Anatomy of spine osteology

Question 1

How are cervical vertebrae different from thoracic and lumbar vertebrae?

Answer 1

1) Bifid spinous processes (apart from C7)
2) Small vertebral bodies
3) Presence of foramen transversarium in their transverse processes

Question 2

What is different about the anatomy of C1 compared to the rest of the cervical vertebrae?

Answer 2

C1 has no vertebral body

Question 3

What is the neural arch? Describe its anatomy.

Answer 3

Curved bony structure that surrounds the vertebral canal. It consists of the anterior and posterior arch. Two laminae join the form the posterior arch and the spinous process. The two pedicles join together to form the anterior arch

Question 4

What is the name of the hole posterior to the vertebral body that contains the spinal cord?

Answer 4

Vertebral foramen

Question 5

What are the names of the surfaces where adjacent vertebrae articulate with each other?

Answer 5

Inferior and superior articular processes/facets

Question 6

On C1 what does the lateral mass connect?

Answer 6

Anterior and posterior arches

Question 7

What movements are possible between C1 and C2?

Answer 7

Rotation of the head

The synovial plane joints (facets) that occur between the superior and inferior articulate processes on the lateral masses contribute 10% to lateral flexion movement

Question 8

What type of synovial joint is found between C1 and C2 rather than an intervertebral disc?

Answer 8

The Atlanta-axial joint is a synovial pivot joint and is formed by the anterior aspect of the dens articulating with the anterior arch

Question 9

What is the pars interarticularis ?

Answer 9

Bony column in between the superior and inferior articular processes of the axis (C2)

Question 10

What movements are possible between the Atlanto-occipital joints?

Answer 10

Flexion (nodding) and lateral flexion (ear to shoulder)

Question 11

At what level do C spine fractures most commonly occur?

Answer 11

C6 is the fulcrum of cervical movement.

C2

Question 12

What type of joint is the intervertebral disc and what other joints connect adjacent vertebrae together ?

Answer 12

A fibrocartilaginous joint otherwise known as a symphysis joint that allows a small amount of movement to occur between vertebrae.

Joints between articular processes are called ‘facet joints’ which are a type of synovial plane joint allowing gliding movements

Question 13

Which vertebral region has the greatest overlap between adjacent spinous processes and what consequence will this have for movement?

Answer 13

Thoracic spine therefore restricting movement

Question 14

How many cervical, thoracic, lumbar, sacral and coccygeal vertebrae are there ?

Answer 14

C- 7
T-12
L-5
S-5 (fused) 
C-4 (fused)

Question 15

What is special about cervical transverse processes?

Answer 15

Contain foremen transversarium which contain vertebral arteries

Question 16

How would you be able to tell a vertebra was from the thoracic region ?

Answer 16

Heart shaped vertebral body
Costal facets on the body and transverse processes (apart from T11 and T12)
Slanted spinous processes that overlap

Looks like a giraffe

Question 17

Describe the vertebrae of lumbar vertebrae

Answer 17

Very large kidney shaped vertebral bodies
Triangular vertebral foramen
No foramen transversarium (only in cervical)

Question 18

Describe features of the three categories of odontoid fracture

Answer 18

1) tip of odontoid fractured . Most likely to be stable and not need treatment as alignment of C1+C2 maintained
2) fracture of dens below the transverse ligament. Most common type and highly unstable
3) fracture at the base of the peg that may extend into C2 body.

Question 19

2 common mechanism of injury in a hangmans fracture ?

Answer 19

1) hanging

2) neck hyper extension due to sudden deceleration e.g. In a RTA

Question 20

Common MOI associated with dens fractured

Answer 20

RTA and falls. Can occur with hyperflexion or hyperextension

Question 21

Complications of odontoid fractures

Answer 21

Avascular necrosis can occur as there is a watershed area between the tip and base of the odontoid process. The tip receives blood from the ICA and the base from the vertebral arteries.

Question 22

What is a hangmans fracture?

Answer 22

Bilateral fracture of the pars interarticularis in the axis (C2)

Question 23

What is the commonest level at which subluxation occurs in the C spine and why?

Answer 23

C5/6 as this is where the greatest amount of flexion and extension occurs

Question 24

What is subluxation?

Answer 24

Incomplete or partial dislocation

Question 25

Describe what a Jefferson fracture is and the mechanism of injury

Answer 25

Jefferson fractures are fractures of the anterior and posterior arches of the atlas (C1) vertebra.

The common MOI is a vertical fall into an extended neck resulting in axial load of the back of the head. E.g. Diving into shallow water or hitting head on the roof of a vehicle in an RTA

Question 26

Which vascular injuries are common in cervical trauma?

Answer 26

Vertebral and carotid artery injury . Damage to the carotid sinus can result in a vagaries response, bradycardia, hypoperfusion and death

Question 27

What structure runs through the foramen transversarium ?

