1. VERTEBRAL COLUMN, RIBS & STERNUM
by Isabella Kung
Kaan Yücel M.D., Ph.D.
6. December.2013 Friday

2. VERTEBRAL COLUMN Vertebrae + intervertebtal (IV) discs Spine Omurga
Onurğa
Wirbelsäule
العمود الفقري
Laf dhabar
Main part of the axial skeleton
VERTEBRAL COLUMN
Mgongo

3. VERTEBRAL COLUMN from the cranium (skull) to the apex of the coccyx
¼ formed by the intervertebral (IV) discs.
IV discs separate and bind the vertebrae together.

4. VERTEBRAL COLUMN Protects the spinal cord and spinal nerves.
Supports the weight of the body superior to the level of the pelvis.
Provides a partly rigid and flexible axis for the body and an extended base on which the head is placed and pivots.
Plays an important role in posture and locomotion
(the movement from one place to another).

5. VERTEBRAE vertebrae (singular = vertebra)
separated by resilient intervertebral (IV) discs.
Vertebral column flexible

6. VERTEBRAE 33 vertebrae arranged in 5 regions 7 cervical 12 thoracic
5 lumbar
5 sacral
4 coccygeal

7. VERTEBRAE Significant motion occurs between 24 superior vertebrae.
Of the 9 inferior vertebrae, 5 sacral vertebrae fused in adults to form the sacrum
After ~ 30, the 4 coccygeal vertebrae fuse to form the coccyx

8. VERTEBRAE become larger as the vertebral column descends to the sacrum
then become progressively smaller toward apex of the coccyx

9. Structures of the vertebrae
A typical vertebra consists of
A Vertebral body
A Vertebral arch
7 processes
3-4 2 1
5-6 7

10. VERTEBRAL BODY Massive, cylndircal Anterior part of the bone
Gives strength to the vertebral column.
Supports body weight.
The size of the vertebral bodies column descends
most markedly from T4 inferiorly
As each bears progressively greater body weight.

11. VERTEBRAL ARCH Posterior to the vertebral body
Consists of two (right and left) pedicles & laminae.
VERTEBRAL ARCH

12. walls of vertebral foramen
vertebral arch + posterior surface of the vertebral body
walls of vertebral foramen

13. Succession of vertebral foramina in the articulated vertebral column
forms
vertebral canal (spinal canal)

14. Vertebral notches (Incisura vertebralis)
Indentations observed in lateral views of the vertebrae
Superior and inferior to each pedicle
Between the superior and inferior articular processes posteriorly
Between the corresponding projections of the body anteriorly.

15. The superior and inferior vertebral notches of adjacent vertebrae and the IV discs form intervertebral foramina
Intervertebral foramina
Spinal (posterior root) ganglia are located
Spinal nerves emerge from the vertebral column with their accompanying vessels through these foramina.

16. Regional Characteristics of Vertebrae
vertebrae having foramina in their transverse processes are cervical vertebrae

17. articular facets orientation in each region different
Movement needed
articular facets of thoracic vertebrae nearly vertical,
define an arc centered in the IV disc
this arrangement permits rotation and lateral flexion of the vertebral column in this region.

18. Regional variations in size and shape of the vertebral canal accommodate the varying thickness of the spinal cord.

19. between the cranium & thoracic vertebrae
CERVICAL VERTEBRAE
skeleton of the neck
between the cranium & thoracic vertebrae

20. Smallest of the 24 movable vertebrae
FEATURES TYPICAL FOR
CERVICAL VERTEBRAE
Smallest of the 24 movable vertebrae
Relatively larger intervertebral discs
discs are thin, but relative to their small size; thick.
3) Greatest range & variety of movement of all the vertebral regions
4) foramen transversarium in the transverse process

21. 5) anterior tubercles of vertebra C6 carotid tubercles
FEATURES TYPICAL FOR
CERVICAL VERTEBRAE
5) anterior tubercles of vertebra C6 carotid tubercles
Chassaignac tubercles

22. 6) Spinous processes of C3-C6 short and usually bifid in white people
FEATURES TYPICAL FOR
CERVICAL VERTEBRAE
6) Spinous processes of C3-C6
short and usually bifid in white people

23. typical cervical vertebrae
Vertebrae C3-C7
typical cervical vertebrae
Large vertebral foramina
restricted rotation
superolateral margin
uncus of the body uncinate process

24. Most prominent spinous process in 70% of people
C7- vertebra prominens
A long spinous process
Most prominent spinous process in 70% of people

25. Atlas (C1) No body No spinous process Widest of the cervical vertebrae
The kidney-shaped, concave superior articular surfaces of the lateral masses articulate with occipital condyles.

26. Anterior and posterior arches
a tubercle in the center of its external aspect
extend between the lateral masses forming a complete ring.
Posterior arch
A wide groove for the vertebral artery on its superior surface.
C1 nerve also runs in this groove.

27. strongest of the cervical vertebrae
C1, carrying the cranium,» rotates on C2 (e.g., when a person turns the head to indicate “no”).
Axis (C2)

28. Axis (C2) The distinguishing feature blunt tooth-like dens
Lies anterior to the spinal cord.
Serves as the pivot about which the rotation of the head occurs.
Axis (C2)

29. large bifid spinous process
Axis (C2)

31. THORACIC VERTEBRAE The thoracic skeleton includes:
12 pairs of ribs and associated costal cartilages
12 thoracic vertebrae and the intervertebral discs between them
Sternum

32. articulation with ribs.
FEATURES TYPICAL FOR
THORACIC VERTEBRAE
articulation with ribs.
1) Bilateral costal demifacets on the vertebral bodies
for articulation with heads of ribs
2) Costal facets on the transverse processes
for articulation with tubercles of ribs

33. greatest degree of rotation is permitted here!
FEATURES TYPICAL FOR
THORACIC VERTEBRAE
articulation with ribs.
3) Articular processes of thoracic vertebrae extend vertically
with paired, nearly coronally oriented articular facets define an arc.
greatest degree of rotation is permitted here!

34. 5) Long, inferiorly slanting spinous processes
FEATURES TYPICAL FOR
THORACIC VERTEBRAE
4) Heart-shaped bodies
5) Long, inferiorly slanting spinous processes

35. T1-T4 vertebrae share some features of cervical vertebrae.
The middle four thoracic vertebrae (T5-T8) demonstrate all the features typical of thoracic vertebrae.

36. 0.5+0.5 demifacet T1 atypical 1+0.5 1+1 costal facet
1. long, horizontal spinous process
Vertebra prominens? No.
2. complete costal facet for the 1st rib
3. demifacet for the 2nd rib.
Typical pattern
1+0.5
1+1 costal facet
@ transverse processes
demifacet

37. 0.5+0.5 demifacet 1+1 demifacet [T9]-T10 vertebrae 1+1 costal facet
No inferior demifacet
1+1 costal facet
@ transverse processes
demifacet
T11-T12 vertebrae
No transverse costal facets
1 complete facet on each side
1+1 demifacet

38. T1 T10 (T9) T12 1 COMPLETE SUP. COSTAL FACET
NO INF. COSTAL DEMIFACET
T12
1 COMPLETE COSTAL FACET
NO INF. COSTAL DEMIFACET
NO COSTAL FACET ON TRANSVERSE PROCESS

39. T12 most commonly fractured vertebra
superior half thoracic in character
costal facets & articular processes
inferior half lumbar in character
no costal facets
articular processes that permit only flexion and extension.

40. in the lower back between the thorax and sacrum
LUMBAR VERTEBRAE
in the lower back between the thorax and sacrum

41. transverse processes project posterosuperiorly as well as laterally.
FEATURES TYPICAL FOR
LUMBAR VERTEBRAE
massive bodies
transverse processes project posterosuperiorly as well as laterally.
mammillary processes & accessory processes

42. SACRUM L. sacred Wedged-shaped
Usually composed of 5 fused sacral vertebrae in adults.
Located between the hip bones
Sacral canal
continuation of the vertebral canal in the sacrum.

43. On the pelvic and posterior surfaces of the sacrum
four pairs of sacral foramina

44. Anterior projecting edge of the body of the S1 vertebra
Sacral promontory (L. mountain ridge)
important obstetrical landmark

45. The sacrum supports the vertebral column and forms the posterior part of the bony pelvis.
The sacrum is tilted so that it articulates with the L5 vertebra at the lumbosacral angle.
Eur Spine J Feb;18(2): Epub 2008 Nov 18.
Assessment of lumbosacral kyphosis in spondylolisthesis: a computer-assisted reliability study of six measurement techniques.
Glavas P, Mac-Thiong JM, Parent S, de Guise JA, Labelle H.

46. The pelvic surface of the sacrum is smooth and concave.
4 transverse lines
Fusion of the sacral vertebrae starts after age 20.

47. The dorsal surface of the sacrum
marked by five prominent longitudinal ridges.
median sacral crest
fused rudimentary spinous processes of the superior three or four sacral vertebra

48. Intermediate sacral crests fused articular processes
Lateral sacral crests tips of the transverse processes of fused sacral vertebrae

49. Inverted U-shaped sacral hiatus
Sacral cornua (L. Horns)
The sacral hiatus leads into the sacral canal.
The sacral cornua, representing the inferior articular processes of S5 vertebra, project inferiorly on each side of the sacral hiatus and are a helpful guide to its location.

50. The superior part of the lateral surface of the sacrum
auricular surface

52. tailbone;kuyruksokumu
COCCYX
tailbone;kuyruksokumu
A small triangular bone
Formed by fusion of 4 rudimentary coccygeal vertebrae.
Co1 may remain separate from the fused group.
Rudimentary articular post. surface

53. Last 3 coccygeal vertebrae often fuse during middle life
forming a beak-like coccyx
Aging- A single bone!
Muscular attachment!
No contribution to support of the body weight in standing!
Coccydynia

54. VARIATIONS IN VERTEBRAE33
32 or 34
race, gender, and developmental factors (genetic and environmental) 32 34
Lumbar sacralization

55. VARIATIONS IN VERTEBRAE
A CRANIAL SHIFT
A cervical rib articulates with C7
Rib 12 is small.
L5 partially "sacralized" .
S5 partially freed
B Common arrangement
C CAUDAL SHIFT
Rib 12 is large.
A small lumbar rib is present.
S1 partially "lumbarized" .
Co1 is incorporated into the sacrum

56. Curvatures in the Vertebral Column
1. The neck or cervical spine, curves gently inward (lordosis)
2. The mid back, or thoracic spine, curved outward (kyphosis)
3. The low back, or lumbar spine, also curves inward (lordosis)
4. Pelvic (Sacral) curvature

57. RIBS, COSTAL CARTILAGES, AND INTERCOSTAL SPACES
Ribs (L. costae) are curved, flat bones that form most of
the thoracic cage.
Remarkably light in weight yet highly resilient.
Each rib has a spongy interior containing bone marrow
(hematopoietic tissue), which forms blood cells.

58. There are three types of ribs that can be classified as
typical or atypical
True (vertebrocostal) ribs (1st-7th ribs):
They attach directly to the sternum through their own costal cartilages.
False (vertebrochondral) ribs (8th, 9th, and usually 10th ribs): Their cartilages are connected to the cartilage of the rib above them; thus their connection with the sternum is indirect.
Floating (vertebral, free) ribs (11th, 12th, and sometimes 10th ribs):
The rudimentary cartilages of these ribs do not connect even indirectly with the sternum; instead they end in the posterior abdominal musculature.

60. Typical ribs (3rd-9th) have the following components:
Head: wedge-shaped and has two facets, separated by the crest of the head; one facet for articulation with the numerically corresponding vertebra and one facet for the vertebra superior to it.
Neck: connects the head of the rib with the body at the level of the tubercle.

61. Tubercle: located at the junction of the neck and body
articulates with the corresponding transverse process of the vertebra

62. Body (shaft): thin, flat, and curved, most markedly at the costal angle where the rib turns anterolaterally.
The angle also demarcates the lateral limit of attachment of the deep back muscles to the ribs.
The concave internal surface of the body has a costal groove paralleling the inferior border of the rib, which provides some protection for the intercostal nerve and vessels.

64. Atypical ribs (1st, 2nd, and 10th-12th) are dissimilar:
The 1st rib is the broadest (i.e., its body is widest and nearly horizontal), shortest, and most sharply curved of the 7 true ribs.
A single facet on its head for articulation with the T1 vertebra only 2 transversely directed grooves crossing its superior surface for the subclavian vessels; the grooves are separated by a scalene tubercle and ridge, to which the anterior scalene muscle is attached. .

65. Main atypical feature is, the tuberosity for serratus anterior
The 2nd rib is has a thinner, less curved body and is substantially longer than the 1st rib.
Its head has two facets for articulation with the bodies of the T1 and T2 vertebrae.
Main atypical feature is, the tuberosity for serratus anterior
a rough area on its upper surfacefrom which part of that muscle originates

66. 10th-12th ribs, like the 1st rib, have only one facet on their heads and articulate with a single vertebra.
11th and 12th ribs are short and have no neck or tubercle.

67. Costal cartilages
Prolong the ribs anteriorly
Contribute to the elasticity of the thoracic wall
Provide a flexible attachment for their anterior ends (tips).
The cartilages increase in length through the first 7 and then gradually decrease. .

68. 11 intercostal spaces and 11 intercostal nerves
Separate the ribs and their costal cartilages from one another.
Named according to the rib forming the superior border of the space.
4th intercostal space lies between ribs 4 and 5.
11 intercostal spaces and 11 intercostal nerves
intercostal muscles and membranes, and two sets (main and collateral) of intercostal blood vessels and nerves
identified by the same number assigned to the space.

69. The space below the 12th rib subcostal space
Anterior ramus (branch) of spinal nerve T12 subcostal nerve .

70. widest anterolaterally widen further with inspiration
The intercostal spaces
widest anterolaterally
widen further with inspiration
further widened by extension and/or lateral flexion of the thoracic vertebral column to the contralateral side.

71. STERNUM G. sternon, chest Flat, elongated bone
Forms the middle of the anterior part of the thoracic cage.
Affords protection for mediastinal viscera in general and much of the heart in particular.

72. STERNUM
G. sternon, chest
Manubrium
Body
Xiphoid process

73. Manubrium A roughly trapezoidal bone.
Widest and thickest of the three parts of the sternum
Manubrium
L.. handle, as in the handle of a sword, with the sternal body forming the blade

74. jugular notch (suprasternal notch)
The easily palpated concave center of superior border of manubrium.
Deepened by the medial (sternal) ends of the clavicles, which are much larger than the relatively small clavicular notches in the manubrium that receive them, forming the sternoclavicular (SC) joints.

75. synchondrosis of the first rib
Inferolateral to the clavicular notch, the costal cartilage of the 1st rib is
tightly attached to the lateral border of the manubrium.
synchondrosis of the first rib

76. sternal angle
The manubrium and body of the sternum in slightly different planes manubriosternal joint sternal angle (of Louis)

77. Body of the sternum (Corpus sterni)
Longer, narrower, and thinner than the manubrium.
Located at the level of the T5-T9 vertebrae.
Its width varies because of the scalloping of its lateral borders by the costal notches. .
Gladiolus

78. Xiphoid process Smallest and most variable part of the sternum
Thin and elongated
Inferior end lies at the level of T10 vertebra.
Xiphoid process

80. Surface Anatomy: Key Landmarks
Jugular (suprasternal)notch:T2 vertebra in male, T4 in female
Sternal angle (of Louis) Th 4 vertebra
The border between superior and inferior mediastinum
Overlies the tracheal bifurcation and aortic arch
Useful for counting intercostal spaces (2nd ribs articulate here).

82. inferior limit of the central part of the thoracic cavity
Xiphoid process an important landmark in the median plane
Its junction with the sternal body at the xiphisternal joint
inferior limit of the central part of the thoracic cavity
Xiphisternal joint site of the infrasternal angle (subcostal angle) formed by the right and left costal margins
Midline marker for superior limit of the liver, central tendon of the diaphragm, inferior border of the heart.