Prognosis: 75% recover Central cord syndrome: Weakness in UE>LE, sacral sensation spared. Common in elderly who fall, associated with spondylosis, hemorrhage, and edema in central cord. Grey matter injury |
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With anterior cord (anterior spinal artery syndrome)
What is the injury mechanism? What is the prognosis? What is damaged and what is spared? |
Mechanism: Flexion injury
Prognosis: Worst, 10% recovery Damaged: Spinothalamic (loss of pain and temp sensation), Corticospinal(paralysis, LE>UE) Spared: Dorsal columns: Vibration & proprioception |
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With brown-sequard syndrome (hemisection of the cord):
What is the typical mechanism? What is the prognosis? What is out? |
Mechanism: Usually penetrating trauma
Prognosis: Best, > 90% recovery Loss of ipsilateral motor, vibration, and proprioception, contralateral pain, temp, touch 2 levels below the level of injury due to decussation in the cord and the fact that it takes 2-3 levels to decusate |
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Within the subarachnoid space, what comes together to form the spinal nerve?
Where does it become extradural? |
The dorsal root and ventral roots converge to form the spinal nerve which becomes extradural is it approaches the intervertebral foramen
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What is the difference in where the spinal nerves exit in the c spine vs the L spine?
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In the cervical spine, the numbered nerve exits at a level above the pedicle of the corresponding vertebral level (e.g., the C2 nerve exits at the level of vertebrae C1 to C2).
In the lumbar spine, the nerve root traverses the respective disc space above the named vertebral body and exits the respective foramen under the pedicle |
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What would be the difference in compression with a desc herniation at the level of L4 to L5 with a central herniation vs a far lateral herniation?
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A central disc herniation at the level of L4 to L5 would cause compression of the traversing L5 nerve root, resulting in a positive tension sign (straight-leg raise) and diminished strength in the hip abductors and extensor hallucis longus (EHL) and pain and numbness in the lateral leg to the dorsum of the foot.
A far lateral disc herniation at the level of L4 to L5 would compress the exiting L4 nerve root, resulting in a positive tension sign (femoral nerve stretch test) and L4 nerve compromise. |
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For the following neurologic levels, what muscle is representative and what reflex is associated (if there is an association).
C5 C6 C7 C8 T1 L4 L5 S1 |
C5 Deltoid Biceps
C6 Wrist extension Brachioradialis C7 Wrist flexion Triceps C8 Finger flexion T1 Interossei L4 Tibialis anterior Patellar L5 Toe extensors S1 Peroneal Achilles |
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What is the location of the cerrvical sympathetic ganglia?
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Superior: C2-C3; largest
Middle: C6; Variable Inferior: C7-T1; Stellate, disruption -> Horner's |
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Where is the spinal blood supply from?
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From segmental arteries located at vertebral midbodies via the aorta
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What is the distance from the spinous process of C1 laterally to the vertebral artery?
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2 cm
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Where does the artery of Adamkiewicz run?
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Enters through the left intervertebral foramen in the lower thoracic spine from T8 to T12; it supplies the interior two thirds of the anterior cord
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What is the definition of an unstable vertebral fracture?
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Greater than 1 column involved in the fracture
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
C1 (Atlas) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
C2 (Axis) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
Cervical (C3-C7) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
Thoracic (T1-T12) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
Lumbar (L1-L5) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
Sacral (S1-S5, fused) |
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What are the ossification centers, age of ossification, and age of fusion for the following vertebrae?
Coccygeal (4 fused) |
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What are the features of spinal shock and what signifies the end of spinal shock?
What if the bulbocavernosus returns and they're still paralyzed? |
Features: cord injury with paralysis and areflexia.
Return of bulbocavernosus reflex marks the end of spinal shock If still paralyzed, you show that this is a complete cord injury and not caused by spinal shock |
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Hypotension + bradycardia = ?
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Neurogenic shock; due to unopposed vagal tone
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Name 3 synovial joints in the spine
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Facet joints, atlanto-dens joint, and the costovertebral joints
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What is the most common location for pseudosubluxation in a child < 8 y.o.?
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C2-C3. You will see that the spinolaminar line remains intact
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On lateral c-spine film the prevertebral soft tissue should measure what at C3 and what at C7?
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< 7mm @ C3 and < 21mm at C7
Remember: 7x3=21 |
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What is the Anderson & D'Alonzo classifcation for dens fractures?
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Type I: transverse fracture at just the tip
Type II: Transverse fx at the base of the dens Type III: Transsverse fx through body of C2 |
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Cervical spondylosis is most common at what level?
What will the XR show? |
C5-C6. XR shows osteophytes, spinal stenosis, narrowed disk space, facet OA, instability
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Where is a lumbar disk herniation most common?
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L4-L5
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What is Scheurmann's disease?
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Thoracic kyphosis with 3 contiguous wedge-shaped vertebrae with a Cobb > 45 degrees.
Schmorl nodes seen (cartilage in vertebral body) |
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What are the 6 types of spondylolisthesis?
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- 1. Congenital: Facet defect of S1
- 2. Isthmic (most common): parse defect L5-S1 associated with hyperextension - 3. Degenerative: Facet arthropathy, most commonly L4-L5 - 4. Traumatic - 5. Pathologic - 6. Iatrogenic |
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What is spondylolysis?
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A parse defect or stress fracture without slippage (Scottie dog wearing a collar)
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Describe the blood supply of the spinal cord
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From the anterior and posterior spinal arteries and segmental branches of the vertebral artery and dorsal arteries, which travel via the dorsal and ventral rootlets to the respective dorsal and anterolateral portions of the cord
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