ANAT: Vertebral Column

Tuberacle

A small rounded projection or protuberance, especially on a bone

Facet joints are innervated by what?

Aka zygapophyial are innervated by articular branches of posterior rami of spinal nerves.

At lumbar levels, the facets are ____ but considered to be more or less __ in the ____ plane, permitting mostly ____, some ____, but greatly limiting ___.

Curved Upright Sagittal Flexion Extension Rotation

Lordosis

Exaggerated lumbar curvature (swayback)

Kyphosis

Exaggerated thoracic curvature (hunchback)

The internal vertebral plexus of veins communicates with the ____ that drain back to _______.

External vertebral plexus of vein Segmental vein system (e.g. Intercostal veins)

posterior Longitudinal ligament limits what motion of the vertebral column?

Flexion

The ligaments flava check (resist) the separation between laminae during __ and also assist in restoring an erect posture following these movements.

Flexion and lateral flexion

Interspinous ligaments resist what motion?

Flexion and rotation

Periosteum

Skin of bone

Cornu

Structure shaped like a horn

Equatorial arterial branch

That supply the outer layer of the bone (deep to periosteum, but not the central/core one)

The recurrent menigeal branches of spinal nerves are distributed to _____.

Periosteum, annuli fibrosi of IV discs, ligaments, and meninges

At the level of the intervertebral foramina, ____ branches provide the ________ to the vertebral arch elements.

Posterior Periosteal and nutrient branches

It is important to remember that a lateral bend must also contain some _____.

Rotation

The adjacent vertebrae also have ________ which articulate with _______ of a high vertebrae to form _____ joints.

Superior articular processes (with a facet) Inferior articular processes Synovial

Uncovertebral joint characteristics

1) Around age 10, small cavities begin to appear in the intervertebral discs of the cervical spine 2) These occur between the uncinate processes of vertebrae and the bodies of vertebrae above them 3) Some consider the joints to be synovial and other consider it to be degenerative 4) Those of the synovial mindset would argue for increased stability of the cervical column 5) Osteophytes (a bony outgrowth associated with the degeneration of cartilage at joints) may compress both the spinal nerve root and the vertebral artery as they pass through the foramina of this area

List the 3 atypical vertebrae

1) Atlas 2) Axis 3) Vertebra prominens

Regional characteristics of thoracic vertebrae

1) Costal facets- typically 6 total: 3 on each side (all 1 vertebrae have costal facets) a) 2 on the body/pedicle junction B) 1 on the transverse process 2) smaller vertebral ramen 3) Articular facets oriented primarily along the coronal plane lowest transitioning to the sagittal plane 4) Bodies increase in size (causally (to the feet)) - upper similar to cervical and lower similar to lumbar 5) Long downward sloping spinous process yields misaligned vertical position of spinous process and transverse processes of the same vertebrae. Mid thoracic with most deviation and T1 with near perfect alignment

Nerve fibers that carry proprioception or pain in the vertebral

1) Facet joint capsules (to a much higher degree in the high mobile cervical region) 2) Spinal ligaments are rich with nerve endings 3) annulus fibrosus is particularly sensitive to pain 4) all musculature associated provides info for proprioception

Regional characteristics about the sacrrum

1) Fusion of 5 vertebral segments 2) Promontory- most superior/anterior point/edge of the S1 vertebra 3) Anterior and posterior sacral foramina separate holes, but are in continuity with each other and the canal 4) Median sacral crest- ridge with 4 tubercles 5) Sacral canal- anterior to the median sacral crest, continuation of vertebral canal 6) Sacral hiatus- lack of posterior fusion of the 5th Sacral vertebra, allowing an inferior opening of the canal, thus no 5th median sacral tubercle 7) Auricular surface- the ear shaped surface on the lateral surface, articulates with the ilium of the pelvis. Thus , the sacrum and coccyx create the posterior wall of the bony pelvis.

