C & T Spine Exam Questions

What makes up the spine?

Many bones called vertebrae

Where is the spine located?

In the midsagittal plane forming the posterior aspect of the bony trunk of the body

What is the vertical spinal canal like?

Opening in each vertebra like up like a tube

Where is the spinal canal?

Begins at the base of the skull and extends distally into the sacrum

What is the spinal canal filled with?

Cerebrospinal fluid

Where is the spinal cord?

Begins below the medulla oblongata of the brain, which passes through the foramen magnum of the skull, and continues down through the first cervical vertebra to the lower boarder of the first lumbar vertebra

What is the name of the point the spinal cord ends at?

Conus medullaris (L1-L2)

What is important to note about the conus medullaris?

It may extend as low as the body of L2

What separates the typical adult vertebrae?

Tough fibrocartilaginous disks

What are the intervertebral disks for?

They give spinal stability, but allow for flexibility and movement of the vertebral column

How many sections is the vertebral column divided into?

5

What are the first 7 vertebrae known as?

Cervical vertebrae

How many thoracic vertebrae does a person have?

12

What are the largest individual vertebrae?

The 5 lumbar vertebrae

How many sacral segments does a newborn have?

5

How many coccygeal segments does a newborn have?

3-5

How many vertebral bones does a young child have?

33

How many is the adult vertebral column have?

26 separate bones

Concave

Rounded or inward depressed surface like a cave

Convex

Rounded outward or elevated surface

Cervical and lumbar regions have what kind of curve?

Concave

How are the cervical and lumbar regions described?

Lordotic

The thoracic and sacral regions have what kind of curve?

Convex described as kyphotic

What are the thoracic and sacral curves referred to as as they begin to develop?

Primary curves

As children begin to raise their heads and sit up what happens?

The first compensatory curve forms in the cervical region

What begins to develop as children learn to walk?

The second compensatory curve, the lumbar curvature

Lordosis

An abnormal anterior concavity of the lumbar spine. Chest puffed out- swayback curvature

Kyphosis

Abnormal condition characterized by increased convexity of the thoracic spine curvature

Scoliosis

Abnormal or exaggerated lateral curvature of the spine

What does a typical vertebra consist of?

Body and vertebral arch

Body of the vertebral vertebrae

Anterior part (mass of bone)

Describe the typical vertebra

Consists of a ring of bone that extends posteriorly from the vertebral body. The posterior surface of the body form the vertebral foramen

Vertebral canal

The space formed by the vertebral foramina of adjacent vertebrae, through which the spinal cord passes

Pedicles

Extend posteriorly from either side of the vertebral body

Laminae

Posterior part of the vertebral arch

Where is each laminae?

Extend posteriorly from each pedicle to unite at the midline

Transverse process

Extends laterally from the junction of each pedicle and lamina

Spinous process of the vertebrae

Extends posteriorly at the midline junction of the two laminae

Intervertebral joints

Amphiarthrodial joints found between the vertebral bodies

Zygapophyseal joints

Four articular processes found at the junction of the pedicles and laminae

What did zygapophyseal joints used to be called?

Apophyseal joints

Thoracic region

12 ribs articulate with the transverse processes and vertebral bodies

What are the articulations of the ribs and thoracic vertebrae called?

Costal joints

Superior vertebral notch

Along the upper surface of each pedicle, the half-moon shaped area

Inferior vertebral notch

Along the lower surface of each pedicle, half-moon shaped area

Intervertebral foramen

When the vertebrae are stacked the superior and inferior vertebral notches line up to form this

What is between every two vertebrae?

Two intervertebral foramina, one on each side, where spinal nerves and blood vessels pass

What separates typical adult vertebrae?

Tough fibrocartilaginous disks

Annulus fibrosus

Outer portion of the tough fibrocartilaginous disks

Nucleus pulposus

Soft inner portion of the tough fibrocartilaginous disks

Herniated nucleus pulposus (HNP)

When the inner portion protrudes through the outer fibrosis layer

What is different about the cervical vertebrae compared to the lumbar and thoracic?

They have the transverse foramina, bifid spinous process tips, and overlapping vertebral bodies

What is the first cervical vertebrae called?

Atlas

What is the second cervical vertebrae called?

Axis

Vertebra prominens

The last (7th) cervical vertebrae

Which vertebrae are the typical cervical vertebra?

