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3 functions of the back
- Support - body's weight, carry and position head
- Movement - of head, upper limbs, and vertebral column
- Protection - of spinal cord
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How many vertebrae are there?
33
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How many of each vertebrae?
C7, T12, L5, S5, C4
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How many bones are fused into the coccyx?
4
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How many bones fuse into the sacrum?
5
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What are the primary curvatures?
Thoracic and Sacral
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What are the secondary curvatures? When do they form?
- Cervical (at 3 months, when baby learns to hold head up)
- Lumbar (10 months-1yr, when baby starts to walk)
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where do kyphoses form?
in the primary curvatures - thoracic + sacral
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where do lordoses form?
in secondary curvatures - cervical + lumbar
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Why does lumbar lordosis form?
B/c of the pressure of the abdominal organs against the lumbar vertebrae
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When does lordosis get worse
during pregnancy
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What are the two sections of a vertebrae
vertebral body & vertebral arch
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What is vertebral canal for?
spinal cord runs through it
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What does superior articular process articulate with?
with inferior articular process of vertebrae above
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What does inferior articular process articulate with?
with superior articular process of vertebrae below
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what hole is formed when vertebral notches are stacked on top of each other?
intervertebral foramen
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what runs through intervertebral foramen?
spinal nerves
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what is a pedicle?
bridge that connects lamina to vertebral body
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what is a lamina?
connects the transverse processes to spinous process
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# of processes on vertebrae typically? what are they?
- 7 total:
- 2 transverse processes
- 1 spinous process
- 2 superior articular processes
- 2 inferior articular processes
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components that make up the vertebral arch?
pedicle + tranverse processes + lamina + spinous process
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distinguishing feature of cervical vertebrae?
- 2 tranvserse foramen on either side of the vertebral body
- vertebral artery goes through this to enter cranium
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describe vertebral foramen of cervical vertebrae
large and triangular, much bigger than other vertebrae
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describe body of cervical vertebrae
small and square shaped
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describe spinous process of cervical vertebrae
most are bifid
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where does vertebral artery run through?
- runs through transverse foramen in cervical vertebrae
- enters at C6 > goes up to C1 > up to cranium
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another name for C1? why?
Axis, b/c it holds the head up
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distinguishing features of Atlas?
has no vertebral body + articular facet for dens to articulate to + 2 lateral masses
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where does C2 articulate with C1?
at the inferior articular surfaces of lateral masses of Atlas
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distinguishing featture of Axis?
dens
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what is the strongest cervical vertebrae?
Axis, because it carries the cranium
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what does the dens articulate with?
articular facet of Atlas
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what motion is done by atlanto-occipital joint?
nodding head yes
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what motion is done by atlanto-axial joint?
rotating head no
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how is the atlanto-occipital joint formed?
when lateral mass of Atlas articulates with occipital condyles of the cranium
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purpose of transverse ligament of Atlas
holds dens against arch of Atlas, without it the dens would press up in spinal cord
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atlanto-axial is what type of joint?
pivot joint - one bone remains stationary (dens), other spins (Atlas)
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atlanto-occipital is what type of joint?
synovial joint
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how is the atlanto-axial joint formed?
when dens of Axis articulates with articular facet of Atlas
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distinguishing feature on C6?
- anterior tubercle aka carotid tubercle
- the carotid artery can be pressed against it to control bleeding
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what is the most prominent cervical vertebrae? what is it used for?
- C7 aka vertebra prominens
- used as landmark to count up or down
- have to bend neck to see it
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distinguishing feature of C7?
- NON bifid spinous process that is long
- sticks out as a landmark aka vertebra prominens
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what do C3-T1 have in common?
uncinate processes
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what do uncinate processes articulate with?
vertebral body above it
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what joint forms between uncinate process and its articulating vertebral body? what can happen here?
- luschka joint
- they can get arthritis
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distinguishing features of C3-C5
short, bifid spinous process
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what is present on the transverse process of cervical vertebrae?
anterior and posterior tubercle
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describe body of thoracic vertebrae?
what else is present?
