list the functions of the vertebral column *
support protection movement
what are the regions of the vertebral column *
cervical thoracic lumbar sacral coccygeal
what is one of the commonest muscoskeletal problems
backpain because of disk herniation etc
describe the support and protection element of the vertebral column *
hold body weight
transmit forces - so can damage spine easily eg when jump with straight legs force goes up into the vertebral column - this is made worse at the points where the vertebral column changes direction from anteriorly to posteriorly between lumbar and sacrum
supports the head supports the upper limbs and aids movement by supporting the muscles that are attached to it
also changes intrabdominal and thoracic pressure
houses spinal cord - protective
describe the movement aspect of the function of the vertebral column *
attachment of muscles to the limbs (extrinsic muscles) or within the vertebral column (intrinsic muscle) that allow you to stand up, stiffen spine, maintain upright stability while moving limbs
when is postural control diminished *
stroke back pain spinal cord injury
what are extrinsic muscles *
they come from the vertebral column but extend out of it
what are intrinsic muscles *
go between adjacent vertebrae or vertebrae or ribs
image of all the vertebral sections *
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where are disk herniations most common *
between lumbar and sacral vertebrae - because there is a sharp change in dirn
describe the curvature of the vertebral column *
start when curled in foetal position - so they’re named depending on whether they were there in foetal development or added in primary curvatures are in the dirn you would expect in a foetus so the concave side facing anteriorly - thoracic and sacral secondary are added in in opposite dirn to allow you to stand upright - concavity facing posteriorly in foetal - everything is curved forward [image]
describe when curvatures of the vertebral column are exaggerated *
in pregnancy - in order to maintain upright stability you lean further back to counter the growth of the baby anteriorly - exaggerate secondary curvature same for obesity this could cause problems with the back because of the extra curvature needed
why does it take muscular activity just to stand upright*
most of the body is hung of the anterior of the vertebral column activate muscles down back of spine and legs just to stand up
describe excessive kyphosis *
excessive thoracic curvature eg in elderly people - due to degenerative changes in the spine over many yrs if vertebral bodies are misshapen spine curves this way to stop them being on top of each other
describe excessive lordosis *
sexual position in 4 legged animals so exaggerated curvature in the lumbar spine resulting from centripetal weight
describe curvatures from the front *
abnormal - it should be straight if curvatures laterally - scoliosis (S shaped curve) - common in females around puberty problem because organs in chest can become compressed when this is severe also causes chronic pain also problem because head needs to be kept upright so pain to do this when you have a curvature
image to show excessive curvatures *
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treatment of lateral curvatures *
add screws via surgery and putting rods either side - adjust so that the vertebral column is upright less severe cases use a brace
number of bones in each section of the vertebral column *
7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 3-5 coccygeal (fused)
what limits movement of the non-fused vertebrae *
the features of the facets - whether they are orientated vertically or horizontally laxative ligaments but the back as a whole is v flexible - but each unit is not
palpable features of the vertebrae *
spinous processes- posteriorly feel them easier if the person is in the foetal position
features of the cervical vertebrae *
there are additional holes at the sides - where the vertebral arteries travel to get into the brain go into the foramen magnum - these are called foramen transversarium
rectangular bodies - concave superior and convex inferior surfaces
triangular vertebral foramen
bifid spinous process
oblique, relatively horizontal articular facets
perforated transverse process with anterior and posterior tubercles
feature of thoracic vertebrae *
associated ribs and so costal facets (2 on each side of body, 1 on transverse process)
heart shaped bodies
long, strong transverrse processes extending posteriolaterally
circular vertebral foramen - relatively small
nearly verticle articular facets - directed primarily posteriorly and anteriorlu
long and sloping spinous process - overlaps inferior vertebrae
describe a typical vertebrae *
body/centrum - weight baring part - disk between each vertebrae (intervertebral disk) spinous process transverse process space for spinal cord vertebral/neural arch - surround the vertebral column articular facet/process - sticks out and comes into contact with another bit to form a joint [image]
what composes the vertebral arch *
lamina - extend posteriorly to form the spinous process the pedicle - stand on the vertebral body forms roof of the vertebral canal has projections for attachment of muscles and ligaments has sites of articulation for adjacent vertebrae
effect of vertical articular facets *
difficult to turn sideways - they touch against each other can move forward and back
effect of horizontal facets *
more rotation more flexible than vertical
describe intervertebral disks *
water filled structures with cartilage, collagen rings around (anulus fibrosis) and gel in the middle called the nucleus - helps with transmitting forces and allow flexibility between vertebrae overtime loses water - disks become dehydrated so shorter at night because of pressure put on disks through the day [image]
describe degenerative disk disease *
