5. Thoracic & Lumbar Spine Flashcards by J Y

how does the thoracic spinal column differ from the other parts of the spine

articulates with the ribs

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how many thoracic ribs are there

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what is the curvature of the thoracic spine

kyphosis (primary curvature)

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what difference do you notice in the bodies and spinous processes between T1 and T12

T12 looks more lumbar in form - big squared body and thick short spinous process - as it needs to support more weight further down the column

continuum of size increase and form change from T1-12

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what passes through the intervertebral foramina

spinal nerves

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each thoracic vertebra articulates with the ribs via what joint type

multiple synovial costovertebral joints

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how many typical vertebral body does each rib articulate with

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how many individual synovial joints does a typical rib form with the vertebral column

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why do the ribs have so many small synovial joints with the vertebrae

stability and movement

many small joints permits movement while also maintaining stability

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which specific parts of the vertebrae do the ribs articulate with

body (superior hemi-facet) and the transverse process of their own vertebrae and body of vertebrae above (inferior hemi-facet)

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what do you notice about the position in the thoracic column in terms of the atypical thoracic vertebrae

they are at the extremity of either end

in transition areas from one part of the spine to another

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what is atypical about rib 1 and therefore T1

there is no Thoracic vertebrae superior to it therefore the rib cannot follow the usual pattern identified above of articulating across 2 bodies

Rob 1 consequently only has one facet on its head and only articulates with T1 which has a complete - not hemi - facet

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why are T10-12 atypical in the way that they are

although there are vertebrae above the lower T vertebrae bodies end up so large like lumbar vertebrae that the ribs end up only articulating with their own level vertebra

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what is the effect that the morphology of T12 has on the 12th rib

one facet on body and no transverse process so more movement and instability (which is good in many ways) and less likely to fracture (protecting the kidneys)

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the winking owl face is indicative of what type of pathology

lytic bone tumor

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what kind of articulations are in a cartilaginous joint

bone -> cartilage -> bone

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what kind of articulations are in a synovial joint

bone -> joint space -> cartilage bone

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what kind of articulations are in a fibrous joint

bone -> fibrous tissue -> bone

eg sutures in the skull

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how many joints does each vertebrae form with its adjacent counterpart

what types are these joints and where are they between

2 are zygapophyseal joints between superior and inferior articular facets of adjoining vertebrae

1 intervertebral disc between the bodies of adjoining vertebrae

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what type of joints are the zygapophyseal joints and what does this morphology allow for

synovial

small sliding movements in limited planes

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the thoracic zygapophyseal joints lock together, when compared to those of the lumbar spine what does this say about the functionality of these 2 areas of the spinal column

thoracic = limited flexion/extension, more twisting and lateral bending

lumbar = more flexion/extension but almost no twisting or lateral bending

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the intervertebral disc acts as which 2 things

joint and ligament

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each IV disc is composed of what 2 components and what are these components made of

annulus fibrosus = concentric layers of collagen running in opposing directions to eachother

nucleus pulposus = jelly like

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what type of joint is the IV disc

symphysis (fibrocartilagenous/secondary cartilagenous)

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what type of joint are all midline joints

symphysis (fibrocartilagenous/secondary cartilagenous)

what are the functions of the IV discs

absorb compressive forces and allow slight movement between vertebral bodies

what 2 ligaments run the length of the spine

anterior and posterior longitudinal ligaments

what 2 structure do the anterior and posterior longitudinal ligaments attach to

vertebral bodies and IV discs

the anterior and posterior longitudinal ligaments both originate from where and run all the way down to where

occipital bone down to proximal sacrum

the anterior and posterior longitudinal ligaments tend to be thicker and width in which part of the spine

anterior = thicker and narrower in the thoracic region posterior = thicker and broader in cervical and thoracic regions than lumbar

what role do the anterior and posterior longitudinal ligaments play in restricting movement of the spine

anterior = restricts extension of spine posterior = restricts flexion of spine

anterior longitudinal ligaments attach to what structure of the spine

top and bottom of vertebral bodies

posterior longitudinal ligaments thicken near what structure of the spine

thicken near the IV discs

what secondary function do the anterior and posterior longitudinal ligaments provide

help prevent the anterior or posterior herniation of the IV discs

what is herniation caused by

when weight isnt applied directly vertically on the IV discs

the anterior longitudinal ligament is implicated in the development of which spinal condition

diffuse idiopathic skeletal hyperostosis

what happens in DISH

the anterior longitudinal ligament gets ossified along its course with other spinal ligaments

