IMAGING OF VERTEBRAE

IMAGES FROM CROSS-SECTIONAL ANATOMY TUTOR PROGRAM

1) REVIEW VERTEBRAL COLUMN AND BACK
2) VERTEBRAE ARE USEFUL LANDMARKS FOR
ORIENTATION IN CT, MRI IMAGES
3) LOOK AT VIEWS OF VERTEBRAE ON X-RAYS IN LAB
1) SAGITTAL PLANE -
divides body in RIGHT
and LEFT parts (Median
Sagittal Plane-divides
body into right and left
halves)
2) CORONAL PLANE -
divides body into FRONT
and BACK parts
3) HORIZONTAL PLANE
Plane = transverse plane -
cross section-divides
body into TOP and
BOTTOM parts
perpendicular to long axis
of body
ANATOMICAL PLANES
Sagittal
Coronal
Horizontal
AXIAL CT SERIES
- generates sections in
HORIZONTAL PLANE
- VIEW FROM
FEET
- viewing patient in
hospital bed from his/her
feet
FEET
PATIENT'S
RIGHT
PATIENT'S
LEFT
POSTERIOR
ANTERIOR
ORIENTATION IN IMAGES - seemingly right/left reversed
Series In Horizontal
Plane = Axial Series
INTENSITIES STORED AS PIXEL VALUES
CAN
'RESECTION'
SERIES
OF DIGITAL
IMAGES IN
ANY PLANE
PATIENT'S
RIGHT
PATIENT'S
LEFT
1. BODY anterior, solid transmits weight
2. VERTEBRAL ARCH posterior, surrounds vertebral canal, spinal
cord; consists of a) PEDICLES project from body
b) LAMINAE unite to form arch posteriorly
BODY
VERTEBRAL
ARCH
PEDICLE
TRANSVERSE
PROCESS-
LATERAL
LAMINA
3. TRANSVERSE AND SPINOUS PROCESSES - projections
from arch for muscle, ligament attach
TYPICAL VERTEBRA by convention thoracic
SPINOUS PROCESS -
POSTERIOR
{
ant.
RIBS- have bumps for articulation with vertebra
Head
Articulates
with facet on Body
Tubercle
Articulates
with facet on
Transverse process
Vertebrae
Ribs
Dorsal view
of skeleton
CT OF THORACIC VERTEBRA
USE FOR ORIENTATION
T5
SUBS
IS
TRAP
RHOMB.MAJ.
body is small
Foramen Transversarium - in
transverse process (C1-C7) for
vertebral artery & veins
ARTICULAR FACETS
- angled superiorly &
medially
SPINOUS PROCESS bifid (divided) for Ligamentum nuchae
TRANSVERSE
PROCESS
BODY
CERVICAL VERTEBRA
ant.
post.
lat.
view
CERVICAL VERTEBRA - CT
Foramen Transversarium
Body - small
Bodies - hefty
Pedicles - stout
Lamina - thick
Spinous Processes- broad
Articular processes
in sagittal plane
spinous
process
lamina
pedicle
body
LUMBAR VERTEBRA
LUMBAR VERTEBRA AXIAL CT
Articular process
Articular process
L3
L5
LATERAL VIEW OF VERTEBRA
4. Spinal nerves leave
vertebral canal via
INTERVERTEBRAL
FORAMINA - between
vertebrae;
bordered by Superior and
Inferior Vertebral Notches
Sup. Vertebral Notch
Inf. Vertebral Notch
5. SUPERIOR AND INFERIOR
ARTICULAR PROCESSES -
(zygapophyses) - Articular
facets form joints between
adjacent vertebrae (Orientation
of facets determines
movement)
6. Bodies -
joined by
intervertebral
discs
MOVEMENTS OF VERTEBRAE IN DIFFERENT REGIONS-
Determined by orientations of articular facets
permit considerable flexion-
extension, lateral flexion,
rotation - useful-move head
permit some rotation little or
no flex-extend (also limited by
ribs); useful- no flex down on
heart, lungs
Lumbar- facets in sagittal plane
Thoracic - facets in coronal plane
permit flex-extend, little or no
rotation; useful- help increase
abdominal pressure;
dangerous- increase load
pressure on vertebral discs
Cervical (C3-C7)-facets angled
superiorly and medially
