Spine

Regions and how many vertebrae: 1. 2. 3. 4. 5.

1. Cervical C1-C7 2. Thoracic T1-T12 3. Lumbar L1-L5 4. Sacrum S1-S5 fused. 5. coccyx: 4 fused

Intervertebral Discs are for: 1. 2. 3.

1. shock abosrbers 2. spacer 3. motion/pivot

3 joint complex is made of: _____________________________________

2 facet joints and the intervertebral disc. Motion segment is the 2 vertebral bodies with their inferior and superior articular processes which make the pair of facet joints and then the disc in the middle.

Facets decrease the weight bearing stress through the vertebral body and disc. Facets carry ____% of the load, the vertebral body carrier ____%

20%, 80%.

Spinal Nerve Roots: ____ pairs. ___ cervical ___ thoracic ___ lumbar ___ sacral ___coccygeal

31 pairs 8 12 5 5 1

Spinal Column: main body support, allows movement, protects spinal cord from injury. Made of ___ regions and ____ vertebral bones. Top ___ are moveable, sacrum and coccyx are fused. Each vertebrae is separated by a ______.

5 regions, 33 vertebral bones, 24 are moveable. Disc

Bear weight of upper body and are larger to support weight. ___% of population has a 6th lumbar vertebra - it is an unsacrilized vertebra. ____________ laminae

8%, broad

All ligaments except the ______ are posterior to the central pivot point of the spine to limit flexion (forward bedding).

A-L-L

_______________ is the longest ligament in the spine.

Anterior Longitudinal Ligament

_____ is the most prominent spinous process, it is the bottom of the nuchal ligament.

C7

Spinal Curvatures: Cervical: ______________ (____ - _____ degrees) Thoracic: ______________ (____ - _____ degrees) Lumbar: ______________ (____ - _____ degrees) Sacrum: ____________ (no regular degrees because it is fused) __________ is straight and occurs in those transition zones where it switches from lordosis to kyphosis. *** this S shape is for balance.

Cervical: Lordosis (20-40 degrees) Thoracic: Kyphosis (20-40 degrees) Lumbar: Lordosis (30-50 degrees) Sacrum: Kyphosis (fused, no normal degrees) Neutral

Meninges: 1. ______ Mater or Thecal Sac is the outer layer. Tough mother. 2. __________ Mater is beneath the dura, in the subchondral space there is cerebrospinal fluid which protects and nourishes the CNS. It looks like a very thin membrane (like spiders web) 3. _____ Mater is the inner layer

Dura Arachnoid Pia

Where in the spine do we see hyaline cartilage?

In the end plates of the disc

____________________________: 2 at each segment. Run from superior transverse process vertically to the inferior transverse process. In the cervical region they are scattered fibers, thoracic tough and fibrous, and lumbar very thin and membranous. Limit side bending (lateral flexion) and twisting (axial rotation).

Intertransverse Ligaments

•___________________ foramen allow exiting nerves to pass though. • unlike any other: _______________ Processes • Vertebral Foramen is _________ shaped

Intervertebral mamillary triangle

_________ Triangle: Describes the zone between the exiting nerve root, transversing nerve and endplates. Usually 6-8 mm. For MIS.

Kambin's

________________: C1-C6. Very thick and strong, provides attachment for neck muscles between C3-C5.

Ligamentum Nuchae or Nuchal Ligament

_________________ is the portion of bone just inferior to the superior articular processes. It is the region of bone that connects the lamina to the pedicle. "In between joints"

Pars interarticularis

________________________: runs on the back (posterior side) of the vertebral bodies. Located inside the spinal canal. Limits flexion (bending forward)

Posterior Longitudinal ligament

_________________ Ligament merges with the Nuchal Ligament at C7.

Supraspinous

T__-T__ are true ribs. T__-T__ are false ribs, of these T__ and T__ are floating ribs

T1-T7, T8-T12, T11 and T12

____________ foramen for the _________ artery that supplies blood to brain. The artery enters at C6 and exits out of C1.

Transverse, vertebral

Spinal Bones: 1. Anterior: _____________________ designed to bear weight and withstand compression. It has a _________- cartilage endplate both superiorly and inferiorly which the discs attach to.

