Spinal Final Objectives

5 osseous features associated with a typical cervical TVP

Costal element, true transverse process, costotransverse bar, anterior tubercle, posterior tubercle

The costotransverse bar on cervical vertebrae is the landmark for…

Sulcus for ventral primary ramus

The anterior tubercle on cervical TVP is located on the tip of the…

Costal element

The posterior tubercle on cervical TVP is located on the tip of the…

True transverse process

C6 variation of the anterior tubercle of a cervical TVP

Carotid tubercle

What structure connects the anterior and posterior tubercles of cervical TVP?

Costotransverse bar

The carotid tubercle is a C6 osseous feature made for the…

Common carotid artery

Location of the 3 primary centers of ossification on typical vertebrae

Centrum (1), vertebral arch (2)

What type of joint do primary centers of ossification leave after growing towards one another in typical vertebrae?

Cartilaginous synchondrosis

What does the neurocentral synchondrosis allow for after primary centers of ossification finish?

Allow for SC growth

Location of 5 secondary centers of ossification in typical vertebrae

Tip of spinous process (1), tips of TVPs (2), superior and inferior epiphyseal plates (2)

When do secondary centers of ossification in typical vertebrae tend to arise and fuse?

Arise 11-16 years old, fuse by 25 years old

Location of chondrification center pairs in typical vertebrae

Centrum, L and R neural arches, L and R TVPs (6 total)

Chondrification of membranous vertebral blastema occurs in a __ form.

Cranial to caudal

Total number of synovial joint surfaces on a typical cervical vertebrae

8

Location of synovial joints on a typical cervical VB

L&R uncinate processes, L&R lateral grooves (synovial saddle)

Location of synovial joints on a typical cervical vertebral arch

Superior and inferior articular processes (synovial plane)

Total number and location of synovial joints surfaces on C1

5 total; median atlantoaxial joint (synovial pivot), lateral atlantoaxial joints (synovial plane), atlanto-occipital joints (synovial ellipsoidal)

Total number and location of synovial joints surfaces on C2

7 total; median atlantoaxial joint (synovial pivot), L&R lateral grooves (synovial saddle), articular facet joints (synovial plane)

Total number and location of synovial joints surfaces on C7

6 total; L&R uncinate processes (synovial saddle), articular facet joints (synovial plane)

Joint classification of median atlantoaxial joint

Synovial pivot

Joint classification of lateral atlantoaxial joints

Synovial plane

What makes up the median atlantoaxial joint?

Dens, osteoligamentous ring (fovea dentis) and transverse atlantal ligament

What makes up the lateral atlantoaxial joints?

C1 inferior articular facets and C2 superior articular facets

What type of cartilage makes up cartilaginous synchondrosis joints?

Hyaline cartilage

What type of cartilage makes up cartilaginous symphysis joints?

Fibrocartilage

Pubic symphysis and IVDs are examples of…

Cartilaginous symphysis

Cartilaginous epiphyseal plates and costochondral joints are examples of…

Cartilaginous synchondrosis

__ are considered permanent cartilaginous joints

Cartilaginous symphysis

The ponticulus posticus is an accessory bone that connects the…

Lateral mass and arcuate rim

Ponticulus posticus is the ossification of…

Posterior atlanto-occipital ligament

A complete formation of the ponticulus posticus creates an…

Arcuate foramen

What lies beneath the ponticulus posticus that may be a potential area of compression?

Sulcus of vertebral artery

What age does the ponticulus posticus tend to form?

2-7 years old

Total number and location of synovial joints surfaces on an atypical T1

10 total; superior costal facets, inferior costal demi-facets, superior and inferior articular facets, transverse costal facets (all synovial plane)

The head of rib 1 articulates with the superior costal facets of __

T1

The superior articular surface on the head of rib 2 articulates with the inferior costal demi-facet of __

T1

The articular surface on rib 1 tubercle articulates with transverse costal facet of __

T1

The articular surface on rib 2 tubercle articulates with transverse costal facet of __

T2

Total number and location of synovial joints surfaces on atypical T10

8 total; single costal facets, transverse costal facets, superior and inferior articular facets (all synovial plane)

Inferior surface on head of rib 7 articulates with superior costal demi-facet of __

T7

Superior surface on head of rib 7 articulates with inferior costal demi-facet of __

T6

The supporting ligaments of costocentral joints

Capsular ligament, radiate ligaments (upper, middle, lower), interarticular ligament

Ligament that connects the interarticular crest on head of rib to IVD

Interarticular ligament

The articular surface on rib 7 tubercle articulates with transverse costal facet of __

T7

Supporting ligaments of costotransverse joint

Capsular ligament, 3 costotransverse ligaments

Costotransverse ligament connecting inferior border of TVP above to neck of rib below

Superior costotransverse ligament

Costotransverse ligament connecting anterior border of TVP to posterior neck of rib at same level

Inferior costotransverse ligament

Costotransverse ligament connecting transverse tubercle on TVP to non-articular surface of rib tubercle at same level

Lateral costotransverse ligament

Articular surface of rib 2 costal cartilage articulates with __ on the manubrium and corpus sterni

Costal notch 2

Joint classification of the second sternochondral/costal joint

Synovial plane

The interarticular ligament in the second sternochondral joint connects the fibrous capsule to the __

