Download ~Spine

~~~~Spine~~~
Marilyn Rose
Vertebral Column
 Supports weight
 Maintain posture
 Protect spinal cord/ nerves
 33 total vertebrae
 Cervical (lordotic curve)
 Thoracic (kyphotic curve)
 Lumbar (lordotic curve)
 Sacral ( kyphotic curve)
 Coccygeal
Vertebrae
 Vary in size and shape by section
 Common parts:
 body (anterior element)
 vertebral arch (posterior element)
 vertebral endplates
 -compact bone- superior/ inferior of body
 vertebral foramen
 Posterior/ ringlike arch space- attaches to
sides of body
Vertebrae contd.
 vertebral Arch (posterior element)
 2 pedicles 2 lamina 1 spinous process 2 transverse
process and 2 superior
 And 2 inferior articular processes ( form
zygapophyseal joints)
 Intervertebral disks
 Vertebral bodies separated by shock absorbers
or disks- consists of inner soft nucleus
pulposus and firm outer annulus fibrosus.
 What herniates when you rupture a disk?
Where does it go?
Cervical Vertebrae
 7 total
 1= atlas- supports the head- atlantooccipital joint
 Anterior/ posterior arch and two large lateral masses
 2= axis – odontoid process (dens)- project upward from superior
surface of body- pivot for atlas.
Cervical Vertebrae
contd.
 Bifid spinous process
 Only seen in C3-C6
 Vertebral prominens
 Long spinous
process
 Not bifid
 Palpable posteriorly
at base of neck
Cervical Vertebrae
Cervical Vertebrae
Thoracic Vertebrae
 12 total vertebrae
 Characteristic- costal
facets (demi facets)
 located on the body and
transverse process and
articulate with the ribs
 Costovertebral joints- head
of rib and vert body
CT scan reveals
 Costotransverse jointsdestruction of the
tuberle of rib and
vertebral body (small
transverse process
arrow) and an
 Spinous processes are
long and slenderprojecting inferior.
associated soft-tissue
mass (large arrows).
Thoracic Vertebrae
1-Vertebral Body 2-Spinous Process 3Transverse Facet
4-Pedicle 5-Foramen 6-Lamina 7Superior Facet
Thoracic Vertebrae
Vertebroplasty- cement filling collapsed
vertebrae
Lumbar Vertebrae
 5 vertebrae total
 Bodies are largest of all the vertebrae-
 Largest L5- massive transverse process
 Body weight is transferred from 5th
lumbar vert to base of sacrum- across L5S1 disk space.
Reconstructed sagittal
CT view of the lumbar
spine demonstrating
an L5/S1 foraminal
spur, visible despite
the presence of metal
instrumentation.
Lumbar Vertebrae
Lumbar Vertebrae
A CT Scan of a Lumbar Vertebra showing
the bony structure and stress
fracture or Spondylolysis.
Athletes and L spine….FYI
Conclusions: high
prevalence of
spondylolysis in athletes
with low back pain
compared with the
general population
suggests that it would be
good practise to include
a radiological
examination of the
lumbar spine in
symptomatic athletes
engaged in sports who
are considered to be at
risk in the light of this
and other studies
Spondylolysis Review:
Sacrum and Coccyx
 5 fused vertebrae= sacrum
 Lateral mass= ala= transverse
processes
 Articulate with pelvic bones=
sacroiliac joints
 Sacral promontory- anterior surface
of body- bony landmark that
separates abdomen from pelvic
cavity
 3-5 fused bony segments= coccyx
 Most inferior portion of vertebral
column
Sacrum and coccyx
sacrococcygeal chordoma
Ligaments
 Anterior longitudinal ligament
 From C1 to the sacrum along entire anterior vertebral column
 Posterior longitudinal ligament
 Inside the vertebral canal and runs posterior to the vertebral bodies.
 ligamentum flava
 Strong ligaments on each side of spinous process- preserve natural
curvature of the spine
Muscles
 Superficial
 Splenius
 Intermediate
 Erector spinae
 Deep layer
 Transverspspinal
 Regions Capitis, cervicis,
thoracis and lumborum
Spinal Cord
 Cerebrospinal fluid- in thecal sac
formed by spinal meningescontinuous with cranial meninges.
 Still 3 layers…

Dura- outer layer-S2-makes thecal sacadhere to long ligament/ surrounds
each spinal nerve.

Arachnoid- thin, attached to inner
surface of dura- subdural
space=arachnoid and dura

Pia and arachnoid- subarachnoid space(CSF)
o pia adheres to spinal cord
Spinal Cord contd.
 Pia extends as filum terminale at L1-
L2 when the spinal cord ends
 Filum is attached to the coccyx
 conus medillaris = where the spinal
cord ends
 cauda equina= splits into bundles
of nerves like a horse’s tail inferior
to the conus
Fatty Filum Terminale
Spinal Cord
 White Matter- external borders of
cord
 Gray Matter- nerve cells/ central
canal
 Axial- butterfly appearance
 Dorsal horns- posterior
o Sensory fibers= afferent nerve roots
o Dorsal root ganglion- oval
enlargement – nerve cell bodies of
sensory neurons
 Ventral horns- anterior
o Efferent or motor neurons
 Ventral and dorsal roots unite to form
31 pairs of spinal nerves
 8 cervical, 12 thoracic and 5 lumbar, 5
sacrum and 1 coccyx
Dermatomes? What are they?
Plexuses
 4 major nerve plexuses
 Cervical
 C1-C4 ventral rami innervate neck, lower face/ear, side of scalp and upper thorax
 Phrenic nerve- major motor branch – continues on to innervate diaphragm.
 Brachial
 C5-C7 /T1 ventral rami
 upper extremity and shoulder
 Lumbar
 T12/ L1-L4 ventral rami abdominopelvic muscles and anterior/medial muscles of thigh.
 Femoral nerve- anterior lower leg and ankle/foot
 Sacral
 L4-L5/ S1-S4- buttock, posterior thigh and feet
 Sciatic Nerve= Largest nerve in the body!!!!- innervate lower extremities
Plexuses
Vasculature of Spine
 Single anterior spinal artery
 caudal to basilar artery
 Supplies the anterior 2/3 of the spinal cord
 Posterior spinal arteries- vertebral/
posterior inferior cerebellar arteries
 Descend along dorsal surface of spinal cord
 Posterior 1/3 of spinal cord is supplied
 Spinal Cord Anterior and Posterior veins- drain gray
matter and
 radial veins drain the white matter
 Vertebral column- internal and external
venous plexuses (valveless)
Spinal cord Ultrasound
What is this?
Coronal STIR image showing neurofibromatosis of the lumbar
plexus. The lesions here are less hyperintense than in the
cervical region.
What is this?
Spina Bifida
Spinal Cord Injuries
Spinal Tap
Epidural
Why? A spinal tap is a procedure performed when a doctor
needs to look at the cerebrospinal fluid (also known as spinal
fluid). Spinal tap is also referred to as a lumbar puncture, or
LP.)
Sword Swallowing??????