4 REGIONAL CURVATURES IN THE
SAGITTAL PLANE
Thoracic and Sacrococcygeal curves – anterior
concavities
Cervical and lumbar curves – posterior
concavities
Curve – serves to align the center of the gravity
of the body through the pelvis. S2 vertebra
Fetal vertebral column – has only one
continuous anterior cavity
VERTEBRAL COLUMN CURVATURES
Lumbosacral angle – appears at the junction of
the L5 and S1
After birth – the cervical curvature forms in
association with the child raising his head and
keeping it poised on the vertebral column
st
Toward the end of the 1 year – lumbar curve
forms in association with the child beginning to
sit up and stand upright
Secondary curves – results in a modification in
the shape of the vertebral bodies and the
intervertebral discs
ABNORMAL VERTEBRAL COLUMN CURVES
Kyphosis – severe exaggeration in the thoracic
curvature caused by structural changes in the
vertebral bodies or intervertebral
Disease-based kyphosis – crush fracture or
tuberculous, direct trauma
Senile kyphosis – osteoporosis and
degeneration of the intervertebral disc
Potts disease – extraspinal source of infection
- A process of osteomyelitis and arthritis
- Affects anterior aspect
- Common in lower Thoracic and Lumbar
vertebrae disc if often spared
Senile osteoporosis – diminished bone mass
due to long standing imbalance between bone
resorption and bone formation
Bone resorption and bone formation –
essential components of remodeling
Osteopenia - -1.0
Osteoporosis - -2.5
Lordosis - exaggeration of either cervical or
lumbar curvature (secondary curvature)
More often an accented lumbar curve
Maybe a severe cervical curvature
Lumbar lordosis – caused by increase in weight
of the abdominal contents, as with the gravid
uterus or large ovarian tumor, or disease such
as Spondylolisthesis
- Postural compensation for a kyphosis in
the thoracic region or disease of the hip
joint
Scoliosis – lateral deviation of the vertebral
column, usually including malrotation
- Commonly found in thoracic region
- Caused by poliomyelitis, congenital
hemivertebra
- Common in females, adolescent growth
spurt
- Idiopathic
VERTEBRAL ARCH
Spina Bifida - The dorsal outgrowths from the
vertebral body may fail to fuse in the posterior
midline, leaving a gap in the vertebral arch of
one or more adjacent vertebrae.
- Lower thoracic, lumbar, and sacral
regions.
- a result of failure of the mesenchyme,
which grows in between the neural
tube and the surface ectoderm
Types of spina bifida

Spina Bifida Occulta – “hairy patch”

Meningocele – spinal fluid

Myelomeningocele – spinal nerves plus spinal

fluid

VERTEBRAL COLUMN DISLOCATION

Dislocations without fracture occur only in the

cervical region because the obliquely oriented
articular processes of the cervical vertebrae are
not interlocked with one another and permit
significant intervertebral movement

Common Dislocations – 4th and 5th, 6th, cervical

vertebrae, where mobility is greatest

In unilateral dislocations, the inferior articular

process on one side of one vertebra is forced
forward over the anterior margin of the
superior articular process of the vertebra
below.

In the thoracic and lumbar regions, dislocations

can occur only if the vertically aligned and
interlocking articular processes are fractured.

VERTEBRAL COLUMN FRACTURE

Anterior compression fractures of the vertebral

bodies are usually caused by an excessive
flexion Compression type of injury and take
place at the sites of maximum mobility or at
the junction of the mobile and fixed regions of
the column. Interestingly, the body of a
vertebra in such a fracture is crushed, whereas
the strong posterior longitudinal ligament
(which resists flexion) remains intact
 segmentally with the veins of the thorax,
abdomen, and pelvis.

Pelvic venous blood enters not only the inferior

vena cava but also the vertebral venous plexus
and, by this route, may also enter the skull.

This is especially likely to occur if the intra-

abdominal pressure is increased.

A rise in pressure on the abdominal and pelvic

veins tends to force the blood backward out of
the abdominal and pelvic cavities into the veins
within the vertebral canal.

NERVE PAIN AND INTERVERTEBRAL FORAMINA

The intervertebral foramina (IVFs) transmit the

spinal nerves and the small segmental arteries
and veins, all of which are embedded in areolar
tissue

FRACTURE DISLOCATIONS

Fracture dislocations are usually caused by a

combination of a flexion and rotation

Site is usually where maximum mobility occurs,

as in the lumbar region, or at the junction of
the mobile and fixed region of the column, as
in the lower lumbar vertebrae.

Unstable, and the spinal cord is usually

severely damaged or severed, with
accompanying paraplegia.

C1- Jefferson Fracture: Direct Vertical Force

C2- Hangman Fracture: Severe extension injury

of the neck

VERTEBRAL VENOUS PLEXUS AND PROSTATE

CARCINOMA (AND OTHER METASTATIC
DISEASE OF THE SPINE)

The longitudinal, thin-walled, valveless

vertebral venous plexus is a clinically important
structure because it communicates above with
the intracranial venous sinuses and
Boundaries:

Superiorly and inferiorly- pedicles of adjacent

vertebrae

Anteriorly- vertebral body and intervertebral

disc,

Posteriorly- articular processes and the

zygapophyseal joint between them.

At this location, the spinal nerve is vulnerable to

compression, stretching, or edematous forces
produced by abnormalities of the surrounding
structures.
The anulus fibrosus ruptures, and the nucleus
Such factors may give rise to dermatomal pain, pulposus is forced posteriorly (like toothpaste
muscle weakness, and diminished or absent out of a tube)
reflexes.

Stenosis of a cervical IVF would affect the

spinal nerve one number higher than the IVF
itself.

Narrowing of a thoracic or lumbar IVF would

CERVICAL VS LUMBAR DISC HERNIATION
affect the spinal nerve of the same number as
the affected IVF . CERVICAL:

Stenosis of the C6 IVF between the C6 and 7 Cervical disc herniations are less common than
vertebrae would influence the C7 spinal nerve, herniations in the lumbar region.
whereas narrowing of the L4 IVF between the
The most susceptible discs are those between
L4 and 5 vertebrae would affect the L4 spinal
the C5 and 6 or C6 and 7 vertebrae.
nerve.
LUMBAR:
HERNIATED INTERVERTEBRAL DISCS

The discs are very effective in resisting

compression forces.

The discs are vulnerable to sudden shocks,

particularly if the vertebral column is flexed
and the disc is undergoing degenerative
changes that favor herniation of the nucleus
pulposus.

Common in transition zones the cervicothoracic

junction and the lumbosacral junction.
Lumbar disc herniations are more common
than cervical disc herniations.

The discs affected most often are those

between the L4 and 5 vertebrae or between
the L5 vertebra and the sacrum

SPINAL CORD INJURIES

Cervical Region

- the large size of the vertebral canal

often result in the spinal cord escaping
severe injury
- Respiration ceases if the lesion occurs
above the segmental origin of the
phrenic nerves (c3, 4, and 5)

Thoracic Region

- Vertebral displacement is often

considerable, and the small size of the
vertebral canal results in severe injury
to the spinal cord

In fracture dislocations in the lumbar region,

two anatomic facts aid the patient.

◦ First, the spinal cord in the adult extends

inferiorly only to the level of about the L1
vertebra.

◦ Second, the large size of the vertebral

canal and the lumbar cistern in this region
gives the roots of the cauda equina ample
room.

Nerve injury may therefore be minimal in

this region.

Injury to the spinal cord can produce partial

or complete loss of function at the level of
the lesion and partial or complete loss of
function of afferent and efferent nerve
tracts below the level of the lesion.