Chapter 8 Cervical and thoracic spine
Begins at the base of the skull and extends distally to the sacrum it contains cerebrospinal fluid?
The spinal canal
for what reason do cartilaginous disks between the inferior lumbar vertebrae commonly become sites of injury?
bc the load of body weight inc toward the inferior end of the column
why are the vertebrae in lumbar the strongest in the column?
bc the load of body weight inc toward the inferior end of the column
when viewed form the lateral perspective, what causes slight overlapping of vertebral bodies cervical?
bc they are small and oblong in shape with the anterior edge more inferior
The spinous processes of C2-C6 are short and end in double-pointed or ______?
bifid tips
What purpose does the curves of the vertebral column serve? 2
increases strength of the vertebral column and helps maintain balance along the center line of gravity in the upright position
Along the lower surface of each pedicle is another half moon shaped area called?
inferior vertebral notch
Tough fibrocartilaginous disks that separate typical adult vertebrae, are cushion-like disks tightly bound to the vertebrae for spinal stability, but allow for flexibility and movement of the vertebral column.
intervertebral disks
In between every 2 vertebra are 2_____, one on each side through which important spinal nerves and blood vessels pass?
intervertebral foramen
begins at base of skull distally to sacrum protects spinal cord filled with cerebrospinal fluid
spinal canal
the spinal cord is protected and enclosed in the:
spinal canal
the spinal canal contains the what?
spinal cord and is filled with cerebrospinal fluid
Extends posteriorly at the midline junction of the two laminae, can often be palpated along the posterior surface of the neck and back is called?
spinous process
sternal angle is how many inches inferior to manubrial notch?
2"
The typical vertebra consists of _____ pedicle, _____ laminae which form the what?? ___ vertebra foramen with the spinal cord, ____transverse process, ____spinous process, --- body. and ______ articular process?
2, 2, =vertebral arch 1, 2,1,1, 4
t7 from jugular notch? from vertebra prominens?
3-4" below 7-8" below
how many bones are in the coccyx?
3-5 (4 avg) newborns; 1 adult
How many vertebrae are in the Cervical region?
7
A ______ oblique position is necessary to open up the zygapophyseal joints in the thoracic spine?
70 degree
In thoracic vertebrae, the zygapophyseal joints form an angle of _____ from midagittal plane?
70-75 degrees
In order to open up and demonstrate the thoracic zygapophyseal joints radiographically, a _______ position with a perpendicular ray is needed?
70-75 degrees oblique
Rotation of head primarily occurs between_____ with the ____ acting as a pivot?
C1-C2, dens
which numbers are the typical cervical vertebrae?
C3-6
The thyroid cartilage landmark varies between the levels of ____ and ____ of the cervical spine?
C4, C6
When a baby begins to learn how to hold their head up, the ______ concave curve forms in the cervical region?
First compensatory
The odontoid fracture involves the dens and can extend into the lateral masses or arches of C1?
Odontoid fracture
Extend posteriorly from either side of the vertebral body form most of the sides of the vertebral arch is _____?
Pedicles
Common disease of unknown orgin that generally begins during adolescences. Results in abnormal spinal curvature of hyphosis and scolisosis?
Scheuermann's disease
The spinous process of the last vertebra, C7 vertebra prominens is at the same level as the body of _____ vertebra?
T1
Delete---what kinds of facets do all thoracic vertebrae have?
T1: full facet and demifacet on inferior margin T2-T8: demifacets on upper/lower margins T9: one demifacet on upper margin T10-T12: full facets
The jugular notch is at what thoracic vertebra?
T2 and T3
sternal angle is at what vertebra level posteriorly? What is significant about this point anteriorly?
T4/T5 -second rib articulates onto the sternum here
what range of tspines are considered typical t-vertebrae?
T5-T8
The xiphoid tip is at the level of _____ thoracic vertebrae?
