Spinal Anatomy 1 Quiz 1

What are the three parts of the IVD?

1. Annulus fibrosis: the outer ring of the disc made of layers of strong fibrocartilage. 2. Nucleus pulposus: inner part of the disc with a consistency of toothpaste. Made of loose collagen fibers and proteoglycans, has a high water content. 3. Cartilaginous end plates: mostly hyaline cartilage attached to bony endplates. Allows nutrients/metabolic waste to pass from vertebral bodies to disc (imbibition).

What are the primary functions of the spine? How are these accomplished?

1. Protect the spinal cord and act as a conduit of the spinal cord and spinal nerves (vertebral canal and IVFs. 2. Absorb and transmit force via the vertebral bodies, IVDs, curves of the spine, and the ligaments and fascia. 3. Movement and stabilization of the neck and trunk via joints such as IVDs and general, stabilizing structure. 4. Neurological input to the CNS via mechanoreceptors, proprioceptors, etc. (mechano and prioprio regulate safe, smooth movement of spinal joints).

What is contained in the appendicular skeleton?

1. Shoulder girdle 2. Upper extremities 3. Pelvis 4. Lower extremities

What is contained in the axial skeleton?

1. Spine 2. Skull 3. Thoracic cage

How many IVDs are there?

23. There are IVDs between each vertebrae, as well as between L5 and S1, EXCEPT for C1-C2. There is also no IVD between C0 (the occiput) and C1.

How many vertebrae in the actual, adult spine itself? How many moveable segments?

24 vertebrae, 24 moveable segments.

How many fused segments make up the coccyx?

3-5

How many pairs of spinal nerves are there? How many spinal nerves total? How many cervical? Thoracic? Lumbar?

31 pairs, 62 total. 8 pairs of cervical, 12 pairs of thoracic, 5 pairs of lumbar.

How many A-P spinal curves within the sagittal plane? Which ones are primary, which ones are secondary? What does this mean?

4. Thoracic and pelvic are primary, cervical and lumbar are secondary. The primary curves are formed before birth., the secondary after birth. Primary is kyphotic, secondary is lordotic.

-What angle are the superior and inferior articular processes oriented at?

45 degrees

How many z-joints does each vertebrae have?

4; 2 superior and 2 inferior.

How many fused segments make up the sacrum?

5

How many total joints are there in the cervical spine?

76

What is the fovea details? Where is it?

A concave facet for articulation with the dens of the C2. It is a smooth articular surface on the posterior aspect of the anterior arch of the atlas.

What is all terminology relative to?

Anatomical position.

Is the fovea dentalis on the anterior or posterior arch? What is it behind? What does it articulate with?

Anterior arch. The anterior tubercle. Dens of axis (C2).

*What is the anterior tubercle an attachment for?

Anterior longitudinal ligament (ALL) and longs Colli muscle.

Where is the basilar process?

Anterior to the foramen magnum. It is the most anterior part of the occiput.

What is the transverse process composed of? What part of the spine. What is considered the true transverse process of the cervical vertebrae? What detail is of note on the transverse process?

Anterior, transverse, and posterior bars. Cervical spine. The posterior bar. The groove for the ventral ramus of the spinal nerve.

What are the anterior aspect(s) of the cervical vertebrae? Posterior?

Anterior: body Posterior: 2 pedicles 2 laminae 1 spinous process 2 transverse processes 4 articular processes

Where is the groove for the vertebral artery?

Atlas (C1) on the superior surface of the posterior arch, behind the superior articular surfaces.

Where do the pedicles attach? What bone are they made of? What do they help form?

Attach to the posterior and lateral aspects of the vertebral body. Made of compact bone. The vertebral notches of the pedicles create the superior and inferior notches, which form the IVF.

What are characteristics of cartilage?

Avascular (receives nutrients via imbibition), little nerve supply, thins with lack of motion, age, and trauma.

-What vertebral artery comes through the transverse foramina of the atlas and wraps around the superior articular processes and goes into the skull?

Basilar artery.

Why do we see early degeneration of the L3-5 vertebrae?

Because it's the base of the spine.

Why aren't there IVDs between C0-C1 and C1-C2?