C3 to C6

Transverse processes of the cervical vertebrae

Small and arise from both the pedicle and the body

Transverse foramen of the cervical vertebrae

The hole in each transverse process, vertebral arteries and veins pass through

Three foramina of the cervical vertebrae

Run vertically, right and left transverse foramina and one large vertebral foramen

Bifid tips

The end of the spinous processes of C2 to C6

Typical C3 to C6 cervical bodies are?

Small and oblong in shape, with anterior edge slightly more inferior

When can you see the zygapophyseal joints of the 2nd- 7th cervical vertebrae?

Only in a true lateral position

When can you see the zygapophyseal joints of C1 and C2?

In an AP open mouth projection

How are the intervertebral foramina situated?

At the 45 degree angle and also directed at a 15-20 degree inferior angle because of the shape of the cervical vertebrae

What would you do to demonstrate the cervical intervertebral foramina radiographically?

45 degree oblique positon with a 15-20 degree cephalad angle on the tube

Why is the 1st cervical vertebrae called the atlas?

Name derived from the Greek god who bore the world on his shoulders

Anterior arch

Found on the atlas, thick arch of bone

Odontoid process/dens

On the 2nd cervical vertebrae held in place by the transverse atlantal ligament

What is the most distinctive feature of the 2nd cervical vertebrae?

The odontoid process that projects up from the superior surface of the body

Where does rotation of the head occur?

Between C1 and C2 with the odontoid process acting as a pivot

Why is radiographic demonstration of C1 and C2 and C1’s relationship with the base of the skull important?

Injury this high in the spinal cord can result in serious paralysis and death

What is a distinguishing feature of all 12 thoracic vertebrae?

Their facets for articulation with the ribs

What does each thoracic vertebrae have on each side of the body?

A full facet, or two partial facets, called demifacets

Each demifacet of the thoracic vertebrae accepts the head of the rib to form?

A costovertebral joint

Costotransverse joints

First 10 thoracic vertebrae have facets that articulate with ribs 1-10

How can you demonstrate the thoracic zygapophyseal joints radiographically?

70-75 degree oblique position

How can you see the thoracic intervertebral foramina radiographically?

In the lateral position

Jugular notch

T2-T3

Sternal angle

T4-T5

Xiphoid tip

T9

Inferior margin of the ribs

L2-L3

Inferior angle of the scapula

T7

EAM

1 inch above C1

Mastoid tip

C1

Angle of mandible

C3

Thyroid/Adams apple

C4/C5

Vertebral prominens

C7

Clay shoveler’s fracture

Results from hyper flexion of the neck, resulting in avulsion fractures on the spinous process of C6-T1

Compression fracture

Involves collapse of a vertebral body, anterior edge collapses, changing the shape of the vertebral body into a wedge instead of a block

Hangman’s fracture

Occurs when the neck is subjected to extreme hyperextension, patient is not sable because the intact odontoid process is pressed posteriorly against the brainstem

Herniated nucleus pulposus (HNP)

Soft inner part (nucleus pulposus) of an intervertebral disk protrudes through the fibrous cartilage outer lateral (annulus) into the spinal canal, may press on the spinal core or spinal nerves (sometimes called slipped disk)

Jefferson fracture

Occurs as a result of axial loading, such as that produced by landing on ones head or abruptly on ones feet. The anterior and posterior arches of C1 are fractured as the skull slammed onto the ring

Kyphosis

Abnormal or exaggerated convex curvature of the thoracic spine the results in stooped posture and reduced height

Scoliosis

Abnormal or exaggerated lateral curvature of the spine

Teardrop burst fracture

Compression with hyperflexion in the cervical region. Vertebral body is comminuted with triangular fragments avulsed from the anterioinferior boarder and fragments from the posterior vertebral body is displaced into spinal canal. Neurologic damage is a high probability

What is the conus medullaris and where it is located?

Starts at the lower border or L1 or the top of L2. It is where the spinal cord transitions from being a solid cord to where it whisps out

From what perspective do we discuss the curvatures of the spine?

Posterior

What are the main parts of the typical vertebra?

Vertebral arch and body

What are costal joints are where are they found?

Thoracic spine, rib articulations

What allows for the passage of important spinal nerves and blood vessels?

Intervertebral foramina