T9-T10
The mechanism of injury is compression with hyperfelxion in the cervical region?
Teardrop burst fracture
Which two parts of the vertebral column is considered concaved?
The cervical and the lumbar vertebra
where is the effect of scoliosis more obvious and why?
When it occurs in the lower vertebral column, where it may create tilting of the pelvis with a resultant effect on lower limbs aka limp
What type of joint is the intervertebral joint? Where are these joints found?
amphiarthrodial -between vertebral bodies
When trying to get a radiographic image of C1 and C2 what are the 2 things that need to be perfectly symmetric or they can imitate injury bc injury would mean they are asymmetric?
atlantoaxial joints and the relationship of the dens to C1
The ______ is thick, weight bearing anterior part of the vertebra and the superior surfaces are flat and rough for attachment of the intervertebral disc?
body
The central portion of the sternum is called the ____?
body
A vertebra consist of two main parts _____ and _____?
body and vertebral arch
Anterior oblique of the intervetbral foramina of the cervical spine with the closest to the IR (downside) would be opened and a 15 degree_____ angle is required? And what side is the intervertebral foramina best demonstrated on?
caudad -downside is open
what curve is the first compensatory curve? When develop?
cervical region concave as children begin to raise their head and sit up
What are the 5 sections of the vertebral column
cervical, thoracic, lumbar, vertebrae, sacrum, coccyx
Frequently associated with osteoporosis, often involves collapse of the vertebral body?
compression fracture
A rounded inward or depressed surface is termed what kind of curve of the vertebral column?
concave
why is it imp to have c spines erect if poss?
demonstrate alignment/ligamnet stability natural curve of spine shoulders depress 72" SID
Severe stress or hyperextension "whiplash" type of injury may cause fracture of the ____?
dens
The costotransverse joints are classified as______ and allow slight ______ movement?
diarthrodial, gliding movements
what is used interchangeably with the term zygapophyseal joint? But distinguish the two...
facet -Facet is the articulating surface instead of entire superior/inferior articular processes
Each 12 thoracic vertebra have ______ with one pair of ribs
facets for articulation
what are imp distinguishing feat of all thoracic vertebrae?
facets for articulation with ribs
ALL cervical vertebra have 3 ______ that run vertically, the right and left transverse ----- and the single large vertebral -----?
foramina: right and left transverse foramina and the single large vertebral foramen
on a lateral view, what are seen projecting from the area of the junction of the pedicles and laminae
four articular processes
With the head in neutral position, the what _____ is at the same level as C3?
gonion aka the angle of the jaw or
When the soft inner part of the disk referred to as the nucleus pulposus protrudes through the outer fibrous layer, it presses on the spinal cord and causes pain and numbness radiating into lower limbs this is called? 2 names
herniated nucleus pulposus HNP -slipped disk
when are intervertebral foramina clearly opened for cervical
in a 45 degree oblique
On each side, between any thoracic vertebrae are __________ which are defined on the superior and inferior margins by the pedicles?
intervertebral foramina
The lateral position of the thoracic spine best shows the _______?
intervertebral foramina
lateral position of thoracic spine best shows
intervertebral foramina
embryologically, the dens is actually the body of C1? But why is it considered part of the C2 in mature bones?
it fuses to C2 during development
in regards to xiphoid and jugular notch, how can you locate T7?
it is midway btw these two points
each ---- extends posteriorly from each pedicle to unite in the midline
lamina
On each side of the of the transverse process when looking at a lateral view you can find the _____ ( these end at the spinous process)
laminae
The posterior part of the vertebral arch is formed by two some what flat layers of bone called____?
laminae
on a lateral view of the vertebral body, what extends posteriorly directly from the vertebral body on each side?
pedicles
Rather than two laminae and spinous process found in typical vertebrae, C1 has a _______ that generally bears a small _____ at midline?
posterior arch, posterior tubercle
what do you need to do for cervical images if the shoulders are too dense for adequate penetration on a routine lateral?
qtake add'l images to demonstrat alignment of c7 to t1
thoracic spines are generally radiographed with the pt how?
recumbent
in an LPO of thoracic skeleton which zygopophyseal joints are easily seen?
right!