intervertebral foramen get smaller - impinge nerves that come out of the holes to the muscles of body = pain, weakness, changes in sensation, paraesthesia
describe the difference in shape between vertebral bodies from above *
thoracic - heart shaped lumbar - kidney shape, bigger than thoracic cervical -rectangular
atypical vertebrae *
C1 (atlas) and C2 - allow movement if head and neck - more flexibility critically important for injury eg fractured in road traffic accidents
describe C1 *
has skull on top facets on skull sit on facets in C1 vertebral body of C1 is not connected to C1 - connected to C2 - create joint that allow you to move head from side to side V superiorly pointing structure so if there is extreme flexion or extension - odontoid peg (dens) breaks free of ligament and crush spinal cord/medulla = death no spinous process transverse foramina - for the vertebral arteries [image]
describe C2 *
peg sits on vertebral body of C2 that is really the vertebral body of C1 - allow rotation of C1 and C2
ligaments around C1, 2 and skull *
from underside of skull to odontoid peg - alar ligaments - wing shaped
from skull to C2 and across C2 - cruciate ligament (cross) - stabilise joint and allow flexibility
effect if ligament breaks *
reduce stability of neck - problem for range of motion, pain and damage neural structures
name of the tough ligaments in front and behind the vertebral bodies *
anterior and posterior longitudinal ligaments - pair
posterior is in the vertebral canal, just behind the vertebral body
anterior - covers and connects the anterior aspect of the vertebral bodies
describe the ligamenta flava *
ligamenta flava - connect adjacent laminae vertically placed
between adjacent vertebral arches
V shaped
describe the supraspinous ligament *
very tough run all the way down back of the spinous processes - connects them
describe the interspinous ligaments *
it runs between adjacent spinous processes vertical limit flexion - ie bend towards the floor
where is CSF taken from/anaesthetic added *
after L2 - the spinal cord finishes and it is just the causa equina
describe prolapsed intervertebral disk *
disk rupture and contents of the disk emerge into space for nerves/spinal cord - therefore get pain and paraesthesia because ligaments at front and back of vertebral bodies - hole posterolaterally to where nerves emerge that the disk can emerge from = nerve impingement, pain and sciatica (lower limbs) more weight transmitted lower down so forces greater as you go down so disc herniation usually happens towards bottom of spine
what are the movements of the spine *
extend/flex lateral flex rotate regions of vertebral column have different extents of this depending on the facets and ribs
muscles and movements of the spine *
abdominal muscles (rectus abdomninus and psoas major) help with flexion
external and internal oblique muscle, SCM, splenius, rhomboids, serratus anterior, quadratus lumborium gluteus amximus and medius help with side bending
obliques, treansversospinalis, SCM, splenius, iliocostalis abd longissimus- help with rotaton
erector spoinae and gluteus maximus - extension
erector spinae muscles - make the spine straight V complicated intrinsic muscles muscles at back of neck that move head up right muscles at front of neck - turn head (SCM)
epidural space of vertebral column *
full of fat and veins catheter inserted to insert anaesthetic and analgesic
what is the dorsal root ganglion *
has the sensory cell bodies of neurons on their way into the posterior of the spine
where are the motor cell bodies *
in the ventral horn of the spinal cord
branches of a mixed spinal nerve *
posterior and anterior ramus posterior for intrinsic muscles down back of spine
movement in cervical spine *
flexible in rotation, extension and bending sideways if have degenerative disease eg arthritis - this becomes very painful
zygapophysial joints slope inferiorly from anterior to posterior allowing flexion amd extension
movement in thoracolumbar *
thoracic - the zygapophysial joints arre verticle - limit flexion and extension but allow rotation
lumbar - joint surfaces are curved and adjacent processes interlock, limiting range of movement - flexion and extension are still major movements in this region
meninges in the spinal cord *
periosteal dura reflects back at the foramen magnum to leave the meningeal dura - making epidural space in vertebral column dura and arachnoid extend further than spinal cord to s2 vertebrae - so there is a large subarachnoid space between S2 and L2 pia mostly stays around the spinal cord - small filament form base of spinal cord, connect to S2 vertebrae - filum terminali
on each side of teh spinal cord, a longitudinally orientated sheet of pia mater stretches toward the dura mater as triangular extensions. they position the spinal cord in the centre of the subarachnoid space these are denticulate ligaments
describe caudal epidural *
possible because spinal cord ends at L2
why is there a hole at the bottom of the spine and its clinical significance *
the last few lamina of sacrum are not there so they don’t fuse to form a spinous process this is the sacral hiatus if you put a needle into the sacral hiatus you infiltrate the lower end of the epidural space with anaesthetic and analgesic - done for people with severe sciatica from disc herniation to reduce inflammation
difference between epidural and spinal anaesthesia *
epi - around dura for duration off labour - because large vol can be entered for many hours spinal - in subarachnoid space spinal block for C section routine, hip replacement when not fit for GA
common spinal pathology *
low back pain prolapsed intervertebral disk - sciatica
spondolysis - degeneration,
spondylolysis - stress fracture of pars interarticularis
spondylolisthesis - forward displacement of vertebrae (pain, nerve impingement and spinal cord vertebrae),
spondylitis - inflammation of vertebrae ligaments can snap and parts of bones can break off in high speed collisions
