Anatomy of the spine

Columna Vertebralis

• 5 regions, 33 bones
Regions
– Cervical ( 7 vertebrae)
– Thoracic ( 12 vertebrae)
– Lumbar ( 5 vertebrae)
– Sacral bone (5 fused =
Sacrum)
– Coccygeal bone (4 fused =
coccyx)
The Vertebral Column
• Vertebrae separated by
intervertebral discs
• Intervertebral discs (anulus
fibrosus + nucleus pulposus)
The Vertebral Column
- Spinal Curvatures
 concave    and convex curves

Curvatures :
• Kyphosis (cervical and
lumbar)
• Lordosis (thoracic and
sacrum)
• Scoliosis (abnormal)
 Vertebra
Typical vertebra has :
– Corpus vertebra
– Arcus vertebra (lamina and pedicle)
– Foramen vertebra
– Processus spinosus (1)
– Processus transversus (2)
– Processus articularis superior (2)
– Processus articularis superior(2)
Cervical Vertebrae
 Thoracic and Lumbar Vertebrae

Modified from Fig. 7.18

Sacrum and Coccyx
Cervical Examination
 INSPEKSI

Symmetry/ asymmetry
Deformity
Torticolis
Hematoma
 PALPATION

STEPS ONE STEPS TWO

Tenderness Palpate the lateral

Tumor mass aspects of the
vertebra
 STEPS THREE STEPS FOUR

Continue palpation into Examine the anterior

the supraclavicular fossa aspect of the neck
 MOVEMENT

STEPS ONE STEPS TWO

Flexion Extension
Ask the patient to bend Ask the patient to till
the head forward the head backward
 STEPS THREE STEPS FOUR

Using a spatula in the Ask the patient to

clenched teeth as a extend the head.
pointer. Then ask the Normal range = 50
patient to flex the head
forward. Normal range The total range in the flexion and extension
= 80 planes should be assessed. Normal range
= 130
 STEPS FIVE STEPS SIX

Lateral flexion Laterral flexion

Ask the patient to tilt For accurancy, using a
his head on to his right spatula as a pointer.
shoulder Normal range = 45
 STEPS SEVEN STEPS EIGHT

If lateral flexion cannot Rotation

be carried out without Ask to ptient to look
forward flexion, this is over the shoulder.
indicative of pathology
involving the
atlantoaxial and
atlanto-occipital joints.
STEPS NINE

Rotation
Again a spatula use a
pointer. Normal range
= 80
Thoracal Physical Examination
Inspection
Palpation
Percussion
Movement
Movement Flexion
• Schober’s method : a 10
cm length of lumbar spine
is used as a base, where a
15 cm length of spine is
employed. Begin by
positioning a tape
measure with the 10 cm
mark level with the
dimples of Venus (which
mark the posterior
superior iliac spines).
Movement Flexion
• Anchor the top of the
tape with a finger and
ask the patient to flex as
far forward as he can.
Movement Flexion
• Flexion in the thoracic
spine may be measured
with the upper point 30
cm from the previous
zero mark.
Movement Extention
• patient arches his back,
assisting him by
steadying the pelvis and
pulling back on the
shoulder
Movement Lateral Flexion
• measure the angle
formed between a line
drawn through T1, S1
and the vertical
Movement Rotation
• The patient should be
seated, and asked to
twist round to each
side. Rotation is
measured between the
plane of the shoulders
and the pelvis. The
normal maximum range
is 40° and is almost
entirely thoracic
Suspected thoracic cord compression
• Use a blunt object such as
the handle of a tendon
hammer to stroke the
skin in each paraumbilical
skin quadrant.
• Failure of the umbilicus to
twitch in the direction of
the stimulated quadrant
suggests cor compression
on that side at the
appropriate level
Suspected thoracic motor root
dysfunction
• Beevor’s sign
The patient places his hands
behind his head, flex his
knees, and sit up
See the movement of the
umbilicus to one side (and
up or down) suggests that
the abdominal muscles on
that side are unopposed
i.e. there is weakness on
the opposite side
Suspected ankylosing spondylitis
• Check the patient’s
chest expansion at the
level of the 4thn
interspace
• Less than 2.5 cm is
regarded as highly
suggestive of ankylosing
spondylitis
Lumbal Examination
Examination of the Vertebra Lumbal
History Taking

Physical Examination
 History taking
1. Note the patient’s age and occupation: both
may be relevant.
2. Ask about the onset of the pain
3. Ask about any directly relevant previous
history
4. Ask about the site and nature of the pain
5. Ask about radiation of the pain
6. Ask about motor involvement
7. Make enquiries in the following areas
 Inspection

Palpation

Percussion

Movements

Physical Examination
Inspection
Palpation
Percussion
Movements