XI. Arthrology of the Vertebral Column Flashcards Preview

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Flashcards in XI. Arthrology of the Vertebral Column Deck (207):
1

What is the Latin term for joint?

arthron

2

What is the study of joints called?

arthrology

3

What is the Latin term for a "tightly bonded together condition"?

syndesmosis

4

What material was responsible for the "tightly bonded together condition" in the joint?

dense fibrous connective tissue, a ligament

5

What is the study of ligaments called?

syndesmology

6

What fibrous connective tissue classically fills the joint space of a syndesmosis?

interosseous ligament

7

What protein fiber is the dense connective tissue primarily composed of?

collagen fibers which give it a whitish color

8

Beside collagen, what other proteins are ligaments composed of?

elastin fibers which can give a yellowish tinge to the ligament

9

What are the examples of the typical syndesmosis from the vertebral column?

most of the ligamentous joints of the vertebral column and the ligamentous sacro-iliac joints

10

The ligamentous sacro-iliac joints (or most of the ligamentous joints of the vertebral column) are examples of which joint classification?

syndesmosis

11

What is the synonym for amphiarthrosis joints?

cartilage joint

12

Which classification of cartilage joint is the first to appear developmentally?

(amphiarthrosis) synchondrosis

13

What is the classification of primary cartilage joints?

(amphiarthrosis) synchondrosis

14

Which cartilage joint classification would be considered secondary?

(amphiarthrosis) symphysis

15

What is the classification of a secondary cartilage joint?

(amphiarthrosis) symphysis

16

Which cartilage joint classification is present along the adult vertebral column?

(amphiarthrosis) symphysis

17

Which cartilage joint occurs between bones formed by endochondral ossification?

(amphiarthrosis) symphysis

18

Which classification of cartilage joint is permanent in its longevity?

(amphiarthrosis) symphysis

19

What type of cartilage is characteristic of the (amphiarthrosis) symphysis?

fibrocartilage or fibrous cartilage

20

What type of cartilage is characteristic of a secondary cartilage joint?

fibrocartilage or fibrous cartilage

21

Which classification of cartilage joint is secondary, permanent and composed of fibrous cartilage (fibrocartilage)?

(amphiarthrosis) symphysis

22

Which cartilage joint has limited motion, lies in the median plane, and occurs between bones formed by endochondral ossification?

(amphiarthrosis) symphysis

23

What are the characteristics of a (amphiarthrosis) symphysis?

limited motion, median plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis, and they occur between bones developing by endochondral ossification

24

What is the classic example of a (amphiarthrosis) symphysis from the vertebral column?

intervertebral disc

25

What are the four consistent features of synovial (diarthrosis) joints?

articular or fibrous capsule, synovial membrane, articular cartilage, and synovial fluid

26

Thickening of the fibrous capsule connective tissue will form the ...

capsular ligament

27

What generic accessory ligaments may accompany and support the capsular ligament?

intracapsular and extracapsular ligaments

28

What are examples of intracapsular and extracapsular ligaments?

intracapsular ligaments: cruciate ligaments of the knee
extracapsular ligaments: collateral ligaments of the knee

29

What is the generic function of ligaments?

stimulate reflex contraction of muscles around the joint

30

Type I articular receptors are morphologicallly identical to which sensory receptor ending?

Ruffini ending

31

Type I articular receptors would be most numerous in which joint of the vertebral column?

cervical zygapophysis

32

What is the function of the type I articular receptors?

they monitor the joint "at rest"

33

What are the common characteristics of type I articular receptors?

located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint "at rest"

34

Type II articular receptors are located in what part of the joint?

deeper strata of the fibrous capsule

35

Type II articular receptors morphologically resemble which type of sensory ending?

Pacinian corpuscle

36

Type II articular receptors are most numerous in what region of the vertebral column?

cervical spine

37

What is the function of type II articular receptors?

they monitor the joint during normal range of motion

38

What are the characteristics of type II articular receptors?

located in deeper strata of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion

39

What is the location of type III articular receptors?

collateral and intrinsic ligaments of many joints, they were not thought to be present along vertebral column

40

Type III articular receptors are morphologically similar to what type of sensory ending?

