Vertebral Column, Part 1

Cervical vertebrae: In the typical cervical vertebrae, the intervertebral foramina of the cervical region are directed anteriorly at a ___ degree angle from the midsagittal plane of the body.

45

In early life, the vertebral column usually consists of ___ small, irregularly shaped bones.

33

What is a herniated nucleus pulposus (HNP)?

A common condition in which the nucleus pulposus ruptures or protrudes into the vertebral canal, impinging on a spinal nerve.

What are the five groups of vertebrae?

Cervical vertebrae, thoracic vertebrae, lumbar vertebrae, sacral vertebrae, and coccygeal vertebrae.

How many lumbar vertebrae are there?

Five.

How many sacral vertebrae are there?

Five.

Where does HNP most commonly occur? Why?

HNP most often occurs in the lumbar region as a result of improper body mechanics, and it can cause considerable discomfort and pain.

Abington's protocol for scoliosis?

Initial exam: AP and lateral. Follow up: AP only. Breast and gonadal shielding, male and female. Half apron shield for gonads - only need to visualize top of iliac crests. Instruct patient to remove shoes.

What is another name for zygapophyseal joint?

Interarticular facet joint.

What are the four main functions of the vertebral column?

It encloses and protects the spinal cord, acts as a support for the trunk, supports the skull superiorly, and provides for attachment for the deep muscles of the back and the ribs laterally.

Cervical vertebrae: All cervical vertebra contain three foramina. What are they?

The left and right transverse foramina and the vertebral foramen.

What makes up the false or fixed vertebrae? Why are they called this?

The pelvic segments in the two lower regions. They are called this because of the change they undergo in adults.

What is a more common name for the vertebral column?

The spine.

How many coccygeal vertebrae are there?

Three to five.

In patients with scoliosis, why does the vertebral column develop a second or compensatory curve in the opposite direction?

To keep the head centered over the feet.

What is most likely the cause of HNP in the cervical spine?

Trauma (whiplash injuries) or degeneration.

Abington's protocol for C-spine?

Trauma: Lateral (x-table), AP, and odontoid. Non-Trauma: AP, obliques, odontoid, and lateral.

A slight lateral curvature is sometimes present in the upper thoracic region. True or false?

True.

Cervical vertebra: The inferior articular processes of the axis have the same direction as the processes of the succeeding cervical vertebrae. True or false?

True.

Cervical vertebra: The laminae of the axis are broad and thick. True or false?

True.

Cervical vertebrae: The laminae are narrow and thin in the typical cervical vertebrae. True or false?

True.

The superior and inferior surfaces of the vertebral bodies are flattened and are covered by a thin plate of _____.

articular cartilage

Cervical vertebrae: In the typical cervical vertebra, the superior and inferior articular processes form short, thick columns of bone called ____.

articular pillars

Cervical vertebrae: The ____, the first cervical vertebra (C1) is a ringlike structure with no body and a very short spinous process.

atlas

Disks of fibrocartilage are interposed between the vertebrae and act as ____.

cushions

Cervical vertebra: The ____ or ____ of the axis is received into the anterior portion of the atlantal ring to act as the pivot or body for the atlas.

dens; odontoid process

Cervical vertebra: The strong conical process arising from the upper surface of the axis body is called the ____ or ____.

dens; odontoid process

Any abnormal increase in the anterior concavity (or posterior convexity) of the thoracic curve is termed ____.

kyphosis

The thoracic and pelvic curves are concave anteriorly and are called ____ curves.

kyphotic

The broad, flat ____ are directed posteriorly and medially from the pedicles.

laminae

Cervical vertebra: A ____ projection is necessary to show the cervical zygapophyseal joints of the typical cervical vertebrae.

lateral

Cervical vertebra: The anterior and posterior arches of the atlas extend between the ____.

lateral masses

Cervical vertebra: The transverse processes of the atlas project ___ and slightly ____ from the lateral masses.

