Spinal Anatomy Exam 4 - Longer set

What is the primary curvature, and where is it located?

Kyphotic

Thoracic & Pelvic (sacrococcygeal)

What is the secondary curvature and where is it located?

Lordotic

Cervical and Lumbar

What direction does the spine face in the earliest stage of development?

Posteriorly

What are the secondary curvatures also known as?

Anterior/compensatory curves

What does the secondary curvature allow for?

Erect posture

When is the secondary curvature detected?

Postnatal period (Developmental milestone)

What creates cervical lordosis?

Lifting of head from prone position (3-4 months)

Sitting upright (9 months)

Incr. anterior dimensions of IVD

What is the upper cervical curve?

Primary curve extending form occiput-axis

What is the lower cervical curve?

Lordotic curve inferior aspect of C2 and below

When is lack of cervical lordosis common?

Children and those under 17

What can lack of cervical lordosis be a sign of?

Ligamentous injury

Anterior cervical muscular hypertonicity

Hyperplastic articular pillars

When does the lumbar curvature develop?

9-18 months (walking upright)

What muscles achieve the position for walking?

Erector spinae

What maintains lumbar lordosis?

Shape of IVD and Vertebral body

What is the orientation of the zygapophysis of L1-L4 in infants?

Coronal

What is the orientation of the zygapophysis of L1-L4 in maturation?

Sagittal

When does facet orientation change and end?

6-18 months

What factors cause zygapophysis movement?

Posture

Walking

Weight transfer in VB to the zygapophysis

Lordotic curvature

What is the unique progression in lumbar curvature development?

Posterior shift fo nucleus pulposus in annulus fibrosus at L4 level

What is lateral curvature?

Slight lateral curve in upper thoracic region

Originally though to be with handedness

What is the angle of the natural kyphotic curve?

20-45 degrees

What is it called when the thoracic curve is greater than 50 degrees?

Hyperkyphosis

What are colloquial terms for hyperkyphosis?

Humpback, hunchback, roundback

What contributes to kyphosis abnormalities?

Poor posture, DDD, Arthritis, Osteoperosis, Trauma, Development

What are the 3 most common types of kyphosis abnormalities in children and adolescence?

Postural kyphosis

Scheuermann's kyphosis

Congenital kyphosis

What is the most common type of kyphosis abnormality? (1 in 10)

Postural Kyphosis

What is postural kyphosis?

Poor posture/slouching

Not associated with sever structural abnormalities

What is Scheuermann's kyphosis?

Disease in 0.4-8.3% of adolescents

Structurally abnormal

Disruption of cartilaginous endplates and epiphyseal rims

Wedge-shaped vertebral bodies

What are the treatments for Sceuermann's kyphosis?

Bracing spine in extension

Palliative treatment for pain and discomfort

Exercises

What is Congenital kyphosis?

Present at birth

Vertebrae do not form properly or fuse together

What are additional birth defects with congenital kyphosis?

Heart and kidney issues; neurological symptoms

Weakness and numbness in legs

What is straight (flat) back syndrome?

Thoracic kyphosis almost completely absent

Results in narrowing of anterior-posterior dimensions of thoracic cage (decr. space for heart)

What is straight (flat) back syndrome associated with?

Systolic heart murmurs

Distorted cardiac silhouette on x-ray

Simulate organic heart disease

Idiopathic mitral valve prolapse (life-threatening)

What can cause lordosis abnormalities?

Posture, weight, trauma, surgery, pregnancy, hip problems

What is the angle of the typical cervical lordotic curve?

20-40 degrees

What is the angle of the hyperlordotic curve? (cervical)

Greater than 40 degrees

What is the angle for the hypolordotic curve? (cervical)

Fewer than 20 degrees

What is the typical lordotic curve angle? (lumbar)

40-60 degrees

What is military (straight) neck?

Decreased anterior curve in cervical region (hypolordotic)

What is swayback?

Increased anterior curve in lumbar region (hyperlordotic)

What is Scoliosis?

Any spine region (thoracic is most affected)

Forward flexion of spine: posterior elevation on one side 6mm or greater

What can cause scoliosis?

Developmental

Anatomical

Idiopathic

What causes lateral curve progression/worsening in scoliosis?

Skeletal growth spurts

From birth to age 2

What is Risser sign?

Test to determine bone maturity

What does the Scoliosis Research Society classify spinal deformity with?

Magnitude

Location

Direction

Etiology

Structural or non-structural

What is Magnitude in spinal deformity?

Lenght and angle of curve on X-ray

Cobb Method

What is Location in spinal deformity?

Location of vertebra at apex of curvature

What is Direction in spinal deformity?

The side the convexity of the curve bends (left or right)

What are the classifications of Etiology in spinal deformity?

Idiopathic

Degenrative

Congenital

Neuromuscular

Thoracogenic

Syndromic

What is non-structural scoliosis?

Mild deviation; unlikely to worsen; not associated with deformities of vertebrae or IVD

Poor posture, unequal leg length, muscle spasm

What is structural scoliosis?

Most common

May worsen; structural deformities of Vertebra and/or IVD

What are possible causes of structural scoliosis?

Disease state

Birth defects

Injury

Infection

Abnormal growth

What is Idiopathic Scoliosis?

