Lumbar Vertebrae:

• Large, Kidney-shaped bodies

• Mammillary processes

• Accessory processes

• L5 - Elliptical shaped

• Males generally hav e larger VB dimensions than Females

• Primarily composed of Cancellous Bones (spongy, trabecular) traveling vertically and horizontally

• Articular processes provide a cling mechanism that resists forward gliding and twisting of VBs

• Muscular forces acting on a vertebra are placed on the posterior elements first

• Lumbar ligaments are the primary stabilizer of the Lumbar spine While also absorbing forces and allowing smooth movement

Reflex Arcs: mechanoreceptors

• a pathway that a reflex takes in the body when stimulated

3 vertebropelvic ligaments:

• Iliolumbar ligament

• Sacrotuberous ligament (Stabilizes SI joint)

• Sacrospinous ligament

Inner body joints: joints between two adjacent vertebral bodies (IVD)

• bears loads

• Allows movement of spine

• Thick ring of fibrocartilage between al Vertebral bodies below C2 Vertebra

Annulus Fibrosus: Mae up of 15-25 concentric layers or lamellar of collagen

• Each layer’s fibers are opposite the adjacent layer. 65* vertical, then opposite

Posterior and Anterior Longitudinal Ligaments both attach to the IVD

Vertebral end plates: continuous with annulus fibrosus

• can fracture, leading to herniation

• Nutrients diffuse across vertebral endplates to achieve imhabition

Load hits Nuleosus pulposis then sends load out to annulus fibrosus

Intradiscal pressure: increases with muscle contraction, external load, posture

• Most pressure caused by lifting a box without bending knees

• Least pressure is by laying Supine

• Pressure is large when holding a load in front of the body, especially being forward

• Causes water content to decrease In ViVo

Kids have more herniation than adults due to flexibility and less cautious movement

When the spine is unloaded, pressure drops allowing water to e replaced. - Disc thickens after 5 hours

Osteophytes results from increased stress on vertebrae

Excessive degeneration leads to deterioration of Annulus Fibrosus

Herniation caused by:

• full flexion to end of range

• Delaminating of annulus fibrosis

• Repetitive motion with sedentary

Lumbar Superior Articular facets face Posteriorly and Medially. Inferior Articular facets face Anteriorly and Laterally

Apophyseal joints: where articular facets meet

• L5/S1 joints are coronal allowing rotation, resists shearing

Flexion of Lumbar spine causes Lordosis to diminish, opening Intervertebral Foramen

Extension of Lumbar spine causes Lordosis to increase, decreasing diameter of Intervertebral Foramen

Centralization - symptoms move from the distal segments of body to proximal segments

Peripheralization - Pain moves from spine to the extremities. Very bad. Symbolizes nerve issue

Lumbopelvic Rhythm: Hip-spine coordination. How the lumbar spine moves itch the Pelvis.

• the ability to flex forward and touch toes is dependent on this

• Dysfunction caused by weakened/fatigued muscles; or if the hip flexors/extensors are weak/tight to rotate pelvis posteriorly- causing spine to take full load.

McKenzie Extension: patient’s pain doesn’t travel to foot.

• Patient Lay prone, arms to the side, full extension of back, then extension on elbows

• Pain should stay in lumbar

Elongation of Collagen ast 4% causes injury

Failure of Annulus Fibrosus during torsion occurs at 12%

Sacral Base Angles: Top of the Sacral bone.

• AKA Sacrohorizonatal angle= 40*

• If out of alignment they will cause Sciatic pain

L5-S1 has the most flexion and extension on the sagittal plane than any other Lumbar vertebrae

Body doesn’t like to lateral flex due to structures in the way (ie. The ribs)

Greek terms:

• Spondylo= vertebra

• Osis= abnormal condition

• Lysis= separation

• Listhesis=Slippage

Spondylosis: Vertebra has something wrong (Osteoarthrtis, Degenerative changes, etc.)

Spondylolysis: Vertebra has defect of the Lamina between the superior and inferior Articular processes (gapping). Typically caused by repetitive stress of injury.

• 2/3 are present by the age of 7.

• The remaining 1/3 occur during adolescence usually athletes.

Spondylolisthesis: Vertebra has slipped from the adjacent. Painful due to hitting the nerves.

Retro=posteriorly

Classification of Spondylolisthesis:

• type 1- dysplasia (abnormal formation of APs)

• Type 2- Pars defect (ischmic) (stress fracture)

• Type 3 (most common) degenerative

• Type 4- post traumatic (fracture in area of the posterior elements other than Pars)

• Type 5 - Pathological (Paget’s disease, Ostogenesis imperfecta)

• Type 6 - Iatrogenic (post surgical)

Anatomy of Thoracolumbar spine ppt slides 91+ (Thoracic Spine and Thoracic Cage)

Most vertebra of any spinal region

Limit movement because of ribs

T2-T8= typical

T1, T9-T12= atypical (unique)

Vertebral size increases from superior to inferior

Kyphosis (primary curve): created and maintained y the larger superior-inferior posterior aspects of the vertebral bodies

• IVD plays a minimal role due to uniform thickness

Hyperkyphosis- too much (poor posture, emphysema, scoliosis, osteoporosis, Scheuerman’s disease)

Hypokyphosis- limited kyphosis

Scoliosis: lateral (sideways) S-shaped or C-shaped curve.