laterally; inferiorly

The vertebral column is held together by ____, and it is joined and curved so that it has considerable flexibility and resilience (elasticity).

ligaments

Cervical vertebra: The transverse processes of the atlas are ___ than those of the other cervical vertebra.

longer

Any abnormal increase in the anterior convexity (or posterior concavity) of the lumbar or cervical curve is termed ____.

lordosis

The cervical and lumbar curves, which are convex anteriorly, are called ____ curves.

lordotic

The five vertebrae that occupy the region of the loin (lower back) are termed ____ vertebrae.

lumbar

The lumbar and pelvic curves join at an obtuse angled termed the ____.

lumbosacral angle

Each intervertebral disk has a central mass of soft, pulpy, semi-gelatinous material called the ____.

nucleus pulposus

The intervertebral disks account for approximately _____ of the length of the vertebral column.

one fourth

The cervical and lumbar curves are called ____ or ____ curves because they develop after birth.

secondary; compensatory

Cervical vertebrae: The first two cervical vertebrae are atypical in that they are structurally modified to join the ____.

skull

The ____ projects posteriorly and inferiorly from the junction of the laminae in the posterior midline.

spinous process

Cervical vertebrae: In the typical cervical vertebrae, the _____ are short, have double-pointed (bifid) tips, and are directed posteriorly and slightly inferiorly.

spinous processes

Thoracic vertebrae: The bodies of the typical (third through ninth) thoracic vertebrae are approximately ___ in shape.

triangular

The vertebral arch is formed by ___ pedicles and ___ laminae.

two; two

Cervical vertebra: C3-C6 are considered the ____ cervical vertebrae.

typical

Cervical vertebrae: In the typical cervical vertebrae, the intervertebral foramina are directed at a ___degree inferior angle to the horizontal plane of the body.

15

Cervical vertebrae: Accurate radiographic demonstration of the intervertebral foramina of the typical cervical vertebrae requires a ___ degree longitudinal angulation of the central ray and a ___ degree medial rotation of the patient.

15; 45

What is spina bifida?

A congenital defect of the vertebral column in which the laminae fail to unite posteriorly at the midline. In serious cases of spina bifida, the spinal cord may protrude from the affected individual's body.

What is a more common term for a herniated nucleus pulposus (HNP)?

A slipped disk.

Cervical vertebra: The joints between the axis and atlas, which differ in position and direction from the other cervical zygapophyseal joints, are clearly visualized in an ___ projection if the patient is properly positioned.

AP

Abington's protocol for the coccyx?

AP (10 caudad) and lateral.

Abington's protocol for the sacrum?

AP (15 cephalad) and lateral.

Abington's protocol for the S.I. joints?

AP 30-45 degrees cephalic and obliques 25-30 degree patient angled.

Abington's protocol for L-spine?

AP collimated, lateral, and spot L5-S1. Obliques are done only if requested.

Abington's protocol for T-spine?

AP, lateral (breathing technique), and cervicothoracic swimmers.

Cervical vertebrae: What makes up the atlas?

An anterior arch, a posterior arch, two lateral masses, and two transverse processes.

Cervical vertebrae: In a typical cervical vertebra, where do the palpable tips of the spinous processes lie?

At the level of the interspace below the body of the vertebra from which they arise.

Cervical vertebra: The spinous process of what vertebra is easily palpable at the posterior base of the neck and is convenient to use as a guide in localizing other vertebrae?

C7.

Cervical vertebrae: In a typical cervical vertebra, where are the superior and inferior articular processes located?

Posterior to the transverse processes at the point where the pedicles and laminae unite.

How many cervical vertebrae are there?

Seven.

What makes up the true or movable vertebrae?

The 24 vertebral segments in the upper three regions that remain distinct throughout life.

Describe the shape and composition of the typical vertebral body.

The body of the vertebra is approximately cylindric in shape and is composed largely of cancellous bony tissue covered by a layer of compact tissue.

When does the cervical curve develop? When does it begin to sit alone?