Golgi tendon organs

41

What is the function of type III articular receptors?

they monitor the joint during extreme motion or beyond normal range or motion

42

What are the characteristics of type III articular receptors?

present in collateral and intrinsic ligaments, resemble Golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion

43

What is the function of type IV articular receptors?

nociceptive, they monitor pain

44

Type IVa articular receptors would be present in what locations?

fibrous capsule, articular fat pads or adventitia of blood vessels

45

Type IVb articular receptors would be present in what locations?

accessory ligaments in general, dense in the posterior longitudinal ligament of the spine

46

Type IV articular receptors are absent in what part(s) of the synovial (diarthrosis) joint?

synovial membrane, articular cartilage, and synovial menisci or intra-articular discs

47

What are the three classifications of synovial membrane?

articular, vaginal, and bursal synovial membrane

48

What are the three modifications of articular synovial membrane?

synovial villi
articular fat pads or Haversian glands
synovial menisci and intra-articular discs

49

What is the generic function of modifications of articular synovial membrane?

aid in spreading synovial fluid

50

What is the name given to finger-like extensions of the synovial membrane?

synovial villi

51

What is the apparent function of synovial villi?

increase the surface of synovial membrane available for secretion - absorption phenomena

52

What role will aging have in synovial villi number?

synovial villi increase with age

53

What is another name for the articular fat pad?

Haversian gland

54

Where are the articular fat pads located?

in the fibrous layer of synovial membrane; they are absent from articular cartilage, synovial menisci and the intra-articular disc

55

Articular fat pads are most numerous in what location along the vertebral column?

lumbar zygapophyses

56

Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called...

synovial menisci or intra-articular discs

57

Intra-articular discs are a feature of what joints examples?

temporomandibular, sternoclavicular, acromioclavicular, and radio-ulnar joints

58

Synovial menisci are a feature of what joint examples?

femur-tibia articulation, cervical zygapophyses, and lumbar zygapophyses

59

What are the layers of the synovial membrane?

outer fibrous layer and an inner (lumenal) cellular layer AKA synovial lamina intima

60

What is the unique name of the inner or lumenal layer of the synovial membrane?

synovial lamina intima

61

What are the specific functions of type A synovial cells?

are phagocytic

62

What is the specific function of type B synovial cells?

secrete proteinaceous substances and hyaluronic acid

63

What is the common function of type A and type B synovial cells?

formation and absorption of synovial fluid

64

How does the articular cartilage thickness vary within the joint?

male (convex) surfaces on bone are thicker at the center of the articular region
female (concave) surfaces on bone are thicker at the periphery of the articular region

65

Where is the male articular surface thicker?

at the center of the articular region

66

Where is the female articular surface thicker?

at the periphery of the articular region

67

What is the source of nutrition for articular cartilage?

blood vessels in the synovial membrane, sinuses of the bone marrow cavity and from synovial fluid itself

68

What is unique about the surface of articular cartilage?

a true perichondrium is absent

69

What are the primary constituents of articular cartilage?

water, cells, collagen type II fibers, and a proteoglycan gel

70

Which collagen fiber type predominates in articular cartilage?

type II

71

What are proteoglycans composed of?

a core proteins and glycosaminoglycans

72

What are glycosaminosglycans?

relatively long, non-branched carbohydrates formed from repeating units of disaccharides

73

What examples of glycosaminoglycans are important in articular cartilage maintenance?

hyaluronic acid, chondroitin sulfates, and keratin sulfate

74

What is the architecture of the largest proteoglycans?

a backbone of hyaluronic acid to which core proteins are are bound, chondroitin sulfates and keratin sulfates are then bound to the core protein

75

What is the primary function of bound glycosaminoglycans in articular cartilage?

form a network water retention

76

Cartilage is able to change shape due to compression, a characteristic known as...

deformation

77

What is implied when cartilage is said to have elastic properties?

cartilage can deform and returns to original volume rapidly, a time independent property

78

What is implied when cartilage is said to have viscoelastic properties?

cartilage can deform but returns to original volume slowly, a time dependent property