Regional characteristics of lumbar vertebrae

1) Large heavy body 2) Broad (tall) spinous process 3) Articular facets nearer the sagittal plane, curved 4) Mammillary processes- found on the posterior tip of the superior articular processes 5) Accessory processes- found on the base of the transverse processes, posteriorly

The vertebral arch consists of the following parts:

1) Pedicles - base of arch, attaching to the body 2) Laminae - broad, thin plates 3) Transverse Process - project laterally from the pedicle/lamina junction 4) Spinous Process - projects posteriorly from the junction of the left/right laminae 5) Superior articular processes- superior projection from near the pedicle/lamina junction 6) Inferior articular processes - inferior projection from the lamina

Anatomical/biomechanical factors that contribute to disc herniation:

1) The nucleus pulposus (inner soft portion of intervertebral disc is positioned more posterior within the annulus fibrosus (outer fibrocartilage rings of the intervertebral disc. 2) As such, the Annulus fibrosus is thinner posteriorly than anteriorly. This arrangement promotes tearing of the annulus fibrosus, thus herniation of the nucleus pulposus in a posterior direction. 3) Increased load on the column, particularly during flexion compress the anterior of the intervertebral disc while causing tension/traction/stretching of the posterior. Couple this with any rotation and the annulus fibrosus is very prone to tearing. 4) A lack of ligament support along the posterolateral surface of the disc allows herniation

Regional characteristics of cervical vertebrae

1) Transverse foramina- holes in transverse process (all C7 have these) 2) Anterior and posterior tubercles on the transverse processes 3) Small bifid spines- found on C3-C6 typically, sometime on C2 4) Large vertebral foramen- accommodates an enlarged cervical spinal cord 5) Small body with uncinate processes for uncovertebral joints 6) Articular facet orientation transitioning from transverse place (0 degrees) to fairly consistent 5 degrees

2 parts to intervertebral discs:

1) annulus fibrosus- an outer, tough fibrocartilaginous ring 2) nucleus pulposus- an inner, soft part

Primary function of nucleus pulposus

1) can absorb water when it is relaxed and lose water when compressed

Each facet joint (zygapophyial) receive innervation from _____ adjacent nerve(s).

2

A single rib will generally have articulations with _____ ribs at ___ points.

2 3

The vertebral column itself is innervated by______.

2-4 recurrent meningeal branches of spinal nerves on each side

The articular facets at the cervical level are inclined _____. Permitting ____.

45 degrees Flexion/extension, lateral flexion, and rotation

The articular facets at the upper to mid-thoracic level are inclined _____with a _____ lateral facing incline surface. Allowing unhindered ______, with modest ___.

45-60 degrees 20 degree Rotation Lateral flexion and flexion/extention

The vertebral column is separated into ______ separate regions consisting of specific numbers of vertebrae. These are:

5 1) Cervical (7 vertebrae) 2) Thoracic (12 vertebrae) 3) Lumbar (5 vertebrae) 4) Sacral (5 fused vertebrae) 5) Coccygeal (4 vertebrae, 3 of which are fused)

A typical vertebra consists of ______.

A body and a vertebral arch

Intervertebral discs

A cartilaginous joint called a symphysis. The fibrocartilaginous discs fuse with hyaline cartilage covering the end-plates of the vertebral bodies.

The head of a rib (say 7) typically articulates with _____ and ____.

A demifacet on the upper part of the boundary of the same numbered vertebrae (7) Also with the demifacet of lower part of the vertebrae above (T6)

Backward tilting of the pelvis causes _____.

A flattening of the normal lumbar curvature

Plexus

A network of nerves or vessels in the body

Facet joint

A synovial joint that occurs between the articular facets of the adjacent vertebrae

Protuberance

A thing that protrudes from something else

Facet joint capsules. Capsules limit what motion?

As with any synovial joint, these joints have a joint capsule. This capsule limits motion of the joint, particularly rotation.

There is no disc between the ____.

Atlas (C1) and Axis (C2)

Vertebral column is part of the ______ skeleton and consists of ___________.

Axial skeleton A series of bones, called vertebrae, that are interconnected at joints and held together by ligaments.

Interspinous ligaments are located where?

