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ESA 2 > MSK 6a: vertebral column > Flashcards

MSK 6a: vertebral column Flashcards

1
Q

Describe the general anatomy of the vertebral column

A

33 vertebrae:

  • 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal
  • 24 are separable (discrete) and all capable of individual movement
  • 9 are fused to give two innominate structures

Separated by intervertebral discs
First 25 also articulate at synovial facet joints which facilitate flexibility

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2
Q

What are the functions of the vertebral column?

A

CENTRE OF GRAVITY: line to project body weight to pelvis and lower limbs, so vertebrae increase in size inferiorly up to L5 to hold more weight, then sacral vertebrae are fused, widened and concave anteriorly to transmit weight through pelvis to legs

ATTACHMENTS FOR BONES: supports skull and ribs

ATTACHMENTS FOR MUSCLES: trunk muscles to maintain erect posture and also the pelvic and pectoral girdle muscles

PROTECTION: of spinal cord-a conduit through which spinal cord passes. Also helps shock absorption

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3
Q

What features make up a typical vertebra? Draw

A

Anterior-rounded vertebral body

Central-vertebral foramen for spinal cord and meninges. Walls formed from vertebral arch and posterior vertebral body

Posterior-vertebral arch. Gives rise to 1 spinous process, 2 transverse processes and 4 articular processes; made up of 2 laminae + 2 pedicles

Lamina- 2 per vertebra. Broad, flat plane of bone which connect the transverse and spinous processes

Pedicle-2 per vertebrae. Connect transverse processes to vertebral body

Vertebral canal (spinal canal)-contains spinal cord, roots of spinal nerves and meninges within a succession of vertebral foramina

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4
Q

Describe the structure of a vertebral body

A
  • usually largest part so main weight-bearing
  • roughly cylindrial
  • size increases as column descends; markedly from T4
  • articular surface covered in hyaline cartilage
  • vascular trabecular bone enclosed by a thin layer of compact bone
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5
Q

Describe the structures of the vertebral processes. There are 7 processes that typically arise from the vertebral arch

A

SPINOUS PROCESS: posteriorly and (usually) inferiorly from vertebral arch. Attachment for deep back muscles and lever function

TRANSVERSE PROCESS: 2 per vertebra; run posterolaterally from junctions of pedicles and laminae. Attachment for deep back muscles and lever function

ARTICULAR PROCESS: 4 per vertebrae; 2 superior and 2 inferior. Superior articlar with vertebrae above and inferior with vertebrae below. From junction of pedicles and laminae, each has an articular facet

  • lined with cartilage
  • synovial joints formed between VA of adjacent vertebrae: ZYGAPOPHYSIAL (facet) joints
  • spinal nerves emerge through intervertebral foramina
  • strengthened by ligamentum flavum
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6
Q

Facet joints

A

Articulation of the superior and inferior articular processes
Interlocking design to prevent anterior displacement of vertebrae
Orientation determines the amount of flexion and rotation permitted

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7
Q

Describe the structure of the intervertebral discs

A

NUCLEUS PULPOSUS: gelatinous centre with high osmotic pressure. The remnant of the notochord. Changes in size through day and age; in infants is central but in adults is more posterior as the annulus fibrosus is thinner on the posterior aspect when adult

ANNULUS FIBROSUS: surrounds the NP. Made from lamellae of annular bands: outer is collagenous and inner is fibrocartilaginous; AF is avascular and aneural. Functions as the major shock absorber and is very resilient under compression-stronger than vertebral body

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8
Q

What happens in intervertebral disc herniation (“slipped disc”)?

A
  1. Disc degeneration: chemical changes associated with ageing weakens discs
  2. Prolapse: protrusion of nucleus pulposus with slight impingement into spinal canal (may get neural symptoms)
  3. Extrusion: NP breaks through AF but remains in disc space (classical herniation)
  4. Sequestration: NP breaks through AF and lies outside disc space in spinal canal; may compress
    - likely to be symptomatic due to proximity of spinal nerve roots: acute localised pain or if chronic can get referred pain
    - may compress the spinal cord or the nerve roots of the cauda equina
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9
Q

Where does IV disc herniation commonly occur?

A

Between L4/5 or L5/S1

-sciatica often due to herniated lumbar disc that compresses L5 or S1 component of sciatic nerve

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10
Q

In what direction will an IV disc usually herniate?

A

Posterolaterally:

  • AF weakest posteriorly as thin and doesn’t have support from ALL or PLL
  • lateral as PLL pushes sideways

If herniates straight posteriorly even more chance of compressing spinal cord–>neurosurgical emergency as need herniated disc material removed

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11
Q

Which spinal nerves are compressed when IV disc herniates?

