Osteology of the vertebral column

Question 1

What is degenerative spine disease

Answer 1

-Chronic back pain which is often caused by disk herniation or age-related degenerative changes
=>generates significant inflammatory response
=>mechanical neural compression
=>radicular symptoms in the upper and lower limbs

-Back pain - could be combination of factors including trauma, stress and strain
(non-specific and mechanical pain)

Question 2

Management of mechanical back pain

Answer 2

-Control of pain and inflammation
-Restoring of joint’s range of movement and soft tissue extensibility
-Improving and maintaining muscle strength

Question 3

Structure of the vertebral column

Answer 3

-Vertebral column contains 33 vertebrae connected by synovial joints, intervertebral discs and ligaments
Divided into 5 regions:
-Cervical
-Thoracic
-Lumbar
-Sacrum
-Coccyx

Question 4

Functions of the vertebral column

Answer 4

-Protects the spinal cord
-Support the weight of the body above the pelvis
-Forms the central axis of the body
-Facilitates in posture and movement

Question 5

Curvatures of the vertebral column

Answer 5

Primary curvatures (concave anteriorly)
-Thoracic
-Sacrococcygeal

Secondary curvatures (concave posteriorly)
-Cervical (when they hold head on shoulders)
-Lumbar (when they start walking)

Question 6

Structure of a vertebra

Answer 6

-Vertebral body (anteriorly)

Vertebral arch (posteriorly and laterally)
-Spinous process
-Transverse processes
-Pedicle
-Lamina
-Articular processes

-Vertebral canal

Question 7

Features of typical cervical vertebra

Answer 7

-Foramen transversarium (vertebral artery, vein and sympathetic nerves)
-Bifid spinous process

Question 8

Features of typical thoracic vertebra

Answer 8

-Vertebral body - heart shaped
-Demi-facets on the sides of each vertebral body - which articulate with the heads of the ribs
-Costal facets on the transverse processes - which articulate with the tubercles of the ribs
-Spinous processes - long slant inferiorly – to horizontal

Question 9

Features of typical lumbar vertebrae

Answer 9

-Vertebral body - kidney shaped
-Spinous processes - short and broad
-Mamillary and accessory processes

Question 10

Joints in the vertebral column

Answer 10

-Between vertebral bodies - adjacent vertebrae are joined by intervertebral discs
-This is a type of cartilaginous joint, known as a symphysis

-Between vertebral arches - by the articulation of superior and inferior articular processes from adjacent vertebrae
-It is a synovial type joint

Question 11

Structure of intervertebral disc

Answer 11

Fibrocartilaginous disc has 2 parts
-Nucleus pulposus
-Annulus fibrosus

End plates - hyaline cartilage

Functions:
-Permits flexibility of the spine
-Acts as a shock absorber
-Supports the curvature of the spine

Question 12

Herniation of an intervertebral disc

Answer 12

Question 13

Ligaments of the vertebral column

Answer 13

-Anteriorlongitudinal ligament
-Posterior longitudinal ligament
-Ligamentum flavum
-Interspinous ligament
-Supraspinous ligament
-Intertransverse ligament

Question 14

How many spinal nerves are there?

Answer 14

-8 Cervical spinal nerves
-12 Thoracic spinal nerves
-5 Lumbar spinal nerves
-5 Sacral spinal nerves
-1 Coccygeal spinal nerve

Question 15

What level does spinal cord end?

Answer 15

-Lower border of L1
-Below that is corda equina

Question 16

The intervertebral foramina

Answer 16

-The spinal nerve roots pass through the intervertebral foramina
-This also contains arteries, vessels, nerves and transforminal ligaments

Question 17

Back muscle classification

Answer 17

Deep layer - associated with movements of the vertebral column

Intermediate layer - associated with movements of the thoracic cage

Superficial layer - associated with movements of the shoulder

Question 18

Dermatomes to understand sensory symptoms

Answer 18

-A strip of skin that is innervated by a single spinal nerve is known as a dermatome
-31 pairs of spinal nerves are present bilaterally
-Diagnostic importance - to determine any damage to a spinal nerve and its extent - sensory symptoms
-Damage to the nerves with these root values also leads to muscle weakness - motor symptoms

Question 19

Features of sciatica

Answer 19

-Sciatica – irritation or compression of the nerve
-Symptoms – may feel pins and needles, numbness, pain and weakness
-Causes – injury, disc herniation, spinal stenosis and spondylolisthesis
-Treatment – exercises, stretches, painkillers, physiotherapy or surgery in worse conditions (decompression surgery)

Question 20

Which nerve is related to sciatica

Answer 20

-Sciatic nerve - L4-S3

-Sensory function - terminal branches innervates the skin of the lateral and posterior side of lower limb, and both the dorsal and plantar surfaces of the foot

-Motor function - innervates the hamstring muscles