Download imaging of vertebrae

IMAGING OF VERTEBRAE
IMAGES FROM CROSS-SECTIONAL ANATOMY TUTOR PROGRAM
1) REVIEW VERTEBRAL COLUMN AND BACK
2) VERTEBRAE ARE USEFUL LANDMARKS FOR
ORIENTATION IN CT, MRI IMAGES
3) LOOK AT VIEWS OF VERTEBRAE ON X-RAYS IN LAB
ANATOMICAL PLANES
Sagittal
1) SAGITTAL PLANE divides body in RIGHT
and LEFT parts (Median
Sagittal Plane-divides
Coronal
body into right and left
halves)
2) CORONAL PLANE divides body into FRONT
and BACK parts
3) HORIZONTAL PLANE
Plane = transverse plane cross section-divides
body into TOP and
BOTTOM parts
perpendicular to long axis
of body
Horizontal
AXIAL CT SERIES
FEET
- generates sections in
HORIZONTAL PLANE
- VIEW FROM
FEET
- viewing patient in
hospital bed from his/her
feet
ORIENTATION IN IMAGES - seemingly right/left reversed
Series In Horizontal
Plane = Axial Series
ANTERIOR
PATIENT'S
LEFT
PATIENT'S
RIGHT
POSTERIOR
INTENSITIES STORED AS PIXEL VALUES
CAN
'RESECTION'
SERIES
OF DIGITAL
IMAGES IN
ANY PLANE
PATIENT'S
RIGHT
PATIENT'S
LEFT
TYPICAL VERTEBRA – by convention thoracic
1. BODY – anterior, solid transmits weight
2. VERTEBRAL ARCH – posterior, surrounds vertebral canal, spinal
cord; consists of a) PEDICLES – project from body
b) LAMINAE – unite to form arch posteriorly
ant.
BODY
{
VERTEBRAL
ARCH
PEDICLE
LAMINA
TRANSVERSE
PROCESSLATERAL
SPINOUS PROCESS POSTERIOR
3. TRANSVERSE AND SPINOUS PROCESSES - projections
from arch for muscle, ligament attach
RIBS- have bumps for articulation with vertebra
Vertebrae
Dorsal view
of skeleton
Ribs
Head –
Articulates
with facet on Body
Tubercle –
Articulates
with facet on
Transverse process
CT OF THORACIC VERTEBRA
USE FOR ORIENTATION
SUBS
IS
T5
TRAP
RHOMB.MAJ.
CERVICAL VERTEBRA
BODY
ant.
– body is small
Foramen Transversarium - in
transverse process (C1-C7) for
vertebral artery & veins
TRANSVERSE
PROCESS
post.
SPINOUS PROCESS – bifid (divided) for Ligamentum nuchae
lat.
view
ARTICULAR FACETS
- angled superiorly &
medially
CERVICAL VERTEBRA - CT
Body - small
Foramen Transversarium
LUMBAR VERTEBRA
spinous
process
lamina
pedicle
Bodies - hefty
Pedicles - stout
Lamina - thick
Spinous Processes- broad
body
Articular processes
in sagittal plane
LUMBAR VERTEBRA AXIAL CT
L3
L5
Articular process
Articular process
LATERAL VIEW OF VERTEBRA
4. Spinal nerves leave
vertebral canal via
INTERVERTEBRAL
FORAMINA - between
vertebrae;
bordered by – Superior and
Inferior Vertebral Notches
5. SUPERIOR AND INFERIOR
ARTICULAR PROCESSES (zygapophyses) - Articular
facets form joints between
adjacent vertebrae (Orientation
of facets determines
movement)
Sup. Vertebral Notch
Inf. Vertebral Notch
6. Bodies joined by
intervertebral
discs
MOVEMENTS OF VERTEBRAE IN DIFFERENT REGIONSDetermined by orientations of articular facets
a. CERVICAL (C3-C7)permit considerable flexionextension, lateral flexion,
rotation - useful-move head
b. THORACIC
Cervical (C3-C7)-facets angled
superiorly and medially
Thoracic - facets in coronal plane
permit some rotation – little or
no flex-extend (also limited by
ribs); useful- no flex down on
heart, lungs
c. LUMBAR
permit flex-extend, little or no
rotation; useful- help increase
abdominal pressure;
dangerous- increase load