A

Usually compresses the nerve root numbered one inferior to the herniated disc: e.g. the L5 nerve is compressed by an L4-L5 disc herniation
-in thoracic and lumbar regions the IV disc forms the inferior half of the anterior border of the IV foramen and superior half formed by bone of the body of the superior vertebra

CERVICAL:

  • spinal nerves exit superior to the vertebra of the same number, so numerical relationship of herniating disc is the same
  • e.g. C5-C6 compresses C6 nerve root
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12
Q

How might a herniated IV disc be caused?

A
  • violent hyperflexion: produces compression anteriorly and tension posteriorly
  • violent rotation e.g. during a golf swing
  • downward or twisting pressure on neck
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13
Q

Describe the passage of spinal nerve roots

A
  • descend to the IV foramen from which the spinal nerve formed by their merging will exit
  • nerve that exits a given IV foramen passes through the superior bony half of the foramen so lies above it (so not affected by herniation)
  • nerve roots passing to IV foramen immediately and farther below pass directly across the area of herniation
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14
Q

Disc degeneration and marginal osteophytosis

A
  • NP can dehydrate with age so height of IV discs decreases
  • load stresses on IVD alter causing marginal osteophytosis adjacent to affected endplates (spondylitis deformans, senile ankylosis)
  • as disc decreases in height, more stress is placed on facet joints leading to osteoarthritis
  • decreased size of IV foramen and compression of spinal nerves leads to cervical spondylosis (pain in neck)
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15
Q

Cervical spondylosis

A

Degenerative osteoarthritis of IV joints in cervical spine:

  • can cause pressure on nerve roots (radioculopathy) giving dermatomal sensory symptoms (paraesthesia, pain) and myotomal muscle weakness
  • less common is pressure on cord (myelopathy). Weakness below level of compression, gait dysfunction, loss of balance, loss of bladder and bowel control
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16
Q

Describe the structure of a typical cervical vertebra

A

Smallest of the discrete vertebrae. IV discs thinner but relatively thick compared to size of vertebral bodies.

Vertebral body: RECTANGULAR, concave superior and convex inferior surfaces. Small and broad as bears little weight. Uncus of body is the slightly raised part at edges

Vertebral foramen: LARGE and TRIANGULAR

Transverse processes: have FORAMEN TRANSVERSIUM on each which are a conduit for the vertebral artery and vein (NOT C7). Processes have anterior and posterior tubercles

Spinous processes: BIFID (except C7)

Articular facets: oblique and horizontal. Superior faces superoposteriorly, inferior faces inferoanteriorly

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17
Q

Describe the movements of the cervical vertebrae

A

Flexion, extension, lateral flexion, rotation

Biggest range of movement due to:

  • relative thickness of IV discs
  • near-horizontal orientation of articular facets
  • small amount of surrounding body mass
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18
Q

Structure of C1-ATLAS

A

Articulations:

  • superiorly: occiput of skull to allow flexion and extension at atlanto-occipital joint 9nodding)
  • inferiorly: with axis. Allows lateral rotation (shaking head) at atlanto-axial joint

Features:

  • no vertebral body or spinous process
  • ring shaped bone, paired LATERAL MASSES instead of body
  • the most lateral transverse processes (widest cervical vertebra)
  • has an anterior and posterior tubercle
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19
Q

Describe fracture of the atlas (Jefferson’s/Burst fracture)

A

Fracture of anterior and posterior arches causing rupture of transverse ligament. May damage arteries at base of skull; there may be neural sequeale
Typical presentation of pain but no neurological symptoms
Due to heavy axial load, e.g. diving into a shallow pool and hitting head

20
Q

Structure of C2-AXIS

A

Pivot synovial joint, strongest cervical vertebra
Features:
-large bifid spinous process: can be felt deep in the nuchal groove
-odontoid process/dens: the old atlas body that fused as man developed-blunt, tooth-like. Projects superiorly from the body. Encircled by atlas. Anterior to spinal cord, pivot about which rotation occurs. Held in position by transverse ligament of atlas so prevents posterior displacement of dens
-rugged lateral mass
-dens and transverse ligament prevent horizontal displacement of the atlas
-two large flat superior articular facets on which the atlas rotates

21
Q

Hangman’s fracture/traumatic spondylosis

A

Hyperextension of head on neck, so axis fractures through both pedicles: usually in bony column formed by sup and inf articular processes (the pars interarticularis)
In severe cases, body of C2 is displaced anteriorly to C3, causing injury or spinal cor and/or brainstem: v. serious, can cause quadriplegia and death

22
Q

Fracture of the dens (“peg fracture”)

A

Common axis injury

Horizontal blow to back of head or complication of osteopenia (pathological loss of bone mass)

23
Q

Describe the structure of the C7 vertebra

A

Long spinous process so C7 called the VERTEBRA PROMINENS
NOT BIFID
Large transverse process, small foramen transversium (transmits accessory vertebral veins)

24
Q

Why does whiplash injury occur?

