Anatomy - vertebrae & bony thorax Flashcards
How many vertebrae in an adult?
26 vertebrae
How many vertebrae in an infant?
33 vertebrae
What makes up adult vertebrae column
7 cervical
12 thoracic
5 lumbar
1 sacrum (5 fused to become 1)
1 coccyx (4 fused to become 1)
What makes up infant vertebrae column
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
In a AP/PA vertebrae column should be:
Straight
In a lateral, the vertebrae column is what? infant vs adult
Curved (1 in infant, 4 in adult)
Normal Curves in Adult: primary
Thoracic and Sacrum/Coccyx - kyphotic curves
Reasons for curves in adults
Increase the strength of the vertebral column, Helps maintain balance by distributing the weight, Helps absorb shock, Helps protect the vertebrae from fractures
Normal lordotic curve in lateral position:
Concave: posterior and convex: anterior
list abnormal curves
Kyphosis, lordosis, scoliosis
Vertebrae consist of
Vertebral Body, Vertebral Arch, Vertebral foramen
Vertebral foramen purpose
Where the spinal cord passes through
Vertebral Body contains
Mostly spongy/trabecular bone (with RBM) surrounded by thin layer of compact bone, and is bounded by anterior and posterior longitudinal ligaments
The vertebral body is
Separated by intervertebral discs and is the weight-bearing part
Vertebral column functions
forms trunk of skeleton, flexible movement, protects spinal cord, supports head, rib attachment, back muscle attachment
Normal Curves in Adult: secondary
Cervical and lumbar - lordotic curves (remember: both words have an “L” - so goes with lordotic)
Thoracic & sacrum/coccyx VS. cervical & lumbar curves
Thoracic & sacrum/coccyx - don’t change (present during development)
Cervical & lumbar curves - do change (form later on)
Normal thoracic/sacrum curve in lateral position:
concave: anteriorly, convex: posteriorly
Explain kyphosis
Exaggeration of the normal kyphotic curve in the thoracic region, mostly in elderly women - osteoporosis (weakened spine causes compression fractures & a lot of force)
Explain lordosis
Exaggeration of the normal lordotic curve - in the cervical and lumbar spine
Explain scoliosis
Abnormal LATERAL curvature of the spine - the vertebra body rotates towards the convex side of the curve*
Why is kyphosis only in the thoracic region, why can’t it get bigger?
because they’re fused
Can patient have kyphosis without lordosis (one without the other)
No, if you develop one, you develop another
Risk of leaving spine curved in scoliosis
breathing issues - because it messes up the lungs / diaphragm
What passes through the vertebral foramen?
opening in the arch - spinal cord passes through
what type of bone is the vertebral body made of
mostly trabecular bone with RBM, surrounded by thin layer of compact bone (thin layer can get weakened)
What is the weight bearing part of the vertebrae?
the vertebral body
posterior to the vertebral body is the ______
pedicle
Vertebral arch consist of:
2 pedicles, 2 laminae
What is located between the vertebral notches of the vertebrae?
intervertebral formina
What occurs at the intervertebral formina?
Spinal nerves enter and exit - where nerve issues can occur (can cause pain in hands/arms if damaged- nerve issues)
Laminae becomes / joins together to form the _______
spinous process
*What forms the intervertebral formina?
the 2 notches: inferior vertebral notch of the vertebra above and superior vertebral notch of the vertebrae below
List the processes of the vertebral arch
2 superior articular processes, 2 inferior articular processes, 2 transverse processes, 1 spinous process
In the T/L spine only, the transverse process comes off where the _______ & ______ meet (junction)
pedicle and laminae
How are the intervertebral disc spaces best demonstrated?
in a AP / lateral
Zygapophyseal joints (facet joints), what forms them
the superior articular process of the vertebrae below and inferior articular process of the vertebrae above (between articular pillars)
Why are Zygapophyseal Joints important?