Because most rotation and movement comes from these areas.

Where do the thoracic, lumbar, and sacral nerves exit in relation to vertebrae?

Below the vert. with the corresponding number.

Where does the C8 spinal nerve exit?

Between C7 and T1

Where is the C1 spinal nerve?

Between the occiput (C0) and atlas (C1).

Describe bilateral and give an example.

Bilateral is having or relating to two sides; affecting both sides. Ex: bilateral contraction of the sternocleidomastoid (SCM) flexes the neck forward.

What is Wolff's law?

Bone will grow or breakdown due to stress, which can result in osteoarthritis.

How is a lateral curve described?

By its direction of convexity.

IVDs can be named two ways. Describe them.

By the two vertebrae the IVD rests between, or solely by the vertebra directly above it.

How is the shape of the IVDs determine?

By the two vertebral bodies to which it is attached.

What is the atlas?

C1

Which vertebra(e)'s transverse foramina have the basilar artery running through it?

C1

Explain why the following vertebrae are not typical: C1 C2 C7

C1 = Does not have a vertebral body, uncinate, semilunar facet, and uncovertebral joints. C2 = Does not have uncinate process. C7 = Does not have a semilunar-facet.

Which vertebrae have arteries through their transverse foramen?

C1-C6

What vertebrae have transverse foramina?

C1-C7 (all cervical).

What is the axis?

C2

-The C3 nerve exists between which two vertebrae? The T8 spinal nerve exits between which two vertebrae? What spinal nerve is between C7 and T1?

C2-3; T8-T9; C8

Where is the first IVD?

C2-C3 (AKA C2 IVD)

Which vertebra(e)'s transverse foramina have the vertebral artery running through it?

C2-C6

Which cervical vertebrae are bifid? Why does this arise?

C2-C6. Bifid SP are caused by 2 ossification centers in the cervical SP.

Which cervical vertebrae are typical?

C3-C6.

Which cervical vertebrae has the largest spinous process?

C7

What does the transverse ligament do? Where is it located?

Crosses the ring of atlas behind the dens (C2) and holds the dens against the fovea dentalis (C1). It creates a synovial joint here. It articulates with the posterior odontoid facet (which has a posterior groove).

What is hypokyphosis?

Decrease or loss of kyphosis.

What is hypolordosis?

Decrease or loss of lordosis. Causes posterior pelvic tilt.

Describe inferior and list an AKA.

Downward direction toward the feet. Caudal = AKA.

What is the cauda equina?

Elongation of the lumbar and sacral nerve roots within the spinal canal so that they can exit through the IVF below the same numbered vertebrae.

Give an AKA for axis.

Epistropheus

Describe distal.

Farther from the point of origin or the midline of the body. Ex: the elbow is distal to the shoulder.

What is the filum terminale?

Fibrous tissue that suspends the coccyx to the caudal equina.

What is the squamous portion of the occiput?

Flat portion of the bone posterior to the foramen magnum. It creates the suture line.

What is the primary movement of the antlanto-occipital articulation? What two bones articulate to create it?

Flexion and extension of the head. The atlas (C1) and occiput (C0) (50%).

Describe convex.

Having a surface boundary that curves or bulges outward, as the exterior of a sphere.

Describe concave.

Having a surface or boundary that is hollowed or rounded inward like the inside of a bowl.

What are the two types of articular cartilage?

Hyaline and fibrocartilage.

What cartilage is on the surface of all bones that articulate?

Hyaline cartilage.

-How does the spine allow for movement?

IVDs and other joints, and the general structure of the spine stabilizes the trunk to allow movement of the extremities.

What happens when stresses are removed from bone?

It will demineralize.

What is fibrous syndesmoses?

Joint surfaces are connected by fibrous connective tissue (ex: ligaments connecting bone to bone).

At what level does the spinal cord end? What is the end of the spinal cord called?

L1/L2. Conus medullaris.

Where are the contact points on the vertebrae for chiropractic adjustment?

Lamina (in cervical spine), spinous process, and transverse process.

What is unique about the atlas transverse processes?

