Organisation of the Body
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| Appendicular skeleton | Bones of the upper and lower limbs
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| Axial skeleton | Skull - cranium
Vertebral column
Ribs
Sternum
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| Properties of vertebral column | Vertebrae + intervertebral discs + long and short ligaments
Central, flexible structure
Supported by muscles
Contains the spinal cord
Weightbearing axis
Transmission of weight through the spine
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| Names of different vertebral regions | 7 cervical C1-C7
12 Thoracic T1-T12
5 lumbar L1-L5
5 fused sacral - Sacrum
3-5 fused coccygeal - Coccyx
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| Curvatures of vertebral column | Cervical lordosis - secondary curvature - 15-30 degrees
Thoracic kyphosis - primary curvature - 30 degrees
Lumbar lordosis - secondary curvature - 45 degrees
Sacral kyphosis - primary curvature - 30 degrees
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| Development of curvatures | Primary curvatures develop in the fetus
Lumber lordosis - 6 months+
Cervical lordosis - when baby can support own head
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| Changes in curvature in pregnancy | Excessive lumbar lordosis in late pregnancy
Weakness of anterior abdominal wall muscles'
Due to changes in centre of gravity
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| Excessive thoracic kyphosis | Age related
Collapse of vertebral bodies (osteoporosis)
Curvature >30 degrees
IV disc disease
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| Scoliosis | Abnormal lateral curvature of the spine
Thoracic spine leans to the side
Lumbar scoliosis can also occur
Can combine to form thoraco-lumbar scoliosis
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| Development of the spine - segmentation | Crucial developmental process
Body divided into repeating segments arranged on a longitudinal axis
Axial skeleton and muscles develop from somites - segmental axial structures of embryo
Each somite forms a sclerotome (bones) and dermomyotome
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| Development of segmental structures | Resegmentation of the sclerotomes to form vertebrae
Each splits into cranial and caudal segments
Segmental spinal nerves grow to innervate the myotomes - cranial segment of sclerotome recombines with caudal segment of next sclerotome
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| Regulation of segmentation | Somites are regionally specified
HOX genes pattern the body axis - investigated in flies (leg/antenna study)
Shh gene expressed in the notochord induces somite cells to form sclerotome
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| Typical lumbar structure | Anterior - body of vertebrae
Pedicle connects body to arch
Neural arch - transverse process, lamina, spinous process
Has two articular facets to articulate with other vertebrae
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| Intervertebral joints - symphysis joints | With superior and inferior vertebrae
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| Intervertebral disc | Annulus fibrosus ring of collage covered fibrocartilage
Layers in different directions
Strong annulus limits rotation between vertebrae
Nucleus pulpsosus - glycosaminoglycans for shock absorption and weightbearing
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| Intervertebral joints - Zygapophysial joints | Plane synovial joints between superior and inferior articular processes
Each joint has restricted range of movement
Combination of all gliding and sliding movements gives a large range of movement - flexion, extension, lateral flexion, rotation etc
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| Vertebral column movements - Cervical | Articular facet joints lie on a loping, transverse plane
Rotation, flexion/extension
Small degree of lateral flexion is possible
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| Vertebral column movements - Thoracic | Articular facets lie on a coronal plane
Rotation
Limited flexion or extension due to presence of the limbs
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| Vertebral column movements - Lumbar | Articular facets aligned to a sagittal plane
Flexion and extension
Limited rotation
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| Movement at atlanto-occupital joint | Nodding
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| Movement at atlanto-axial joint | Extensive rotation
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| Long ligaments of the spine | Anterior longitudinal ligament
Posterior longitudinal ligament
Supraspinous ligament
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| Posterior Longitudinal ligament | Limits extension
From base of the skull to the anterior surface of the sacrum
Attached to intervertebral discs and vertebral bodies
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| Posterior Longitudinal ligament | Resist flexion
Acts to restore head and spine to upright position
Attached on posterior side of vertebrae
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| Supraspinous ligament | Ligamentum nuchae - between C7 and skull - strong abd thick triangle, base between occipital protuberance and foramen magnum, apex attached to spinous process of C7
