Cauda equina (horse’s tail): bunch of spinal nerves at the conus medullaris (contains lumbar, sacral and coccygeal spinal nerves).Conus medullaris: tapered end of spinal cord at its termination.It travels the vertebral column in the neural arch and terminates at L1/2 vertebral level in adults (元/4 at birth) and measures about 45–50 cm in adults ( Figure 4.3). The spinal cord is the specialised nerve tissue continuous with the medulla oblongata, enclosed circumferentially by the spinal meninges and suspended in the cerebrospinal fluid. Recurrent sinuvertebral nerve, which arises in the dorsal root ganglion.The peripheral annulus receives its nutrients from segmental arteries, which are branches of the aorta. In adults, most parts of the disc are avascular.Two vertebral endplates – also formed by proteoglycans and type II collagen, produce a layer of the hyaline cartilage between discs and the adjacent vertebral bodies.An inner nucleus pulposus – formed of type II collagen and proteoglycans produced by the chondrocyte-like cells, holds water within the disc.An outer annulus fibrosus – made of type I and type II collagen produced by fibroblast cells, organised as lamellae.They are important in providing structural support and helping with movement.ĭiscs are bounded anteriorly and posteriorly by the anterior and posterior longitudinal ligaments, respectively. The intervertebral discs lie between the vertebral bodies and are responsible for 25% of total height of the vertebral column. What physiological changes happen with spinal cord injury? How do you clear C-spines in a multi-trauma patient? A distance of >3 mm in adults (>7 mm in children) signifies atlanto-axial subluxation and hence the patient is at risk of cervical cord injury if manipulated. The atlanto-dens interval (predendate space) is the distance between the odontoid process and the anterior arch of the atlas. The anterior arch contains a facet which articulates with the dens of C2 (axis) and is supported by the transverse ligament which connects the two lateral masses. It has lateral masses bound by the posterior and anterior arch. Figure 4.2 Comparison of the cervical, thoracic and lumbar vertebrae.Ĭomparison of cervical, thoracic and lumbar vertebraeĪll except T11 and 12 have facets for ribsĬ1 (Atlas) has no vertebral body or spinous process. They are distinct in sizes and shapes, and the anatomy of a typical cervical, thoracic and lumbar vertebrae is summarised below. There are 33 vertebrae in the human body – seven cervical, 12 thoracic, five lumbar, five sacral and four coccygeal. Ligamentum flavum – connects the facing borders of adjacent laminae.Interspinous ligament – connects the facing borders of the adjacent spinous processes.Supraspinous ligament – connects the tips of spinous processes.The array of ligaments present posteriorly adjoining the vertebral arch, which are pierced by the needle during spinal anaesthetic, as shown in Figure 4.1, include Superior and inferior articular processes with their articular facets connect adjacent vertebral arches.The intervertebral foramina are present between the successive pedicles and transmit the spinal nerve and radicular vessels.Two laminae – between transverse process and spinous process.Two pedicles connecting the body to the transverse process.Two transverse processes – posterolateral projections.Vertebral body – anterior and weight bearing.The primary and secondary curvatures give the classical sinusoidal pattern with cervical and lumbar lordosis, thoracic and pelvic kyphosis.Ī typical vertebra has a vertebral body situated anteriorly and the vertebral arch posterolaterally thereby enclosing the vertebral canal containing the spinal cord. The vertebral column is made up of seven cervical, 12 thoracic, five lumbar, five fused sacral and four fused coccygeal vertebrae (33 in total) separated by intervertebral discs.
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