A LPO position opens up the foramina on the _____side and a ______ angle is needed? Cervical
right, 15 degree cephalad (A posterior oblique of the cervical the upside is the side on which in the intervertebral foramina are opened well)
The zygopophyseal joints of the 2nd-7th cervical vertebrae are located at _____ angles or _____ degrees to the midsagittal plane and thus are visualized only in a true lateral position?
right, 90
Exaggerated lateral curvature of the spine is referred to as?
scoliosis
The _______ concave curve, the lumbar curvature develops when children learn to walk?
second compensatory
adjacent vertbrae stacked openenings in each vertebra line up to create tubelike canal
spinal canal
any fx of the vertebral column at the dens could also result in serious damage to the what?
spinal cord!
The blunt_____ with its bifid tip extends posteriorly on the C2 vertebra?
spinous process
The first thoracic vertebra can be located by palpating the posteriorly at the base of the neck for the ________ prominens?
spinous process of C7 vertebra
the most posterior extensions of the vertebrae
spinous processes
Condition is neck stiffness due to age related degeneration of intervertebral disks?
spondylosis
In a lateral oblique perspective of the thoracic spine the superior articular processes and the inferior articular processes are shown to connect the successive thoracic vertebrae to form the _______ joint?
zygapophyseal joint
are a set of synovial, plane joints between the articular processes of two adjacent vertebrae.
zygapophyseal joints
what joint is located btw articular pillars of each vertebra
zygapophyseal joints
70 LPO thoracic vertebrae best visualized what
zygapophyseal joints on upside or those far away from IR -right zygapophyseal joints
two anatomic areas of the spine that need to be demonstrated by the proper cspine radiographs. WHY?
1. intervertebral foramina 2. zygapophyseal joints --rad gains imp info concerning the relat of consecutive vertebrae by studying these two areas
How many inches superior to the jugular notch is the T1?
1.5 inches
how many thoracic are there?
12
The intervertebral foramina are also directed at a _____ CR degree _____ angle because of shape and overlapping of the cervical vertebrae
15, inferior
After fusion of the sacral bones in adult life how many bones is the vertebral column composed of?
26 separate bones
Before fusion of sacral coccyx bones how many bones does a young child have in a vertebral column?
33 separate bones
CERVICAL The intervertebral foramina are situated at a ___ angle to the midsagittal plane?
45 degree
To open up and demonstrate the cervical intervertebral foramina radiographically, a _____degree oblique position combined with a ______ angle of the x-ray tube is required?
45, 15 degree cephalad
how many lumbar bones are there?
5
how many bones are in the sacrum?
5 in newborn; 1 in adult
The openings of the intervertebral foramina on the thoracic vertebra are located at what angles _________ to msp?
90 degree to the midsagittal plane
The cervical zygopophyseal joints of C1 and C2 (atlantoaxial joints) are visualized only on what projection?
AP open mouth
Disease that affects men ages 20-40 years old results in pain and stiffness and inflammation of the sacroiliac, intervertebral and costovertebral joints?
Ankylosing Spondylitis
where is the most common site for a lumbar puncture into the spinal canal and why?
At the level of l3-l4 because the conus medullaris extends as low as the body of L2..So we go lower to avoid striking the spinal cord
Fracture which results from hyperflexion of the neck?
Clay shovelers fracture
A rounded outward or elevated surface curve of the vertebral column is?
Convex
The _____ or ______ is part of the second cervical vertebra but it can be seen through a superior perspective of C1?
Dens odontoid process
The conical process that projects up from the superior surface of the body of C2 is called which is the most distinctive feat of C2?