Resists flexion and acts mechanically to restore the head to an upright position
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| Short ligaments of the spine | Ligamentum flavum
Interspinous ligaments
Intertransverse ligaments
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| Ligamentum flavum | Series of short ligaments
Between lamina of the neural arches of vertebrae C2-S1
Resist flexion of vertebral column
Elastic - helps to pull flexed vertebral column back into extension when flexor muscle relaxes
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| Interspinous ligaments | Between spinous processes
Blending with supraspinous ligament
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| Intertransverse ligaments | Between transverse processes
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| Atlas C1 | No body - became dens of C2
Anterior arch - articular facet for dens - transverse ligament of atlas
Transverse process with foramen transversarium
Superior articular facets - large, articulate with occipital condyle
Posterior tubercle -spinous process
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| Axis C2 | Body-large superior articular facets (articulate with inferior facets of atlas allowing rotation)
No intervertebral disc between C1 and C2
Dens - reinforced by transverse ligament of atlas and 2 alar ligaments
Transverse process
Spinous process-bifid
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| Cervical vertebrae C3-C7 | Body smaller that thoracic/lumbar
Transverse process- foramen transversarium for vertebral arteries except C7
Anterior and posterior tubercles
Spinous process-bifid
C7 - long spinous process easily palpable - vertebra prominens
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| Thoracic vertebrae | Body heart shaped
Superior and inferior costal hemi-facets for articulation with tow pairs of ribs (except final 3)
Transverse process - facet for articulation with tubercle on neck of rib at same level
Spinous process - not bifid
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| Lumbar vertebrae | Body kidney shaped
Transverse processes - long
Superior and inferior articular facets orientated to reduce rotational movement
Spinous process - square
L5 may fuse with S1 - sacralisation - leads to lower back pain
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| Sacrum | 5 fused vertebrae
Base articulate with L5
Apex points inferiorly- articulates with coccyx
Pelvic surface - 8 anterior sacral foramina
Posterior surface -8 posterior SF
Median sacral crest
Ala or wing of sacrum articulates with ilium-sacroiliac joint
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| Coccyx | 3-5 fused rudimentary vertebrae
Apex articulates with sacrum
Base
Transverse process
Coccygeal horns - cornua
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| Contents of the vertebral spinal cord | Pia mater (internal)
Subarachnoid space (contains CSF)
Arachnoid mater (middle)
Subdural space
Dura mater (outer)
Epidural space
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| Spinal nerves and Vertebral canal | C1 nerve emerges between skull and C1
C2-C7 nerves emerge above vertebral pedicles
C8 nerve below pedicle of C7
T1- Co emerge below pedicles of respective vertebrae
Spinal cord ends at L1/L2 - safe access below this
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| Termination of the spinal cord | Spinal cord ends at L1/L2 disc as conus medularis
Cauda equine (spinal nerves L2-coccygeal) in the Cerebrospinal fluid filled lumbar cistern
Dura mater tapers off at S2
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| Supracristal plane | Jacobys/Tuffiers line
Intersects the L4 vertebrae L4/5 in most individuals
Where spine can be safely accessed
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| Lumbar puncture | Skin
Subcutaneous tissue
Supraspinous ligament
Interspinous ligament
Ligamentus flavum
Epidural space
Dura matter
Subdural space
Arachnoid mater
Sub-arachnoid space - CSF collected
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| Epidural injection | Skin
Subcutaneous tissue
Supraspinous ligament
Interspinous ligament
Ligamentus flavum
Epidural space
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| Intervertebral disc herniation | Spinal nerve compression
With age nucleus pulposus moves posteriorly in the disc
Most common in lumbar region-posterolateral herniation
Impacts spinal nerves of interventricular foramen below
L4/L5 herniation - L5 nerve
L5/S1 herniation - S1 nerve
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| Sciatica | Pain and paresthesias caused by irritation or compression of sciatic nerve (L4-S3)
Irradiation from the lower back to the posterior part of the thigh, the leg and foot
Most common cause- herniated or bulging disk and lumbar/sacral nerve root compression
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| Determination of spinal level | Cervical region - C7 vertebra prominens easily palpable
Thoracic region - T12 spinous process is smaller than L1. Can also feel 12th rib
Lumbar region - Sacrum between posterior borders of iliac bones, palpate in cranial direction to find L5
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| Imaging of spine | Cannot easily see C1 as it has no body
The first visible vertebrae is therefore C2
White - CSF
Vertebrae get smaller inferiorly
Can visualise where lumbar puncture can be performed - no spinal cord
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