BACK VIVAS

(Demonstrate the bony features of the Atlas and Axis.Ant and post arch of C1Odontoid process, aka peg or densBody, lamina, spinous process C2Describe the movements of the head on the neck.Rotation occurs at level C1 on C2:Via the synovial atlantoaxial joints, 2 lateral 1 medianLateral atlantoaxial joints: gliding of inferior facets of lateral masses of C1 and superior facets of C2Median atlantoaxial joint: pivoting of anterior arch of C1 and dens of C2 Flexion and extension (nodding) as well as some lateral flexion and rotation occur at the atlanto-occipital joints superior facets of lateral masses of C1 with the occipital condylesWhat are the components of the soft tissue shadow located anterior to the upper cervical vertebrae 2007-2Anterior longitudinal ligamentLongus colli musclePrevertebral fasciaRetropharyngeal spaceAlar fasciaBuccopharyngeal fasciaPharyngeal muscle)2011-2, 2007-2

XR: Lateral Cx-spine

2010-1, 2005-1

Cervical Spine XR

Identify the major bony features of the cervical spine on this xray

Atlas: Anterior and posterior arches

Axis: Dens, spinous process

C3-7: Body, pedicle, lamina, superior and inferior articular process, spinous process

Zygapophysial(facet) joint

Intervertebral disc space

Describe the ligaments which maintain alignment of the cervical spine 2010-1&2

Anterior Longitudinal ligament -> Anterior atlantoaxial and atlanto-occipital membrane

Posterior longitudinal ligament -> Tectorial membrane

Ligamentum flavum (between lamina) -> Posterior atlantoaxial and atlanto-occipital membrane

Interspinous ligaments

Supraspinous (tips of spinous processes) to C7, then -> nuchal ligament

Intertransverse ligament

Transverse ligament of the atlas

Cruciate ligament

Alar ligament

Extra: The 5 lines of stability

1. Prevertebral (anterior) soft tissue

2. Anterior vertebral bodies

3. Posterior vertebral bodies

4. Spino-lamina line

5. Tips of spinous processes

One line of disruption indicates a stable fracture

Two or more lines of disruption indicate an unstable fracture2010-2, 2006-1

PEG XR aka Oral atlanto axial view

Demonstrate the bony features of the upper cervical vertebrae on this x-ray?

Lateral mass of Atlas (C1), Body of Axis (C2), Dens of Axis (C2), Lateral atlanto-axial joints, Spinous process of Axis (C2), Mandible w/ rami, Occiput w/ occiptal condyles, atlanto-occiptal joint

2011-2, 2007-2, C2 only: 2009-2, 2003-2

Bone: C1-C2

Name these bones. Demonstrate their features and describe the structures stabilising the atlantoaxial joint.

(Stabilising structures:Anterior arch of AtlasTransverse ligament, part of theCruciate ligament, including superior and inferior longitudinal bandsAnterior longitudinal ligament -> Anterior atlantoaxial membrane -> Anterior atlantoccipital membrane Posterior longitudinal ligament -> Tectorial membrane Alar ligaments (check rotation)Capsule of lateral atlanto-axial joints)

Bone: C2

What are the major ligaments attaching to this bone and where do they attach? 2009-2

Tectorial membrane (PLL): post. part of body in canal via foramen magnum to cranial cavity

Anterior atlanto-axial membrane (ALL): Anterior body to anterior arch of atlas

Posterior atlanto-axial membrane (LF): Laminae to posterior arch of atlas

Alar: Sides of dens to lateral margins of the foramen magnum

Cruciate - inferior longitudinal part: from post. body of C2 -> transverse ligament between tubercles of lateral masses of C1, and superior longitunal part to anterior rim of foramen magnum

2004-2

Bone: mid cervical

Identify the major parts of this bone

1. Body (smaller than triangular vertebral foramen)

2. Transverse Process with foramen transversarum (vertebral artery and veins except C7 veins only)

3. Lamina (w/ pedicles form the vertebral arch) note pars interarticularis

4. Spinous Process often bifid

5. Superior and Inferior Articular Processes

Describe the joint between adjacent cervical vertebrae

1. Intervertebral Joint

Symphyses (i.e. secondary cartilaginous joints)

Anulus fibrosus (inserted into epiphysial rims) and nucleus pulposus

2. Zygapophyseal aka facet joints

Plane synovial joints

Between adjacent superior and inferior articular surfaces

Surrounded by joint capsule that is loose in the cervical region

What movements occur at the facet joints?