Large, lack anterior and posterior bars, largest transverse foramen in the cervical spine. Atlas TP is homologous to the posterior bar (true transverse process).

*What is the posterior bar an attachment for?

Ligamentum niche, the rectus captious posterior muscles.

*What is the spinous process an attachment site for?

Ligamentum nuchae.

What is special about the C7 spinous process?

Long, prominent, and extends beyond the other cervical spinous processes. Not bifid.

What is a lordotic curve and why is lordosis important in the cervical spine?

Lordotic curve refers to a curve that is concave posteriorly and convex anteriorly. It refers to secondary curves. In the cervical spine, it is the key to maintaining proper weight-bearing of the head, spinal movement, and spinal cord and cervical nerve root function.

What are the 2 braces for scoliosis (boards Q)

Milwaukee brace and Philadelphia brace.

What is a synovial articulation?

Movable, gliding, diarthrodial joint with hyaline cartilage surfaces, synovial fluid, and articular capsule. Most common joint in the spine.

Are the sacrum and coccyx part of the spine?

NO, technically different. The sacrum is the BASE OF THE SPINE, not the spine.

Is C7 typical? Explain.

No, because it does not have a bifid spinous process or semilunar facet. Also, vertebral arteries DO NOT go through its transverse foramina.

Does the vertebral artery go through all transverse foramina?

No, it does not go through the C7. Also, it is called the basilar artery after it goes through C1.

Do IVDs have a direct blood supply?

No.

Are lateral curvatures normal? What plane do they occur in?

No. Coronal plane.

How is the transverse foramina of the axis oriented?

Obliquely oriented (45 degrees).

Give an AKA for the dens. What is the dens considered in respect to the Atlas (C1)?

Odontoid process. Considered the body of the atlas.

Describe orthogonality and its importance for anatomical planes.

Orthogonal means they meet each other at 90 degrees to each other.

What is bone made of? What does it do in general?

Osteocytes, collagen fibers, and bone salts. Support and protect body structures.

What is the price of cervical complexity and range of motion?

Over 50% of the population suffers from neck pain or dysfunction.

What is the external occipital protuberance (EOP)?

Prominent tubercle at the posterior portion of the occiput. Palpable superior to the SP of C2.

What shape are the cervical vertebral bodies?

Rectangular

Describe median and what is special about it.

Refers to structures that lie in the midline of the body. Median is an absolute term, it does not require two structures to compare to each other. Ex: the nose is a median structure.

-Where is there naturally occurring spina bifida?

S5. Creates the canal for the sacrum to attach to the coccyx.

Is the anterior arch of the atlas smaller or larger than the posterior arch?

Smaller.

Where is hyaline cartilage and what is it?

Smooth, "glassy" surface that allows movement between boney joint surfaces. Most joints in the spine have them. Z-joints are an example.

What passes through the IVF? How do they pass in relation to the vertebral artery?

Spinal nerves. Posteriorly.

What is the vertebral body composed of?

Spongy/cancellous bone surrounded by compact/cortical bone. The compact bone is perforated by small holes called nutrient foramina for passage of blood vessels, lymphatic, and nerves (imbibition).

Describe anatomical position.

Subject standing, head looking forward, legs and feet together, arms at sides, and palms open and facing forward.

What are the boarders for the IVFs?

Superior and inferior vertebral notches, pedicles, bodies, discs, and z-joints.

Compare the size of the axis superior articular facets (processes) and inferior articular facets (processes).

Superior is large, flat, and oval shaped. The Inferior is small and oriented at 45 degrees.

Where is the superior nuchal line? The inferior nuchal line?

Superior is lateral to the EOP and further from the foramen magnum (more posterior), inferior is lateral to the external occipital crest and closer to the foramen magnum (more anterior).

What is a cartilaginous symphysis?

Surfaces lined with hyaline cartilage and joined by fibrocartilaginous disc.

What are the types of articulations that occur in the spine and pelvis?

Synovial, cartilaginous symphysis, and fibrous syndesmoses.

What kind of joint is a z-joint?

Synovial.

Describe medial.

That which is closer to the midline or in the direction of the midline.

Describe lateral.

