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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

ANATOMICAL PLANES

Sagittal

1) SAGITTAL PLANE divides body in RIGHT


and LEFT parts (Median
Sagittal Plane-divides
Coronal
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

Horizontal

AXIAL CT SERIES

FEET

- generates sections in
HORIZONTAL PLANE

- VIEW FROM
FEET
- viewing patient in
hospital bed from his/her
feet

ORIENTATION IN IMAGES - seemingly right/left reversed


Series In Horizontal
Plane = Axial Series

ANTERIOR

PATIENT'S
LEFT

PATIENT'S
RIGHT
POSTERIOR

INTENSITIES STORED AS PIXEL VALUES


CAN
'RESECTION'
SERIES
OF DIGITAL
IMAGES IN
ANY PLANE

PATIENT'S
RIGHT

PATIENT'S
LEFT

TYPICAL VERTEBRA by convention thoracic


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
ant.

BODY

VERTEBRAL
ARCH

PEDICLE

LAMINA

TRANSVERSE
PROCESSLATERAL

SPINOUS PROCESS POSTERIOR

3. TRANSVERSE AND SPINOUS PROCESSES - projections


from arch for muscle, ligament attach

RIBS- have bumps for articulation with vertebra


Vertebrae

Dorsal view
of skeleton

Ribs
Head
Articulates
with facet on Body

Tubercle
Articulates
with facet on
Transverse process

CT OF THORACIC VERTEBRA

USE FOR ORIENTATION

SUBS
IS

T5

TRAP

RHOMB.MAJ.

CERVICAL VERTEBRA
BODY

ant.

body is small
Foramen Transversarium - in
transverse process (C1-C7) for
vertebral artery & veins

TRANSVERSE
PROCESS
post.

SPINOUS PROCESS bifid (divided) for Ligamentum nuchae

lat.
view

ARTICULAR FACETS
- angled superiorly &
medially

CERVICAL VERTEBRA - CT
Body - small

Foramen Transversarium

LUMBAR VERTEBRA
spinous
process

lamina

pedicle

Bodies - hefty
Pedicles - stout
Lamina - thick
Spinous Processes- broad

body

Articular processes
in sagittal plane

LUMBAR VERTEBRA AXIAL CT


L3

L5

Articular process
Articular process

LATERAL VIEW OF VERTEBRA


4. Spinal nerves leave
vertebral canal via
INTERVERTEBRAL
FORAMINA - between
vertebrae;
bordered by Superior and
Inferior Vertebral Notches
5. SUPERIOR AND INFERIOR
ARTICULAR PROCESSES (zygapophyses) - Articular
facets form joints between
adjacent vertebrae (Orientation
of facets determines
movement)

Sup. Vertebral Notch

Inf. Vertebral Notch

6. Bodies joined by
intervertebral
discs

MOVEMENTS OF VERTEBRAE IN DIFFERENT REGIONSDetermined by orientations of articular facets


a. CERVICAL (C3-C7)permit considerable flexionextension, lateral flexion,
rotation - useful-move head
b. THORACIC

Cervical (C3-C7)-facets angled


superiorly and medially

Thoracic - facets in coronal plane

permit some rotation little or


no flex-extend (also limited by
ribs); useful- no flex down on
heart, lungs
c. LUMBAR
permit flex-extend, little or no
rotation; useful- help increase
abdominal pressure;
dangerous- increase load
pressure on vertebral discs

Lumbar- facets in sagittal plane

VERTEBRAL LIGAMENTS
View inside vertebral canal

1. ANTERIOR
LONGITUDINAL
LIGAMENT Strong band on
anterior side

2. POSTERIOR
LONGITUDINAL
LIGAMENTweaker, narrower
band

3. LIGAMENTA
FLAVA - yellow
elastic bands
connecting
laminae

SAGITTAL SECTION
4. INTERSPINOUS AND SUPRASPINOUS LIGAMENTS connect spines

INTERSPINOUS

ANT

SUPRASPINOUS

Greatly thickened in cervical region to form LIGAMENTUM


NUCHAE- from Ext. Occip. Protuberance of skull to C7;
Support Head, Provide muscle attachments