79

What is the function of articular cartilage?

to provide a wear-resistant, low-friction, easily lubricated surface for joint movement

80

What are the properties of synovial fluid?

it is yellow-white, viscous, slightly alkaline and tastes salty

81

Synovila fluid consists of what specific chemical groups?

fats, salts, albumins, and hyaluronate

82

Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?

lubricin

83

What cells are often observed in synovial fluid?

white blood cells and a few other types of connective tissue cells

84

What is the function of synovial fluid?

provides a nutritive source for articular cartilage and supply the lubricant for the cartilage surface

85

What are the three broad methods of joint classification?

1) number of articulating surfaces or bones in the joint
2) degree(s) of freedom and/or types of motion accommodated in the joint
3) surface appearance of the bony surfaces or shape of the joint cavity

86

What are the classifications of synovial joints (diarthroses) based on the number of articulating surfaces?

simple and compound synovial joints

87

What is a simple synovial joint (diarthrosis)?

only one pair of articulating surfaces are observed

88

What is a compound synovial joint (diarthrosis)?

more than two articulating surfaces are present in the same synovial joint

89

What is a complex synovial joint (diarthrosis)?

within the simple joint or the compound joint, the articulating surfaces are separated by an articular disc (intra-articular disc) meniscus

90

What are the classifications of synovial joints (diarthroses) based on type of movement?

nonaxial, uniaxial, biaxial and multiaxial synovial joints

91

What movements are accommodated by nonaxial synovial joints?

translational movement, a plane or gliding movement

92

What morphological classification of synovial joints is classified as nonaxial?

plane (diarthrosis arthrodial)

93

What movements are accommodated by uniaxial synovial joints?

a single combination of movements relative to a single axis:
flexion-extension or medial rotation-lateral rotation

94

What morphological classifications of synovial joints would be classified as uniaxial?

hinge (diarthrosis ginglymus) and pivot (diarthrosis trochoid)

95

What movements are accommodated by biaxial synovial joints?

movement in two independent planes at right angles to each other:
flexion-extension combined with abduction - adduction

96

What morphological classifications of synovial joints would be classified as biaxial?

(diarthrosis) bicondylar, (diarthrosis) condylar, (diarthrosis) ellipsoidal, and saddle (diarthrosis sellar)

97

What movements are accommodated by multiaxial synovial joints?

combinations of motion including flexion - extension, abduction - adduction, medial rotation - lateral rotation, circumduction, and even translation

98

What morphological classification of synovial joints would be classified as multiaxial?

ball and socket (diarthrosis enarthrosis), (diarthrosis spheroidal), (diarthrosis cotyloid) are all classifications given to the same type of joint

99

What are examples of synovial plane (diarthrosis arthrodial) joints?

most zygapophyses of the vertebral column
intercarpal, carpometacarpal, and intermetacarpal joints of the hand
intercuneiform, tarsometatarsal, and intermetatarsal joints of the foot

100

What are examples of synovial hinge (diarthrosis ginglymus) joints?

humero-ulnar joint of the elbow and interphalangeal joints of the fingers and toes; temporomandibular joint

101

Diarthrosis ginglymus joints are commonly called .... joints based on action.

synovial hinge

102

Synovial hinge (diarthrosis ginglymus) joints are characterized by strong extracapsular ligaments called .... ligaments.

collateral

103

Diarthrosis trochoid joints are commonly called .... joints based on action.

synovial pivot

104

What are the examples of synovial pivot (diarthrosis trochoid) joints?

median atlanto-axial joint and proximal radio-ulnar joint

105

What is the shared morphological characteristic of diarthrosis trochoid joints?

an osseous pivot point and an osteo-ligamentous ring

106

What is the pivot point in the median atlanto-axial joint?

in the median atlanto-axial joint, the pivot point is the dens or odontoid process of C2 which is stationary while the osteo-ligamentous ring formed by the radial notch of the ulna and the annular ligament

107

What is a common name for the diarthrosis sellar joint?

synovial saddle joint

108

What are examples of synovial saddle (diarthorsis sellar) joints?

