Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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