- heart shaped
- has 2 costal facets for articulation with the head of rib
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describe vertebral foramen of thoracic vertebrae
circular and smaller than those of cervical and lumbar vertebrae
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why are thoracic vertebrae unique?
bc they articulate with ribs and thoracic cage
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describe transverse processes of thoracic vertebrae
- long and strong
- extend posterolaterally
- gets shorter from T1 to T12 (T1-T10 have facets for articulation with tubercle of rib)
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describe spinous process of thoracic vertebrae
- long
- slopes posteroinferiorly (back and down)
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how many costal facets on typical thoracic vertebrae?
- 6 total:
- 2 superior costal facets
- 2 inferior costal facets
- 2 transverse costal facets
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where does the head of the rib fit?
superior costal facet
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where does tubercle of rib fit?
transverse costal facet
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which are the atypical thoracic vertebrae?
T1, T9-12
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distinguishing feature for thoracic vertebrae?
costa facet on vert. body + transverse processes for rib articulation
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most commonly fractured vertebra and why?
T12 because it bears more weight and subject to transitional stress but it was not made to hold all the body weight
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distinguishing features of lumbar vertebrae?
- no costal facets
- 2 tiny processes - mamillary and acessory
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describe body of lumbar vertebrae
large + kidney shaped
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where are mammillary and accessory processes located?
on lumbar vertbrae
- mamillary - posterior surface of each superior articular process
- accessory - posterior surface of transverse process
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function of mammillary process?
gives attachment to multifudus + intertransversarii muscles of the back
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function of accessory process?
provides attachment for intertransversarii muscles of back
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what is the largest vertebra?
- L5
- has massive transverse processes
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what does sacrum articulate with? what does it form?
with hip bones at sacroiliac joint to form pelvic girdle
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function of sacrum?
transmits body weight to pelvis
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what is the sacral hiatus?
end of sacral canal
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fused spinous processes in sacrum form?
median crest
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fused articular processes in sacrum form what?
intermediate sacral crests
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fused tips of the transverse processes in sacrum form what?
lateral sacral crests
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what structure do you palpate on a pt for injecting caudal anasthesia?
- sacreal corneae
- located below the ending of sacral canal laterally on both sides
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where does sacrum articulate with hip bone?
at auricular surface
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how does sacrum connect to coccyx?
sacral corneae articulate with coccygeal corneae
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which joint joins together sacrum and coccyx?
sacrococcygeal symphysis
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function of coccyx?
provides site of attachment for gluteus maximus + coccygeal muscles + anococcygeal ligament
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what structures does the coccyx lack?
pedicles, laminae, spines
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type of joint between vertebral bodies?
symphyses = secondary cartilaginous joints
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type of joints between articular processes?
synovial joints
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how many joints do typical vertebrae have? + names?
- 6 total:
- 4 synovial joints b/w articular processes (2 above, 2 below)
- 2 symphyses b/w vert. bodies (1 bove, 1 below) = IVD disc
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purpose of IV disc?
absorbs shock, takes all the weight from body
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what makes up the symphysis b/w adjacent vert. bodies?
layer of hyaline cartilage on each body + IVD disc in the middle
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purpose of symphysis between vert. bodies?
weight bearing and strength
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Total # of discs in human spine?
- 23:
- 6 cervical
- 12 thoracic
- 5 lumbar
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structure of IV disc?
anulus fibrosus (outer rings) + nucleus pulposus (inner jelly like substance)
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no IV disc in between?
C1 and C2
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last IV disc located between?
L5 and S1
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what does it mean for a disc to herniate?
if the anulus fibrosus rings tear, the nucleus pulposus will spill out = herniation
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what direction do most disc herniations occur in? why is this bad?
- posterolaterally
- bad because this pushes jelly back into intervertebral foramen > this pushes on the nerves and causes pain or damage
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IV disc protrusion most common in what levels?
- b/w L4 and L5
- b/w L5 and S1
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what are joints of vertebral bodies b/w uncinate processes called?
joints of luschka aka uncovertebral joints
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uncovertebral joints are frequent sites of?
bone spur formation in later years > can cause neck pain
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joints of the vertebral arches are called?
- zygapophysial joints = facet joints
- b/w superior and inferior articular processes
- allow for gliding movement b/w articular processes
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zygapophysial joint is what type of joint?