Answer 27

Vertebral artery and vertebral vein. Important to note that the vertebral artery does not pass through the foramen transversarium of C7

Question 28

Name the four types of fracture commonly seen in the thoracic vertebrae

Answer 28

Anterior wedge compression fracture , burst fracture, chance fracture, fracture dislocation

Question 29

What causes an anterior wedge compression fracture?

Answer 29

Axial loading with flexion - because vertebral column is flexed, the anterior portion of the vertebral bodies become compressed.

Typically occur in patients with underlying osteoporosis

Question 30

Are anterior wedge compression fractures generally stable or unstable?

Answer 30

Stable because of the rigidity of the rib cage . Tend to only affect anterior column

Question 31

What is the difference between a stable and unstable fracture?

Answer 31

Unstable fracture are those that tend to displace after reduction, whereas stable fractures remain in place after reduction. In relation to vertebral fractures, instability occurs when injuries affect two contiguous columns (i.e. anterior and middle column or middle and posterior column).

Question 32

Describe the three vertebral columns

Answer 32

Anterior, middle and posterior column.
Anterior column involves the anterior longitudinal ligament, anterior 2/3 of the vertebral body and anterior 2/3 intervertebral disc.

The middle column involves the posterior 1/3 of the vertebral body and IV disc up to the posterior longitudinal ligament

The posterior column involves everything posterior to the posterior longitudinal ligament I.e. Pedicels, articular processes, lamina (therefore ligamentum flavum) and spinous processes

Question 33

What MOI cause burst fractures ?

Answer 33

High energy vertical axial compression so can occur from falls from a height or RTAs

Question 34

What is a burst fracture?

Answer 34

Highly unstable fracture resulting in compression and repulsion of vertebral bodies which cause compression on spinal cord. Result from high energy axial loading

Question 35

What levels do burst fractures tend to occur?

Answer 35

T9-L5. 90% L1

Question 36

What symptoms do burst fractures present with?

Answer 36

Lower back pain and lower limb neurological deficit

Question 37

What type of fracture is described in the CT findings below?

Anterior wedge fracture of the vertebral body with horizontal fracture through posterior element

Answer 37

Chance fracture

Question 38

What common history is associated with chance fractures?

Answer 38

Backseat passenger wearing a lap belt involved in a RTA

Question 39

What happens in chance fractures ?

Answer 39

Hyperflexion of vertebral column. Compression of the anterior and middle column and distraction of the posterior column resulting in spinal cord injury

Question 40

What vertebral levels do chance fractures commonly occur?

Answer 40

Upper lumbar

Question 41

What other form of injury is common with chance fractures?

Answer 41

Intra-abdominal injuries especially pancreas and duodenum

Question 42

Fracture dislocation most commonly occurs at which vertebral level?

Answer 42

Thoracolumbar column at the junction

Question 43

What types of movement tend to cause fracture dislocations?

Answer 43

Extreme flexion or severe blunt trauma disrupting posterior vertebral elements

Question 44

What signs and symptoms are commonly associated with sacral fractures?

Answer 44

Neurological compromise

Lower extremity deficits, urinary/rectal and sexual dysfunction

Question 45

What should be tested in a neurotically exam in a patient with a suspected sacral

Answer 45

Rectal exam
Perianal wink
Bulbocavernous and cremastic reflex
Light touch and pinprick along S2-S5

Question 46

Does osteoporosis affect the vertical or horizontal trabeculae more severely ?

Answer 46

Horizontal

Question 47

What is spinal stenosis?

Answer 47

Abnormal narrowing of the vertebral foramen resulting in spinal cord compression and neurological deficit.

Question 48

What is the difference in neurological deficit in cervical and lumbar stenosis

Answer 48

Cervical stenosis is more serious because it can lead to compression of the spinal cord whereas lumbar stenosis involves compression of cauda equina

Question 49

What is the main aim of spinal immobilisation ?

Answer 49

Vertebral body alignment in attempt to prevent impingement or transection of the spinal cord

Question 50

What equipment is needed in spinal immobilisation?

Answer 50

Semirigid cervical collar, spinal board/scoop, tape and head blocks

Question 51

How many people are required to perform a log roll and what are their responsibilities ?

Answer 51

1) head and c spine
2) control body and limbs
3) inspect back and palpate its length for body tenderness

Question 52

Describe what happens to the cervical spine of a victim of whiplash

Answer 52

Hyperextension of cervical spine,

Minor cases can cause damage to anterior longitudinal ligament whereas more major causes compression of cervical vertebral bodies with the potential of spinal cord damage.

Most commonly occur at C6/7. If spinal cord affected at C2/3 then quadriplegia/ death can occur