Manubrium symphysis

Ligaments that help support the second sternochondral joint

Interarticular ligament, anterior and posterior radiate ligaments

T1 TVP muscle attachments

Longissimus thoracis, cervicis, capitis; semispinalis cervicis, capitis; multifidus; rotators; intertransversarii; levator costorum brevis

T2-T8 TVP muscle attachments

Longissimus thoracis, cervicis, capitis; semispinalis cervicis, capitis; multifidus; rotators; intertransversarii

T9 TVP muscle attachments

Longissimus thoracis, semispinalis thoracis, multifidus, rotators, intertransversarii, levator costorum longus and brevis

T10 TVP muscle attachments

Longissimus thoracis, semispinalis thoracis, multifidus, rotators, intertransversarii, levator costorum longus and brevis

T11 TVP muscle attachments

Longissimus thoracis, semispinalis thoracis, multifidus, rotators, intertransversarii, levator costorum brevis

In the thoracic kyphotic/posterior/primary curve, the posterior height of ___ is greater than its anterior height by 1-2 mm

Vertebral body

Centers of ossification on rib 1

Primary=body; secondary=head, tubercle

Centers of ossification on rib 2

Primary=body; secondary=head, art surface and non-art surface of tubercle

Centers of ossification on ribs 3-9

Primary=body; secondary=head, art surface and non-art surface on tubercle

Centers of ossification on rib 10

Primary=body; secondary=head, tubercle

Centers of ossification on ribs 11-12

Primary ONLY=body (lacks head and tubercle

Order of ossification centers (rib 1, 2, 3-9, 10, 11-12)

3, 4, 4, 3, 1

When do primary centers of ossification on the ribs appear?

2nd month of fetal development

When do secondary centers of ossification on ribs appear?

During puberty

Joint classification of sacrococcygeal joint

Cartilaginous symphysis

Congenital fusion of the sacrococcygeal joint is considered…

Sacralization of Co1

Sometimes, a __ joint will develop in the sacrococcygeal joint

Synovial

Hofmann ligament that connects the anterior aspect of dura to the posterior aspect of lumbar VB and PLL (the most numerous and robust)

Anterior Hofmann/midline Hofmann/midline meningovertebral ligament

Hofmann ligament that connects the posterior aspect of dura to laminae and ligamentum flavum (less common)

Posterior Hofmann/meningovertebral/epidural ligament

Hofmann ligament that connects anterolateral aspect of dura to lateral extensions of the PLL attached to IVD, ligamentum flavum, or laminae (less common and robust than anterior Hofmann)

Lateral Hofmann/meningovertebral/epidural ligament

Hofmann ligament that connects exiting dural root sleeve to inferior pedicles in IVF, limiting medial and superior mobility of nerve roots (less robust; not found in all lumbar segments)

Lateral root ligament

Fusion of arcuate rim to posterior aspect of foramen magnum

Fusion of occipital condyle to sup art facet and lateral masses

Fusion of ant arch to ant aspect of foramen magnum

Occipitalization/assimilation of C1

Formation of new or larger lines for C1 post arch

Hypochondylar arch for C1 ant arch

3rd occipital condyle (homologue to fovea dentis)

Cervicalization of occiput

Rib small or absent

Transverse foramen (fusion of rib 1 to TVP)

Sup art facet orientation becomes BUM

Uncinate processes appear (true joint of Luschka)

Cervicalization of T1

Typical development of bilateral primary centers of ossification in dens

Subdental synchondrosis

Subdental synchondrosis persisting beyond age 7

Os odontoideum

Typical development of secondary ossification centers in tip of dens

Tip of dens synchondrosis

Tip of dens synchondrosis persisting beyond age 12

Terminal ossicle

Base of brain/brainstem appears sunken over C1/C2 due to chondrocranium persisting longer than normal with increase in brain weight

Basilar invagination

What is the diagnostic test called for basilar invagination, which is seen on a lateral x-ray?

Chamberlin line

Inferior opening of sacral spinal canal

Sacral hiatus

Contents that go through the sacral hiatus

Cauda equina, meninges, Co1 spinal nerve, S5 (sometime S4) spinal nerves

What takes part in the formation of the sacral hiatus?

Lack of fusion of laminae and spinous tubercles at S4/S5

What spinal nerve exits out of the IVF of C4/C5?

C5

What spinal nerve exits out of the IVF of T10/T11?

T10

What ligament forms the posterior border of the spinal canal?

Ligamentum flavum

Where is the ligamentum flavum at its thickest?

Lumbar

Superior continuation of ligamentum flavum

Posterior atlanto-occipital membrane, posterior atlantoaxial ligament

Where is ossification of ligamentum flavum most common?

Thoracic and thoracolumbar region

__ correlates with mechanical stress in thoracolumbar region

Ossification of ligamentum flavum

Contents that ossification of ligamentum flavum may compress

SC, exiting spinal nerves, cauda equina

Pathological ossification of ALL and ossification of PLL are variants of __

Diffuse idiopathic skeletal hyperostosis (DISH)

Ossification of __ decreases cervical mobility

ALL

__ is associated with obesity and glucose intolerance

DISH

High salt, low meat, estrogen levels are linked to…

OPLL

Bones that make up the floor of the temporal fossa

Frontal, parietal, sphenoid, temporal

Joint classification of temporomandibular joint (TMJ)

Synovial hinge