Posterior Spine Anatomy & Pathologies Flashcards

40%

an accessory vertebrae

anterior longitudinal ligament

very strong

brings in nutrients

weightbearing, changing seated position, traction/separation

CN XI (spinal accessory nerve)

vertebral artery and suboccipital nerve

bed rest

thoracic vertebrae is out of place and affects rib cage, this in turn affects lungs as they cannot expand as much (due to bony structure)

one curve

two curves

slipping of C1 and C2 vertebrae

surgical excision of one or more SP and the adjacent supporting vertebral laminae

flows along anterior aspect of vertebral bodies from occiput to sacrum, woven into anterior surface of IV disc, offers resistance to vertebral distraction, TAUT DURING EXTENSION, SLACKENED DURING FLEXION.

located within the spinal canal along the posterior surfaces of the vertebral bodies and IV discs from axis to coxxyx, interwoven with posterior aspect of IV disc, thickest in thoracic region, lateral expansions over IV disc are thinner than in central portion

yellow elastic collagen fibers, form posterior wall of vertebral column, arise from posterior, upper 1/3 of lamina and course superiorly to insert on lower 1/3 of lamina above

ligament arising from nuchal line of the occiput and extending to SP of C7, attachment point for many posterior back muscles

symphysis joints, also make up 25% of the spine

bind vertebral bodies together, permit movement within a vertebral segment, transmits load across the segment

annulus fibrosis and nucleus pulposus

outer ring composed of concentric lamellae of fibrocartilage

inner mass of collagen fibers and mucoprotein gel

containment of nucleus pulposus, stabalizes vertebral segment, permission of movement, imbibe fluids and nutrition, transmission of force, equalization of stress

bulging of discs or herniation, no direct blood flow so its important to load and unload the spine.

sitting, coughing, sneezing, lifting, trunk rotation

standing, lying down

medial 1/3 of superior nuchal line, external occipital protuberance, ligamentum nuchae, SP of C7-T12

lateral 1/3 of clavicle, acromion, spine of scapula

spinal accessory nerve (CNXI)

upper fibers: elevate scapula

middle fibers: retract scapula

lower fibers: depress scapula

elevation, depression, protraction, retraction, upward rotation, downward rotation

SP of inferior 6 thoracic vertebrae, thoracolumbar fascia, iliac crest, inferior 3-4 ribs

floor of intertubecular groove of humerus

thoracoabdominal nerve (C6-C8)

extends, adducts, medially rotates the humerus

posterior tubercles of TP of C1-C4

superior aspect of medial border of the scapula

dorsal scapular nerve (C5) and cervical (C3,C4) nerves

elevates scapula and tilts the glenoid cavity inferiorly by rotating the scapula in a downward direction

nuchal alignment & SP of C7+T1

medial border of scapula from the spine to the inferior angle

dorsal scapular nerve (C4-5)

retract scapula and rotate the scapula in downward direction to depress the glenoid cavity, fix scapula to thorax; can assist with elevation of scapula with L.S

SP of T2-T5

ligamentum nuchae, SP of C7-T3

superior borders of ribs 2-4

2nd-5th intercostal nerves

elevate ribs, assist with inhalation

Serratus posterior superior

SP of T11-L2

inferior borders of ribs 8-12 near angles

ventral rami of 9th-12th thoracis spinal nerves

depress ribs, assist with exhalation

ligamentum nuchae & SP of C7-T6

mastoid process and superior nuchal line of occipital bone

dorsal rami of spinal nerves

acting alone: ipsilateral lateral flexion and rotation

acting together: extend the head and neck

tubercles of TP C1-C3 or C4

broad tendon from posterior aspect of illiac crest, posterior surface of sacrum, inferior lumbar SP, supraspinous ligament

SP of thoracic and cervical vertebrae, skull

dorsal rami of spinal nerves

unilateral: lateral bending of vertebral column

bilateral: extend the head and neck

broad tendon from posterior surface of sacrum, inferior lumbar SP, supraspinous ligament

to ribs superiorily between tubercle and angle, mastoid process

dorsal rami of spinal nerves

unilateral: lateral bending of vertebral column

bilateral: extend the head and the neck

broad tendon from superior aspect of illiac crest, posterior surface of sacrum, inferior lumbar SP, supraspinous ligament

angle of lower ribs and cervical TP

dorsal rami of spinal nerves

unilateral: lateral bending of vertebral column

bilateral: extend the head and neck

dorsal rami of spinal nerves

unilateral: lateral bending of vertebral column

bilateral: extend the head and neck

TP C4-T12

occipital bone, SP in thoracic and cervical regions spanning 4-6 segments

dorsal rami of spinal nerves

extend head, cervical, and thoracic regions. contralateral rotation

TP of C4-T12

occipital bone, SP in thoracic and cervical regions spanning 4-6 segments

dorsal rami of spinal nerves

extend head, cervical and thoracic regions. Contralateral rotation.