That which is further from the midline or in the direction away from the midline.

What structures make up the transverse processes of the typical cervical vertebrae?

The anterior bar, posterior bar, and transverse bar form the transverse process. There is a transverse foramen in each cervical vertebra's transverse processes.

Where do we expect to see degeneration first? Why?

The apex of each A-P curve, because there is the most stress here.

What two bones create the antlantoaxial articulation? What is its primary movement? --What percentage of the rotation is it responsible for?

The atlas (C1) and axis (C2). Right and left rotation of the head (rotation about the y-axis) (45-50%).

What bones articulate to create the atlanto-axial joint? What kind of joint is it?

The atlas and axis. Two synovial joints; an anterior joint between the anterior odontoid facet and the fovea details, and the posterior joint between the posterior odontoid facet and the transverse ligament.

What comes out of the foramen magnum?

The medulla oblongata (superior part of the spinal cord) comes through the foramen magnum. The spinal cord does not start until it comes out of the foramen magnum.

In what way does the mid-sagittal plane divide the human body?

The mid-sagittal plane passes through the midline of the body and divides the body into equal left and right halves.

What is considered true transverse process?

The posterior bar of the transverse processes.

Explain how the spine supports the body.

The shape and stacking of vertebral bones, discs, and attachments of stabilizing muscles, help maintain normal posture.

What acts as a lever of motion for vertebrae?

The spinous processes and transverse processes.

What is osteology?

The study of bone.

-What creates a z-joint?

The superior and inferior articular processes of 2 adjacent vertebrae.

What creates the atlanto-occipital articulation? How?

The superior articular surface of the atlas, because they are concave and bean shaped. They articulate with the occipital condyles.

What are uncinate processes? Which vertebrae have them?

The uncinate process is the posterolateral "lips" of the superior aspect of the vertebral body. It articulates with semilunar facet of the superior adjacent vertebra to create an uncovertebral joint. C3-C7 have them.

What are uncovertebral joints? What part of the spine are they in? What creates them?

The uncovertebral joint is the joint that is created by the articulation of the uncinate process and semi-lunar surface of adjacent vertebrae. Cervical spine. It is just the joints between vertebrae.

-How does the spine protect the spinal cord?

The vertebral canal is a bony tube in the spine that protects the spinal cord.

Describe the x-axis in the Cartesian coordinate system.

The x-axis runs horizontally from left to right. The left is positive, the right is negative. Flexion and extension are forward and backward rotation about the x-axis respectively. Stepping laterally right to left is moving along the x-axis.

Describe the y-axis in the Cartesian coordinate system.

The y-axis runs vertically, superior to inferior along the length of the body. Superior is positive, inferior is negative. Left and right rotation are rotation about the y-axis.

Describe the z-axis in the Cartesian coordinate system.

The z-axis is the horizontal axis that runs straight posterior to anterior through the center of the motion segment. Anterior is positive, posterior is negative. Right lateral flexion and left lateral flexion are rotation over the z-axis.

-Do the vertebral arteries go through the transverse foramina of C7? Descirbe their size?

They DO NOT go through its transverse foramina. They are smallest in cervical spine. Accessory arteries and veins usually pass through, instead.

Describe the shape of the inferior articular surfaces of the lateral masses of the atlas. What do they articulate with?

They are circular, slightly convex, and articulate with the superior articular surfaces of the axis (C2) to create the atlanto-axial articulations.

Where are the articular surfaces (facets)? What are the two different kinds of articular surfaces? How does their shape change in the lower cervicals?

They are oriented posteriorly at 45 degrees to the horizontal plane. The superior and inferior articular processes. Articular surfaces become more vertical in the lower cervicals.

How does the size of the axis transverse processes compare to other cervical vertebrae? Does it have a true transverse process?

They are small. They end in a single tubercle, which is homologous to the posterior bar (the true TP). Therefore, does not have a TRUE transverse process.

What are the articular pillars?

They are the z-joints collectively.

Explain what it means for a cervical vertebrae to be typical.

They have to have all three of the following: uncinate process, semilunar-facet, and uncovertebral joints.

Describe how the cervical vertebral bodies increase in size. Explain why this occurs.