carpometacarpal joint of the thumb, talocrural joint of the ankle and the calcaneocuboid joint of the foot

109

What is an example of a modified synovial saddle/diarthrosis sellar joint?

the joint of Luschka in the cervical spine

110

What are examples of diarthrosis condylar or diarthrosis bicondylar joints?

temporomandibular joint and femur-tibia joint of the knee

111

What are examples of diarthrosis ellipsoidal joints?

radiocarpal joint of the wrist, metacarpo-phalangeal joints of the hand, metatarsal-phalangeal joints of the foot and the atlanto-occipital joint of the vertebral column

112

Which synovial joint classifications are now often interchanged in textbooks?

ellipsoidal and condylar synovial joints

113

What is the common name for diarthrosis enarthrosis, diarthrosis cotyloid, diarthrosis spheroidal joints?

ball and socket joints

114

What are examples of diarthrosis enarthrosis joints?

femur-acetabulum of the innominate articulation at the hip and the humerus-glenoid cavity of the scapula articulation at the shoulder

115

What are examples of diarthrosis cotyloid joints?

femur-acetabulum of the innominate articulation at the hip and the humerus-glenoid cavity of the scapula articulation at the shoulder

116

What are examples of diarthrosis spheroidal joints?

femur-acetabulum of the innominate articulation at the hip and the humerus-glenoid cavity of the scapula articulation at the shoulder

117

What are the common ligaments of the vertebral column?

those ligaments commonly found between vertebral couples from C2/C3 to L4/L5

118

Which vertebrae will have common ligaments?

segements C2 to L5 inclusive

119

Identify the common ligaments of the vertebral column.

the 9 common ligaments are the anterior longitudinal ligament, intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament, and intertransverse ligament

120

What is the maximum number of common ligaments identified with a vertebral couple?

eight

121

What is the reason that nine common ligaments are identified bu only eight will be attached at any specific vertebral couple?

the ligamentum nuchae and supraspinous ligaments attach to the spinous tubercles, but only one of these will be identified at a single vertebral couple

122

Which common ligaments will attach to the vertebral body?

the anterior longitudinal ligament, intervertebral disc and posterior longitudinal ligament

123

What common ligament/s will attach to the vertebral arch?

the ligamentum flavum

124

Which common ligaments will attach to the apophyseal regions of a vertebra?

the capsular ligament, interspinous ligament, supraspinous ligament, ligamentum nuchae, and intertransverse ligament

125

Which common ligament/s will attach to the lamina?

the ligamentum flavum

126

Which common ligament/s will attach to the articular apophysis?

the capsular ligament

127

Which common ligaments will attach to the spinous apophysis?

the interspinous ligament, supraspinous ligament and ligamentum nuchae

128

Which common ligament/s will attach to the transverse apophysis?

the intertransverse ligament

129

What is the classification of the intervertebral disc?

cartilaginous (amphiarthrosis) symphysis

130

In the fetus, which vertebral levels will demonstrate intervertebral discs?

those between C2 and Co1 inclusive

131

What is the number of true intervertebral discs indentified in the adult?

twenty-three

132

In the adult, which vertebral levels will demonstrate a true intervertebral disc?

those between C2 and S1 inclusive

133

What percent of the vertebral column length is contributed by the intervertebral disc?

twenty to twenty-five percent

134

What is the length of the intervertebral disc contribution to the vertebral column length?

about seven inches

135

What is the percent of the intervertebral disc height contribution to the length of each region of the vertebral column?

cervical: 22-25%
thoracic: 20%
lumbar: 33%

136

What is the percent of intervertebral disc height contribution to cervical region length?

cervical: 22-25%

137

What is the percent of intervertebral disc height contribution to thoracic region length?

thoracic: 20%

138

What is the percent of intervertebral disc height contribution of the lumbar region?

lumbar: 33%

139

What is the intervertebral disc histologically composed of?

cells, collagen fibers, and a hydrated proteoglycan gel

140

What are the names of the central, peripheral, and horizontal zones of the intervertebral disc?

nucleus puposus - central zone
annulus fibrosus - peripheral zone
cartilaginous end plate - horizontal zone