Dens or odontoid process
Zygapophyseal joints in the cervical region can be disrupted during trauma. Zygapophyseal joint may be out of alignment with unilateral subluxation?
Facets, unilateral subluxation and bilateral locks
Fracture extends through the pedicles of C2 with or without subluxation of C2 on C3, from hyperextension?
Hangman's fracture
The soft inner part of the intervertebral disk protrudes through fibrous cartilage outer layer into the spinal canal, it can press on nerves and spinal cord?
Herniated nucleus pulposus
Type of fracture splintered or crushed at site of impact occurs as a result of axial loading, such as landing on ones head abruptly?
Jefferson fracture
Abnormal or exaggerated convex curvature of the thoracic spine that results in stopped posture and reduced height?
Kyphosis
Refers to an abnormal concavity of the lumbar spine is termed? Swayback
Lordosis
Slight lateral curvature of the thoracic spine?
Scoliosis
A transitional vertebra is an incidental finding occurs when the vertebra takes on a characteristics of adjacent region of the spine?
Transitional vertebra
placement of the IR far from the spine during lateral cervical radiography creates what?
an air gap that reduced the amnt of scatter
The segments of bone between the superior and inferior articular processes are called? Just for C1 name?
articular pillars -lateral masses
C1 is also referred to as the _____?
atlas
C2 is also referred to as the _____?
axis
why isn't the anterior arch of C1 which lies in front of the dens, not clearly visible on the ap open mouth radiograph?
bc it is thin compared with the larger denser dens
why is shielding of breasts/thyroids in c spines not a common pract?
bc of the practicalities of maintainging such shields ie erect positions and flexion/extension views -scatter radiation is in the pt and surface shielding does little
how can t7 indicate the approx center of the 12 thoracic vertebrae?
bc the inferior vertebrae are larger than the superior ones
The intervertebral joints between C2-T12 are classified as ______type, _______ mobility type, and _______ movement type?
cartilaginous, amphiarthrodial, N/A
delete---what is located behind the transverse process at the junction of the pedicle and lamina?
cervical articular processes
Articulations of the ribs to the thoracic vertebra consists of joints called?
costal joints
All of the first 10 thoracic vertebrae also have facets that articulates with the tubercles of ribs 1-10, these articulations are called______? What are two articulation points specifically?
costotransverse joints -facet on transverse process articulates with tubercles of ribs
Each facet or combination of two demifacets accepts the head of a rib to form a ________?
costovertebral joint
Ribs 11 and 12 articulate only the _______?
costovertebral joint. They do not also have costotransverse joints
Each thoracic vertebra has a full facet or two partial facets called_____?
demifacets
The anterior oblique of the thoracic spine would demonstrate the _____ joints?
downside
inferior cuves aka lumbar and sacral are more pronounced in what gender?
females
these provide a resilient cushion btw vertebrae helping to absorb shock during movement of the spine
fibrocartilage disks
Another way to localize the level of C1 is to ...?
go about 1 inch below the level of the EAM- external acoustic meatus
vertebrae with two demifacets share articulations with the what? EX head of 4th rib/// Explain all costoverteb rib articulations
heads of ribs: Head of 4th rib straddles/articulates with demifacets on vertebral bodies of T3/T4. Superior portion of rib head articulates with demifacet on inferior margin of t3 and inferior portion of rib head articulates with demifacet on superior margin of T4 -rib 1 articulates with T1 -rib 2 articulates with T1/T2 and so forth -ribs 11 and 12 only with t11 and t12
What lies inferior to the lamina that articulates with C3 on C2 vertebra?
inferior articular process
Allow for flexibility and movement of the vertebral column located tightly bound to adjacent vertebral bodies for spinal stability?
intervertebral disk
When vertebra are stacked the superior and inferior notches line up, these half moon shaped areas form a single opening called?
intervertebral foramen
The thoracic intervertebral foramina are best demonstrated on a ______ position?
