Cervical Spine
How many segments in an adult spinal column? In a child? 26, 33
How many intervertebral discs does a vertebral column have? What is the overall height that it takes up? 23, 25%
Where does convexity in the spine? Concavity? concavity: cervical, lumbar; convexity: thoracic, sacrum
Kyphotic curves are primary or secondary? Lordotic curves? primary, secondary
How are secondary curves obtained? placing child on tummy so he/she can lift his/her head
What is hyperkyphosis/lordosis? What is hypokyphosis/lordosis? extreme vs. underwhelming curves
What do curves in the spinal curve serve? balance strength, stress
Which cervical vertebrae are typical? Which are atypical? C3-7 typical, C1-2 atypical
In which area of the spine are vertebral bodies the smallest? Biggest? cervical, lumbar
The inferior endplate is ________ side to side and ________ AP and has a __________ anteriorly. convex; concave; lip/beak
What forms an uncovertebral joint? What’s another name for an uncovertebral joint? semilunar facet and uncinate process; joint of von Lushka
What kind of facets on an uncinate process? semilunar facets
What do uncovertebral joints serve? stabilized lateral flexion
What happens when disc heights decrease? osteophytes
Pedicles in the cervical spine are ___ degress to the sagittal plane? 45
What do pedicles form? IVF
Are pedicles more oval or circular in the c-spine? Where are they ovoid? circular, ovoid in thoracic and lumbar
IVF’s are ____ degress to the sagittal plane. 45-60, more 60 than 45
TP’s in the cspine display what kind of shape? What angle are they to the sagittal plane? Caudal plane? gutter; 60 degrees to sagittal, 15 degrees caudal
What is found within the TP? transverse foramen
What runs through the transverse foramina? vertebral artery
What arises from the articular pillar? facets
What forms facet joints? Articular facets
Superior facets face what direction? Inferior facets? up and posterior; down and anterior
What angle are facet joints to the transverse plane? What’s another name for facet joints? What creates stress on facet joints? 45 degrees; zygophyseal joints;
What do lamina form when they come together? spinolaminar junction
Which sp in the cspine is the biggest? SP’s are bifid where in the c-spine? C2, C2-C7
Do SP’s angle downward of upward relative to the VB? downward
What are the AP dimensions of the central canal? 16 mm for C1, 14 mm for C2, 13 mm for C3, 12 mm onwards
What is Torg’s ratio? 80% central canal to vertebral body
What is the name of the facet that articulates with the odontoid process? fovea dens
Lateral masses of C1 slope what way? Is there a turbercle on lateral masses? inward from lateral to medial; yes, for the transverse ligament
What is Steel’s law of thirds? 1/3 for dens, 1/3 for cord, 1/3 for space
What is another name for C2? axis/epistropheus
Superior portion of C2 is atypical or typical? Inferior? atypical, typical
What is the odontoid process used for? pivot
True of false: inferior facets of C2 have semilunar facets. true
Is Tp of C2 smaller or bigger than Tp of C1? Are they bifid? Which way do they project? smaller; no; lateral
Does C2 have pars? yes
Which way do superior facets face? Inferior facets? up and lateral; down and lateral
Is SP of c2 bifid? yes
What is another name for C7? vertebral prominens
On which of the TP’s of the cspine would you not find an anterior tubercle but a large posterior tubercle? C7
Inferior facets of C7 of far or wide? farther apart and wider
What is the ADI space? What length should it be in adults? In kids? atlantodental interspace; 3 mm adults; 5 mm kids
What is Hangman’s Fracture? fracture at C2 at pars
Where is the first IVF formed? C2 pedicle
What is Wolfe’s Law? increase stress at ligamentous attachment sites, increase bone density
Thoracic Spine
What type of curvature is present within the thoracic spine? kyphotic
What does the thoracic cage consist of? 12 thoracic vertebrae, 12 ribs, sternum
What facets are found on the VBs? costal facets, demi facets
What facets are found on the TPs? costal facets
Where would you find imbrication on the thoracic spine? Which way do the SP’s point? What segments would you find them on? T5-8, obliquely downward
True or False: The foramina (IVF and central canal) of the Thoracic spine are the smallest within the whole spine? What clinical implications would you consider to be associated with it? true; stenosis
In typical Thoracic vertebrae, what type of body shape would you see? What shape does it exemplify near the top and what shape near the bottom? heart; rectangular, kidney bean
Do the lateral and anterior surfaces of the VB have concave or convex surfaces? concave
How many facets and processes are present on a thoracic segment? 10 facets, 7 processes
Which body height is shorter, posterior or anterior? What is the measurement of this shortage? 1-2 mm shorter anterior
A multi sport 16-year old male with mild low back pain comes to see you? You get the x-rays back and see that his anterior VB height is more than 1-2 mm shorter than the posterior VB height? What disease would you correspond this to? What ages is it common? Scheuermann’s disease; 13-17