Largest # of patients suffering form scoliosis fall under this

Causes: Inherited factors, physical abnormalities, coordination problems

What are the 3 types of idiopathic scoliosis based on age of onset?

Infantile idiopathic scoliosis

Juvenile idiopathic scoliosis

Adolescent idiopathic scoliosis

What is Infantile Idiopathic Scoliosis?

Birth-3 years

Uncommon

Most resolve spontaneously

56% male

The vertebral bodies rotated to the left

What is Juvenile idiopathic scoliosis?

3-10 years old

12-21% of patients

No gender difference until age 6 (mc in females)

Right thoracic deviation curve pattern

What is Adolescent idiopathic scoliosis?

Over 10 years old

~80% of cases

Primarily females (growth spurts)

>90% curves deviate right, can have double curves

Linked to autosomal dominant inheritance

What are the ligaments related to VB jxns?

Intervertebral disc

ALL

PLL

What are the ligaments related to the vertebral arch jxn?

Ligamentum flavum

What are the ligaments related to the apophyseal region jxns?

Capsular ligament

Interspinous ligament

Ligamentum nuchae

Supraspinous ligament

Intertransverse ligament

What are the 3 distinct zones of the IVD?

Central zone (nucleus pulposus)

Peripheral zone (Annulus fibrosus)

Horizontal zone (sup. & inf. margins, cartilaginous end plates)

What is the IVD made of?

Proteoglycan gel and collagen

What happens to IVD volume throughout the day?

Water concentration loss

8 hours of supine returns H2O, restoring height

What happens to the nucleus pulposus as we age?

It becomes more fibrous as H2O and proteoglycan decrease

Overall IVD height diminishes

What are the cartilaginous end plates composed of?

Hyaline and fibrocartilage

Where is hyaline cartilage attached to in the end plates?

Centrum

Where is the fibrocartilage attached to in the end plates?

IVD

What do the Cartilaginous end plates do?

Prevent centrum form atrophy and pressure

Keeps IVD in border

Extremly porous

Diffusion of gases, nutrients and waste material

What is the centrum?

Body of vertebra

What is the posterior/posterolateral disc innervated by?

Sinu-vertebral nerve (recurrent meningeal nerve)

What is the Lateral disc innverated by?

Gray ramus communicans

What is the anterior disc innervated by?

Sympathetic branches, sympathetic trunk/ganglia

What are the two most common problems with the IVD?

Degeneration

Herniation

What makes IVD degeneration unique?

Avascular nature

Degeneration process occurs early in life (second decade)

What the hallmarks of IVD degeneration?

Loss of fluid and fluid psi

Disruption or breakdown of collagen and proteoglycans

Sclerosis of cartilaginous endplates

How does aortic atherosclerosis promote IVD degeneration?

Ca deposits in the posterior wall incr. the risk of degeneration

Associated with back pain

What is a herniated disc?

Sudden or overtime

Tearing of inner layer of annulus fibrosis

Bulging annulus fibrosis

Extrustion of nucleus pulposus through annulus fibrosis

What is a disc bulge?

Expansion of disc material beyond its normal border

Bulging of annulus fibrosis

When does NP discal material herniate?

younger than 30

When does AF discal material herniate?

Older than 30

What are the 3 subcategories of IVD herniation?

Protrusion

Extrusion

Sequestration

What is protrusion?

Discrete localized bulge in AF

Discal material displaced

NP or other fragments of IVD protrude through inner layer of AF

"true" herniated disc present

What is extrusion?

Pedunculated protrusion

NP protrude (herniate) through all layers of AF while remaining attached to disc of origin

What are the subcategories of extrusion?

Subligamentous extrusion

Transligamentous extrusion

What is subligamentous extrusion?

Does not penetrates PLL

What is Transligamentous extrusion?

Penetrates PLL

Can protrude both PL and dura but is rare

Where does the ALL attach?

Anterior VB from occiput to sacrum

What does the ALL do?

Limits extension

Constant tension in lumbars from weight bearing

What innervates the ALL?

Anterior neural plexus (ventral primary rami)

Where is the ALL thicker?

From anterior to posterior at regions of bodies compared to region of IVD

Describe the superficial layer of the ALL

Fibers span several vertebrae

Describe the deep layer of the ALL

Course one vertebra to the next

Define the pathology of the ALL

Can ossify = OALL

Pathology: Forestier's disease/diffuse Idiopathic skeletal Hyperostosis (DISH)

Describe OALL in the cervical region

OALL reduces cervical mobility

Associated w/ presence of a fibrous mass directly posterior to the odontoid process (Retro-odontoid pseudotumor)

What Retro-odontoid pseudotumor associated with?

Rheumatoid arthritis and atlanto-axial subluxation

Degenration of the transverse ligament due to chronic mechanical stress

What is the innervation of the PLL?

Posterior neural plexus (fibers from recurrent meningeal nerve)

Receives significant nociceptive and vasomotor innervation

What does the nociceptive innervation to the PLL do?

Makes it one of the most pain sensitive of the spine

What does the vasomotor innervation to the PLL do?

Incr. regional blood flow to promote healing after damage

What does the PLL prevent?

Limits/breaks flexion of spine

What is the PLL a continuation of?

Tectorial membrane