Anatomy of Cervical, Thoracal, Lumbar, Sacral Vertebrae.pptx

Anatomy of Cervical, Thoracal, Lumbar, Sacral Vertebrae.pptx

1. Anatomy of CERVICAL, THORACIC, LUMBAR, SACRAL & COCCYGEAL Nia Tri Mulyani

2. LANDMARK Cervical Region Anterior C2: Transverse process palpated at the angle of the mandible C3: Hyoid bone C4, C5: Thyroid cartilage C6: First cricoid ring, carotid tubercle Posterior C2: First palpable midline spinous process (two finger-breadths below the occiput). C7: Vertebral prominens (largest spinous process; nonbifid ). Articular pillars: Lateral off the spinous process bilaterally. Thoracic Region T3: Spine of the scapula T8: Inferior angle of the scapula T12: Lowest rib Lumbar Region L4: Iliac crests S2: Posterior superior iliac spine (PSIS)

3. = vertebral canal

4. Lynn & lypert

5. Anatomy of CERVICAL VERTEBRAE

6. FUNCTIONAL ANATOMY

7. Cervical Vertebrae Atypical: C1 and C2 C1 Vertebra (Atlas) (Figure 4–138) Ring-shaped bone containing two lateral masses. No vertebral body or spinous process. FIGURE 4–138 The atlas superior view. C2 Vertebra (Axis) (Figure 4–139) Its vertebral body has an odontoid process=dens Bifid spinous process (C2 to C6 vertebrae have bifid spinous processes) FIGURE 4–139 The axis superior view.

8. Typical: C3 to C7 Vertebrae Anterior region Presence of vertebral bodies. Cervical uncinate processes: Raised margins along the lateral aspect of the superior surface of a cervical vertebral body. As cervical discs degenerate, these raised margins approximate with the body of the superior vertebra. The end result is the degenerative joint change called the joint of Luschka (uncovertebral joint). The joints of Luschka function to limit lateral translation (Figure 4–141) Posterior region Pedicles, superior articular processes (SAP), inferior articular processes (IAP), laminae, transverse processes (TP), foramen transversarium, and spinous processes. C3, C4, C5, C6: Bifid spinous processes C7: Nonbifid spinous process

9. Anatomy of THORACIC VERTEBRAE Nia Tri Mulyani

10. T1–T12 Anterior region Vertebral bodies with articulations for the rib heads. Posterior region Pedicles, SAP, IAP, laminae, transverse processes with articulations for rib tubercles and spinous processes.

11. Anatomy of LUMBAR VERTEBRAE Nia Tri Mulyani

12. Lumbar Vertebrae L1–L5 Anterior region Presence of vertebral bodies. Posterior region Pedicles, SAP, IAP, transverse processes, mammillary processes, laminae, and spinous processes.

13. Transitional Lumbosacral (LS) Anatomy Sacralization of L5 Anomalous partial or complete fusion of the L5 vertebra to the sacrum  assimilation of L5 to sacrum Incidence: Approximately 1% complete, approximately 6% incomplete. Lumbarization of S1 Refers to an anomalous partial or complete nonunion of the first segment of the sacrum  assimilation of S1 to lumbar spine This forms an additional lumbar segment (“L6” vertebra) and leaves four remaining fused sacral segments. – Incidence approximately 4% (Lumbosacral Transitional Vertebrae = LSTV  Congenital anomaly in the LS vertebral anatomy that occurs in approximately 4% to 8% of the general population)  Castellvi classification

14. zygapophyseal

15. Anatomy of SACRAL VERTEBRAE Nia Tri Mulyani

16. Sacral Vertebrae S1–S5 A triangular-shaped bone consisting of five fused vertebrae (S1–S5). Four pairs of foramina (anterior and posterior), sacral promontory, sacral ala, hiatus, cornua , medial, intermediate, and lateral crests, which are analogous to the spinous processes. Sacral Ligaments (Figure 4–146) FIGURE 4–145 The sacrum and coccyx. (A) Dorsal surface. (B) Pelvic surface

17. Anatomy of COCCYGEAL VERTEBRAE Nia Tri Mulyani

18. Coccygeal Vertebrae –Three to four fused segments, with transverse processes, hiatus, and cornua FIGURE 4–145 The sacrum and coccyx. (A) Dorsal surface. (B) Pelvic surface