common fractures *
posterior or anterior part of the atlas - easy to see on x-ray
identify the superficial extrinsic muscles of the back
what are the called
what is there function *
trapezius, latissimus dorsi, levator scapulae and the rhomboids (major and minor)
the latissimus dorsi, levator scapulae and the rhomboids (major and minor) are located deep to the trapezius in the superior part of the back
they attach the superior part of the appendicular skeleton (clavicle, scapular and humerus) to the axial skeleton (skull, ribs and vertebral column)
primarily involved in movemenmt of the appendicular skeleton
they are involved in the movement of the arm, shoulder and back movement
what are the muscles of the erector spinae
identify them
what is there function *
iliocostalis, longissimus, spinalis
they are a group of deep intrinsic muscles, lie posterolaterally to the vertebral colummn
they arise from a thick tendon that is attached to the sacrum, the spinous process of lumbar and thoracic vertebrae amd teh iliac crest. divides in the upper lumbar region into 3 columns of muscles
function: stabalise and control the movement of the vertebral column. primary extensors of vertebral column and head - straighten backa nd pull head posteriorly. control vertebral column flexing by relaxing and contracting in a coordinated way. and control lateral bending and turning head from side to side
what is the conus medullaris *
the bundled, tapered end of the spinal cord nerves
it ends at the cauda equina
identify 1 anterior and 2 posterior spinal arteries
identify supplementory radicular arteries
identify internal and external vertebral venous plexuses
what is the clinical significance of the connection between the venous plexuses in terms of prostate cancer
clinical significance - prostate cancer metastises early to the vertebral venous plexuses via the internal iliac vein which drains the prostate
describe the lumbar vertebrae *
massive kidney shaped body
vertebral foramen triangular
short, broad and blunt spinal process
transverse process long and slender - directed laterally and medially
what are the palpable landmarks of the spine *
C7 - only palpable cervical spine
T3- level with the medial end of scapular spine
T7 - level with inferior angle of scapular
L2 - level of lowest part of 12th rib
L4 - level of the iliac crest
describe the ligaments, meninges and spaces traverrsed by the needle during positioning into the epidural space or subdural space *
skin
fat
muscle
supraspinous ligament
intraspinous ligament
ligamentum flavum
(for the subarachnoid space: dura mater, arachnoid mater)
why dont you do a lumbar puncture if there is a raised intracranial pressure *
if the intracranial pressure is raised but the pressure is low in the subarachnoid space in the vertebral column - taking a LP will make the difference worse and the brainstem will herniate through the foramen magnum in attempt to get to the lower pressure sacrum
what ligament is most likely to tear in a whiplash injury *
anterior longitudinal
image of ligaments in spine *
number of spinal nerves in each section of the spine *
C - 8
T -12
L - 5
S - 5
C - 1
what would be affected if the nucleus pulposis of L4/5 herniated *
L4 spinal nerve would be saved because it would have already passed out of the spinal column
L5 would be compressed, and so would any nerves going to lower levels
joints of C1 and C2 *
joint between C1 and C2 - atlanto-axial joint
joint between C1 and skull- atlanto-occipital joint - allow you to nod ie flexion and extension (yes joint)
because horizontal joints odontoid peg - allow C1 to move around on C2 - no joint - atlanto-axial joint allow rotation ligament allow flexibility and strength
describe the nuchal ligament *
extends from the occipital proturbance to the C7 spinous process
continuous with the supraspinous ligament
clinically significant in utero - if it is enlarged it is a sigh that the child might have Down’s syndrome
important for stabalisation of verticle column
is the spinal cord uniform in size *
no, there are cervical and lumbar enlargements - for the limbs
image showing Jefferson fracture *
burst C1 fracture
describe the trapezius *
flat and triangular
origenates from the vertebral column
inserts into shoulder
function: raise the scapular, rotate the lateral aspect of the scapular upward (to lift arm above head)
describe the latimuss dorsi *
large flat triangular muscle
begins in the lower portion of the back and tapers as it ascends to a narrow tendon that attaches to the humerus anteriorly
function: adduction, extension and medial rotation of the upper limb. depress the shoulder preventing upward movement
describe the levator scapulae *
slender muscle
descends from the transverse process of upper cervical vertebrae to the upper position of the scapular on its medial border at the superior angle
function: elevates the scapular, assists other muscles in rotating lateral aspects of the scapular inferiorly
describe the rhomboid major and minor *
minor is superior to major
minor - small, cylindrical muscle that arises form the ligamentum nuchae of neck and spinous process of vertbrae CVII and TI. attaches to the medial scapular border
major - originates from the spinous process of upper thoracic vertebrae and attaches to medial scapular border, inferior to minor
work together to pull the scapular to the vertebral column
with other muscles they may rotate the lateral aspect of the scapula inferiorly
summarise the anatomy of intervertebral joints *
symphysis between vertebral bodies - formed by layer of hyaline cartilage on each body and disc
synovial joints between articular processes- zygopophysial joints between superior and inferior articular facets, a thin articular capsule attached to the margins of the facets encloses the joints
vertebrae has 6 joints with adjacent vertebrae - 4 synolvial, 2 symphysis (includes intervertebral disc)