lateral
The zygapophyseal joints of the cervical spine are best visualized in a ______ position?
lateral
What does a LAO thoracic vertebrae best visualize?
left zygapophyseal joints
normal compensatory concave curvature of cervical/lumbar spine
lordosis
where are lordosis and kyphosis found in vertebrae regions
lordosis-lumbar kyphosis-thoracic
sternum is divided into 3 basic sections...
manubrium, body, xiphoid tip
The ______ is the anatomy that corresponds to the level of C1?
mastoid process (tip)
zygapophyseal joints on thoracic vertebrae are best visualized on what position
oblique in 70 degrees
The articulations between C1 and the occipital condyles of the skull are called?
occipitoatlantal joints
Type of arthritis characterized by degenertation of one or many joints?
osteoarthritis
Condition characterized by loss of bone mass. Bone loss that increases with age?
osteoporosis
Injury to C1 and C2 can cause what?
paralysis or death
between thoracic vertebrae there are intervertebral foramina which are defined on the superior/inferior margins by the what?
pedicles
Inflammation of the vertebrae?
spondylitis
The manubrium and the body connect at a slight easily located angle termed?
sternal angle
which way do superior articular processes face? inferior articular processes?
sup--posteriorly inf--anteriorly
Depending on the patient body habitus the shoulders may _____ the last cervical vertebra on a lateral position?
superimpose
Each of the left and right C1 superior articular processes presents a large depressed surface called a _____for articulation with the respective left and right occipital condyles of the skull?
superior facet
what also assist the dens in rotating the head?
superior facets of the superior articular processes that articulate with the skull
Along the upper surface of the pedicle is a half moon shaped area called on a lateral.
superior vertebral notch
The occipitoatlantal joint between skull and C1 is ________classification type, _______ mobility type, _______ movement type?
synocial, diarthrodial, ellipsoid
The superior cross-sectional perspective of typical rib articulations show that articulations are closely spaced and are enclosed in______?
synovial capsules
The costovertebral joints between T1-T12 are classified as _______ type, ______mobility type, and _______ movement type?
synovial, diarthrodial, plane (gliding)
The right and left lateral atlantoaxial joints between C1 and C2 are classified as ______ type of joint with a _____mobility type and a________ movement type?
synovial, diarthrodial, plane (gliding)
The zygapophyseal joints between C2-T12 are classified as ______ type, _______ mobility type, and ______ movement type?
synovial, diarthrodial, plane (gliding)
the costotransverse joint between T1-T10 are classified as ______ type, ______ mobility type, and ________movement type?
synovial, diarthrodial, plane (gliding)
The medial atlantoaxial joint between C1 anterior arch and C2 dens held in place by transverse atlantal ligament is classified as ______type, _______mobility type, and _________ movement type?
synovial, diarthrodial, trochoid/pivot
Which vertebra of the thoracic spine are smaller and share features of the cervical vertebrae?
t1-t4
there are intervertebral disks btw the bodies of every two vertebrae except btw which ones...
the first and second cervical vertebrae
what portions of C1 are most bulky/solid and why?
the lateral masses of C1 bc they support weight of head/assist in rotation of the head
what is a unique characteristic of the thoracic region besides ribs.
the long spinous process is projected so far inferiorly. During an ap tspine, the spinous process of T4 will be superimp on the body of T5
Which 4 vertebra of the thoracic spine are larger and share characteristics of the lumbar vertebrae?
the lower 4 thoracic vertebra
what serves as a pivot point for arclike movement of the ribs?
the spine
How can you tell it is a thoracic over cspine or tspine aka What does it connect to?
they connect to a pair of ribs!
how do the sizes compare in the cervical spine...vertebrae?
they continue to get larger progressing down to C7
The ______ or the adams apple is at the approximate level of C5?
thyroid cartliage
what color is a radiograph when it is overexposed?
