Vertebral Column

Question 1

What forms the intervertebral foramen? What passes through this?

Answer 1

-Superior & inferior vertebral notches of adjacent vertebrae & intervertebral disc which the spinal nerve passes through

Question 2

What are the variations of cervical vertebrae?

Answer 2

• Body small with elevated uncus laterally
• Transverse process & pedicle
• Transverse foramina
• Spinous process is bifid
• Articular facets superior direction superoposteriorly and inferior direction infer-anteriorly

Question 3

What passes through the transverse foramen?

Answer 3

-Vertebral artery and vein to/from the brain, DO NOT pass through C7

Question 4

Describe the different severities of a dislocated cervical vertebrae?

Answer 4

(A) flexion sprain
(B) 25% subluxation
(C) 50% subluxation
(D) Complete dislocation 'facet jumping'
Vertebral foramen relatively wide so subluxation may not compress spinal cord

Question 5

Which spinal vertebrae are prone to dislocation?

Answer 5

Cervical as relatively flat articular facets

Question 6

Describe the Atlas

Answer 6

• C1
• No spinous process or body
• Anterior & posterior arches each with a tubercle and lateral mass
• Medial surface of lateral mass has a tubercle for the transverse ligament which holds in place the dens of the axis

Question 7

Describe the Axis

Answer 7

• C2
• 2 large flat surfaces (Superior articular facets which the atlas rotates)
• Dens or Odontoid process
• Held in position by transverse ligament of Atlas prevents horizontal displacement of Atlas

Question 8

Describe a fracture of the Dens

Answer 8

• Less dense so prone to fracture
• Caused by hyperextension or hyperflexion
• Spinal cord not usually affected
• 30-50% result in non-union
• Atlantoaxial arthrodesis using bone graft from iliac crest

Question 9

Describe the features of the thoracic vertebrae

Answer 9

• Heart shaped body with superior & inferior costal demi-facets for articulation with head of rib
• Long poster-inferiorly extending spinous process
• Transverse process- costal facet for articulation with tubercle of rib
• Articular facets

Question 10

What does the head of the rib articulate with?

Answer 10

superior & inferior costal demi-facets

Question 11

What does the tubercle of the rib articulate with?

Answer 11

Transverse process

Question 12

Which rib articulates with the superior demi-facet?

Answer 12

Head of the rib with the same number as the vertbrae

Question 13

Describe the features of the lumbar vertebrae

Answer 13

• Large body

- spinous process short & sturdy

Question 14

Describe the features of the Sacral vertebrae and coccyx

Answer 14

• Sacral promontory at S1
• Anterior & posterior sacral foramen
• Apex below S5
• Sacral hiatus on posterior
• Sacral canal
• Sacral & coccygeal cornua on posterior
• Superior articular facet posterior of S1

Question 15

How are the vertebrae held together?

Answer 15

• Zygapophysial joints between superior & inferior articular processes
• Intervertebral discs
• Ligaments

Question 16

What does the orientation of articular facets determine?

Answer 16

Types of movement possible

Question 17

Describe the structure of intervertebral discs

Answer 17

-Annulus fibrosis= outermost, fibrocartilage ring attached to epiphyseal rim of vertebral body
-Nucleus pulposus= centre, gelatinous substance that acts as a shock absorber
Thickness determines flexability

Question 18

Name the ligaments of the vertebral column and what they do

Answer 18

• Ligamentum flavum- binds lamina of adjacent vertebrae (behind pedicle)
• Posterior longitudinal ligament=C2-Sacrum, prevents posterior herniation of IV discs
• Anterior longitudinal ligament= Occipital bone & C1-sacrum
• Intertransverse ligament=between transverse processes
• Interspinous ligament= between spinous processes
• Supraspinous ligament=tips of spinous process C7-sacrum

Question 19

Which ligament resists hyperflexion which resist hyperextension

Answer 19

Anterior longitudinal ligament only one to resist hyperextension all others resist hyperflexion

Question 20

Describe what happens in whiplash

Answer 20

• Hyperextension of cervical neck
• Anterior longitudinal ligament torn
• Severe cases part of vertebral body avulsed & vertebrae dislocated- compression of spinal cord

Question 21

What are the curvatures of the spine and where are they?

Answer 21

• Thoracic & sacral kyphosis (primary)
• Cervical & lumbar lordosis (secondary)
• Primary curvature present in foetus

Question 22

What are the effects of ageing on vertebral bones?

Answer 22

• Osteoporosis= loss of trabeculae=compression fracture
• Loss of bone density=concave vertebral bodies
• Osteophyte development=increase force on rims of vertebrae

Question 23

What are the effects of ageing on intervertebral discs?

Answer 23

• Slipped disc/ herniation of nucleus pulposus
• Posterolateral direction between L4/L5 or L5/S1
• Can compress spinal nerve roots= lower back pain or sciatica
• Severe cases compresses most of cauda equina (cauda equina syndrome)

Question 24

Where does the caudal equina descend? What is this?

Answer 24

• Lumbar Cistern

- Subarachnoid space between termination of cord & termination of dura/arachnoid matter

Question 25

Where does the lumbar cistern extend from?

Answer 25

Conus Medullaris L1/L2-S2