Between adjacent spinous processes

Sacroiliac joints are formed where?

Between the auricular surfaces of the sacrum and the ilium

Lumbar region curvature due to _____.

Both discs and vertebral bodies

Forward tilting of the pelvis causes _____.

Compensatory lordosis Can be caused from muscle imbalance, joint disease, obesity, pregnancy

Primary curvatures

Concave anteriorly, as seen in the fetus/embryo, maintained in normal adult anatomy. 1) thoracic 2) sacral

Secondary curvatures

Concave posteriorly, normally developed in young child 1) cervical- develops to raise head 2) lumbar- develops to accommodate walking

The vertebral plexus of veins is in communication with ______ as well as with _____. A valveless system interconnected from _____ to _____.

Cranial dural sinuses Venous plexus in the pelvis Intracranial plexus

Scoliosis causes a lateral bend, this will result in compensatory ____.

Curvatures and rotations

Based on the source of curvature, which curvatures are more deformable by external forces?

Curvatures caused by articular discs are the tissue is able to undergo more movement

anterior longitudinal ligament is located where?

Extends from the occipital bone, anterior tubercle of C1, along the anterior surface of the vertebral bodies to the upper part of the sacrum. It is a broad, thick ligament.

anterior longituidal ligament limits what motion of the vertebral column?

Extension

Supraspinous ligaments resist what motions?

Flexion and rotation

When adjacent vertebrae are stacked on top of each other the bodies are separated by ______, the vertebral foramina form a ______, and superior and inferior vertebral notches on pedicles are converted into ______ for the passage of _______.

Intervertebral discs Vertebral canal Intervertebral foramina Neurovasculature

Spinal arteries enter the vertebral canal through the _______, providing branches to the ____, and also nutrient arteries to the _______.

Intervertebral foramina Spinal cord and meninges Inner core of the vertebral bodies

Process

Is a mass of bone, many processes will have smooth surfaces called facets to form joints

posterior longitudinal ligament is located where?

It is attached to the posterior surface of vertebrae and intervertebral discs, inside the vertebral canal.

What does the posterior longitudinal ligament do in the lower thoracic and lumbar levels? How does it appear?

It narrows over vertebral bodies and widens over intervertebral discs, creating a saw toothed appearance.

The last disc is between the ___.

L5 and the sacrum.

T12 and L1 are roughly the same size, with very similar features. What definitive feature will allow you to differentiate T12 and L1?

Mammillary process will be present on L1, but not T12. This is located between the spinous process and transverse process. The T12 will also have a costal facet on the transverse process or a smooth area on the transverse process. The L1 will also have an accessory process (between transverse process and mammillary process) though this is not prominent

At the lower thoracic levels (T9-12), the slightly laterally facing facet of the upper thoracic levels begins to turn to face more _____ and to incline to near _____, similar to lumbar regions. This impedes ______, but significantly improves ____.

Medial 90 degrees Rotation Flexion/extension particularly flexion

What is important to note when comparing thoracic and lumbar vertebrae with respect to OMT?

On a thoracic vertebra the transverse process is found minimally deep to the spinous process On a lumbar vertebra the transverse process is found much deeper than the spinous process. Many will palpate the mammillary processes thinking it is the transverse process.

The vertebral arch projects _____ and encloses ______.

Posteriorly A space called the vertebral foramen (hole in spinal column)

Facet

Smooth surface on a process (mass of cone)

The primary and secondary curvatures provide a degree of _____ to the vertebral column.

Springiness

What is the function of the Iigamenta flava?

Strong, highly elastic ligaments interconnect laminae of adjacent vertebrae

How can the nucleus pulposus alter the height of a person?

The intervertebral discs accounts for 25% of the height of the vertebral column. Thus, different amounts of water can affect a person's height by up to 1-2 cm.

Sciatica

The pain caused when several roots contributing to the sciatic nerve are compressed.

radiculopathy

The pain caused when the nucleus pulposus herniates through the annulus fibrosis

Lumbago

The pain that is felt as an acute, violent pain from a muscle spasm that is caused from strains on the intervertebral disc, which causes shifting in the nucleus pulposus and thus causes unequal force in that joint

Supraspinous ligaments are located where?