pressure on vertebral discs
Lumbar- facets in sagittal plane
VERTEBRAL LIGAMENTS
View inside vertebral canal
1. ANTERIOR
LONGITUDINAL
LIGAMENT Strong band on
anterior side
2. POSTERIOR
LONGITUDINAL
LIGAMENTweaker, narrower
band
3. LIGAMENTA
FLAVA - yellow
elastic bands
connecting
laminae
SAGITTAL SECTION
4. INTERSPINOUS AND SUPRASPINOUS LIGAMENTS connect spines
INTERSPINOUS
ANT
SUPRASPINOUS
Greatly thickened in cervical region to form LIGAMENTUM
NUCHAE- from Ext. Occip. Protuberance of skull to C7;
Support Head, Provide muscle attachments
JOINTS BETWEEN VERTEBRAE
1. Joints between
articular processes synovial plane joints
permit Sliding
Movements
2. Intervertebral Discinterposed between
bodies
ORIENT TO MEDIAN MRI
ant
SAGITTAL
PLANE
BODY
post
ant
SPINE
post
BODY
SPINE
LUMBAR MRI
STRUCTURE/
FUNCTION OF
INTERVERTEBRAL
DISC
a) Nucleus
pulposusinner
gelatinous
core
Shock
absorbers in
young quite
strong
trauma to
vertebra
fractures
b) Anulus fibrosus collagen fibers &
fibrocartilage
MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK
ANTERIOR
POSTERIOR
HERNIATION
OF
NUCLEUS
PULPOSUS
DAMAGE TO INTERVERTEBRAL DISC
Posterolateral post
POSTERIOR
LONGITUDINAL
LIGAMENT
lateral
ANTERIOR
LONGITUDINAL LIGAMENT
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal
Ligament; often L4-L5 or L5-S1; can lead to nerve compression at
intervertebral foramen
NORMAL CURVATURES OF VERTEBRAL COLUMN
Ant
Post
Primary - concave anterior - remains
In thorax and sacrum
Secondary - concave posterior
Cervical
curvature
a. Cervical curvature - concave
posteriorly - help support head
Thoracic
curvature
b. Lumbar curvature
- concave posteriorly
- develops with walking
- helps support trunk, upper body
Lumbar
curvature
Right handed
c. Lateral curvature concave to side opposite
handedness - helps to carry
R
L
bags of money
Sacral
curvature
LUMBAR CURVATURE ON LATERAL X-RAY
LATERAL X-RAY TRANSVERSE
PROCESSES
LOOK LIKE
RINGS
Transverse
process
INTERNAL STRUCTURE OF BONE
Long bone in cross-section
OUTER COMPACT (CORTICAL) BONE
INNER SPONGY BONE
COMPACT
SPONGY
LATERAL
VIEW
IN LATERAL
VIEW SEE
TRANSVERSE
PROCESSES
ON END
Transverse
process
ATTENUATION HIGHEST
(X-RAY IS MOST WHITE)
WHEN PASS THROUGH
MOST COMPACT BONE
ANTERIOR-POSTERIOR
(AP)
X-RAY OF LUMBAR
VERTEBRAE
Pedicles look like
‘eyes’
PEDICLE
SPINE
AP VIEW
PEDICLE
SPINE
SEE
PEDICLES AND
SPINES ALONG
THEIR LENGTH
ABNORMAL CURVATURES
KYPHOSIS ‘hump’
SCOLIOSIS
LORDOSIS
back, exaggerated
curvature; often in
thorax of elderly;
concave anteriorly
abnormal lateral
curvature (‘kink’ in
spine); can be due
to hemivertebra
exaggerated
lumbar curvature
concave
posteriorly
LATERAL X-RAY THORACIC SPINE
NORMAL ADULT
T11
ELDERLY PATIENT
ERECTOR SPINAE
1. Act to extend trunk
2. Located dorsal to vertebral column
3. Innervated by dorsal primary rami of
spinal nerves
SPINALIS- most medial – spinous
process to spinous process
LONGISSIMUS- intermediatetransverse process to transverse
process
ILIOCOSTALIS- lateral – ilium and
ribs to ribs and transverse
processes
Deep: Transversospinalis – transverse
process to spinous process
IMAGING OF VERTEBRAE
IMAGES FROM CROSS-SECTIONAL ANATOMY
TUTOR PROGRAM
TRANSVERSOSPINALIS
ERECTOR SPINAE