sacrum, illium, TP T1-T3, articular processes C4-C7

pass superomedially to SP of vertebrae above, spanning 2-4 segments

dorsal rami of spinal nerves

stabilize the vertebrae during movement of the vertebral column

TP of vertebrae, best developed in thoracic area

pass superomedially to attach at the junction of lamina and TP or SP of vertebrae above their origin, spanning 1-2 segments

dorsal rami of spinal nerves

stabilize the vertebrae, assist with extension and rotary movements ??? propioception

medial 1/2 of inferior border of 12th rib and tips of lumbar TP

iliolumbar ligament and internal lip of illiac crest

ventral branches of T12 and L1-L4 nerves

extends and laterally flexes the vertebral column, fixes 12th rib during inspiration

superior surfaces of SP of cervical and lumbar vertabrae

inferior surfaces of SP of vertebrae superior to vertebrae of origin

dorsal rami of spinal nerves

aid in extension and rotation of vertebral column

TP of cervical and lumbar vertebrae

TP of adjacent vertebrae

dorsal and ventral rami of spinal nerves

unilateral: aid in lateral bending of vertebral column

bilateral: stabilize the vertebral column

Tips of TP of C7 and T1-T11

inferiorily to rib between tubercle and angle

dorsal rami of spinal nerves C8-T11

elevate the ribs, assist in inspiration, lateral bending of vertebral column

lies deep to the trapezius and semispinalis capitis

rectus capitis posterior major (superomedial border), rectus capitis posterior minor, inferior oblique of the head (inferolateral border), superior oblique head (superolateral border)

suboccipital triangle

involves ligamentous tissue, usually as a result of excessive force (contraction or motion)

involves overly strong muscle contraction resulting in stretch or microtear of muscle fibers

muscle reaction to injury or inflammation of structures within the back (disc, ligaments, etc.) , involuntary contraction of a muscle or group of muscles creating pain

never recommend bed rest!

pain, numbness, weakness, gait change, "stuck", worse in AM

unloading of the spine, alignment, posture, NSAID's, surgery last resort

stenosis, bone spurs, herniated discs

used for laminectomies, fractures of TP or SP

greater visualization of discs

juvenile kyphosis, male adolescents primarily, etiology uncertain, backache and local changes in vertebral bodies

anterior wedging of 3 or more thoracic bodies (5 degrees), irregular end plates, separated epiphysis, Schmorl's nodes, loss of disc height

reduce WB, exercise for better use of postural muscles, bracing and serial casting, NSAID's

results in less mobility and less shock absorption

disc spaces narrower on concave side, vertebral wedging, thinning of pedicles and laminae, narrowing of vertebral canal

80% of cases, prevalent in females, 1 in 4 children need treatment, genetic predisposition increases 20% if someone in family has it

spine disease or bony abnormality

muscle weakness

CNS disorder

routine physical exam, shoulder assymetry

bracing, exercise, prenatal, surgery

closed vertebrae: wedge vertebrae

open vertebrae: myelomeningocele

cerebral palsy, muscular dystrophy, polio

only needed if curvature > 45 degrees, severe pain, neurological symptoms, insertion of rods posterior fusion of spine and in worse cases anterior.

degenerative lesions/changes in vertebral bodies

loosening of the spine (pars interarticularis is fractured)

slipping of the spine (usually at L5 - vertebral bodies start to slip forward on the sacrum)

narrowing of vertebral foramen

chronic, progressive inflammation of joints in spine (rheumatoid), onset 20-40 years of age, 75% in males, decreased mobility in forward bending, bamboo spine, ossification of annulus and longitudinal ligaments

exercise, proper positioning, NSAIDS, radiotherapy, fusion of spine

positioning, meds, avoid increased loadbearing and hyperextension

PRIMARY OSSIFICATION CENTERS, vetebrae begin to develop around early notochord during embryonic period, ossify week 8, each vertebrae has 3 bony structures (centrum and 2 halves of arch), bones united via hyaline cartilage

SECONDARY OSSIFICATION CENTERS develop during puberty and account for continued growth of spine, tips of SP and TP, anular epiphyses on superior and inferior surfaces of body

spina bifida occulta, spina bifida meningocele, spina bifida myelomeningocele

involves only a bony structure, incomplete fusion of posterior vertebral arch

only involves the meninges, spinal cord still in tact

spinal cord and membranes protrude, spinal cord doesnt develop properly and spinal nerves damaged.

muscle paralysis below level of lesion, lack of sensation below level of lesion, bladder/bowel issues, hydrocephalus, etc.

surgery, ADL training, bowel/bladder training, maintain ROM, family involvement in developmental program

vertical force (diving or fall), compress masses, more likely with rupture of transverse ligament

40% of cervical fractures, usually in pars interarticularis, hyperextension of head on neck, fracture of the dens, blow to the head, can result in avascular necrosis

sudden forceful forward flexion (car accident), fall in upright seated position (toilet), stretch or tear of longitudinal ligament

mechanical/surgical stabilization, prevention of complications, restoration of function