too dark
The dens or the odontoid process is held in place by the ______?
transverse atlantal ligament
Vetebral arteries and veins and certain nerves pass through the _______ of cervical vertebrae?
transverse foramen
the transverse processes of C1 are smaller but still contain what?
transverse foramina distinctive of all cervical vertebrae
Extending laterally from approximately the junction of each pedicle and lamina is a projection termed?
transverse process
below and lateral to the superior articular process is the what?
transverse process
pedicles terminate in the area of the what process
transverse process
The posterior oblique of the thoracic spine on the right shows the zygapophyseal joint on the ______ ?
upside
what is the ensiform process?
xiphoid
An abnormal condition characterized by increased convexity of the thoracic spine curvature?
Kyphosis
Which of the cervical vertebra has no body?
The first one
Which two parts of the vertebral column is considered convex?
Thoracic and sacral
The 12 vertebrae following the 7 cervical where each connect to a pair of ribs is the____?
Thoracic vertebrae
C7 has many features of thoracic vertebrae including...
an extra long/more horizontal spinous process that can be palpated at base of neck
Each disk consists of an outer fibrous portion called the _____ and soft inner part called ______?
annulus fibrosus, nucleus pulposus
C1, the atlas, has no body but does have a thick arch of bone called the ______?
anterior arch
The anterior arch of C1 includes a small______?
anterior tubercle
In a lateral perspective between the superior and inferior articular processes is short column of bone that is more supportive than the similar area in the rest of the spinal column. This column of bone is called______, and sometimes called_____ when referring to C1
articular pillar, and lateral mass when referring to just C1
the superior and inferior articular processes are located over and under what? What are they directly lateral to?
articular pillars -large vertebral foramen
lordotic and kyphosis match up with the terms concave/convex how?
lordotic--concave kyphosis--convex
what are the second compansatory curves? When develop?
lumbar curve that is concave and begins to develop when children learn to walk
The spinal cord begins with the ___ of the brain, passes through the ___ of the skull and continues through the first ___ all the way down to the lower border of the __ lumbar vertebra, where it tapers off to a point called the ___
medulla oblongata/foramen magnum/cervical vertebra/first/conus medullaris
where is the vertebrae column located? What does it form?
midsagittal plane, forming the posterior or dorsal aspect of the bony trunk of the body.
Seen on a lateral view the right and left ______ and the lower pair of the right and left ________ are superimposed. importance of these...?
superior articular processes, inferior articular processes ---allow certain imp joints that are unique and must be visualized radiographically for each section of the vertebral column
what forms the inferior and superior boundaries of the intervertebral foramina?
the pedicles!
what curves are called primary curves?
thoracic and sacral
in a healthy adult there is a slight lateral curvature in which vertebrae region? And what is the curvature associated with?
thoracic upper ---with the dominant extremity so this curvature is convex to the right in a right handed person. convex to left in left handed
In a superior view of the vertebra of C3-C6 the transverse processes are small and arise from both the pedicle and the body, rather than from the pedicle lamina junction. The hole in each of the transverse process is called?
transverse foramen
cervical vertebrae have 3 unique characteristics such as...
transverse foramina bifid spinous process tips overlapping vertebral bodies
in the thoracic region, the 12 ribs articulate with the what and what specifically on the vertebra?
transverse processes and vertebral bodies
The last or seventh cervical vertebra is called the______?
vertebra prominence
complex succession of many bones
vertebrae
provides a flexible supporting column for the trunk and head and also transmits the weight of the trunk and upper body to the lower limbs
vertebrae
Ring like or arch of the bone that extends posteriorly from the vertebral body.
vertebral arch
The _____ contains the spinal cord?
vertebral foramen
The posterior surface of the body and arch from a circular opening is called_____?
vertebral foramen
When several vertebrae are stacked the succession of vertebral foramina form a tube like opening the _____ which encloses/protects spinal cord
vertebral/spinal canal