A

C spine has high mobility but low stability so prone to injury. Often during rear-end motor vehicle collisions
Hyperextension: ALL severely stretched/torn
Hyperflexion: head “rebounds” quickly after hyperextension, facet jumping may occur

25
Q

Structure of thoracic vertebrae

A

Vertebral foramen: SMALL and CIRCULAR

Vertebral body: HEART shaped; has DEMI-FACETS on the sides for articulation with head of ribs (T9 and T10 have whole facets)

Transverse process: long (length decreases inferiorly) and strong, extend postero-laterall.y. Has COSTAL FACETS on sides for articulation with tubercle of ribs, except T11 and T12

Spinous processes: long, slope posteroinferiorly, tips extend to the level of the vertebral body below

26
Q

Movements of thoracic vertebrae

A

Flexion, rotation (arc made by articular facets) and lateral flexion: but all only small amounts due to the arrangement of spinous processes and the ribs

27
Q

Individual features of thoracic vertebrae?

A

T5-T8: all features of typical T vertebrae

T1-T4: have some features of cervical vertebrae

T1 has long horizontal SP almost as prominent as that of C7 and a complete costal facet on the superior edge for 1st rib and a demifacet on inferior edge for 2nd rib

T9-12 have some features of lumbar, e.g. tubercles similar to accessory processes; most transition occurs at T12: superior half is thoracic in character and inferior half is lumbar so T12 is most commonly fractured

28
Q

Structure of lumbar vertebrae

A

Vertebral body: MASSIVE, KIDNEY-shaped

Vertebral foramen: TRIANGULAR, intermediate (larger than thoracic, smaller than cervical)

Spinous process: short, broad and blunt. Point almost straight backwards

Transverse processes: long and slender, directed laterally , accessory processes on posterior surface of base. NO FORAMINA, NO COSTAL FACETS

Articular facets: nearly vertical, superior directed medially (inwards) and posterior directed laterally (outward): permit flexion

29
Q

Movements of lumbar vertebrae

A

Flexion, extension, lateral flexion

Almost no rotation: due to the articular facet orientation

30
Q

Articulations and functions of the sacrum

A

Articulate superiorly with L5, inferiorly with the coccyx and laterally with the ilium (sacroiliac joint: almost no movement)

31
Q

Structure of the sacrum

A

5 fused vertebrae, wedge-shaped. Triangular shape due to rapid decrease in the size of inferior lateral masses of sacral vertebrae

SACRAL CANAL: continuation of vertebral canal in sacrum. Contains bundle of spinal nerve roots inferior to L1 (CAUDA EQUINA)

SACRAL FORAMINA: 4 pairs, on pelvic and posterior surfaces, for exit of posterior and anterior rami of spinal nerves

BASE OF SACRUM: superior surface of S1. Anterior projection of body of S1 is sacral promontory

APEX OF SACRUM: tapering inferior end, has oval facet for articulation with coccyx

DORSAL SURFACE: rough, convex, has 5 prominent longitudinal ridges. Central ridge: median sacral crest: fused spinous processes of S1-3/4. Intermediate sacral crest: fused articular processes. Lateral sacral crests: tips of transverse processes

SACRAL HIATUS: inverted U-shaped/triangle part. Absence of laminae and spinous processes of S5 and leads into spinal canal

SACRAL CORNUA: inferior articular processes of S5

Lateral surrface-auricular surface. Site of synovial part of sacro-iliac joint; covered in hyaline cartilage

32
Q

Function of sacrum

A

Strength and stability of pelvis

Transmits weight of body to pelvic girdle

33
Q

Structure of the coccyx

A

4 fused vertebrae (ranges 3-5), small and triangular, remnant of early embryonic “tail” (W4-8)
Co1: largest and broadest, may remain unfused
Coccygeal cornua: articulates with sacral cornua
Doesn’t support standing weight; when sitting may flex slightly anteriorly
Attachment for part of gluteus maximus and anococcygeal ligaments

34
Q

Describe the foetal vertebral column

A

Flexed in a single curvature: C-shaped
Concave anteriorly: KYPHOSIS

This arrangement is the PRIMARY CURVATURE which is retained throughout life in the thoracic, sacral and coccygeal regions

35
Q

Describe the young adult vertebral column and its development

A

Primary curvature remodelled to add two secondary curvatures:

  • C-spine develops first posterior concavity (cervical lordosis)
  • Lumbar spine loses its primary kyphosis during crawling: lumbar lordosis develops when stands up and walks

So 4 distinct curvatures giving a SINUSOIDAL profile (good flexibility and resilience):

  • 2 KYPHOSES (anterior flexions): thoracic and sacral (primary curvature)
  • 2 LORDOSES (posterior flexions): cervical and lumbar (secondary curvature)
36
Q

Where does the centre of gravity pass?