141

What is the name of the growth zone of the intervertebral disc?

transition zone

142

What maintains the height of the cervical intervertebral disc?

the uncinate processes

143

What is the effect of aging on the intervertebral disc nucleus pulposus?

it becomes more fibrous as water and proteoglycan concentrations diminish

144

What are the names of the glycosaminoglycans of the intervertebral disc?

keratin sulfate, hyaluronic acid, chondroitin-4-sulfate, condroitin-6-sulfate

145

What is the contribution of the nucleus pulposus to intervertebral disc cross-section area?

about forty percent

146

What is the cervical nucleus pulposus composed of?

fibrocartilage

147

What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?

birth: 88%
thirty: 70%

148

What is the organizational pattern for glycosaminoglycans in the lumbar nucleus puplosus?

they typically lack a binding site for hyaluronic acid and are thus non-aggregated

149

What is the consequences of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus?

the nucleus pulposus will lose water under deformation conditions

150

What cell is associated with the nucleus pulposus until about age eleven?

notochord cells

151

What cells are associated with the mature nucleus pulposus?

reticulocyte-fibroblast and chondroblast

152

Which type of collage is dominant in the nucleus pulposus?

collage type II

153

What is the organizational pattern for collagen fibers in the nucleus pulposus?

they are irregularly oriented and randomly scattered

154

What general tissue location is described as having an abundance of collagen type II fibers?

cartilage

155

What is the role of collagen type II fibers based on locations where it is dominant?

it appears to be related to tissues having a deformation - reformation ability

156

What is unusual about the cervical annulus fibrosus?

it lacks any lamellar or layered organization

157

What is the appearance of the cervical annulus fibrous?

a horse-shoe with the anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin

158

What compensates for the thinness of the posterior part of the cervical annulus fibrosus?

posterior longitudinal ligament

159

What is the organization of the lumbar annulus fibrosus?

it has 12-14 concentric cylindrical lamellae

160

What is the reason the anterior margin of the lumbar intervertebral disc is less susceptible to rupture, herniation, prolapse, or protrusion?

the anterior margin of each lamellus is thick and the anterior longitudinal ligament is also better developed than the posterior lamellae or posterior longitudinal ligament

161

Why is the posterior part of the lumbar annulus fibrosus more susceptible to rupture, herniation, prolapse, or protrusion?

the posterior margin of each lamellus is thin and the posterior longitudinal ligament is also less developed

162

What is the mechanism for growth of the lumbar annulus fibrosus?

the outside of the lumbar annulus fibrosus adds new lamellae by appositional growth

163

What is the water concentration in the lumbar annulus fibrosus at birth and after thirty?

birth: 78%
thirty: 70%

164

What is the organizational pattern for glycosaminoglycans in the lumbar annulus fibrosus?

they typically have a binding site for hyaluronic acid and are thus aggregated

165

What is the consequence of aggregated glycosaminoglycans in the lumbar annulus fibrosus?

the annulus fibrosus will retain water under deformation conditions

166

Which type of collagen is dominant in the annulus fibrosus?

collagen type I

167

What is the organizational pattern for collagen fibers in the annulus fibrosus?

they are parallel with one another in a single lamellus and angled

168

What is the organization of collagen fibers between lamellae?

collagen fibers will be angled in the opposite direction such that a spiral - counterspiral organization is observed

169

What is the average angle of collagen fibers within the annulus fibrosus?

they average 50 to 60 degrees

170

What is the difference in the angle of collagen fibers within the inner lamellae and outer lamellae of the annulus fibrosus?

the outer lamellae collagen fibers are more vertical; the inner lamellae collagen fibers are more horizontal

171

What is the attachment site for collagen fibers within the annulus fibrosus?

collagen fibers of the outer lamellae will become Sharpey's fibers and penetrate the epiphyseal rims; collagen fibers of the inner lamellae will attach to the cartilaginous end plate

172

What is the origin for the cells of the annulus fibrosus?

sclerotomites

173

What cell type is associated with the annulus fibrosus?

fibroblast and fibrocyte

174

What is the cartilage end plate derived from?