JOINTS BETWEEN VERTEBRAE

1. Joints between
articular processes synovial plane joints
permit Sliding
Movements

2. Intervertebral Discinterposed between


bodies

ORIENT TO MEDIAN MRI


ant
SAGITTAL
PLANE

BODY

post

ant

SPINE
post

BODY

SPINE

LUMBAR MRI

STRUCTURE/
FUNCTION OF
INTERVERTEBRAL
DISC

a) Nucleus
pulposusinner
gelatinous
core

Shock
absorbers in
young quite
strong
trauma to
vertebra
fractures

b) Anulus fibrosus collagen fibers &


fibrocartilage

MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK

ANTERIOR

POSTERIOR

HERNIATION
OF
NUCLEUS
PULPOSUS

DAMAGE TO INTERVERTEBRAL DISC


Posterolateral post

POSTERIOR
LONGITUDINAL
LIGAMENT

lateral

ANTERIOR
LONGITUDINAL LIGAMENT
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal
Ligament; often L4-L5 or L5-S1; can lead to nerve compression at
intervertebral foramen

NORMAL CURVATURES OF VERTEBRAL COLUMN


Ant

Post

Primary - concave anterior - remains


In thorax and sacrum
Secondary - concave posterior

Cervical
curvature

a. Cervical curvature - concave


posteriorly - help support head

Thoracic
curvature

b. Lumbar curvature
- concave posteriorly
- develops with walking
- helps support trunk, upper body

Lumbar
curvature

Right handed
c. Lateral curvature concave to side opposite
handedness - helps to carry
R
L
bags of money

Sacral
curvature

LUMBAR CURVATURE ON LATERAL X-RAY

LATERAL X-RAY TRANSVERSE


PROCESSES
LOOK LIKE
RINGS

Transverse
process

INTERNAL STRUCTURE OF BONE


Long bone in cross-section
OUTER COMPACT (CORTICAL) BONE

INNER SPONGY BONE

COMPACT

SPONGY

LATERAL
VIEW

IN LATERAL
VIEW SEE
TRANSVERSE
PROCESSES
ON END

Transverse
process

ATTENUATION HIGHEST
(X-RAY IS MOST WHITE)
WHEN PASS THROUGH
MOST COMPACT BONE

ANTERIOR-POSTERIOR
(AP)
X-RAY OF LUMBAR
VERTEBRAE
Pedicles look like
eyes

PEDICLE

SPINE

AP VIEW

PEDICLE

SPINE

SEE
PEDICLES AND
SPINES ALONG
THEIR LENGTH

ABNORMAL CURVATURES

KYPHOSIS hump

SCOLIOSIS

LORDOSIS

back, exaggerated
curvature; often in
thorax of elderly;
concave anteriorly

abnormal lateral
curvature (kink in
spine); can be due
to hemivertebra

exaggerated
lumbar curvature
concave
posteriorly

LATERAL X-RAY THORACIC SPINE


NORMAL ADULT

T11

ELDERLY PATIENT

ERECTOR SPINAE
1. Act to extend trunk
2. Located dorsal to vertebral column
3. Innervated by dorsal primary rami of
spinal nerves
SPINALIS- most medial spinous
process to spinous process
LONGISSIMUS- intermediatetransverse process to transverse
process
ILIOCOSTALIS- lateral ilium and
ribs to ribs and transverse
processes
Deep: Transversospinalis transverse
process to spinous process

IMAGING OF VERTEBRAE
IMAGES FROM CROSS-SECTIONAL ANATOMY
TUTOR PROGRAM

TRANSVERSOSPINALIS

ERECTOR SPINAE