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Saint Louis University

School of Medicine
Dr. Laygo | Back and Upper Extremities (10/05-06/15)

VERTEBRAL COLUMN: Composition, Development and

Regional Characteristics LORDOSIS VS. KYPHOSIS
Normal: shift right to left curve
A. FUNCTION  LORDOSIS: large belly, pregnant women
1. Protective: spinal cord and nerves  Compensatory mechanism
2. Attachment for muscles and tendons  Sacral angle is pushed forward, curving the
3. Origin of pelvic/ pectoral girdle lumbar vertebrae
4. Maintenance of erect posture: supports the weight
of the body, locomotion
 Hunchback, older individuals (osteoporosis),
5. Provides a partly rigid and flexible axis for the body more in female than male
and pivot for head  Dowager’s hump

PRIMARY VS. SECONDARY  Curvature of spine in AP view (10 degrees
• Primary: present at birth curvature deviation is accepted)
 Thoracic and sacral concavity is ANTERIOR  Arm dominancy factor
 Anterior vertebral height is shorter
 Posterior vertebral height is longer producing a C
1. Number:
like curve
a. 33 in child
• Secondary b. 26 in adult
 Cervical and lumbar concavity is POSTERIOR 2. Motion: 24 vertebrae
 Develops when a child starts to lift his head and  No motion: Sacrum and coccyx
walk 3. Configuration : “double isosceles”
 Difference in height in vertebral disc 4. Parts
o Thick: anterior a. Anterior (Body): cylindrical, flat surfaced,
a. (+) Intervertebral disk
o Thin: posterior
b. Intervertebral foramen
 Development of curvature starts at 2/12 months up to b. Posterior:
10/12 years of age  Lamina
 Pedicle: arises from body as it meets the lamina
on each side
• Cervical: convex
 1 spinous process: 2 lamina meet
• Thoracic: concave
 2 transverse: junction of pedicles and
• Lumbar: convex
• Sacral: concave
 2 superior articular
 2 inferior articular
 Superior/inferior articular facet and joint
 A.ka. superior/inferior zygapophyseal
 Junction of pedicle and lamina

c. Joints
 True: intervertebral (single)
 Joint: amphiarthrodial type
 Facet joint (paired): arthrodial
 False: uncovertebral joint of Lushka (only in

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*Intervertebral foramen: spinal nerves; in between vertebral

notch 3. C7: long non-bifid spinous process (“vertebral
*Intervertebral canal: spinal cord, meninges, areolar tissues; prominens”)
continuous vertebral foramen  Vertebral prominence
 Longest spinous process
 Important landmark

A. TYPICAL (C3 to C6)
 Small body with uncinated process (Luschka
joint), downward pointing transverse process
 bifid spinous process
 Transverse process with vertebral arterial
 Anteriior tubercle of transverse process/
Chaissagnac’s tubercle: landmark for control of
carotid artery bleeding; and local anesthesia of
brachial plexus and cervical plexus via
supraclavicular approach
Part Characteristics
B. ATYPICAL Vertebral Small and wider from side to side than anteroposteriorly,
1. C1: ATLAS; body superior surface concave with uncus of body (uncinated
process); inferior surface convex
 Body joins C2; articulates with occiput Vertebral Large and triangular
 Kidney shape foramen
 With depression: NUCHAL GROOVE Transverse Transverse foramina small or absent in C7; vertebral
 Superior articular facet are concave Process arteries and accompanying venous and sympathetic
plexuses pass through foramina except C7, which
2. C2: AXIS transmits only small accessory vertebral veins; anterior
 With dens/ odontoid process projects from and posterior tubercles
the body superiorly Articular Superior facets directed superioposteriorly, inferior
 Thick spinous process o no C1-C2 process facets directed inferioanteriorly; obliquely placed facets
are most nearly horizontal in this region
intervertebral disk
Spinous Short (C3-C5) and bifid (C3-C6) process of C6 long that of
 Strongest cervical vertebra process C7 is longer (thus C7 called “vertebra prominens”)

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Part Characteristics
C. CERVICAL MOTION Vertebral Heart shaped; 1 or 2 costal facets for articulation
MOTION 0-C1 C1-C2 TOTAL RANGE body with head of rib
Flexion 10 degrees 5 degrees 60 degrees Vertebral Circular and smaller than those of cervical and
Extension 25 10 80 foramen lumbar vertebrae
Rotation 0 45 75 Transverse Long and strong and extend posterolaterally; length
Lateral Bend 5 10 45 process diminishes from T1–T12 (T1-T10 have facets for
articulation with tubercle of rib)
Articular Nearly vertical articular facets; superior facets
D. CLINICAL CORRELATION process directed posteriorly and slightly laterally; inf facets
 “pinched nerve” directed anteriorly and slightly medially
 (+) collapsed or fractured vertebral foramen Spinous Long; slope postero-inferiorly ; tips extend to level of
 transverse process of the 2 adjoining cervical process vertebral body below
vertebra compresses with each other (pinched