A

Through the weak points of the vertebral column:

  • C1 & C2
  • C7 & T1
  • T12 & L1
  • L5 & S1
37
Q

Describe the vertebral column in old age

A

Secondary curvatures start to disappear with continuous primary curvature re-established: SENILE KYPHOSIS

38
Q

Physiological curvatures

A

Exagerration of lumbar lordosis in pregnancy to compensate for alterations to their normal line of gravity. May cause lower back pain, naturally disappears soon after childbirth

Can also be caused by obesity “pot belly”

39
Q

Excessive thoracic kyphosis (shortened to kyphosis) and excessive lumbar lordosis (shortened to lordosis)

A

“Hunchback”
Abnormal increase in thoracic curvature, due to erosion from osteoporosis

“Hollow/sway back”
Anterior tilting of pelvis and increased extension of lumbar vertebrae. Usually due to weakened trunk muscles

40
Q

Scheurmann’s disease/juvenile kyphosis

A

Uneven vertebral growth in childhood: posterior border of vertebral body longer than anterior border, so vertebrae are wedge-shaped.
Usually thoracic, may be lumbar
Causes increased kyphosis, poor posture and backache. Common in adolescents

41
Q

Scoliosis

A

Abnormal lateral curvature with rotation of vertebrae

  • spinous processes turn toward the cavity of the abnormal curvature
  • when individual bends over the ribs protrude (rotate posteriorly) on the side of the increased convexity
  • primary (congenital), secondary (neuromuscular disease), idiopathic (most)

Prominent ribs and/or scapula, uneven “apparent” arm/leg length

KYPHOSCOLIOSIS: scoliosis combined with excess thoracic kyphosis. Can decrease lung capacity, cause pulmonary hypertension, spinal cord compression

42
Q

Describe the ligaments of the spine

A

ANTERIOR LONGITUDINAL LIGAMENT: stronger than PLL

  • from anterior tubercle of atlas to the sacrum
  • covers front and sides of the vertebral bodies, attached to superior and inferior edges, thick and strong
  • mobile over IV discs
  • prevents hyperextension: tightness helps prevent back and forth movement of vertebral bodies

POSTERIOR LONGITUDINAL LIGAMENT

  • from body of axis to sacral canal, runs along the back of the vertebral bodies (need to cut pedicles to see)
  • continuous superiorly to the axis as “tectorial membrane”
  • narrow where overlies each body, widens to cover the back of each disc
  • helps prevent hyperextension

LIGAMENTUM FLAVUM strongest ligament

  • collection of yellow elastic ligaments running between adjacent laminae (front of upper lamina to back of lower lamina and bases of spinous processes; need to cut pedicles to see)
  • stretched during flexion
  • in lumbar region runs laterally, covering anterior aspect of facet joints

INTERSPINOUS LIGAMENTS

  • weak sheets of fibrous tissue uniting spinous processes
  • only well-developed in lumbar region to give stability in flexion
  • fuse with supraspinous ligaments: from lower edge of one SP to upper edge of the next

SUPRASPINOUS LIGAMENTS

  • tips of adjacent spinous processes. Emerges with interspinous ligaments, runs whole length of vertebral column
  • provides midline attachment for muscles
  • strong bands of white fibrous tissue
  • lax in extension, tight in flexion (mechanical support, limit flexion)

LIGAMENTUM NUCHAE: dense and triangular

  • from external occipital protruberance to spinous processes of all cervical vertebrae (ends at C7)
  • maintains secondary curvature, helps C-spine support head, attachment of neck and trunk muscles e.g. trapezius, rhomboids
43
Q

Describe how a lumbar puncture is perfomed

A

Withdraw CSF from the midline between the spinous processes of L3/4 or L4/5: after the CONUS MEDULLARIS (end of spinal cord) so least chance of neurological damage

44
Q

Which structures does the needle pass through in lumbar puncture?

A 
Skin
Subcutaneous tissue
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Epidural fat and veins
Dura mater
Arachnoid mater
Subarachnoid space
45
Q

Spina bfida

A

Birth defect involving incomplete development of vertebral column

Spina bfida occulta: neural arches of L5 and/or S1 develop abnormally and fuse posterior to the vertebral canal. Usually in vertebral arches. Usually no symptoms

Spina bfida cystica: severe type. One or more vertebral arch fails to develop completely; associated with herniation of meninges. Neurological symptoms. severe cases paralysis of limbs/bladder/bowel control. Can be due to neural tube defect in W4 development

ESA 2 (58 decks)

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