They increase from C3 -> C7 because they transition to the thoracic vertebrae.

What are the pedicles?

They project posterolaterally form the vertebral bodies at 45 degrees. They form the medial boundary of the transverse foramina. They are midway off the vertebral body, so the superior and inferior vertebral notches are almost the same size.

What do the lateral masses of the atlas do? What are the two parts to them?

They support the weight of the head. Each has a superior articular surface and an inferior articular surface.

-What do the laminae form? What happens when this doesn't occur?

They unite to form the spinous process. Failure to unite results in spina bifida (spinal cord leaks out of the spinal canal).

Describe posterior and list an AKA.

Toward the back of the body. Dorsal = AKA.

Describe anterior and list an AKA.

Toward the front side/face side of the body. Relating to the abdomen. Ventral = AKA.

What is the cervico-thoracic junction?

Transition from cervical to thoracic (C7->T1). This is why C7 is considered a transitional segment and is similar to T1 in terms of size and shape.

What is the overall shape of the typical cervical vertebrae (the vertebral canal and foramina).

Triangular shaped.

What is a functional spinal unit?How many joints are formed? What kind of joints?

Two articulated adjacent vertebrae. 2 z-joints (one on either side of the vertebrae; synovial) and 1 interbody joint (vertebral bodies + disc; fibrocartilaginous joint).

What are the inferior vertebral notches?

Two shallow grooves between the posterior aspect of the inferior articular surfaces lateral mass.

What is required to use directional terms?

Two structures, because they describe their relation to each other.

Describe unilateral and give an example.

Unilateral is relating to, occurring on, or affecting only one side of an organ or structure, or of the body. Ex: unilateral contraction of the sternocleidomastoid (SCM) flexes the neck on the same side of contraction.

Describe superior and list two AKAs.

Upward direction toward the head. Cephalad = AKA. Cranial = AKA.

What goes through the transverse foramina?

Vertebral artery, venous plexus and sympathetic nerve fibers.

What's an AKA for C7? Is it always this AKA, or just generally?

Vertebral prominens (VP). It is typically the VP, but T1 can be the VP. Typically the last moveable vertebra (drop and extension).

-Is the spinal cord shorter than the spinal canal?

Yes

-Is bone a living tissue? Explain.

Yes! It is constantly degenerating and regenerating.

Does the anterior arch of the atlas have a tubercle?

Yes, the anterior tubercle.

Do the IVFs change shape during movement? What are they impacted by in general?

Yes. Impacted by disc herniation, disc degeneration, z-joint degeneration, and ligament injury.

What is the vertebral canal? What is special about the cervical vertebral canals?

The hole through which the spinal cord goes through. It is largest in the cervical vertebrae, even though the cervical vertebrae are the smallest. This is to accommodate the cervical enlargement of the spinal cord (it enlarges due to innervation to the upper extremities).

What is the clivis? What is an AKA?

The intersection of the basilar process and the sphenoid bone. Considered the most anterior part of the basilar process. It is sometimes called the basilar process.

What is the zygopophyseal joint?

The joint created by the articulation of the superior and inferior articular processes/facets of adjacent vertebrae (the superior articular process is on the inferior vertebra, and the inferior articular process is on the superior vertebral).

What is the uncovertebral joint? What does it do? What part of the spine is it in? Give an AKA for it.

The joint created by the articulation of the uncinate process and the semilunar facet. Its a small synovial joint. They limit lateral flexion and help prevent lateral disc protrusion. Function as a gliding mechanism for spinal flexion and extension. The cervical spine. AKA is the Joint of Von Luschka

What comes together to form the spinous process? What happens when the spinous process fails to form?

The lamina come together. Spina bifida.

*What is filled by the gap between adjacent laminae?

The ligaments flavum.

What is scoliosis? Is right or left thoracic scoliosis worse?

An angle of 20 or greater in a lateral curve. Left, because the convexity can press against the heart.

What is hypolordosis?

A lordotic curve that is not as angular/dramatic as it should be.

What is the coronal plane, and what is an AKA?

