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Segmental structure
Organisation of the Body
| Question | Answer |
|---|---|
| Appendicular skeleton | Bones of the upper and lower limbs |
| Axial skeleton | Skull - cranium Vertebral column Ribs Sternum |
| Properties of vertebral column | Vertebrae + intervertebral discs + long and short ligaments Central, flexible structure Supported by muscles Contains the spinal cord Weightbearing axis Transmission of weight through the spine |
| Names of different vertebral regions | 7 cervical C1-C7 12 Thoracic T1-T12 5 lumbar L1-L5 5 fused sacral - Sacrum 3-5 fused coccygeal - Coccyx |
| Curvatures of vertebral column | Cervical lordosis - secondary curvature - 15-30 degrees Thoracic kyphosis - primary curvature - 30 degrees Lumbar lordosis - secondary curvature - 45 degrees Sacral kyphosis - primary curvature - 30 degrees |
| Development of curvatures | Primary curvatures develop in the fetus Lumber lordosis - 6 months+ Cervical lordosis - when baby can support own head |
| Changes in curvature in pregnancy | Excessive lumbar lordosis in late pregnancy Weakness of anterior abdominal wall muscles' Due to changes in centre of gravity |
| Excessive thoracic kyphosis | Age related Collapse of vertebral bodies (osteoporosis) Curvature >30 degrees IV disc disease |
| Scoliosis | Abnormal lateral curvature of the spine Thoracic spine leans to the side Lumbar scoliosis can also occur Can combine to form thoraco-lumbar scoliosis |
| Development of the spine - segmentation | Crucial developmental process Body divided into repeating segments arranged on a longitudinal axis Axial skeleton and muscles develop from somites - segmental axial structures of embryo Each somite forms a sclerotome (bones) and dermomyotome |
| Development of segmental structures | Resegmentation of the sclerotomes to form vertebrae Each splits into cranial and caudal segments Segmental spinal nerves grow to innervate the myotomes - cranial segment of sclerotome recombines with caudal segment of next sclerotome |
| Regulation of segmentation | Somites are regionally specified HOX genes pattern the body axis - investigated in flies (leg/antenna study) Shh gene expressed in the notochord induces somite cells to form sclerotome |
| Typical lumbar structure | Anterior - body of vertebrae Pedicle connects body to arch Neural arch - transverse process, lamina, spinous process Has two articular facets to articulate with other vertebrae |
| Intervertebral joints - symphysis joints | With superior and inferior vertebrae |
| Intervertebral disc | Annulus fibrosus ring of collage covered fibrocartilage Layers in different directions Strong annulus limits rotation between vertebrae Nucleus pulpsosus - glycosaminoglycans for shock absorption and weightbearing |
| Intervertebral joints - Zygapophysial joints | Plane synovial joints between superior and inferior articular processes Each joint has restricted range of movement Combination of all gliding and sliding movements gives a large range of movement - flexion, extension, lateral flexion, rotation etc |
| Vertebral column movements - Cervical | Articular facet joints lie on a loping, transverse plane Rotation, flexion/extension Small degree of lateral flexion is possible |
| Vertebral column movements - Thoracic | Articular facets lie on a coronal plane Rotation Limited flexion or extension due to presence of the limbs |
| Vertebral column movements - Lumbar | Articular facets aligned to a sagittal plane Flexion and extension Limited rotation |
| Movement at atlanto-occupital joint | Nodding |
| Movement at atlanto-axial joint | Extensive rotation |
| Long ligaments of the spine | Anterior longitudinal ligament Posterior longitudinal ligament Supraspinous ligament |
| Posterior Longitudinal ligament | Limits extension From base of the skull to the anterior surface of the sacrum Attached to intervertebral discs and vertebral bodies |
| Posterior Longitudinal ligament | Resist flexion Acts to restore head and spine to upright position Attached on posterior side of vertebrae |
| Supraspinous ligament | Ligamentum nuchae - between C7 and skull - strong abd thick triangle, base between occipital protuberance and foramen magnum, apex attached to spinous process of C7 Resists flexion and acts mechanically to restore the head to an upright position |