- plane synovial joint
- two flat surfaces come together, slide across each other
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what are zygapophysial joints innervated by?
articular brances that arise from posterior rami of spinal nerves
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what can help with arthritis of facet joints?
facet injections > help with inflammation + pain
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attachment & function of anterior longitudinal ligament
- A - anterior bodies & intervert. discs
- F - prevents hyperextension, maintains stability of IV discs
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attachment & function of posterior longitudinal ligament
- A - posterior bodies & intervert. discs
- F - prevents hyperflexion, prevents IV disc herniation
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which ligament prevents IV disc herniation?
posterior longitudinal ligament
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attachment & function of intertransverse ligament
- A - connects adjacent transverse processes
- F - limits lateral bending
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attachment & function of interspinous ligament
- A - connects adjacent spinous processes
- F - limits flexion
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attachment & function of supraspinous ligament
- A - connects tips of spinous processes
- F - limits flexion
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attachment & function of ligamenta flava
- A - paired ligaments uniting lamina of adjacent vertebrae
- F - limits flexion, preserves curvature of column, prevents injury to IV discs
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attachment & function of ligamentum nuchae
- A - C7 to occipital bone
- F - prevents cervical hyperflexion, attachment site for trapezius and rhomboid minor
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which ligament is the cervical extension of supraspinous ligament?
ligamentum nuchae
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order of ligaments needed to pass through for lumbar puncture?
supraspinous lig. > interspinous lig > ligamentum flavum
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last ligament needed to pass through to get to spinal canal for lumbar puncture?
ligamentum flavum
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what are intervert. discs secured by?
anterior long. + posterior long. ligaments
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what 3 joints is atlantoacial joint made of?
- 1 pivot joint - medial atlantoaxial joint b/w dens and atlas
- 2 plane joints - right and left lateral atlantoaxial joints b/w articular proceses of lateral masses
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how is dens of C2 held in place?
- anteriorly by anterior arch of atlas
- posteriorly by transverse ligament of atlas
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what is cruciate ligament made of + where is it located?
- located b/w C1 and C2
- made of superior longitudinal band + transverse ligament of atlas + inferior longitudinal band
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superior longitudinal band of cruciate ligament
passes from transverse ligament to occipital bone
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inferior longitudinal band of cruciate ligament
passes from transverse ligament to body of C2 inferiorly
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what is the tectorial membrane
the strong superior continuation of the posterior longitudinal ligament that broadens + passes posteriorly over median atlanto-axial joint and its ligaments
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plexus of veins located on anterior aspect of vertebral bodies?
anterior external vertebral venous plexus
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plexus of veins located on posterior aspect of spinous processes?
posterior external vertebral venous plexus
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plexus of veins located on anterior aspect of vertebral canal?
anterior internal plexus
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plexus of veins located on posterior aspect of vertebral canal?
posterior internal plexus
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internal plexus veins connect w/external plexus through?
communicating veins of basiverteral vein
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downside to internal veous plexus
both are valve-less > blood flow can happen in any direction > bad because infections from outside can come inside and travel to the brain (cancers spread this way)
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network of valve-less veins known as?
batson plexus of veins
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basivertebral vein
connects internal and external vertebral venous plexus
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intervertebral vein
connects spinal venous plexus to vertebral venous plexus
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nucleous pulposus lacks what kind of innervation?
pain innervation
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spinal nerves supply to
vertebral bodies
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5 types of movements along vertebral column
flexion, extension, lateral flexion, lateral extension, rotation
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range of movement along vert. column is limited by? (5 things)
- thickness, elasticity, + compressibility of IV discs
- shape + orientation of zygapophysial joints
- tension of the joint capsules of zygapophysial joints
- resistance of the back muscles + ligaments
- attachment to thoracic rib cage
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flexion is greatest in what area of the vertebral column?
cervical region
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extension is greatest in what area of the verteral column?
lumbar region
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the interlocking of the articular proceses in lumbar region prevents what movement?
rotation of vertebral column
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lateral flexion of vertebral column is greatest in what area of vertebral column?
cervical and lumbar regions
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rotation is most prominent in what region of vertebral column?
thoracic region (cant flex much)
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