POINTS REQUIRED

1. Upper facets face obliquely up and back

2. Lower facets face down and forwards

3. Flexion/Extension, lateral flexion (abduction)

4. No rotation

2011-2, 2011-1, 2009-1, 2007-1, 2003-2

Bone: Thoracic Vertebra

(Identify this bone, and demonstrate its bony features.BodyPedicleTransverse processesArticular facets: Superior and inferior Costal facets: Superior/Inferior costal facets (head of rib), Transverse costal facet (tubercle of rib)Spinous processLamina Vertebral foramenIntervertebral notch (space for intervertebral foramina))

What movements are possible at thoracic vertebrae?

Rotation: the facets joint planes are aligned vertically on arc centred on vertebral bodies

Some lateral flexion, very limited flexion + extension stability is conferred though connections to sternum

Demonstrate the ligaments.

Anterior longitudinal

Posterior longitudinal

Interspinous

Supraspinous

Ligamentum flavum

(How does this differ from vertebrae in other regions 2009-1Cervical: smaller body, larger canal, very small and often bifid spinous process, canal for vertebral artery, facet joints flatter, no ribs.Lumbar: larger body, smaller canal, spinous process square and more directly posterior, no articulations for ribs, more prominent transverse processes.)Intertransverse

What changes occur from upper to lower thoracic vertebrae. 2003-2

Body: heart to kidney shape

Spinous process: from long vertical to short horizontal

Facets on transverse process: concave to flat, A-P to lat-med directed

Costal facets on body: from demi to single on 10,11,12

Spinal canal: from round to triangular

2011-1, 2009-1, 2007-1, 2005-2, 2003-2, LP only: 2009-2, 2006-1, 2003-1

Bone: Lumbar Vertebra

(Identify this bone, and demonstrate its bony features.BodyPedicle (to upper half)Transverse processes Superior and inferior articular facetsSpinous process Lamina Vertebral foramen Intervertebral foraminaAlso: Groove for medial branch of post ramus spinal nerve with mamillary process above, and accessory tubercle below)

What movements occur in the lumbar spine?

Flexion + extension (sagitally orientated facet joint planes)

Lateral flexion

Very limited rotation

What structures are traversed when you perform a lumbar puncture?

(Sterilized skinSubcutaneous fatSupraspinous ligamentInterspinous ligamentLigamentum flavum (pop)Epidural space w/ Extradural fat and venous plexusDura materArachnoid materCSF in subarachnoid spaceWhat level would you LP an adult and why?Supracristal plane (highest point of iliac crest) ~L4Between L3/4 or L4/5The cord ends behind L2 in adults (conus medullaris), but L4/5 at birthIn vertebral cistern = filum terminale, less likely to be damaged than cord b/c mobile in this space)

What factors are responsible for stability between adjacent lumbar vertebrae? 2007-1, 2003-2

1. Bony: Large body with intevertbral joint/discs (not really bony), orientation of facets

2. Ligamentous: Anterior longitudinal, posterior longitudinal supraspinous, interspinous, intertransverse, ligamentum flavum

3. Muscular: thick mass of muscle both anterior and posterior (erector spinae)

2005-2

Which area is this vertebra from and why?

Lumbar vertebra

No costal facets

No foramen transversarium

Triangular vertebral foramen

Articular facets lie in AP plane

Kidney shaped body

Large Mamillary bodies

Extra: The Scotty Dog on posterolateral oblique view note the pars interacrticularis = neck

2010-2

BONE: Sacrum

Identify the features of this bone?

Sacrum consists of 5 fused bones and the coccyx

4 pairs of sacral foramina S1-S4 anterior larger than posterior

Ala

Sacroiliac joint

Superior Articular facets

Lumbrosacral joint

5 Vertical lines median, intermediate and lateral