Gross Anatomy Lecture 2: Vertebral Column I. II. Introduction Vertebral Column as a whole A. Functions 1.

Weight bearing upper body weight transferred to pelvis and ultimately to the lower limbs through vertebral column, with majority o weight on vertebral bodies 2. Movement small amt occurs between each of 24 vertebrae, primarily at intervertebral disk and facet joints a. Result in significant range of motion of trunk and neck 3. Protection B. Movements 1. Flexion/extension: occurs in mid-sagittal plane a. Flexion is forward bending, extension is backward movement b. Flexion greatest in cervical region followed by lumbar c. Extension greatest in lumbar region 2. Rotation: a. Freest in cervical and thoracic regions b. Minimal in lumbar region 3. Lateral flexion side to side bending a. Greatest in cervical and lumbar regions C. Regions and curvatures 1. Primary curvature (concave anteriorly) thoracic and sacral curves 2. Secondary curvature cervical and lumbar curve 3. Abnormal curves a. Kyphosis hunchback increase in thoracic curve b. Scoliosis lateral deviation in spine c. Lordosis increase in lumbar curvature, pregnancy Individual vertebra A. Typical vertebra B. Cervical vertebra 1. Transverse foramen in transverse process through which vertebral artery and vein go through 2. C-1 atlas only vertebra without a body or spinous process a. Articulates with base of skull and allows flexion /extension 3. C-2 axis bony projection, the dens, which extends vertically up from body to articulate with atlas a. C1-C2 joint allows for rotating head side to side C. Thoracic vertebra 1. Costal facets for articulation with ribs 2. Appear on bodies and on transverse processes of thoracic vertebrate 3. Long, slender, overlapping spinous processes D. Lumbar vertebrae 1. Massive bodies, non-overlapping spinous processes, absence of costal facets E. Sacrum 5 vertebrae that fused during development 1. Spinous processes = dorsal sacral crest

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2. Sacral canal ends inferiorly at sacral hiatus a. Anesthesia can be injected for caudal epidural block 3. No intervertebral disks 4. Ventral primary rami of sacral spinal nerves exit sacral canal through pelvic sacral foramina 5. Dorsal rami exist via dorsal sacral foramina Connections between vertebrae A. Intervertebral discs 1. 23 IV discs positioned between adjacent vertebrate a. 6 in cervical, 12 in thoracic, and 5 in lumbar 2. Function to bear weight, absorb forces of body weight and allow for small amount of movement 3. 2 parts a. Annulus fibrosus: formed by concentric layers of fibrocartilage and collagen fibers i. Tough, dense structure that forms the periphery of a disk and serve to contain the nucleus pulposus ii. Avascular and only its most peripheral layers innervated with pain fivers iii. More brittle with age, more prone to fissures and degradation b. Nucleus pulposus: central core of the IV disc is an avascular, soft, pulpy cartilaginous mass with high water content i. Distends during movements of vertebral column ii. Main contributor to weight bearing and sock absorbing roles of discs iii. Water content reduced with age (minimizes shock absorbing function of the discs and making people shorter) B. Facet or zygapophyseal joints 1. Synovial joints between inferior articular process of one vertebra and superior articular process of next lower vertebra a. Movements allowed at joints determined by orientation of joint surfaces C. Ligaments interconnected by series of 5 ligaments 1. Anterior longitudinal ligament attached to anterior surface of vertebral bodies and is outside vertebral canal a. Limits extension 2. Posterior longitudinal ligament attached to posterior side of vertebral bodies and is within vertebral canals, attached to posterior margins of IV discs a. Limits flexion 3. Ligamentum Flavum segmental ligament that spans adjacent laminae a. Paired at each level b. Yellowish because it contains elastic fibers c. Limit flexion 4. Supraspinous ligament long narrow ligament that spans from skull to sacrum and attaches to tips of each of the spinous processes a. Limits flexion

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5. Interspinous ligament series of segmental ligaments between each of spinous processes; connects with supraspinous ligament a. Limits flexion Meninges 3 CT layers that enclose spinal cord A. Dura mater- tough, fibrous, tubular sheath 1. Continuous with dura mater surrounded brain and it extends inferiorly to level of S2 where if forms a cul-de sac a. Located within vertebral canal 2. Separated from vertebrae by epidural space that is filled with epidural fat and plexus of vertebral veins B. Arachnoid mater thin, delicate transparent membrane that lies immediately deep to dura mater 1. Extends inferiorly to the s-2 level 2. Encloses subarachnoid space which contains CSF 3. Subarachnoid space and CSF, along with dura extend laterally as a sleeve over distal parts of each of the nerve roots and DRGs that form a spinal nerve in intervertebral foramina a. Elevations in CSF pressure can stimulate sensory neurons within DRGs and cause radiating pain C. Pia mater innermost covering of SC 1. Delicate webbing or meshwork between pia and arachnoid 2. Pia mater at the tip of conus medularis continues inferiorly y as filum terminale single thread of tissue that anchors to the coccyx and provides minor stability to the spinal cord Innervation of dura, facet joints, IV disc and vertebral ligaments A. Recurrent meningeal nerve innervate dura, annulus of IV disc, and ligaments within vertebral canal 1. Convey somatosensory pain fibers from structures and involved in back pain Clinical correlations A. Anatomy of herniated disc 1. Iv discs herniate posterolaterally due to weak area between anterior and posterior longitudinal ligaments a. Occurs most frequently in lumbar, then cervical and rarely in thoracic 2. Posterolateral herniation cause pain by compressing exiting spinal nerve, its DRG and dura mater surrounding these structures and meningeal recurrent nerves 3. Also herniated posteriorly toward spinal cord, causing pain by stimulating dura and compressing SC B. Spinal stenosis narrowing of vertebral canal 1. Pressure on SC (Cervical or thoracic regions) or nerve roots of the cauda equina (lumbar) a. Caused by congenital problems or by disc herniation, thickening of ligaments (Ligamentum Flavum), bony growths, arthritis of facet joints, trauma and certain metabolic diseases 2. Symptoms vary depending on area of spine affected (C and L most common) C. Epidural block

1. Injection of pain medication into epidural space for anesthetizing selected spinal nerves a. Diffuse through epidural fat and out intervertebral foramina to bathe spinal nerve and its rami 2. Technique: inserting Tuohy needle in midline between adjacent spinous processes a. Needle traverses supraspinous, Interspinous and then Ligamentum Flavum i. Once needle pierces through Ligamentum Flavum it is in epidural space D. Spondylolysthesis displacement of vertebral column relative to vertebra below the displacement 1. Common in Lumbar region (btwn L4 and L5, btwn L5 and sacrum) 2. Displacement leads to impingement or compression of the roots of cauda equina within vertebral canal, causing generalized pain in lower back with intermittent bouts of shooting pain down back of thigh and leg a. Mimic disc herniation 3. Caused by defect in area of the bone between superior and inferior articular processes of a vertebra a. Stress fracture, degenerative changes, development E. Using dermatome maps to make a diagnosis 1. Dermatome maps and patients pain locations sued to determine site of nerve lesions