Marilyn Rose

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Spine

• Marilyn Rose

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Vertebral Column

• Supports weight
• Maintain posture
• Protect spinal cord/ nerves
• 33 total vertebrae
• Cervical (lordotic curve)
• Thoracic (kyphotic curve)
• Lumbar (lordotic curve)
• Sacral ( kyphotic curve)
• Coccygeal

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Vertebrae

• Vary in size and shape by section
• Common parts
• body (anterior element)
• vertebral arch (posterior element)
• vertebral endplates
• -compact bone- superior/ inferior of body
• vertebral foramen
• Posterior/ ringlike arch space- attaches to sides
  of body

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Vertebrae contd.

• vertebral Arch (posterior element)
• 2 pedicles 2 lamina 1 spinous process 2
  transverse process and 2 superior
• And 2 inferior articular processes ( form
  zygapophyseal joints)
• Intervertebral disks
• Vertebral bodies separated by shock absorbers or
  disks- consists of inner soft nucleus pulposus
  and firm outer annulus fibrosus.
• What herniates when you rupture a disk? Where
  does it go?

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Cervical Vertebrae

• 7 total
• 1 atlas- supports the head- atlantooccipital
  joint
• Anterior/ posterior arch and two large lateral
  masses
• 2 axis odontoid process (dens)- project upward
  from superior surface of body- pivot for atlas.

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Cervical Vertebrae contd.

• Bifid spinous process
• Only seen in C3-C6
• Vertebral prominens
• Long spinous process
• Not bifid
• Palpable posteriorly at base of neck

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Cervical Vertebrae
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Cervical Vertebrae
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Thoracic Vertebrae

• 12 total vertebrae
• Characteristic- costal facets (demi facets)
• located on the body and transverse process and
  articulate with the ribs
• Costovertebral joints- head of rib and vert body
• Costotransverse joints- tuberle of rib and
  transverse process
• Spinous processes are long and slender-projecting
  inferior.

CT scan reveals destruction of the vertebral body
(small arrow) and an associated soft-tissue mass
(large arrows).
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Thoracic Vertebrae
1-Vertebral Body 2-Spinous Process 3-Transverse
Facet 4-Pedicle 5-Foramen 6-Lamina 7-Superior
Facet
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Thoracic Vertebrae
Vertebroplasty- cement filling collapsed
vertebrae
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Lumbar Vertebrae

• 5 vertebrae total
• Bodies are largest of all the vertebrae-
• Largest L5- massive transverse process
• Body weight is transferred from 5th lumbar vert
  to base of sacrum- across L5-S1 disk space.

Reconstructed sagittal CT view of the lumbar
spine demonstrating an L5/S1 foraminal spur,
visible despite the presence of metal
instrumentation.
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Lumbar Vertebrae
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Lumbar Vertebrae
A CT Scan of a Lumbar Vertebra showing the bony
structure and stress fracture or Spondylolysis.
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Athletes and L spine.FYI
Conclusions high prevalence of spondylolysis in
athletes with low back pain compared with the
general population suggests that it would be good
practise to include a radiological examination of
the lumbar spine in symptomatic athletes engaged
in sports who are considered to be at risk in the
light of this and other studies
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Spondylolysis Review
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Sacrum and Coccyx

• 5 fused vertebrae sacrum
• Lateral mass ala transverse processes
• Articulate with pelvic bones sacroiliac joints
• Sacral promontory- anterior surface of body- bony
  landmark that separates abdomen from pelvic
  cavity
• 3-5 fused bony segments coccyx
• Most inferior portion of vertebral column

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Sacrum and coccyx
sacrococcygeal chordoma
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Ligaments

• Anterior longitudinal ligament
• From C1 to the sacrum along entire anterior
  vertebral column
• Posterior longitudinal ligament
• Inside the vertebral canal and runs posterior to
  the vertebral bodies.
• ligamentum flava
• Strong ligaments on each side of spinous process-
  preserve natural curvature of the spine

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Muscles

• Superficial
• Splenius
• Intermediate
• Erector spinae
• Deep layer
• Transverspspinal
• Regions-
• Capitis, cervicis, thoracis and lumborum

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Spinal Cord

• Cerebrospinal fluid- in thecal sac formed by
  spinal meninges- continuous with cranial
  meninges.
• Still 3 layers
• Dura- outer layer-S2-makes thecal sac- adhere to
  long ligament/ surrounds each spinal nerve.
• Arachnoid- thin, attached to inner surface of
  dura- subdural spacearachnoid and dura
• Pia and arachnoid- subarachnoid space- (CSF)
• pia adheres to spinal cord

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Spinal Cord contd.

• Pia extends as filum terminale at L1-L2 when the
  spinal cord ends
• Filum is attached to the coccyx
• conus medillaris where the spinal cord ends
• cauda equina splits into bundles of nerves like
  a horses tail inferior to the conus

Fatty Filum Terminale
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Spinal Cord

• White Matter- external borders of cord
• Gray Matter- nerve cells/ central canal
• Axial- butterfly appearance
• Dorsal horns- posterior
• Sensory fibers afferent nerve roots
• Dorsal root ganglion- oval enlargement nerve
  cell bodies of sensory neurons
• Ventral horns- anterior
• Efferent or motor neurons
• Ventral and dorsal roots unite to form 31 pairs
  of spinal nerves
• 8 cervical, 12 thoracic and 5 lumbar, 5 sacrum
  and 1 coccyx

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Dermatomes? What are they?
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Plexuses

• 4 major nerve plexuses
• Cervical
• C1-C4 ventral rami-
• innervate neck, lower face/ear, side of scalp and
  upper thorax
• Phrenic nerve- major motor branch continues on
  to innervate diaphragm.
• Brachial
• C5-C7 /T1 ventral rami
• upper extremity and shoulder
• Lumbar
• T12/ L1-L4 ventral rami-
• abdominopelvic muscles and anterior/medial
  muscles of thigh.
• Femoral nerve- anterior lower leg and ankle/foot
• Sacral
• L4-L5/ S1-S4- buttock, posterior thigh and feet
• Sciatic Nerve Largest nerve in the body!!!!-
  innervate lower extremities

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Plexuses
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Vasculature of Spine

• Single anterior spinal artery
• caudal to basilar artery
• Supplies the anterior 2/3 of the spinal cord
• Posterior spinal arteries- vertebral/ posterior
  inferior cerebellar arteries
• Descend along dorsal surface of spinal cord
• Posterior 1/3 of spinal cord is supplied
• Spinal Cord-
• Anterior and Posterior veins- drain gray matter
  and
• radial veins drain the white matter
• Vertebral column- internal and external venous
  plexuses (valveless)

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Spinal cord Ultrasound
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What is this?
Coronal STIR image showing neurofibromatosis of
the lumbar plexus. The lesions here are less
hyperintense than in the cervical region.
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What is this?
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Spina Bifida
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Spinal Cord Injuries
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Spinal Tap
Epidural
Why? A spinal tap is a procedure performed when a
doctor needs to look at the cerebrospinal fluid
(also known as spinal fluid). Spinal tap is also
referred to as a lumbar puncture, or LP.)
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Sword Swallowing??????