Vertebral Body, hyaline

The spine bones get larger as you go down because of ________ Law.

Wolffs

Wings of the sacrum aka ______ are good fixation points. Ilium attaches making the - __________ joint.

ala, sacroiliac

________________: concentric collagen rings that make the outer layers of the vertebral disc. The fibers are tightly wound and each layer goes the opposite direction like a basket weave. 8-20 sheets, type 1 collagen

annulus fibrosis

The disc is made up of 2 sections. 1. __________________ and 2. __________________

annulus fibrosis and nucleus pulposis

____________________: runs along the front (anterior side) of vertebral bodies. It is very wide. It is the only ligament that limits extension (arching backward)

anterior longitudinal ligament

Disc firmly adheres to the hyaline cartilage endplate. Disc is broader _________ than ______________. The disc is wedge shaped in the lateral view which creates lordosis in the cervical and lumbar spine as disc is taller anteriorly and shorter posterioly. In the thoracic spine it is the opposite for kyphosis.

anteriorly than posteriorly.

___________________ Ring: is the hard growth plate surrounding the superior and inferior outer perimeter of the vertebral body. Also called cortical ring. Helps cushion stress across the disc joint.

apophyseal

So in summary cervical only: 1. _________ C1 and C2 2. _______________ 3. ___________ joints (uncinate processes) 4. __________ foramen for vertebral artery. Made by the transverse processes. 5. ________ spinous processes and short, they also extend backward 6. Bodies are and endplates are ______ or ________shaped. 7. No _____ between C1 and C2

atypical lateral masses uncovertebral joints transverse bifid oval or football disc

Discs are ______________ which means poor healing Receive nutrition via ___________ across the endplates

avascular, diffusion

__________ Spinous processes (2 projections)

bifid

Where the spinal cord ends, the _________________ or horses tail picks up. It is a bundle of paired off spinal nerves and rootlets for L2-L5, sacrum and coccyx. Innervates lower 1/2 of body.

cauda equina

_____________ region of the spine has the greatest range of motion and greatest amount of rotation

cervical

The ____________ vertebrae are smaller because they are built for finite movements, rotation, and flexibility. The ____________ spine is built for biomechanics support of the entire spinal column.

cervical, lumbar

_____________ provides a place for muscle attachment for pelvic floor.

coccyx

Spinal cord ends with __________________typically at ___ - ___.

conus medullaris, L1-L2

___________________ where ribs articulate with spine

costal facets

Articulations in thoracic spine: Basic facet joints (superior articular process and inferior articular process of the vertebral bodies) _________________ joint (the head of the rib articulates with the vertebral body) ________________ joint (transverse process and rib tubercle)

costo-vertebral costo-transverse

This is know as the _____________ complex: C1: ______, allows nodding head. No spinous process or body. C2: ______ with the dens bone (aka ___________ process), allows head shake no. Has body with the dens bone and has a spinous process.

cruciform, atlas, axis, odontoid

__________ Joints: formed by 2 articular processes. They are where the posterior portion of the vertebrae connect, so the vertebrae on top meets with the vertebrae below. Aka ______________ joints.

facet zygapophyseal joints

Discs are classified as _________________ joints. avascular, anaerobic (no oxygen)

fibrocartilage

Pedicle means little _______. Pedicles are located at the upper ____ of the vertebral body.

foot, 1/3

In the thoracic spine, Vertebral bodies are ______ shaped Vertebral Foramen is ________ shaped.

heart circle

Each vertebral body has 2 layers of endplate: ___________ cartilage which is on the disc and then the ___________ bony layer.

hyaline, subchondral

It is where the _________ articular facet (aka the bottom of the top vertebrae) and the _________ articular facet (aka the top of the bottom vertebrae) articulate. The inferior articular process is more ___________ in relation and the superior articular process is more _______. **think of the butterfly.

