Chapter 2 Vertebrae 7 cervical 12 thoracic 5 lumbar 5 sacral and 4 5 coccygeal Connected by zygapophysial joints intervertebral discs and ligaments 4 curvatures Thoracic and sacral curvatures primary which form during pregnancy and the Cervical and Lumbar secondary which form after birth Scoliosis is curvature to the left or right The vertebral foramen contains the spinal cord meninges and roots and Cervical Vertebrae vessels Vertebral notches join to form the intervertebral foramen These intervertebral foramen contain nerve roots and vessels including the dorsal root ganglion The transverse foramen transmit the vertebral artery Cervical vertebrae have bifid spinous processes C1 No body 2 lateral masses Larger vertebral foramen for the odontoid process Fovea Dentis Transverse ligament C2 Large vertebral foramen bifid spinous process Dens odontoid process the facet for articulation w dens holds the dens in place o Atlas o Axis o C3 C7 Uncinate processes develop into uncovertebral joints which may lead to tearing of intervertebral discs C7 vertebra prominence 3 meningeal layers o Outer layer dura mater o Inner layer pia mater o Middle layer arachnoid mater 3 intermeningeal layers Ligaments that support the spinal cord are called the denticulate ligaments o Epidural space between the bone and the dura mater o Subdural space between the dura mater and the pia mater o Subarachnoid space between arachnoid mater and pia mater This space contains the CSF and this space is larger in certain areas called cisterns Lumbar cistern o Lies below termination of the spinal cord medullary cone o Contains the cauda equina consists of nerve roots and filum terminale The Vertebral artery has 3 parts o From origin to the transverse foramen o Ascending the transverse foraminae o Turns medially found in the suboccipital triangle Thoracic Vertebrae Heart shaped body smaller vertebral foramen Spinous process have a posteroinferion slope Costal facets articulate w ribs and form the costovertebral joints T1 T10 have costal facet on transverse process which form the costotransverse joints Lumbar Vertebrae Larger bodies triangularly shaped foramen Long and slender transverse process The spinal cord ends at L1 in adults and L3 in newborns The dura mater continues to S2 where the lumbar cistern is found location of lumbar puncture A needle is passed between L3 and L4 or L4 and L5 into the subarachnoid space Anesthetics can be given here CSF can be withdrawn here L4 location of iliac line Lumbar puncture should be done at L4 L5 in newborns to avoid injury Sacrum Promontory anterior edge of S1 Anterior sacral foraminae through which the anterior branches of the spinal nerves leave sacral canal Sacral canal cauda equina and meninges Sacral hiatus epidural anesthesia is given here to block pelvic nerves Spina Bifida failure of development and or fusion of L5 or S1 vertebrae Spina bifida cystica may be associated w meningocele or meningomyelocele may be accompanied by paralysis of limbs Some forms of spina bifida may be due to a neural tube defect when the caudal neural tube fails to close in the 4th week Folic acid may decrease chance of this Sacralization Lumbarization fusion of L5 to sacrum S1 separates from sacrum Coccyx has cornu and transverse process Intervertebral discs Bear weigh facilitate movement absorb shock No disc between C1 C2 Considered symphyses between vertebrae Anterior and posterior longitudinal ligaments keep intervertebral discs in Lowest functional disc is L5 S1 disc place Made up of annulus fibrosus outer and nucleus pulposus inner Herniation more prone in posterolateral parts because of thinner annulus Herniation most common between L3 L4 and L4 L5 Lateral herniation may result in pinched nerves lumbar disc herniation pain radiates down leg Symptoms include Sciatica weakness in dorsiflexion L5 and or plantar flexion S1 Cervical disc herniation pain in lower neck shoulders Joints and Ligaments Vertebrae allows rotation of head between superior articular facets of C1 Uncovertebral joints may lead to pathogenic cleft or even split or tear in disc Atlanto occipital articulation occipital condyles Flexion and extension are permitted by this joint Atlanto axial articulation Anterior longitudinal ligament runs down column anteriorly Posterior longitudinal ligament is connected along posterior aspect of vertebral bodies w in the vertebral canal This ligament prevents hyperflexion of the vertebral column Ligamentum flavum This ligament brings a flexed vertebral column back to erect position Apical ligament extends from head of dens to anterior border of foramen located between vertebral arches yellow appearance Alar ligaments originate from both sides of dens to lateral borders of magnum foramen magnum Vertebrobasilar Syndrome caused by artheroschlerosis of vertebral arteries in and around suboccipital triangle due to insufficient blood supply to hindbrain Chapter 7 Suboccipital triangle 1 Rectus Capitis posterior major 2 Obliquus capitis superior 3 Obliquus capitis inferior Suboccipital nerve innverates all muscles Hip Bone Ilium o Upper border iliac crest o Arcuate line lower limit of the ala extends to the iliopubic eminence Ischium Pubis o Joins pubis at inferior ramus of pubis o Lesser sciatic notch between ischial spine and ischial tuberosity o Pectineal pubis also known as pectinate line extends from the iliopubic eminence Sacrum Articulates with hip bones at the sacroiliac joints and reinforced with dorsal ventral and interosseous sacroiliac ligaments Iliolumbar and iliac crest It supports the connection of vertebrae to hip bone ligament lies between transverse process of the lumbar vertebra Ligaments of the Pelvis t between ischial spine and the sacrum converts Sacrospinous ligamen greater sciatic notch into the greater sciatic foramen which the piriformis muscle and sciatic nerve pass through Sacrotuberous These 2 ligaments cross to form the lesser sciatic foramen where the obturator internus muscle and the pudental nerve and vessels pass ligament extends between ischial tuberosity and sacrum The obturator membrane covers the obturator foramen but leaves a small canal where the obturator nerve and vessel pass through Pelvic Inlet Extends from middle of first sacral bone the promontory to the symphysis pubis It is a heart shaped border that extends from the promontory onto the ala passing at the arcuate line the iliopubic eminence the pectineal line the pubic crest and the upper border of