Movement (flexibility can be from the disc)
Problem with herniated disc
Presses on spinal nerves
Bump on the back of the neck landmark for:
C7 - vertebral prominens - helps you know you have top of thoracic cage on the image
Does the C1 ____ have a body?
atlas - no
The size of the bodies _______ from C2 to C7
increase (if they get smaller - sign of compression fracture)
What has the largest vertebral foramina of all vertebrae
Cervical vertebrae - spinal cord is enlarged here for nerves
Each transverse process in the C spine has a _______
transverse foramen (ONLY the C spine has a transverse foramen)
In the C spine, the transverse process is located where?
arises from the pedicle and body (junction)
What passes through the transverse foramen?
the vertebral artery / vein / nerve
Where are articular pillars located?
between superior and inferior articular processes of the same vertebra (each vertebral level has a right and left articular pillar)
How to demonstrate the zygapophyseal joints on C spine
true lateral - the articular pillars should be superimposed to see the zygapophyseal joints
Angle that the intervertebral foramina are on in the body
45 degrees to the midsag plane, 15 degrees inferiorly
What angle demonstrates the right intervertebral foramina
LPO (45 degrees) with 15 degree cephalad angle, OR, RAO with 15 degrees caudad - so when you are doing POSTERIOR - its opposite of the side ordered (R - LPO) - same side if its ANTERIOR
What part of the vertebral arch connects to the vertebral body
pedicle
What part of C1 articulates with odontoid process*
anterior arch
What does the head of the 4th rib articulate with
the superior demifacet of the 4th thoracic vertebrae and the interior demifacet of the 3rd thoracic vertebrae
What does the tubercle of the 4th rib articulate with
the transverse process of the 4th vertebrae
Superior articular process of the lateral masses of C1 articulate with _______ to form what?
Occipital condyles to form Atlanto-occipital joint
What movement does Atlanto-occipital joint
allow for?
nodding head back / forward - “yes”
Inferior articular process of the lateral masses of C1 articulate with _______ to form what?
C2 to form atlanto-axial joint
C2 (axis) contains the _______ process
Odonotid (dens)
What parts of C spine is bifid?
C2-C6
Atlanto-axial joints permits rotation of the head to say _____
No
Is C7 bidif?
no, only C2-C6
What best demonstrates C1-C2
Lateral, open mouth odontoid view
How can you tell it’s C2 on an image?
Blunt (rounded), bigger spinous process, has the odontoid process
Lateral masses of C1, should align with the _________ part of C2
lateral - should be same width - if they’re not it’s a sign of fracture (jeffersons fracture head first into object)
What doesn’t C1 have?
body or spinous process
What are the distinguishing features of the thoracic vertebrae?
largest transverse process (pedicle and laminae), facets for articulations with the ribs, spinous process project inferiorly (down)
What are the distinguishing features of the cervical vertebrae?
Transverse process (pedicle and body), has transverse foramin, bifid spinous process
What are the distinguishing features of the lumbar vertebrae?
largest vertebral bodies - that are bigger anteriorly than posteriorly, bodies con-caved, spinous processes project horizontally (straight back), smaller transverse process (pedicle and laminae)
What is a costovertebral joint
joint between the head of the rib in the vertebral body (Head of rib articulates with the posterolateral part on vertebral body)
What is a costotransverse joint
tubercle of rib articulates with the transverse process of the vertebrae ONLY T1-T10
What is it called if head of rib articulates with 1 vertebrae vs 2 different vertebrae
Whole facet if it’s 1 and demifacet (half facet) if its 2
What facets does T1 have
whole facet on SUPERIOR boarder for articulation with 1st rib and demifacet on INFERIOR. boarder for articulation with 2nd rib
What facet does T9 have
only a superior demifacet (not an inferior)
What facets do T2-T8 have?
demifacets on upper (supperior) and lower (inferior) boarders
What do the T2-T9 articulate with?
the same # vertebrae and vertebrae above
Do T11 and T2 have a costotransverse joint?
no
“describe all articulations of the 7th rib”
Posteriorly:
Costotransverse joint: from the tubercle of the 7th rib to the transverse process of the 7th rib of the vertebrae
Costovertebral joint: Head of the 7th rib articulates with the superior demifacet on T7 and inferior demifacet of T6
How are the intervertebral foramen of the thoracic vertebrae demonstrated?
lateral
On a true lateral, would you see through the Zygapophyseal joints?
No - only with obliques
A LAO 75 degree demonstrates what?
Left side of Zygapophyseal Joints
A LPO 75 degree demonstrates what?
Right side of Zygapophyseal Joints
If the inferior vertebral body was smaller than the superior one, what would that indiviate?
Compression fracture
Spinal cord ends at the disc between ____ and ____ in adult pt
L1 and L2
In the sacrum, the base is ______ and apex is _______
superior and inferior
sacrum is con-caved which direction?
anteriorly
Can you use shield a female pt when doing AP scarum?
no, can’t do PA either - has to be AP (the diverging beam matches the curve)
Auricular surface is on the lateral edge of sacrum forms what?
SI joint
How many sacral foramina are there?