a. CERVICAL (C3-C7)-
b. THORACIC
c. LUMBAR
1. ANTERIOR
LONGITUDINAL
LIGAMENT -
Strong band on
anterior side
VERTEBRAL LIGAMENTS
2. POSTERIOR
LONGITUDINAL
LIGAMENT-
weaker, narrower
band
3. LIGAMENTA
FLAVA - yellow
elastic bands
connecting
laminae
View inside vertebral canal
SAGITTAL SECTION
4. INTERSPINOUS AND SUPRASPINOUS LIGAMENTS -
connect spines
Greatly thickened in cervical region to form LIGAMENTUM
NUCHAE- from Ext. Occip. Protuberance of skull to C7;
Support Head, Provide muscle attachments
ANT
SUPRASPINOUS
INTERSPINOUS
JOINTS BETWEEN VERTEBRAE
1. Joints between
articular processes -
synovial plane joints
permit Sliding
Movements
2. Intervertebral Disc-
interposed between
bodies
ORIENT TO MEDIAN MRI
BODY
SPINE
ant
post
ant
SPINE BODY
post
SAGITTAL
PLANE
LUMBAR MRI
Shock
absorbers in
young quite
strong
trauma to
vertebra
fractures
STRUCTURE/
FUNCTION OF
INTERVERTEBRAL
DISC
a) Nucleus
pulposus-
inner
gelatinous
core
b) Anulus fibrosus -
collagen fibers &
fibrocartilage
MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK
ANTERIOR
POSTERIOR
HERNIATION
OF
NUCLEUS
PULPOSUS
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal
Ligament; often L4-L5 or L5-S1; can lead to nerve compression at
intervertebral foramen
Postero-
lateral
lateral
post
DAMAGE TO INTERVERTEBRAL DISC
ANTERIOR
LONGITUDINAL LIGAMENT
POSTERIOR
LONGITUDINAL
LIGAMENT
Cervical
curvature
Lumbar
curvature
NORMAL CURVATURES OF VERTEBRAL COLUMN
Secondary - concave posterior
a. Cervical curvature - concave
posteriorly - help support head
b. Lumbar curvature
- concave posteriorly
- develops with walking
- helps support trunk, upper body
c. Lateral curvature -
concave to side opposite
handedness - helps to carry
bags of money
Ant Post
Right handed
R L
Thoracic
curvature
Sacral
curvature
Primary - concave anterior - remains
In thorax and sacrum
LATERAL X-RAY -
TRANSVERSE
PROCESSES
LOOK LIKE
RINGS
Transverse
process
LUMBAR CURVATURE ON LATERAL X-RAY
INTERNAL STRUCTURE OF BONE
OUTER COMPACT (CORTICAL) BONE
INNER SPONGY BONE
COMPACT
SPONGY
Long bone in cross-section
IN LATERAL
VIEW SEE
TRANSVERSE
PROCESSES
ON END
LATERAL
VIEW
ATTENUATION HIGHEST
(X-RAY IS MOST WHITE)
WHEN PASS THROUGH
MOST COMPACT BONE
Transverse
process
ANTERIOR-POSTERIOR
(AP)
X-RAY OF LUMBAR
VERTEBRAE
Pedicles look like
eyes
SPINE
PEDICLE
AP VIEW
SEE
PEDICLES AND
SPINES ALONG
THEIR LENGTH
SPINE
PEDICLE
ABNORMAL CURVATURES
KYPHOSIS hump
back, exaggerated
curvature; often in
thorax of elderly;
concave anteriorly
SCOLIOSIS
abnormal lateral
curvature (kink in
spine); can be due
to hemivertebra
LORDOSIS
exaggerated
lumbar curvature
concave
posteriorly
LATERAL X-RAY THORACIC SPINE
NORMAL ADULT ELDERLY PATIENT
T11
ERECTOR SPINAE
SPINALIS- most medial spinous
process to spinous process
LONGISSIMUS- intermediate-
transverse process to transverse
process
ILIOCOSTALIS- lateral ilium and
ribs to ribs and transverse
processes
1. Act to extend trunk
2. Located dorsal to vertebral column
3. Innervated by dorsal primary rami of
spinal nerves
Deep: Transversospinalis transverse
process to spinous process
IMAGING OF VERTEBRAE
IMAGES FROM CROSS-SECTIONAL ANATOMY
TUTOR PROGRAM
ERECTOR SPINAE
TRANSVERSOSPINALIS