the epiphyseal plate

175

What is the thickest part of the cartilage end plate?

around the periphery

176

What is the thinnest part of the cartilage end plate?

the central part, over the nucleus pulposus

177

What part of the vertebral body will the cartilage end plate cover?

the cancellous bone at the top or bottom of the vertebral body

178

What part of the vertebral body upper and lower surfaces will the cartilage end plate not cover?

the epiphyseal rim

179

What is the principal type of collagen fiber within the cartilage end plate?

the type II collagen fiber

180

What is the direction of collagen fibers within the cartilage end plate?

collagen fibers are aligned anterior and posterior

181

What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus?

the cartilaginous end plate

182

What cell type is associated with the cartilage end plate?

chondrocytes

183

What is the earliest indicator of intervertebral disc pathology or degeneration?

changes in the histology of the cartilage end plate

184

What part of the intervertebral disc is the "growth plate"?

the transition zone

185

What is the area of maximum metabolic activity in the intervertebral disc?

the transition zone

186

What part of the intervertebral disc will exhibit constant remodeling?

the transition zone

187

What part of the intervertebral disc is innervated?

the outer lamellae of the annulus fibrosus

188

What part of the cervical intervertebral disc is highly innervated?

the middle third of the annulus fibrosus

189

What are the types of receptor endings in the intervertebral disc?

nociceptors and proprioceptors

190

What morphological classifications of receptor ending density in the anterior part of the intervertebral disc?

free nerve endings, Pacinian corpuscles, Golgi tendon organs, Ruffini endings and Meissner's corpuscles have been identified

191

What is the relationship between size of the intervertebral disc and receptor endings?

the larger the disc, the greater the variety of receptor endings

192

What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?

they provide feedback during extension

193

Other than receptor endings, what type of innervation is present in the intervertebral disc?

vasomotor postganglionic sympathetic nerve fibers to blood vessels

194

What are the sources of innervation of the intervertebral disc?

the sinu-vertebral nerve (sinus vertebral nerve, recurrent meningeal nerve), fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans

195

What nerve(s) have been shown to give off the sinus vertebral/sinu-vertebral/recurrent meningeal nerve?

the mixed spinal nerve, ventral primary ramus, dorsal primary ramus, gray ramus communicans and white ramus communicans have all been implicated

196

The reccurent meningeal/sinu-vertebral/sinus vertebral nerve has typically been shown to originate from which source?

the gray ramus communicans

197

What part of the intervertebral disc is innervated by the reccurent meningeal/sinu-vertebral/sinus vertebral nerve?

the outer lamellae of the annulus fibrosus at the posterior part of the intervertebral disc

198

What is innervated by the recurrent meningeal/sinu-vertebral/sinus vertebral nerve?

the outer lamellae of the annulus fibrosus at the posterior part of the intervertebral disc, the posterior longitudinal ligament and dura mater plus vessels and connective tissue of the epidural space

199

What innervates the annulus fibrosus at the posterior part of the intervertebral disc?

the recurrent meningeal/sinu-vertebral/sinus vertebral nerve

200

What forms the posterior neural plexus of the vertebral column?

the sinu-vertebral nerve (sinus vertebral nerve, recurrent meningeal nerve)

201

What forms the anterior neural plexus of the vertebral column?

fibers from the ventral primary ramus

202

What forms the lateral neural plexus of the vertebral column?

fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers fromt he paradiscal ramus communicans, fibers from the gray ramus communicans

203

What neural plexus(es) is formed, in part, by fibers from the ventral primary ramus?

the lateral and anterior neural plexuses of the vertebral column

204

What innervates the annulus fibrosus at the anterior part of the intervertebral disc?

fibers from the ventral primary ramus

205

What part of the intervertebral disc is innervated by fibers from the ventral primary ramus?

the outer lamellae of the annulus fibrosus at the anterior and lateral part of the intervertebral disc

206

What neural plexus is formed, in part, by fibers from the white ramus communicans?

the lateral neural plexus of the vertebral column

207

What innervates the annulus fibrosus at the lateral part of the intervertebral disc?

fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans