Clinical Anatomy of Thorax

1. VERTEBRAL
COLUMN

2. Contents:
1. General characteristics
of vertebral column
2. Structure of a typical
and atypical vertebrae
3. Regional peculiarities
of vertebrae
4. Joints and ligaments of vertebral column, intervertebral disks and
clinical problems 5. Sacrum and coccyx
6. Age related changes of vertebrae
8. Radiologic anatomy of VC
9. Spine canal and its contents
10. Clinical procedures on VC
7. Spine pathology: spondylosis,
spondylolysis, spondylolisthesis

3. Vertebral
Column
7 cervical
12 thoracic
5 lumbar
5 sacral (fusedto form the
sacrum), and 4 coccygeal (the
lower 3 are commonly fused)
33 vertebrae:

4. Curvatures of
Vertebral Column

5. Abnormal Curvatures of VC
• structural scoliosis
• myopathic scoliosis
• functional scoliosis
• habit scoliosis
ScoliosisExcessive lumbar lordosis
“hollow back” or “sway back”
Excessive thoracic kyphosis
“humpback” or “hunchback”

6. Structure Of a Typical Vertebra
Body
Pedicles
Laminae
Spinous
process
Transverse
processes
Articular
processes
Transverse
process
Notches
Vertebral
foramen
Vertebral
canal
Intervertebral
foramina

7. Joints of Vertebral Bodies
Luschka's joints, b/w C3-C7

8. Herniation or Protrusion
of IV Disks
Disc degeneration Prolapse
Extrusion Sequestration
Posterior
longitudinal
ligament

9. Joints of Vertebral Arches
Zygapophysial joints
1. Ligamentum flavum
3. Interspinous ligaments
4. Supraspinous ligaments
2. Nuchal ligament
5. Intertransverse ligaments
2
5
1
4
3

10. Term Describing Pathology of Vertebral Column
Spondylosis Spondylolysis Spondylolisthesis
Spondylo = spine/vertebrae
- osis = pathologic condition
- lysis = break
- listhesis = slippage

11. Regional Characteristics of Vertebrae
1. Shape and size of the body
2. Shape and size of the
vertebral canal
3. Orientation of the articular
processes
4. Features of the spinous and
transverse processes
Cervical Thoracic Lumbar

12. Typical Cervical Vertebrae
The vertebral foramen
is large and triangular.
The body is small and
broad from side to side.
The spines are small and bifid
The transverse
foramina in
transverse process
(foramen
transversarium)
The superior articular
processes face
posterosuperiorly;
the inferior processes
face inferoanteriorly.
• Flexion,
• Extension,
• Lateral flexion,
• Rotation,
• Circumduction.
Movements:
Grooves for
spinal nerves
Anterior and
posterior
tubercle
Uncus

13. Radiologic Anatomy of Cervical Region
Midsagittal MRI of lower head and neck.
T1 T2

14. Traumas of Cervical Vertebrae
Crush/compression fracture of vertebral body
(hyperflexion injury)
Hyperextension injury (“whiplash” injury)

15. Atypical Cervical Vertebrae
The seventh cervical vertebra may possess a
cervical rib.
Vertebra prominens
features
◦ ithe longest non-bifid
spinous process;
◦ small foramen
transversarium transmits
the vertebral vein only.

16. Atypical Cervical Vertebrae
It hasn’t:
◦ No body
◦ No spinous process
It has:
1. anterior arch
2. posterior arch
3. lateral masses
4. groove for the
vertebral artery
Has a peglike
odontoid
process (dens)
that projects from
the superior
surface of the
body (representing
the body of the
atlas that has
fused with the
body of the axis).
Atlas Axis

17. Craniovertebral Joints
Articulations:
1) atlanto-occipital joint (superior
articular facet)
2) Atlantoaxial
articulation:
• lateral atlantoaxial
joints (two) +
• median atlanto-
axial joint (one)
1. Anterior and 2. Posterior atlanto-occipital membrane; 3. Membrana tectoria.
1
2
3
Transverse
ligament
Longitudinal
bands
Alar
ligaments
Tectorial
membrane
Cruciate ligament= transverse ligament+
longitudinal bands
Supportive Apparatus:
Supportive Apparatus:

18. Fractures of Axis
Rupture of Transverse or
alar Ligaments of Atlas
Fractures of the vertebral arch
(traumatic spondylolysis of C2, hangman’s fracture)
Type 3 = best prognosis for healing
Fractures of Dens
(Anderson and D’Alonzo Classification)
Atlanto-axial subluxation

19. Fractures of Atlas
Jefferson or Burst fracture
Characterized by fractures
in both the anterior and
posterior arches.
Stable: transverse ligament
is intact
Unstable: transverse
ligament is ruptured
Mechanism:

20. Typical Thoracic Vertebrae
Body: is medium size, heart
shaped; has 1-2 costal facets.
Vertebral
foramen: is small
and circular
Spinous processes: long and
inclined downward overlying
vertebral body below
Articular processes: superior -
face posterior and slightly
laterally; inferior - anteriorly
and slightly medially.
Transverse
processes:
strong, facets
for articulation
with costal
tubercle.
Posterior viewSuperior view
Neural arch
Lamina
Pedicle
Transverse
process
Spinous
process
Superior
articular
process
Transverse
processes facet
supports rib
tubercle
Demifacets
Vertebral features
which support the ribs

21. Typical Lumbar Vertebra
The body is large
and kidney shaped.
The vertebral
foramina are
triangular.
The transverse processes
are long and slender.
The spinous
processes are short,
flat, and quadrangular
and project posteriorly.
The SAP faces
posterior and medially,
and the IAP faces
anterior and laterally.
Accessory process
(intertransversarii mm)
Mammillary processes
(multifidus and
intertransversarii mm.)

22. Radiologic Anatomy of Thoracic and Lumber Region

23. Radiology of Lumbar Region
The lumbosacral angle varies from 130° to 160°.

24. Laminectomy
Approach to vertebral canal DE compressive laminectomy

25. Sacrum
Base
Apex
Sacral canal
Dorsal
sacral
foramina
Median
sacral
crest
Intermediate
sacral crests
Lateral
sacral crests
Sacral
hiatus
Sacral
cornua
Auricular
surface
Anterior
sacral
foramina
Sacral
promontory
Dorsal surface Pelvic surface

26. Caudal
Epidural
Anesthesia

27. Sagittal CT view of Sacrum
◦ (A) The sacral promontory,
◦ (B)the dominant concave
curvature of the sacrum,
◦ (C) forward curvature of
the coccyx,
◦ (D-right CT image) the
superior articular processes
of the first sacral segment,
and the sacral canal,
◦ (yellow arrows) the
vertebral canal of the spine

28. Coccyx
Anococcy-
geal lig.
Supraspinous lig.
Anterior longitudinal lig.
Co1
cornua
Injury of Coccyx

29. Surface Anatomy of Vertebral Column
nuchal
groove
median
longitudinal
furrow
median sacral crest
sacral hiatus intergluteal
cleft
Sacral triangle

30. Ossification of Vertebrae
Spinal asymmetry due malformation
of L2 vertebral body:

31. Ossification
of
Vertebrae

32. Variations in Vertebrae
Variations in the number Cervical and lumber ribs
Sacralization
and
lumbarization

33. Anomalies of Vertebrae
Spina bifida occulta Spina bifida cystica

34. Effect of Aging on Vertebrae
Decrease in bone density and strength
(vanishing of horizontal trabeculae)
Narrowing of the intervertebral “space” on
radiographs
Increase in compressive forces at the
periphery of the vertebral bodies
Formation of osteophytes around the
margins of the vertebral body
Spondylosis (vertebral bodies), and
osteoarthrosis (zygapophysial joints) =
normal anatomy for a particular age range. * - osteophytes
Vertebral body osteoporosis
Age-related decrease in the body's
production of hormones.

35. Contents of
Vertebral Canal
1. Spinal cord
2. Spinal meninges
3. CSF
4. Spinal arteries
5. Spinal venous plexus

36. Spinal
Meninges

37. Lumbar Puncture
Layers to pass:
1. Skin, fascias
2. Supraspinous ligament
3. Intraspinous ligament
4. Ligamentum flavum
5. Dura mater
6. Arachnoid matter

38. Spinal Vessels

39. Vasculature of Vertebral Column

40. Nerves
of
Vertebral
Column

41. Back Pain
Fibroskeletal structures: periosteum,
ligaments, and anuli fibrosi of IV discs.
Spinal meninges.
Capsules of the zygapophysial joints.
Intrinsic muscles of the back.
Nervous tissue: spinal nerves or nerve
roots exiting the IV foramina.
Sources:
Articular and muscular
branches of posterior rami
Referred pain (from myotome)
Localized acute lower back pain
Localized chronic lower back pain
Secondary reflexive spasms – ischemia,
painful movements
Aging (osteoarthritis) or disease
(rheumatoid arthritis)
Fractures - acute periosteal pain
Disc herniation – acute pain from anulus
fibrosus and posterior longitudinal ligament
Dislocations – ligamentous pain
Recurrent meningeal
branches of the spinal nerves

42. Summary
Cervical
Thoracic
Lumbar

43. Thank you for
your attention!