Do thoracic pedicles angle 45 degrees from the midline of the segment or project straight back from the VB? project straight back
Where do the SAP’s and IAP’s project from? What structure on the thoracic segment? pars; junction of pedicle and lamina
Which way do the SAP’s face? What are the angles? superior, posterior, lateral; 60 degrees to horizontal and 20 degrees lateral
Which way do the IAP’s face? What are the angles? inferior, anterior, medial; 60 degrees to horizontal and 20 degrees medial
True or false: Thoracic laminae are thick, broad, imbricated. True
Where do the TP’s originate from? pars
Do TP’s increase or decrease in size from T1-T12? decrease
What do the oval facets of the TPs articulate with? rib tubercles
Why would you care for imbrication of T5-T8? vertebral body is superior to TPs
Which of the thoracic vertabrae are atypical? T1, T9-12
Which of the thoracic vertebrae are typical? T2-8
Would you find a full costal facet or demi costal facet on the VB of T1? full costal facet
What is it about the T1 SP that makes it atypical? body is rectangular like cervical vertebra, SP is anticlinal, widest TPs
T9 costal facet on the VB articulates with which rib? Is it a large demifacet or full costal facet? Which rib does it sometimes articulate with? 9; large demifacet; 10
What facets are found on the T10 VB? Which rib(s) does it articulate with? costal; 10
Where is the costal facet of T11 & T12 found? between body and pedicle
Is the SP of T11 anticlinal or imbricated? anticlinal
True or false: There is hardly any TP on T12. true
SAP of T12 is atypical or typical? typical
IAP of T12 faces which direction? Is it convex or concave? anterior and lateral; convex
What structures in the thoracic spine increase in size superior to inferior? VBs, pedicles
Which decrease in size? TPs
Which thoracic vertebrae are anticlincal? T1, T11
Which SPs of the thoracic spine are most imbricated? T5-8
The spinal canal is smallest in which segments? T4-9
How many pairs of ribs are there? 12
From PA which way do they angle? inferiorly
Which ribs articulate with the sternum via costal cartilage? 1-7
Which of the ribs is longest? 7
Where would you see the ribs begin to decrease in length? 8
How do ribs 8-10 connect with the sternum? costal cartilage of rib above
Do ribs 11 and 12 articulate with the sternum? no
What is costal cartilage made of? hyaline cartilage
Why is costal cartilage visible on x-rays? calcified
What is pectus excavatum? hollowed chest
What is neurofibromatosis? neurofibromas, lumps within the skin, scoliosis, hearing loss, vision loss
Lumbar Spine
How many segments are in the lumbar spine? 5
What kind of curvature is found in the lumbar spine? lordotic
True or false: Lumbar spine has costal facets. false
What type of shape does the lumbar VB display from above? kidney shaped
Which of the segments in the lumbar spine have a shorter anterior VB height than the posterior VB height? 1-2
Which of the segments in the lumbar spine have a shorter posterior VB height than the anterior VB height? 4-5
Is there any height difference between the anterior and posterior VB heights of L3? no
Which way do the pedicles of L1 and L2 extend? L3-5? straight back; 45 degrees
In which of the portions of the whole vertebral column would you find pedicles to be widest apart? lumbar
True or false: Laminae of the lumbar spine are short and broad. true
At which segment in the lumbar spine are the TP’s the widest? L3
How do the TP’s project from pedicle? lateral, posterior
Which way do the superior facets of the lumbar spine face? What kind of surface is it? Which way do the inferior facets face? What kind of surface is it? posterior, medial, concave; anterior, lateral, convex
In what plane would you find the facets of the upper lumbar spine to be in line with? sagittal
In what plane would you find the facets of the lower lumbar spine to be in line with? coronal
What is facet tropism? Is it common? one facet oriented in sagittal plane, other oriented in coronal plane; yes
Where do the mammillary processes extend from on the lumbar spine? posteriorly from SAP
What ligament and muscle attaches to the mammillary process? MAL, multifidi
What is the point of contact when adjusting the lumbar spine? mammillary process
What attaches to the accessory process? What purpose does it serve? MAL; protects medial branch of dorsal ramus nerve root
Where is it found on the lumbar vertabra? posterior aspect of TP base
“isthmus” of bone is located where? What’s located anterior, posterior, superior, and inferior to it (inferior aspect only occurs on two of the VB)? between SAP and IAP; SAP above, pedicle anterior, lamina posterior, IAP below at L1-2
IAP extends off the lamina in which of the segments of the lumbar spine? mid to lower lumbar spine
Which of the lumbar segments is atypical? L5
True or false: L5 is taller anterior than posterior. true