The cervical curve develops when an infant begins to hold the head up at about 3 to 4 months of age and begins to sit alone at about 8 to 9 months of age.

Which curve is the least pronounced?

The cervical curve.

What are the four curves of the vertebral column that arch anteriorly and posteriorly from the midcoronal plane?

The cervical, thoracic, lumbar, and pelvic curves.

Why is the slight lateral curvature of the vertebral column curved to the right in right-handed persons and to the left in left-handed persons?

The lateral curvature of the vertebral column is believed to be the result of muscle action and to be influenced by occupation.

For our purposes, the vertebral curves are discussed in reference to the anatomic position and are referred to as "convex anteriorly" and "concave anteriorly". Because physicians and surgeons evaluate the spine from the posterior aspect of the body, convex and concave terminology can be the exact opposites. True or false?

True.

The acuity of the lumbosacral angle varies among patients. True or false?

True.

The cervical and thoracic curves merge smoothly. True or false?

True.

The movable vertebra, with exception to the first and second vertebrae, are similar in general structure. Each group has certain distinguishing characteristics, however, that must be considered in radiography of the vertebral column. True or false?

True.

The planes of the facets vary in direction in the different regions of the vertebral column and often vary within the same vertebra. True or false?

True.

Whether or not the vertebral curves are described as "concave posteriorly" and "convex anteriorly", the curvature of the patient's spine is the same. True or false?

True.

How many thoracic vertebrae are there?

Twelve.

When does the lumbar curve develop?

When the child begins to walk at about 1 to 1 1/2 years of age.

Cervical vertebra: The ____ portion of the atlas ring receives the dens (odontoid process) of the axis, and the ____ portion transmits the proximal spinal cord.

anterior; posterior

The nucleus pulposus is surrounded by an outer fibrocartilaginous disk called the ____.

anulus fibrosus

Cervical vertebra: The ____, the second cervical vertebra (C2), has a strong conical process arising from the upper surface of its body.

axis

A typical vertebra is composed of two main parts - an anterior mass of bone called the ____ and a posterior ringlike portion called the ____.

body; vertebral arch

The vertebral column forms the ____ axis of the skeleton and is centered in the ____ plane of the ____ part of the trunk.

central; midsagittal; posterior

The seven superior most vertebrae occupy the region of the neck and are termed ____ vertebrae.

cervical

Thoracic vertebrae: The super thoracic bodies resemble ___ bodies and the inferior thoracic bodies resemble ___ bodies.

cervical; lumbar

The terminal vertebrae, located in the pelvic region, vary from three to five in number in adults and are termed the ____ vertebrae.

coccygeal

The coccygeal segments fuse into one bone called the ____.

coccyx

The superior and inferior surfaces of the pedicles, or roots, are ____.

concave

When viewed posteriorly, the normal lumbar curve can correctly be referred to as "____ posteriorly".

concave

Cervical vertebrae: In the typical cervical vertebra, the fibrocartilaginous articulating surfaces of the articular pillars contain ____.

facets

The articulating surfaces of the four articular processes are covered with fibrocartilage and are called ____.

facets

The lumbar and pelvic curves are more pronounced in ____, who have a more acute angle at the lumbosacral junction.

females

From the superior aspect of the vertebral body, the posterior surface is _____, and from the lateral aspect, the anterior and lateral surfaces are _____.

flattened; concave

In the typical vertebra, there are ___ articular processes, ___ transverse processes, and ___ spinous process.

four; two; one

Cervical vertebra: The spinous process of the axis is ____ in position.

horizontal

Thoracic vertebrae: The bodies of the thoracic vertebrae ____ in size from the first to twelfth vertebrae.

increase

Generally, the width of the spine gradually ____ from the second cervical vertebra to the superior part of the sacrum and then ____ sharply.

increases; decreases

In the articulated spine, the vertebral bodies are separated by ____, forming the cartilaginous intervertebral joints.

intervertebral disks

By articulation with the vertebrae above and below, the vertebral notches form ____ for the transmission of spinal nerves and blood vessels.