what happens in ankylosing spondylitis

inflammatory arthritis of the spine causes ossification of the IV disc peripheries

what is the difference between DISH and AS on the x-ray image

DISH = fusion lines across vertebrae on anterior aspect usually, easily seen on lateral radiograph AS = lateral and posterior fusion across bodies as whole IV disc periphery is involved and SI joint fusion

bamboo spine in PA view and squaring of vertebral bodies in the lateral view appearance in an image is associated with which spinal condition

how many vertebrae are there in the lumbar region

what features differentiate the lumbar from thoracic vertebrae

larger squarer bodies in lateral view short and squared spinous processes smaller transverse process no articulation for ribs

what are lumbar vertebrae more specialised at doing in the spine

supporting weight

what kind of curvature does the lumbar spine have

lordosis (secondary curve)

the spinous processes of the lumbar region differ from the thoracic vertebrae for what reason

creates access path to spinal canal and therefore spinal cord eg for lumbar puncture

the sacrum consists of ___ ____ ____ with the coccyx attaching ___

5 fused vertebrae inferiorly

the sacral vertebra have lateral bodies that fuse to form the ___

alae

the sacrum foramina that the other vertebrae dont have is formed by the fusion of what what is this foraminas name

fusion and alar formation anterior and posterior sacral foramina

the sacral hiatus marks what and what is this useful for clincially

the termination of the sacral canal access to the spinal canal contents (eg sacral nerve blockers)

the sacrum has 3 joints which are these

one joint with L5 superiorly 2 with the pelvis laterally

what part of the pelvis does the alae articulate with what is this joint called

iliac bones sacroiliac joint

the sacroiliac joint is part ___ but mostly ___ and hence this allows for what

part synovial, mostly fibrous allows for a little movement whilst predominantly maintaining a strong articulation

the spinal cord begins where and ends at which vertebral level what is its end called

base of brain stem to L1/L2 Vertebral level conus medullaris

below the conus medullaris are spinal nerves which emerge lower than L1/L2 level where do these continue down to and what level of the spine do they emerge from what is the name given to these nerves

down to sacral hiatus emerge from L2-S5 and coccygeal branches cauda equina

what are the 3 layers that surrounds the spinal cord what are these layers called

meninges outer dura mater intermediate arachnoid mater inner pia mater

what is the spinal cord bathed in

cerebrospinal fluid

where is the CSF found what is the fluids purpose

in the subarachnoid space protects and nourishes spinal cord

lumbar punctures are made to extract what from where are they performed in the upper/lower lumbar spaces why is this? why is it not in the thoracic region

extract CSF from spinal canal lower lumbar regions - below L2 - as theres less risk of damage around the cauda equina than spinal cord (smaller nerves get pushed aside more easily) in the thoracic region there is no access to the spinal cord due to spinous processes

what pass through the intervertebral foramina of the thoracic and lumbar vertebrae

spinal nerve roots

how many thoracic and lumbar spinal nerves are there

thoracic = 12 lumbar = 5

what is the relationship of the spinal nerve roots to their respective vertebrae

each spinal cord emerges inferior to its respective vertebra

what are the 2 plexus that supply the lower limb and pelvis

the lumbar plexus and sacral plexus

out of the 2 plexus supplying the pelvis and lower limbs which one is the more proximal

lumbar plexus

what nerve roots form the lumbar plexus

T12, L1-4

the lumbar plexus is associated and forms within which muscles

psoas major

for the psoas which is more medial and which is more lateral in terms of major and minor

``` major = lateral minor = medial ```

which regions of the lower limb/pelvis does the lumbar plexus mostly supply

anterior thigh muscles and skin on anteromedial thigh and medial leg

what symptoms are expected from damaging the lumbar plexus

burning/numbness and muscular pain in the anterior thigh muscles and skin on anteromedial thigh and medial leg regions

the sacral plexus is made of which nerve roots

L4-5 and S1-4

where is the sacral plexus located in terms of the pelvis and sacrum

deep within the pelvis ontop of the sacrum

what does the sacral plexus supply

majority of the lower limb

where do the sacral nerve roots contributing to the sacral plexus emerge from specifically

anterior sacral foramina

which muscle does the sacral plexus form anterior to

piriformis

through which space do the sacral plexus nerves exit the pelvis

greater sciatic foramen

what is more common - lumbar or sacral nerve root injuries/compressions why

lumbar as sacral spine is very immobile and stable so therefore less prone to OA changes/injuries that might cause nerve root compression