What impression is common on the inferior endplate of an xray image of the L5 segment? prominent nuclear impression
Where is the lateral recess located in the lumbar spine? medial aspect of pedicles
What is spondylosis? very small spurring at anterior vertebral body corners
What is spondylolysis? break in pars
How does spondylolysis occur? severe trauma, repetitive micro trauma
What view is best to see spondylolysis? lateral
What is spondylolisthesis? forward shift of VB
What is a backwards slip of the VB? retrolisthesis
What are one of the causes for spondylolisthesis? pars defects
What system is used to classify spondylolisthesis? Newman or Wiltse
How many types of spondylolisthesis are there? 6
What is type 1 spondylolisthesis? congenital or dysplastic
What shape does the L5 VB have? trapezoid
What is type 2 spondylolisthesis? isthmic (lytic)
What are the three subtypes of Spondylolisthesis? stress fracture (type A), elongated (type B), acute fracture (type C)
Where is spondylolisthesis common? L5
What is type 3 spondylolisthesis? degenerative
Are there any breaks in type 3? no
What allows the verebtra to slip forward in degenerative spondy? Where is type common? facet joint degeneration; L4
What is type 4 spondylolisthesis? traumatic
Where does the fracture occur in type 4? anywhere except pars
What is type 5 spondylolisthesis? pathologic
What may contribute to fracture in the VB in type 5? primary or metastatic brain tumors
What is type 6 spondylolisthesis? iatrogenic
What is the Meyerding Classification system? How many grades are there? How do you use it? quantify spondylolisthesis; 4; endplate of the level below slip is used as reference point, posteroinferior corner of slipped VB is observed, grade is determined
What is Ulman’s Line? 90 degree angle drawn from superior endplate of VB below; if VB above is over 90 degree angle, then spondylolisthesis
Composition of Bone
What are the 3 osseous cells of the bone? osteoblasts, osteoclasts, osteocytes
What builds bone? osteoblasts
What do osteoblasts secrete? osteoid
What is osteoid composed of? collagen, GAG
What are osteoblasts which are surrounded by mineralized osteoid? osteocytes
What do osteocytes communicate cell to cell with? canaliculi
What do canaliculi transport? waste and nutrients
What break down osteoclasts? bone
What are Howeship’s lacunae? contains osteoclasts, in bone which is undergoing reabsorption
What hormone helps to regulate serum calcium in the body? parathormone
What is hyperparathyroidism? too much osteoclast activity
What are Haversian canals? What axis do they run in? for blood supply, long axis
What are Volkmann canals? What plane do they run in? for blood supply, transverse plane
What is osteopenia? mild osteoporosis
What is osteoporosis? osteoclastic activity exceeds osteoblastic activity
What is used to evaluate osteoporosis? DEXA scan
What are some risk factors of osteoporosis? increased age, family history, female, small/petite body, smoking, low physical activity, diet
Idiopathic, neuromuscular, congenital are a structural or non-structural classification of osteoporosis? Which is the most common form of structural osteoporosis?
What is the %?
What is idiopathic scoliosis most common, what age groups? adolescent; 10+
What ages is progression of idiopathic scoliosis most rapid? 12-16
When does progression slow or stop? skeletal maturation
What is the Heuter-Volkmann Principle? tensile forces increase bone growth; compressive forces decrease bone growth
Do tensile forces stimulate or inhibit bone growth? Compressive forces? stimulate; inhibit
What is one common type of neuromuscular scoliosis? polio
What is congenital scoliosis associated with? hemivertebrae, block vertebrae, fusion of ribs
What can non-structural scoliosis be affected by? muscle tone, antalgia, limb length inequality
What is osteoid osteoma? benign bone tumor
What degrees would you consider slight convexity laterally in the spine? 0-9
What degress would you consider a mild scoliosis? 10-19
What degress would you consider a moderate scoliosis? 20-29
What degrees would you consider a marked scoliosis? 30-39
Muscles of the Spine
1. List the muscles that produce contralateral rotation of the spine.
rotatores, semispinalis, multifidus, SCM
2. List muscles that produce ipsilateral rotation.
longissimus capitus, splenius capitus, splenius cervicis, suboccipitals (all together), oblique capitus inferior, levator scapulae
3. List the muscles that primarily produce lateral flexion (little/no rotation).
Scalenes, Longissimus cervicis & thoracis, Iliocostalis, Levator scapulae (w/ scapula fixed), Intertrasversarii, Oblique capitus superior, Quadratus lumborum (w/ pelvis fixed)
4. Arrange this list of muscles from most deep to most superficial
Posterior: Splenius, Intertransversarii, Longissimus, Quadratus lumborum, Oblique capitus inferior, Multifidus
Anterior: Anterior Scalene, Rectus capitus anterior, Sternocleidomastoid, Longus capitus
CNS
Muscles of the back
Ligaments of the spine and pelvis
