1. zygopophyseal joints
    facet joints
  2. endplate
    • found on superior and inferior end of each vertebral body
    • contained within rim of cortical bone
    • contains 2 layers cartilagionous external, bony internal
    • functions as growthplate
  3. it is important to leave the bony layer of endplate intact for fusion surgery because
    it prevents subsidence of device into soft cancellous bone
  4. apophyseal ring
    ring of cortical bone that surronds the vertebral body beneath portions of endplate
  5. intervertebral foramen
    • formed by pedicles
    • opening through which spinal nerve roots leave spinal cord
  6. sacralization
    L5 fuses to S1
  7. lumbarization
    S1 remains separate from S2
  8. lateral mass
    large concave articulating surfaces of cervical vertebrae
  9. odontoid process aka
  10. uncinate processes
    subaxial cervical spine upward projections on lateral margins
  11. uncovertebral joint aka
    • joints of luschka
    • articulating vertebral bodies of cervical spine C3-C7
  12. cervical nerve roots travel out of
  13. vertebral prominens
    longer larger spinous process at C7
  14. costal vertebral joints are found
  15. pars lateralis
    • area of sacrum surrounding the foramina
    • made from fused transverse processes of formal sacral vertebrae
  16. sacral hiatus
    • anchor for spinal cord and cauda equina
    • contains the filum terminale
  17. internal substance of disc
    nucleus pulposus
  18. annulus fibrosus
    outer collagenous part of disc
  19. blood supply to disc
    diffusion through endplate
  20. motion segment composition
    • two adjacent vertebrae
    • the disc between them
    • connecting capsular facet joints
    • ligamentous structures
  21. occiput to C1 articulation
    • occipitocervical joint or
    • alantooccipital joint
  22. C1-C2 joint
    atlantoaxial joint
  23. occipitocervical joint ROM
    mainly flexion and extensino
  24. atlantoaxial joint ROM
    motion in transverse plane for rotation
  25. zygapophyseal joints between C1 and C2 ROM
    allow for flexion-extension, side bending, rotational movements
  26. occipitoatlantal ligament complex
    • between C0 and C1
    • anterior occipitoatlantal ligament
    • posterior ociipitoatlantal ligament
    • lateral occipitaoatlantal ligaments
  27. atlantoaxial ligament complex
    • ligaments betweem C1 and C2
    • anterior atlantoaxial ligament
    • posterior atlantoaxial ligament
    • lateral ligaments
  28. occipitoaxial ligament complex
    • occipital ligament
    • alar ligaments x2
    • apical ligament
  29. occipital axial ligament
    • extends from
    • axis posterior body (spinal canal) to anterior foramen magnum
    • (continuation of posterior longitudinal ligament)
  30. alar ligaments
    • aka check ligaments
    • extend laterally from superior tip of odontoid process to occipital condyles
  31. apical ligament
    extends from tip of odontoid process in C2 to anterior foramen magnum
  32. cruciate ligament complex
    • transverse ligament
    • superior and inferior longitudinal fascicles
  33. transverse ligament
    helps stabilize atlantoaxial complex
  34. anterior longitudinal ligament
    • extends from anterior axis to sacrum.
    • attaches at endplates
  35. intertransverse ligaments
    extend from inferior surface of entire length of transverse process to superior surface of adjacent transverse process
  36. costal ligaments
    connect heads of ribs to vertebrae
  37. posterior longitudinal ligament
    • weaker than ALL
    • run from axis to sacrum caudally
    • may help to contain herniated discs
  38. intraspinous ligament
    connect adjacent spinous process
  39. ligamentum flavum
    • aka the yellow ligament
    • extends from anterio inferior surface of lamina above and below
  40. supraspinous ligament
    extends from spinous process to spinous process
  41. iliolumar ligaments
    extend from TP of L4, L5 to iliac crest
  42. lumbarsacral ligament
    extends from aterior inferior aspect of TP L5 to lateral surface of sacrum
  43. sacroliliac liagaments
    extend from sacrum to iliac bone
  44. at what level does the spinal cord terminate
    at L1 it terminates as the conus medullaris
  45. epidural space contains
    • fatty tissue
    • veins and arteries
  46. epidural space of spinal collum functions as a
    shock absorber
  47. epinueurum
    membrane covering spinal nerves
  48. subdural space
    small space between dura and arachnoid layer
  49. subarachnoid space
    • layer between arachnoid and pia mater
    • contains CSF
  50. ciculating CSF acts
    • to protect by acting as a shock absorber
    • to nourish containnig electrolytes, proteins, and glucose
  51. pia mater
    • closely adherent to spinal cord
    • highly vascular suppling blood to neurological structures
  52. # of pairs of cervical, thoracic, lumbar, sacral, coccygeal, and total nerve roots
    • cervical 8
    • thoracic 12
    • lumbar 5
    • sacral 5
    • coccygeal 1
    • total 31 pairs
  53. motor fibers are located
    in anterior spinal cord
  54. multiple motor filament fibers are refered to as
    ventral roots
  55. cell bodies of motor nerve roots are located
    within spinal cord
  56. damage to motor root will result in
    loss of musculoskeletal function
  57. sensory fibers are located
    posteror spinal cord
  58. collection of sensory fibers
    dorsal root
  59. peripheral nerve
    jointing of dorsal and ventral root
  60. vertebral arteries joint to form
    basilar artery
  61. basilar artery joins with ICAs to form
    circle of willis
  62. abdominal aorta bifurcates into
    common illiac arteries