| Short ligaments of the spine | Ligamentum flavum Interspinous ligaments Intertransverse ligaments |
| Ligamentum flavum | Series of short ligaments Between lamina of the neural arches of vertebrae C2-S1 Resist flexion of vertebral column Elastic - helps to pull flexed vertebral column back into extension when flexor muscle relaxes |
| Interspinous ligaments | Between spinous processes Blending with supraspinous ligament |
| Intertransverse ligaments | Between transverse processes |
| Atlas C1 | No body - became dens of C2 Anterior arch - articular facet for dens - transverse ligament of atlas Transverse process with foramen transversarium Superior articular facets - large, articulate with occipital condyle Posterior tubercle -spinous process |
| Axis C2 | Body-large superior articular facets (articulate with inferior facets of atlas allowing rotation) No intervertebral disc between C1 and C2 Dens - reinforced by transverse ligament of atlas and 2 alar ligaments Transverse process Spinous process-bifid |
| Cervical vertebrae C3-C7 | Body smaller that thoracic/lumbar Transverse process- foramen transversarium for vertebral arteries except C7 Anterior and posterior tubercles Spinous process-bifid C7 - long spinous process easily palpable - vertebra prominens |
| Thoracic vertebrae | Body heart shaped Superior and inferior costal hemi-facets for articulation with tow pairs of ribs (except final 3) Transverse process - facet for articulation with tubercle on neck of rib at same level Spinous process - not bifid |
| Lumbar vertebrae | Body kidney shaped Transverse processes - long Superior and inferior articular facets orientated to reduce rotational movement Spinous process - square L5 may fuse with S1 - sacralisation - leads to lower back pain |
| Sacrum | 5 fused vertebrae Base articulate with L5 Apex points inferiorly- articulates with coccyx Pelvic surface - 8 anterior sacral foramina Posterior surface -8 posterior SF Median sacral crest Ala or wing of sacrum articulates with ilium-sacroiliac joint |
| Coccyx | 3-5 fused rudimentary vertebrae Apex articulates with sacrum Base Transverse process Coccygeal horns - cornua |
| Contents of the vertebral spinal cord | Pia mater (internal) Subarachnoid space (contains CSF) Arachnoid mater (middle) Subdural space Dura mater (outer) Epidural space |
| Spinal nerves and Vertebral canal | C1 nerve emerges between skull and C1 C2-C7 nerves emerge above vertebral pedicles C8 nerve below pedicle of C7 T1- Co emerge below pedicles of respective vertebrae Spinal cord ends at L1/L2 - safe access below this |
| Termination of the spinal cord | Spinal cord ends at L1/L2 disc as conus medularis Cauda equine (spinal nerves L2-coccygeal) in the Cerebrospinal fluid filled lumbar cistern Dura mater tapers off at S2 |
| Supracristal plane | Jacobys/Tuffiers line Intersects the L4 vertebrae L4/5 in most individuals Where spine can be safely accessed |
| Lumbar puncture | Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentus flavum Epidural space Dura matter Subdural space Arachnoid mater Sub-arachnoid space - CSF collected |
| Epidural injection | Skin Subcutaneous tissue Supraspinous ligament Interspinous ligament Ligamentus flavum Epidural space |
| Intervertebral disc herniation | Spinal nerve compression With age nucleus pulposus moves posteriorly in the disc Most common in lumbar region-posterolateral herniation Impacts spinal nerves of interventricular foramen below L4/L5 herniation - L5 nerve L5/S1 herniation - S1 nerve |
| Sciatica | Pain and paresthesias caused by irritation or compression of sciatic nerve (L4-S3) Irradiation from the lower back to the posterior part of the thigh, the leg and foot Most common cause- herniated or bulging disk and lumbar/sacral nerve root compression |
| Determination of spinal level | Cervical region - C7 vertebra prominens easily palpable Thoracic region - T12 spinous process is smaller than L1. Can also feel 12th rib Lumbar region - Sacrum between posterior borders of iliac bones, palpate in cranial direction to find L5 |
| Imaging of spine | Cannot easily see C1 as it has no body The first visible vertebrae is therefore C2 White - CSF Vertebrae get smaller inferiorly Can visualise where lumbar puncture can be performed - no spinal cord |
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