Osseous Anatomy of the Spine
What angles are formed by the cervical/thoracic/lumbar facet joints in relation to the transverse (horizontal) plane?
Cervical- 45 degrees
Thoracic- 60 degrees
Lumbar- 90 degrees
Do ligaments have good blood supply and recovery times?
No, they have poor blood supply, long recovery times (6-9 months), usually do not regain 100% integrity.
Explain the nerve roots at cervical, thoracic, and lumbar. (how many in each, where they are located in comparison to vertebral body) ?
Cervical: C1-C7 cephalic to vertebral body, C8 caudal to C7
Thoracic: T1-T12 caudal to vertebral bodies
Lumbar: L1-L5 caudal to vertebral bodies
What is the difference between the Anterior spinal artery and posterior spinal artery in regards to space taken up?
ASA: Anterior 2/3
PSA: Posterior 1/3
What muscles are part of the superficial layer?
Splenius capitis
Splenis cervicis
What angles do the superior articular facets face in the cervical/thoracic/lumbar spine.
Cervical- Posterior, Superior, Medial
Thoracic- Posterior, Superior, Lateral
Lumbar- Posterior, Medial
What is Diffuse idiopathic skeletal hypertosis?
Bonus 100 points: what is it associated with?
Ossification of ALL, more common in the right side.
Bonus: Type 2 diabetes mellitus
What are the basic components of the intervertebral discs?
Annulus fibrosus, nucleus pulposus, endplates.
What is the Anterior Spinal Artery's location and clinical implications?
Arise from vertebral artery, anterior to median fissure, narrows at conus medullaris.
ASA syndrome: caused from ischemia, motor dysfunction, loss of pain and temp. sensation, acute bladder bowel changes.
What muscles are in the intermediate layer, what is their common name, and what is their orientation lateral to medial?
Iliocostalis: lumborumn, thoracis, cervicis
Longissimus: Thoracis, Cervicis, capitits
Spinalis: thoracis, cervicis, capitis
What angles do the inferior articular facets face?
Cervical- Anterior, Inferior, Lateral
Thoracic- Anterior, Inferior, Medial
Lumbar- Anterior, Lateral
What are the 3 main ligaments of the spine, where are they located, and which motion does it help prevent.
Anterior longitudinal ligament- Anterior VB of C2 to sacrum, connects mid portion of each VB. anterior to the vertebral body, hyperextension.
Posterior longitudinal ligament- Posterior VB of C2 to sacrum, attaches to intervertebral discs, posterior to VB in spinal canal, hyper flexion.
Ligamentum Flavum- Extends C2 to sacrum, connects laminae, posteirior boundary of spinal canal, aids in return to neutral spine.
What is the Nucleus pulposus made of and what is its importance?
Steal 100 points: what type of collagen is the annulus fibrosus and what is it called when a disc dries up.
Type II collagen and proteoglycans. Proteoglycans attract and retain water which maintains disc height and helps the disc to act as a shock absorber.
Steal: Type 1 collagen, desiccation
What is the posterior spinal artery's location and clinical application?
Mystery prize included if you get Tig to put on his sexy, yummy, scrumptious flannel.
2 arteries, branch of vertebral artery, one at each posterolateral aspect of the cord, ends at conus medullaris.
Mystery: if you get Tig to wear his famous sexy flannel, +100 points for you and +500 for Tig (He doesn't know he will get points for putting it on so he is gonna be upset when he doesn't do it)
What are the muscles of the Deep Layer, and what is their common name and why?
short and long rotators, multifidi, and semispinalis muscles,. Transversospinalis muscles because they pass from TP to SP.
interspinalis and intertransversarii are also included in the deep layer.
What is the difference between the facet joint orientation in the upper lumbar versus the lower lumbar?
Upper lumbar- More in saggital plane
Lower Lumbar- More in the coronal plane
What are the stabilizing ligaments of the upper cervical spine, location, and clinical implications?
Transverse: Deep to sectoral membrane, attaches medial tubercle of lateral mass. Trauma, arthritis, etc. enlarged ADI space, prevents hyperflexion.
Alar: *wings* sup. lat. aspect of dens to side of foramen magnum. prevents excess rotation.
Apicial: Apex of dens to ant. margin of foramen magnum, between alar ligaments, not a significant stabilizer.
What are the 5 different types of a "slipped disc"
Disc bulge, Protrusion, extrusion, sequestration, annular fissure
What is the artery of adamkiewicz origin and clinical implications?
Arises from left posterior intercostals, varies entry between T9-L3. From T10-T12 it is the ASA main blood supply, ASA can happen with damage to Adamkiewicz.
What muscles make up the suboccipital triangle, what is the action of these muscles, and what nerve innervates them?
Obliques capitis superior, obliquus capitis inferior, rectus capitis posterior major. Rotate and extend the head to the same side. suboccipital nerve.
What is the primary spodylolisthesis and what is is caused by?
Type II- Isthmic
Defect in the pars (stress fx, elongated but intact pars, acute fx)
What is the nuchal ligament, location, what is it importance, what does it turn into?
Need all for the points.
Nuchal ligament is a strong, fan shaped ligament. Connects EOP of occiput, C1 posterior tubercle, C2-C7 SP's. Provides muscular attachment. Turns into supraspinous ligament.
Why do disc herniations hurt? 2 answers
Hint: endplate changes, disc changes
Endplate changes impair transport efficiency so neoinnervation and neovascularization take place
Disc herniation causes mechanical pressure on nerve roots, and chemical irritation by inflammatory mediators.
What is the significance of Batson's Venous plexus and why can it be dangerous?
Batsons venous plexus have no veins therefore cancerous cells can hang around longer and cause metastatic disease.
What is the name for the group of muscles that run along the neck and connect the vertebrae to first and second ribs? List them all.
Scalenes
Anterior, Middle, Posterior