Hangman’s fracture – usually at C2

1. Bodies are thick and wide; broad thick posteriorly
oriented spinous process; facet oriented along
sagittal plane
2. Motion:
a) Lateral bending = 20 degrees
b) Rotation = 30 degrees
c) flex-extension= 80 degrees: in which occurs at:
75% at L5 S1; 20% at L4-L5; 5% at L1-L4
Part Characteristics
Vertebral Massive, kidney shaped when viewd superiorly
Vertebral Triangular, larger than in thoracic vertebrae and
foramen smaller than in cervical vert.
Transverse Long and slender; accessory process on posterior
Process surface of base of each process
Articular Nearly vertical facets; sup facets directed
process posteromedially; inf facets directed anteromedially;
mammillary process on posterior surface of each sup
articular processs
Spinous Short and sturdy; thick, broad, and hatchet shaped


1. Bodies increasing in size; caudally oriented spinous
process; facet joint along frontal plane; transverse
process with rib articulation (thru coastal facet)
2. Motion = minimal due to rib cage splinting
3. Clinical Correlation: rare and is correlated with
fracture and dislocation

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1. One or two bones from 4 vertebrae
2. Rudimentary tail
3. Anatomically insignificant BUT clinically problematic
(as in childbearing and fracture/dislocation)
*Coccygo-dynia – pain in coccyx region, common in elderly.

Abnormal Fusion of Vertebrae

In approximately 5% of people, L5 is partly or
completely incorporated into the sacrum (hemisacralization
and saralization of the L5 vertebra, respectively. In others, S1
is more or less separated from the sacrum and is partly or
completely fused with L5 vertebra, which is called
lumbarization of the S1 vertebra. When L5 is sacralized, the L5-
S1 level is strong and the L4-L5 degenerates, often producing
painful symptoms.

IV. SACRUM Clinical Correlations:

1. Transverse processes (ala) and bodies of S1 – S5 are I. Abnormalities in Curvature:
fused into one bone a. Scoliosis
2. Sacroiliac Joint: synovial joint; kidney-shaped; fixed to  Deviation from the normal, vertical and straight line
pelvis; and part of pelvic ring of the vertebral column
3. Motion: None  Causes an abnormal rotational and lateral curvature
of spine. Although the etiology may be
neuromuscular, it is often idiopathic in nature. The
condition may be progressive or remain the same.

b. Lordosis/Kyphosis
 Refers to the normal inward lordotic curvature of the
lumbar and cervical regions of the spine. Excessive
curvature on the back is known as lumbar
hyperlordosis, commonly called sway back, hollow
back, or saddle back (after a similar condition that
affects some horses)

 Curvature in the opposite convex direction, in the

thoracic and sacral regions is termed ‘kyphotic’.
When this curvature is excessive it is called
‘kyophosis’ or ‘hyperkyphosis’.

II. Abnormalities in Alignment (Assignment!)

a. Spondylolisthesis
 Forward displacement of a vertebra, especially the
L5, most commonly occurring after a break or
fracture. The body of the L5 may slide anteriorly on
the sacrum and overlaps the sacral promontory.

b. Spondylosis
 Degenerative disease of intervertebral discs

c. Spondylolysis
 Defect allowing part of a vertebral arch to be
separated from its body.

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* Vertebral arch - the posterior projection from the vertebral Inter-Vertebral Disk
body that surrounds the spinal canal and bears the articular, Functions:
transverse, and spinal processes. 1. Add 25% to total length of spine
2. Binds vertebra yet allow motion
III. Abnormalities in Parts 3. Contribute to formation of curvature
a. Number 4. Shock absorber during vertical loading stress
1. cervical rib
 rib arising from the anterior tubercle of the
transverse process of the 7th cervical
2. sacralization
 The distal lumbar spine, usually the 5th
lumbar spine is attached to the superior
part of the sacrum
3. Lumbarisation
 Instead of fusing with sacral segments, the
1st part of the sacrum becomes the 6th
lumbar vertebrae.

b. Anterior Segmentation
1. Hemi vertebra
 Congenital defect where the vertebral body
seems to appear like equally divided parts.
2. Wedge vertebra
 Abnormality wherein there are several
fragments or divisions of the vertebra.

c. Posterior Segmentation
1. spina bifida manifesta (“meningocoele”,
2. spina bifida occulta
 Not very apparent but there is a defect
within the spine. There is no structure that
is protruding up the spinal column.

IV. Laminectomy
 Removal of lamina, to decompress spinal cord
 Most common surgical orthopedic procedures in the
spinal column

V. Winking Owl Sign

 Metastatic necrotic sign/ sign of presence of lytic
changes seen in vertebra

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