  63. common illiac arteries bifurcate into
    internal and external illiac artery
  64. exteral iliac artery becomes the
    femoral artery
  65. IVC bifurcates to
    common iliac veins
  66. internal jugulars join to form
  67. adominal aorta ends at what level
  68. in a ACDF what structures should be carefully avoided/protected
    • vertebral arteries C1-C6
    • Carotid arteries
    • juglar veins
    • pharynx C1-C2
    • larynx C5
    • recurrent laryngeal nerves
    • thyroid gland
    • esophagus
    • trachea
  69. at what level do the heart and great vessels rest against vertebral bodies
  70. structures in abdomen and pelvis that must be carefully protected in surgery
    • great vessels
    • kidneys
    • ureteres
    • urinary bladder
    • middle sacral artery
  71. spondylolisthesis
    anterior subluxation of one vertebra on another
  72. retrolisthesis
    posterior slippage of one vertebra on another
  73. lateral listhesis
    slippage to one side or the other
  74. spondylosis
    degenerative changes in vertebrae at articulation points
  75. spondylolysis
    defect in the vertebrae, usually the pars interarticularis
  76. spondyloptosis
    spondylolisthesis in which the entire L5 vertebral body has fallen bellow the horizontal line across the top of the sacrum
  77. Classifications of spondylolistesis
    • Type I - Dysplastic
    • Type II - Isthmic
    • Type IIA - Lytic or Stress
    • Type IIB
    • Type IIC
    • Type III degenerative
    • Type IV traumatic
    • Type V pathologic
    • Type VI iatrogenic
  78. Type I - Dysplastic or congenital spondylolisthesis
    • usually at L5-S1
    • congenital defect in sacral articulating processes or posterior elements of L5
    • intact posterior elements may compress dura as subluxation increases
  79. Type II - Isthmic
    • defect or fx of pars interarticularis of lamina
    • L5-S1 most common site
    • Contains three subtypes
  80. Type IIA - lytic or stress
    • recurrent microfractures in pars interarticularii from hyperextension cause complete separation of posterior elements - stress fx of the pars
    • most common type
    • L5-S1 most likely location
    • more common in males: wt lifters, football linemen, gymnasts
  81. Type IIB
    microfractures in pars which remains intact but stretches as fxs fill with new bone causing pars to enlongate and the body to sublux forward
  82. Type IIC
    • acute fx of pars
    • difficult to distinguish from Type IIA
  83. Type III - degenerative spondylolisthesis
    • results from degenerative changes in facet joints causing hyper mobility of motion segment
    • L5 nerve root is often compressed
    • most common at L4-L5
    • more common in females
  84. type IV traumatic spondylolisthesis
    fracture of vertebra in area other than pars: pedicles, lamina, or facets
  85. type V pathologic spondylolisthesis
    tumor or metabolic type
  86. Type VI iatrogenic spodylolisthesis
    excessive surgical decompression of posterior elements
  87. symptoms of spondylolisthesis
    • LBP
    • mild backache that may be exertion related
    • posterior thigh radiculopathy
    • forward center of gravity
    • lordodic curve with possibly a horizontal sacrum
    • knees and hips partially flexed
    • shuffling gate
    • sciatica
    • claudication - from decreased vascular circulation
  88. X-ray signs that indicate spondylolysthesis
    • Napoleon's hat
    • Scotty Dog Sign
  89. Meyerding Grading system
    • Normal - no slip
    • Grade I - 25% slip
    • Grade II - 45-49% slip
    • Grade III - 50 - 74% slip
    • Grade IV - 75-99% slip
    • Grade V - body completely off level below
  90. Slip Angle Method of grading
    angle made from top of posterior body of level below slip and inferior endplate of slipped vertebra
  91. Sacral inclination method of grading
    angle of sacrum to a line drawn perpendicular to floor
  92. sagittal rotation method of grading
    measure with one line against posterior sacrum the other the anterior body of the subluxed vertebrae
  93. Modified Newman Method
    amount of roll the L5 has along sacral endplate - degree of slip and amount of tilt measuring the horizontal and vertical position
  94. conservative tx of sympomatic spondylolisthesis
    • cessation of precipitating activities
    • bed rest
    • traction
    • bracing
    • back exercises
    • medications
  95. tx of spondyloslisthesis in adults refractory to conservative tx
    surgery in cases of intractable pain or with neurological symptoms
  96. degenerative diseases
    loss of normal tissue sturcture and function due to aging process
  97. osteoarthritis
    inflammation of bones and cartilage due to degenerative process
  98. spondylosis
    symptomatic, degenerative changes of osteoarthritis
  99. common causes of spondylosis
    • DDD
    • spinal stenosis
  100. water content of nucleus at birth and at fifth decade of life
    • 90%
    • 70%
  101. 7 ligaments that attach the motion segment
    • anterior longitudinal ligament
    • posterior longitudinal ligament
    • ligamentum flavum
    • face capsular lifagment
    • intertransverse ligament
    • interspinous ligament
    • supraspinous ligament
  102. spinal stenosis is often the result of
    lifamentous damage that has led to reduced or excessive ROM of the the motion segment which causes spurs and osteophytes leading to spinal stenosis.
  103. sclerosis
    • increased bone formation in subchondral bone adjacent to endplate
    • decreases blood flow to cartilaginous endplate into disc causing degeneration
    • stiffens endplate making it less able to absorb loads.
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