• Most common in children and teens

Causes of altered Kyphosis:

• imbalance of muscles in the upper back and neck

• Degeneration

• The pectoralis major and minor muscles, and the muscles in the back of the neck are shortened and tight

• The muscles at the back of the shoulders and upper back are weakened or stretched

Typical Thoracic vertebrae: T2-T8

• heart shaped bodies

• AP dimensions=lateral dimension

• Body is about 5X taller than the supra-adjacent disc (5:1 body:disc ratio)

• Posterior height > posterior height by 1-2mm

• AP direction is lateral

• Pedicles attach relatively high on body (no superior vertebral notch)

• 4 costal Demi-facets (2 larger superior, 2 smaller inferior)

• T5-T8 Left anterior aspect of body (Epiphyseal rim) slightly flattened due to the descending Thoracic Aorta

• Scalloped anterior margin

Thoracic TPs

• progressively shorten from T1-T12

• Projects obliquely posteriorly and lie in a more posterior plane

• Facet for articular tubercle of rib

  • T1-T6 face anterior and slightly lateral

  • T7-T12 face anterior, laterally, and superior

Vertebral Canal in Thoracic:

• More smoothly rounded than any other region

• Smaller than Cervical and Lumbar canals

• Cord is smaller in diameter than the cervical and lumbar regions

SPs:

• T1-T4 project posteriorly like Cervical

• T5-T8 project dramatically inferiorly

• T9-T12 project posteriorly like Lumbar

• Spinous Tubercle at tip

• Serve as attachment sites for many muscles and ligaments

IVFs:

• face directly lateral

• Ribs help form the anterior-inferior boundaries of T1-T10

• Spinal nerve only takes up 1/12 of IVF

IVD:

• even thickness throughout

• Upper Thoracic IVDs are thinner, providing less mobility

• Make up ~20% of height of thoracic spine

• Make up <1% of all disc protrusions

• Increased IVD degeneration occurs at the apex of scoliotic curvatures

  • Increased matrix metalloproteinase production

Apophyseal joints

• Oriented in the coronal plane with a slope that measures around 15* from vertical

  • Limits flexion and extension

• Superior articular facets face laterally by approximately 10* form coronal plane

  • Facilitates rotation

Articular Processes

• Superior APs lie about 60* to horizontal

  • Facets face posteriorly, laterally and slightly superiorly

• Inferior articular facets face anteriorly, medically and slightly inferiorly

• Z-joint capsules are similar to other regions

  • Synovial folds

  • Fewer mechanoreceptors

  • Orientation Allows significant rotation

Kinematics:

• few studies exist

  • ROM data must be interpreted with caution.

  • Neumann says:

    • 30-40 flexion

    • 20-25 extension

    • 25-30 lateral flexion

    • 30-35 rotation

  • Connection to the rib cage and the relatively thin intervertebral discs act to limit motion

• Sagittarius plane-

  • Flexion limited by bones of thoracic cage and posterior spinal ligaments

  • More flexion and extension in lower region

  • Extension limited by bony impingement of the SPs, APs and laminae

    • Lesser role is played by the ALL

• Axial plane -

  • Orientation of articular facets facilitates rotation around the axis that passes vertically through the vertebral bodies and IVDs

  • limited by rib cage and ligaments

  • Rotation diminishes in lower region

• Flexion allows IVF to open

• Extension causes IVF to compress

• Articular process orientation should allow for lateral bending range of motion

• Severely limited by attachments to the thoracic cage

Typical Ribs: 3rd-9th

• Each contains a head, neck, tubercle, and shaft

• Head articulates with 2 adjacent vertebral bodies

• Neck located between rib head and tubercle

• Tubercle has articular and non-articular components

• Shaft begins at the articular timber Lee and extends to the end of the rib

• Head contains 2 articular facets (superior and inferior)

  • Articulate with the superior costal Demi facet of the same # and the inferior costal Demi facet of the # above (5th rib is with T5 and T4)

  • Crest runs between the two articular facets

    • Intra-articular ligament attaches crest to IVD

• Neck (between head and tubercle)

  • attachment site for the costotransverse ligament and superior costotransverse ligament

• Articular portion: TP

• Tubercle:

  • Articular portion: articular facet for the joint with the transverse costal facet of the TP (same # vertebra)

  • Non-articular portion: Lateral costotransverse ligament attachment

• Shaft: located from the tubercle distally

  • Curves inferiority and anteriorly

  • Angle - sharpest anterior bend, a few cm distal to tubercle

  • Costal groove: inferior aspect of each rib; houses intercostal vein, artery, and nerve

• Costal cartilage: Composed of Fibrocartilage

  • 1st-7th attach directly to Sternum

  • 8th-10th articulate with the costal cartilage immediately above

  • Substernal angle- xiphoid process, 7t costal cartilage, and junctions of the 8th-10th costal cartilages from the angle

• Costovertebral articulations

  • Rib to vertebral bodies and IVD

  • Surrounded by fibrous articular capsule, lines with synovium

  • Ligaments involved Capsular, intraarticular and radiate

  • Thin, fibrous capsule lined by synovial membrane

  • Rib heads articulate with 2 vertebrae and an IVD

    • Crest of the head of the rib found between VB articulations

    • Intraarticular ligament

      • Attaches the rest and the IVD

    • Articular capsule surrounds each Demi facet and rib forming a synovial diathrodial gliding joint

    • Radiate ligament

    • