Fundamentals
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The axial skeleton consists of the vertebral column and skull plus the ribs and associated bones of the thorax. It is the central part of the skeleton and the appendicular skeleton attaches to it through the shoulder and pelvic girdles. The vertebral column contains 33 vertebrae in four regions; moving distally from the head, these are the 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. Vertebrae within a region are numbered in ascending order in a proximal to distal direction. The sacrum and coccyx are made up of fused vertebrae, whereas the vertebrae in the other regions are movable. The vertebral column is not simply a stack of vertebrae, but has four curved regions. The cervical curve is convex anteriorly, followed by the thoracic curve, which is concave anteriorly, the anteriorly convex lumbar curve, and the anteriorly concave pelvic curve. Since the vertebrae protect the spinal cord, injuries to this region are potentially very severe. Depending on the vertebral level at which the spinal cord is damaged, more or less of the body may be paralyzed. As a result, most sports have rules that are designed to minimize the risk of spinal cord damage. For example, American football bans tackles made with the head of the tackler as the first point of contact with the opponent. This rule was introduced after changes to protective headgear led to a large increase in cervical spine injuries because of an increase in the use of this tackling technique.
Trunk
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno in Understanding Human Anatomy and Pathology, 2018
Some basic concepts of the development of trunk musculoskeletal tissues have already been covered in Section 2.1 and Boxes 4.1 and 4.2. The axial skeleton is composed of the skull, ribs, sternum, and vertebral column (Plate 6.2). The vertebral column consists of 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 3–5 coccygeal vertebrae. This column of bones forms the axis of the body and protects the spinal cord. Cervical, thoracic, and lumbar vertebrae are easily distinguished from one another by several criteria. Generally, vertebrae from more superior regions of the vertebral column have more oval-shaped vertebral bodies and relatively larger vertebral foramina. Each vertebral foramen, through which the spinal cord runs, is bounded on the ventral (anterior) side by the vertebral body and on the dorsal (posterior) side by vertebral arch, formed by the pedicles and lamina. The shapes of the vertebral arches change over a cranio-caudal gradient that reflects their function: The main function of the upper vertebral column is to allow flexibility and movement of the neck and head, while the main function of the lower vertebral column, particularly the sacral region, is to provide support to the upper body and pelvic girdle. In fact, as will be explained below, cervical vertebra 1 (atlas) has no body at all but instead encircles the dens of cervical vertebra 2 (axis), allowing the head to rotate through a large range of motion (Plate 3.31b,c).
Neuropathic Low Back Pain
Gary W. Jay in Practical Guide to Chronic Pain Syndromes, 2016
The lumbar spine consists of five separate lumbar vertebrae and links the thoracic vertebral column to the sacrum. Each vertebra consists of a vertebral body, paired sets of transverse processes, laminas, pedicles, superior and inferior articular processes, and a single spinous process. An intervertebral foramen is formed anteriorly by the posterior aspect of the vertebral body and intervertebral disk, superiorly and inferiorly by the adjacent pedicles, and posteriorly by the superior and inferior articular processes of the respective facet joints. Each intervertebral disk consists of a centrally placed, semifluid nucleus pulposus and a peripheral, collagen-rich annulus fibrosus. The annulus is made up of strong collagen fibers that form highly ordered concentric rings and surround the disk nucleus. Each lumbar facet joint is formed by a superior articular process of the caudally positioned vertebra and an inferior articular process of the overlying adjacent vertebra. This joint is a typical synovial joint consisting of an articular cartilage, synovium, and an encapsulating fibrous capsule.
Current epidemiological profile and characteristics of traumatic cervical spinal cord injury in Nanchang, China
Published in The Journal of Spinal Cord Medicine, 2022
Fanhui Wu, Yibin Zheng, Bingkai Ren, Leiwen Huang, Dong Yang
Regarding treatment of the TCSCI patients, 660 cases received decompression and internalfixation, whereas 630 cases were treated with traction, rehabilitation therapy, hyperbaric oxygen therapy, neurotrophic medicine such as Neurotropin, hormonotherapy with methylpredniso- lone, bed rest or other non-surgical treatment. The number of patients undergoing surgery is increasing from 2012 to 2018, P = 0.02, there is considered to be statistically significant. We thought that the reasons for the increase in the proportion of surgical patients are as follows. First, the number of TCSCI patients is increasing every year. Second, cervical decompression surgery is prevalent, and surgeons pay more attention to cervical decompression surgery. The most common neurological level of TCSCI observed in the present study was C5, which accounted for 24.3% of the total 1290 cases, followed by C6 (16.8%) and C4 (13.6%). These results are in agreement with those of other studies.9,11,13 The present findings suggest that C4, C5, and C6 injuries have a high frequency. The structures of the spinal column and the mechanisms of fractures determine the injury severity and level. These results might suggest that the cervical vertebra have poor mechanical stability, and that the cervical spine is therefore more susceptible to trauma than any other areas of the vertebral column. Indeed, among the cervical vertebra, the most mobile motion segments are C4–C6, which are the most frequently injured.
Findings in ancient Egyptian mummies from tomb KV64, Valley of the Kings, Luxor, with evidence of a rheumatic disease
Published in Scandinavian Journal of Rheumatology, 2023
LM Öhrström, R Seiler, S Bickel, F Rühli
The cervical vertebrae C1–C6 (which are skeletonized and each individually separated from the rest of the vertebral column) show pathological changes, notably osteophyte formation. In particular, the dens axis is strongly affected, as well as vertebrae C4 and C5, which show considerable osteophyte formation at the anterior and posterior vertebral body (Figure 4). The spinous process of vertebra C3 is (post-mortem) fractured; the distal end is missing. The rest of the vertebral column from C7 downwards is intact and found in the anatomical position. However, the spine is malpositioned, showing a hyperkyphosis of the thoracic spine and a thoracoabdominal scoliotic deformation, which is probably due to post-mortem positioning. On the lateral radiographs, the vertebral alignment of the thoracic and lumbar spine appears to be intact, and no obvious height reduction of the vertebrae or substantial osteophytic formation is observed. On the anteroposterior projections, on the other hand, a pointed osteophytic outgrowth can be assumed at the endplate of the lumbar vertebra L2 on the right side. No obviously pathological calcifications in the surrounding soft tissues are observed. However, C7 and the proximal part of the thoracic spine are difficult to interpret in the lateral projections owing to superimposition of other anatomical structures.
Unilateral lag screw fixation of isolated non-union atlas lateral mass fracture: a new technical note
Published in British Journal of Neurosurgery, 2019
Majid Reza Farrokhi, Arash Kiani, Hamid Rezaei
Atlas fractures are usually stable which can also be unstable if they are associated with atlantoaxial ligamentous complex injury that may necessitate surgical intervention. Various conditions such as trauma, arthritis, infection or congenital malformations could make the atlantoaxial joint unstable.11,13 If cervical spinal column injuries are treated improperly, they could cause chronic pain, limitation of motion and even cervical cord injuries resulting in severe neurological impairment. The lateral mass screw fixation of atlas is a well-known described technique.19,20 This procedure is usually being performed bilaterally in combination with C2 pedicular screw fixation,21 resulting in favorable fusion outcomes. There are no reports of unilateral lag screw fixation of atlas lateral mass fracture in the literature. In this report, we successfully fixed the lateral mass fracture of atlas via a single lag screw using standard posterior approach. An important point in this study was that the distance between the fracture’s edges was significant and thus spontaneous healing and fusion could not be achieved even after immobilization. Using a lag screw provided us with the ability to successfully reduce and approximate the fracture’s edges. Considering the large fracture gap, the screw had to be inserted in full length so that the gap could be totally reduced that caused 3 mm extrusion of the screw’s tip from the anterior border of atlas.
Related Knowledge Centers
- Animal
- Cartilage
- Collagen
- Endoskeleton
- Notochord
- Vertebra
- Axial Skeleton
- Glycoprotein
- Mineralized Tissues
- Irregular Bone