A plane that lies parallel to the plane of the coronal suture of the cranium (which runs side to side across the top of the head). It divides the body into anterior and posterior portions. AKA frontal plane.

Describe the atlas and its articulation with the occiput.

A ring bone that supports the head. It is composed of anterior and posterior arches and two lateral masses (which include the transverse processes). The lateral masses are concave superiorly and articulate with the occipital condyles.

What is the posterior tubercle of C1?

A rudimentary spinous.

What are semilunar facets? Which vertebrae have them?

A semi-lunar facet is the rough surface of the inferior aspect of the vertebral body. It articulates with the uncinate processes of the inferior adjacent vertebra to create an uncovertebral joint. C2-C6 have them.

What is the internal occipital protuberance?

A small tubercle located directly internal from the EOP.

What is the transverse plane and what is an AKA?

A transverse plane divides the body into superior and inferior portions. AKA horizontal plane.

Where do cervical nerves exit the spinal canal in relation to vertebrae?

Above the vertebrae with the corresponding number.

What is the space between the atlas and dens called? In adults, what amount of space is considered normal for ADI? What is a greater amount a possible sign of?

Adentointerval (ADI). 45mm is normal in adults. Greater space than this without Down's syndrome could be a sign of osteoarthritis.

-Which cervical vertebrae have transverse foramina?

All of them.

What is fibrocartilage and where is it?

Allows for strong support, and stands up to compression and tension. IVDs are an example.

What are the regions of the spine? How many bones/segments?

Cervical (7 vert.), neck; thoracic (12 vert.), mid-back; lumber (5 vert.), low back; sacral/sacrum (5 fused), base of spine but NOT SPINE; coccygeal/coccyx (3-5 fused), tail-bone.

What is the apex of the cervical curve, thoracic curve, and lumbar curve?

Cervical: C4/5 Thoracic: T7 Lumbar: L3

Describe proximal.

Closer to the origin or midline of the body Ex: elbow is proximal to the wrist.

What does kyphotic mean?

Concave anteriorly. Refers to primary curves.

Describe contralateral and give an example.

Contralateral is situated or appearing on, acting on, or affecting the opposite side of the body. Ex: contralateral rotation of the face/head (face is turned toward the opposite side of contraction).

What does lordotic mean?

Convex anteriorly. Refers to secondary curves.

What are the occipital condyles?What do they articulate with?

Convex surfaces on either side of the anterior half of foramen magnum. They articulate with the superior articular surface of the atlas (C1).

Where are the IVF? What view MUST be used to view them in x-rays?

In the oblique plane facing antereolaterally. Oblique (45 degrees).

What is hyperkyphosis?

Increase or exaggeration of kyphosis.

What is hyperlordosis?

Increase or exaggeration of lordosis. Causes anterior pelvic tilt.

-Where is the colliculus Atlantis? What is it and what attaches to it?

Inferior to the medial margin of each superior articular facets of the atlas. They are tubercles that act as attachment sites of the transverse ligament. The transverse ligament keeps the dens in place.

Describe ipsilateral and give an example.

Ipsilateral is situated or appearing on, acting on, or affecting the same side of the body. Ex: unilateral contraction of the SCM will produce ipsilateral lateral flexion of the head and neck (head and neck bend toward side of contraction).

What is the classification of vertebral and sacral bones?

Irregular bones.

In what way does the sagittal plane divide the human body?

It divides it into right and left portions.

What does the vertebral body do? Which vertebral bodies are smallest? Largest?

It is the weight bearing structure. Smallest is cervical, largest is lumbar.

Where are the attachment sites for ribs?

The body and transverse processes of the thoracic vertebrae.

Where are the bony endplates? What are the cartilaginous endplates?

The bony endplates are superior and inferior surfaces of the vertebral body. Cartilaginous endplates are attached to the superior and inferior surfaces of the bony endplates and made primarily of hyaline cartilage.

When does the cervical curve develop? Lumbar?

The cervical curve is formed after birth when the baby starts to hold its head up, lumbar starts to form when the baby starts to stand and walk.

Which part of the spine has the most complicated articular system and why?

The cervical spine, because there is the most movement in this part of the spine. (It is also highly inervated.)