The tips of spinous process from C7 to 1st tubercle of the median sacral crest

Intertransverse ligaments are located where?

They are interconnected to adjacent transverse processes and are often intertwined with intertransversarii muscles

Does the posterior longitudinal ligament position leave room for possible herniation?

Yes because the ligament does not cover the posterior lateral portion of the intervertebral discs leaving an area not reinforced with a ligament.

Scoliosis

Lateral curvature

Vertebral nerve fibers carry ___ and _____.

Pain Proprioceptive information

Ligaments flava are often ____ and a space is often present between the ___.

Paired Right and left parts

Regional characteristics about the coccyx

1) four rudimentary vertebra 2) Last 3 usually fused in early adulthood, but all four can be fused together and with the sacrum in later adulthood 3) Cornua- small horns, articulate with apex of the sacrum

Primary functions of annulus fibrosus part of intervertebral disc

1) shock absorption- bulges when compressed 2) allows rotation

Ribs _______ have single facet heads

1, 10,11,12

A typical thoracic vertebrae (T2-T8) articulates with ____ pairs of ribs.

2

Initial branches of these arteries course on the _____ surfaces of vertebrae and provide these two kinds of branches.

Anterolateral surfaces (front/side) 1) Periosteal 2) Equatorial

The vertebral column has what vasculature?

Arteries and veins

Atlas characteristics and vertebrae number

C1 1) No body 2) No spinous process 3) Anterior/posterior arches with anterior/posterior tubercles 4 Lateral masses with articular surfaces

Axis characteristics and vertebrae number

C2 1) Dens (odontoid process)- forms a pivot joint with the anterior arch of C1

The first disc is between the ____.

C2 and C3. This is also the best way to name discs (between x and y)

The greatest overall mobility is at ____.

C5-C6

vertebrae prominens characteristics and vertebrae number

C7 1) Long spinous process (key landmark for palpation)

Differentiate between C7 and T1.

C7 has a long spinous process and a transverse foramen

Ligaments

Connect bone to bone

Nuchal ligaments are located where?

From the external occipital protuberance of the skull to C7 spinous process exists a strong bilaminar intermuscular septum (a partition separating 2 chambers (e.g. Nostrils), rather than the supraspinous ligament. Acts as a muscle attachment site and is situated within the nock of the bifid spinous processes

Proprioception

Indicates body position thru stretching/slackening of muscles and ligaments

Venous bodies mainly drain to the ______.

Intervertebral plexus of veins

Intertransverse ligaments resist what motion?

Lateral flexion, contralaterally (occurring on or acting in conjunction with a part on the opposite side of the body)

Since the intervertebral is still permit movement between adjacent vertebrae in any direction, it is the ______ that greatly determine the movement possible between the vertebrae.

Orientation of these joints at the articular facets

Describe normal posture with respect to iliac spines and pubic tubercle.

The anterior superior iliac spine (ASIS) and the pubic tubercle lie in the same vertical plane. The anterior and posterior iliac spines (ASIS and PSIS) are in the same horizontal plane.

Craniovertebral joints occur between ___.

The head and the Atlas and axis

A slight lateral curvature in the ____ region based on ______ is common.

Thoracic Handedness

Periosteal arterial branch

To the periosteum (surface)

Additionally the ____ of the rib will articulate with a ____ on the ______ of the corresponding vertebrae.

Tubercle Facet Transverse process Rib 6/vertebrae 6

Scoliosis could be due to _____.

Uneven growth, one leg shorter than the other, muscle spasm, genetic error, etc.

The curvatures are due to a combination of ______ and ______.

Vertebral bodies and articular discs

Thoracic region curvature due to ____.

Vertebral bodies, meaning the bodies are slightly wedge shaped

The sacroiliac joint transfers weight from ____ to ____.

Vertebral column Lower limb

Cervical region curvature due to_____

discs, meaning discs are slightly wedge shaped