intervertebral foramina

Cervical vertebrae: The ___ of the typical cervical vertebra project laterally and posteriorly from the body, and their superior and inferior vertebral notches are nearly equal in depth.

pedicles

The ____ are short, thick processes that project posteriorly, one from each side, from the superior and lateral parts of the posterior surface of the vertebral body.

pedicles

Four articular processes - two superior and two inferior - arise from the junction of the ___ and ___ to articulate with the vertebrae above and below.

pedicles; laminae

In a typical vertebrae, each superior articular process has an articular facet on its ____ surface, and each inferior articular facet has an articular facet on its ____ surface.

posterior; anterior

Thoracic vertebrae: The vertebral bodies of the typical thoracic vertebrae are deeper ___ than ___, and their posterior surface is ___ from side to side.

posteriorly; anteriorly; concave

The thoracic and pelvic curves are called ____ curves because they are present at birth.

primary

The upper limbs are supported indirectly to the vertebral column via the ____, which articulate with the sternum. The sternum then articulates with the ____.

ribs; shoulder girdle

Cervical vertebrae: The zygapophyseal facet joints of the second through seventh cervical vertebrae lie at ____ angles to the midsagittal plane and are clearly shown in a ____ projection.

right; lateral

The slight lateral curvature sometimes present in the upper thoracic region is to the ____ in right-handed persons and to the ___ in left-handed persons.

right; left

The five vertebrae located in the pelvic region are termed ____ vertebrae.

sacral

The ____ articulations support the vertebral column and transmits the weight of the trunk through the hip joints and to the lower limbs.

sacroiliac

The vertebral column articulates with each hip bone at the ____ joints.

sacroiliac

The sacral segments fuse into one bone called the ____.

sacrum

An abnormal lateral curvature of the spine is called ____. This condition also causes the vertebra to rotate toward the concavity.

scoliosis

Cervical vertebra: The ____ processes of the atlas lie in a horizontal plane, are large and deeply concave, and are shaped to articulate with the occipital condyles of the occipital bone of the cranium.

superior

Cervical vertebra: At each side of the dens on the superior surface of the vertebral body of the axis are the _____, which are adapted to join the inferior articular processes of the atlas.

superior articular processes

Cervical vertebra: Each lateral mass of the atlas bears a ___ and ___ articular process.

superior; inferior

The twelve bones that lie in the dorsal, or posterior, portion of the thorax are called the ____ vertebrae.

thoracic

Cervical vertebrae: The seventh vertebrae is atypical and slightly modified to join the ____.

thoracic spine

Cervical vertebra: The ring formed by the arches of the atlas is divided into anterior and posterior portions by a ligament called the ____.

transverse atlantal ligament

Cervical vertebrae: The transverse processes of the typical cervical vertebra are short and wide, and are perforated by the ____ for transmission of the vertebral artery and vein, and present a deep concavity on their upper surfaces for passage of the spinal nerves.

transverse foramina

Cervical vertebrae: The ____ of the typical cervical vertebrae arise partly from the sides of the body and partly from the vertebral arch.

transverse processes

The ____ project laterally and slightly posteriorly from the junction of the pedicles and laminae.

transverse processes

Cervical vertebrae: The ____ vertebrae have a small, transversely located, oblong body with slightly elongated anteroinferior borders. The result is anteroposterior overlapping of the bodies in the articulated column.

typical cervical

Cervical vertebra: The seventh cervical vertebra (C7), termed the ____, has a long, prominent spinous process that projects almost horizontally to the posterior.

vertebra prominens

The vertebral column is composed of small segments of bone called ____.

vertebrae

In the articulated column, the vertebral foramina form the ____.

vertebral canal

The vertebral body and arch enclose a space called the _____.

vertebral foremen

The concavities of the pedicles are termed ____.

vertebral notches

The articulations between the articular processes of the vertebral arches are the synovial intervertebral joints, referred to as ____.

zygapophyseal joints