inferior, superior. medial, lateral

____________________: connects the superior spinous process to the inferior spinous process. It meets with the ligamentum flavum in the front and the supraspinous ligament behind. Limits flexion.

interspinous ligament

_________: broad flat bone on either side of the spinous process.

lamina

Cervical spine has _________________: tall column of bone on both sides of vertebrae with an articulating surface

lateral masses

_______________ is the strongest ligament in the spine.

ligamentum flavum

___________________- is the yellow ligament. It runs from lamina to lamina. Highly elastic which gives it the yellow color (elastin). It is the STRONGEST spinal ligament. Basically looks like it covers the posterior side of the spinal canal.

ligamentum flavum

Thoracic spine holds the ribcage and protects the heart and lungs. It has ______ ROM. The curve is __________.

limited ROM kyphosis

Provide motor and sensoryy function to body Form peripheral nerves Exit laterally through _______ or _______ Foramen

neural or lateral

Inferior _________ create an Intervertebral Forman for nerve roots to go through.

notches

***the most posterior ligament in the cervical spine is the _______ ligament.

nuchal

_________________: the gelatinous collagen center (like a jelly donut), it distribute weight every on the disc. Full of proteoglycans which are __________ molecules. It fills with water (absorbs fluid at night when lying down) and pushes out fluid during the day with pressure. Water and loose type 1 collagen fibers

nucleus pulposis, hydrophilic

Base of skull is called the _______________. It is attached to C1 with ligaments. The thickest point of the skull is the external occipital protuberance (EOP) which is the bump at the base of your skull. It is also called Inion and is approximately 12mm - 15 mm thick.

occiput

Degeneration: 1. _____________ of the PLL (OPLL) most often occurs in the cervical spine. 2. _____________ of the ligaments can narrow the canal (stenosis) and effect the spinal cord. Seen with the PLL and Ligamentum Flavum which both are in the canal.

ossification, hypertrophy

What is the main bone that connects anterior to posterior

pedicle

You will commonly use ____________ screws which make a fixation point for rod attachment in the spine.

pedicle

2. Posterior: posterior arch which includes: __________ which attach the body to the posterior portion of the spine. _________ the flat regions in between the processes _________ which are designed as outriggers for soft tissue attachment (muscles and ligaments). This posterior arch protects the _______________ which contains the spinal cord and cauda equina.

pedicles laminae processes spinal canal

The center of rotation is the __________, ______ of vertebral disc

posterior 1/3

Sacral ______________ is the most anterior projection of bone that articulates with the lumbar spine. This is S1 and is a cortical lip that is used as a fixation point.

promontory

S shaped curve provides ____________ balance. The weight of head (8-10 lbs) combined with axial load (downward forces) put about 25 lbs on the spine.

sagittal

Dorsal Roots (posterior) = ________ function Ventral Roots (anterior) = __________ function

sensory motor

_______________ nerves line the outer 1/3 of the annulus on the posterior side of the disc. These nerves signal pain when there is pressure or damage to the disc. They are type ___ fibers.

sinuvertebral, type C fibers

The spinous processes are horizontal and ________ shaped. There is more space in between the spinous processes to allow for more movement.

square

Facet joints are ________ joints that provide motion (flexion, extension and rotation).

synovial

_________ region degenerates the least because there is a very limited ROM.

thoracic

___________ Processes are the wings where muscles and ligaments are attached.

transverse

______________________ ligament holds the atlas and axis together, it is most important structure for stability. C1 and C2 allow for the largest ROM out of all vertebrae.

transverse

Lumbar: _____________ Nerve Root: stays more medial until it exits at the level below. It passes across the disc and then becomes the exiting nerve root on the inferior vertebra. _________ Nerve Root: hug the superior pedicle as it exits. Exit though the lateral Forman, they exit below the pedicle for which it was named.

transversing, exiting

_______________ Processes: makes uncovertebral joints. The lateral aspects of the bodies in the cervical spine are pointed. They form joints where they meet the endplate of the next vertebrae. They are also known as Joints of __________. Not true joints. They prevent excess lateral bending.

uncinate, Luschka