4 pairs (8)
What does the apex of the sacrum articulate with?
coccyx
What passes through the sacral canal
Spinal nerves
What projection for S1 joints?
oblique
Where does the spinal cord end?
disc space between L1 and L2
Thoracic cage composed of:
thoracic vertebrae, ribs, and sternum
Only _______ of the clavicle articulates with the manubrium
inferior 1 half
What is at the junction between the manubrium and body of sternum
Sternal angle (2nd rib attaches here posteriorly from T1/T2 to T4/T5 inferiorly
Whats the vertebral level of the sternal angle
T4-5
Landmark for xiphoid process
T10 (where ribs meet)
What part of the vertebral arch connects to the vertebral body*
Pedicle
How do you demonstrate the left intervertebral foramina of the cervical spine*
RPO 45 degree with 15 degree cephalad angle, LAO 45 degrees 15 degree caudad angle
What is the pars interarticularis?
Part of the lamina that is located between the superior and inferior articular processes
Why are the Pars Interarticularis
important clinically?
Because you can get a fracture (spondylosis)
What is spondylosis
Fracture in pars interarticularis
Spondylosis vs Spondylolisthesis
Spondylosis: fracture in ONE pars
Spondylolisthesis: fracture in BOTH pars (vertebrae can slip forward) bilateral - twisting
Slipping forward on one vertebrae onto another (spondylosithesis) is best demonstrated how? and spondylosis?
lateral for spondylothesis and oblique for spondylosis
Fracture through the pars is best demonstrated how?
oblique
What makes up the ear scotty dog?
superior articular process of the vertebrae
What makes up the front leg of scotty dog?
Inferior articular process of the vertebrae
What makes up the eye scotty dog?
pedicle
What makes up the nose scotty dog?
transverse process
What makes up the neck scotty dog?
PARS
What makes up the ebody scotty dog?
Lamina
What way does the scotty dog face?
the same way the patient is facing and demonstrate that side (Nose pointed in that direction - in an image if nose is pointing to the right - its a RPO, left - nose is left) *
Joint between front leg and ear of scotty dog?
zygapohyseal joint
What is demonstrated oblique scotty dog? *
Neck of scotty dog / PARS (to see if there’s a fracture) and zygapophyseal joint(In LAO – left zygapophyseal joint and left pars interarticularis joint)
In a L-spine, how is the intervertebral foramen best demonstrated?
lateral (same as the lateral)
In lumbar spine, rotate patient ____ degrees for zygapophyseal joints
45 degrees
Distinguishing features of C3 - C6
smaller vertebrae bodies, larger vertebral foramen, Transverse process is at junction of pedicle and body
Thoracic vs lumbar spine
Thoracic: has facets for ribs, smaller body, spinous process inferior, pointy spinous processes, has largest transverse process (facets for ribs)
Lumbar: spinous process straight back, blunt spinous processes
How do you demonstrate the right pars interarticularis in the lumbar spine? which way is scotty dog facing?
RPO 45 - scotty towards the right / patient to the right - “right pars interarticularis in the right zygapophyseal joints”
What part of the scotty dog is represented by the pars interarticularis? why is this important?
Neck (fractures)
How many ribs?
12
How do you know where the first rib is?
around C7 (vertebral prominence)
Anterior part of rib attaches to a ___________
costocartilage
Spaces between the ribs?
intercostal spaces
Costal groove runs along the ________ surface of the rib
inferior
Purpose of the costal groove in the ribs?
allows things to pass through (artery, vein, vessels)
Widest portion of the thorax?
inferior part
Compression fracture best demonstrated how?
lateral
On a PA chest - how to access for full respiration
need to be able to count 10 posterior ribs ABOVE diaphragm on the left side * because the left sits lower – liver pushes the right side up
How many facets does the 10th rib have?
1 (only articulates with the 10th rib)
Does the 11th rib have costal cartilage facet?
no, its a floating rib - and doesn’t have tubercle
Features of a typical rib:
Head, neck, tubercle, body, sternal end
What does the sternal end of ribs attach to?
costocartilage (attaches ribs to sternum)
What does the tubercle of the rib articulate with?
transverse process
What does the head of the rib articulate with?
vertebral body
How to identify ribs: true ribs
1-7 (attach to sternum via costo-cartilage - the first rib attaches to the manubrium, second attaches to sternal angle)*
How to identify ribs: false ribs
8-12
How to identify ribs: floating ribs
11 and 12 (also false & don’t attach to anything anteriorly)
What happens to the 10th rib anteriorly?
attaches to costo-cartilage of the 7th rib