19. FACET JOINT

20. Facet Joints Also known as zygapophyseal (ZP or Z) joints, apophyseal joints Superior articular process (SAP) Inferior articular process (IAP) Joint capsule Articular cartilage Meniscus Facet Joint Orientation Cervical : AA and OA joints have no true facet joints due to their atypical anatomy. C3–C7 facets are positioned in the frontal (coronal) plane. Thoracic facets are also positioned in the frontal plane. Lumbar facets begin in the sagittal plane and progress to the frontal plane at L5–S1

21. Facet Innervation Each facet joint has dual innervations from the medial branches of the dorsal primary ramus off that spinal nerve. Facet joints in the cervical spine contain innervations from that level and the level below. Example: C5–C6 facet is innervated by C5 and C6 medial branches. Facets in the thoracic and lumbar spines contain innervations from that level and the above level. Example: L4–L5 facet is innervated by the L4 and L3 medial branches Facet Function Limit vertebral motion. Resist shearing and rotational forces. Weight bearing: Increased with extension and with decreased disc heights

22. THE INTERVERTEBRAL DISC

23. Characteristics THE INTERVERTEBRAL DISC Nucleus pulposus A viscous mucoprotein gel mixture of water and proteoglycans in a network of Type II collagen that braces the annulus to prevent buckling. Annulus fibrosus Type I collagen fibers arranged in obliquely running lamellae that encase the nucleus pulposus and are attached to the vertebral endplate plates. This orientation withstands distraction and bending but is relatively weaker for torsional stresses Vertebral endplate Cartilaginous covering of the vertebral body apophysis, forming the top and bottom of the disc.

24. Function Allows for vertebral body motion. Weight bearing (Figure 4–149).

25. Innervation The outer 1/3 of the intervertebral disc that contains the annulus fibrosis receives dual innervations from ventral rami. The nucleus pulposus lacks any innervations. The anterolateral part of the annulus fibrosis is innervated by ventral rami and gray rami communicans. The posterior part of the annulus fibrosis is innervated by sinuvertebral nerves (recurrent branches off of the ventral rami). Vascularization Vascular Supply  Essentially avascular by adulthood

26. FIGURE 4–150 The lumbar spine innervations. Cross-sectional view, which incorporates the level of the vertebral body (VB) and the periosteum (P) on the right and the intervertebral disc (IVD) on the left. The following abbreviations are used in the above diagram: (PM) psoas muscle, (QL) quadratus lumborum, (IL) iliocostal lumborum, (LT) longissimus thoracis, (M) multifidus, ( altlf ) anterior layer of thoracolumbar fascia, ( pltlf ) posterior layer of thoracolumbar fascia, ( esa ) erector spinal aponeurosis, (ds) dural sac, ( zj ) zygapophyseal joint, ( pll ) posterior longitudinal ligament, (all) anterior longitudinal ligaments, ( vr ) ventral ramus, ( dr ) dorsal ramus, (m) medial branch, intermediate branch, (l) lateral branch, ( svn ) sinuvertebral nerve, ( grc ) gray ramus communicans, ( st ) sympathetic trunk

27. LIGAMEN

28. Spinal Ligaments Anterior longitudinal ligament (ALL) Runs the entire length of the anterior spine, covering the anterior aspect of each vertebral body and disc. Function: Limits hyperextension and forward movement. Posterior longitudinal ligament (PLL) Attaches to the posterior rim of the vertebral bodies and disc from C2 to the sacrum. It continues superiorly with the tectorial membrane to the occiput. Function: Prevents hyperflexion of the vertebral column. Ligamentum flavum (LF) Connects adjacent vertebral arches longitudinally, attaching laminae to laminae. Function: Maintains constant disc tension and assists in straightening the column after flexion. Interspinous ligament and supraspinous ligaments (ISL, SSL) Run from spinous process to spinous process. The supraspinous ligament runs from C7–L3. – Function: Weakly resist both spinal separation and flexion. Ligamentum nuchae (LN) Superior continuation of the supraspinous ligament extending from the occipital protuberance to C7. Function: Boundary of the deep muscle in the cervical region. Intertransverse ligament (IL) Connects transverse process to transverse process. Function: Resists lateral bending of the trunk

29. BACK MUSCULATURE Extrinsic Back Muscles Superficial layer : Trapezius Latissimus dorsi Intermediate layer : Serratus posterior superior and inferior Intrinsic Back Muscles Superficial layer : Splenius capitis and cervices Intermediate layer : Erector spinae Iliocostalis: Lumborum, thoracis, cervices Longissimus: Thoracis, cervicis, capitis Spinalis: Thoracis, cervicis, capitis Deep layer Transversospinal muscles Semispinalis: Thoracis, cervicis, capitis Multifidus Rotators – Interspinalis , intertransversarii muscle