Spinal anatomy

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

Fasciculus cuneatus, fasciculus gracilis, medial lemniscus, neospinothalamic, paleospinothalamic, spinoreticular, cuneocerebellar, dorsal spinocerebellar
Ventral spinocerebellar, ventral trigeminothalamic, spinotrigeminal
Corticospinal, corticobulbar
Reticulospinal, reticulobulbar, rubrospinal, tectospinal, lateral vestibulospinal, medial vestibulospinal, medial longitudinal fasciculus
Vestibulocerebellum, spinocerebellum, pontocerebellum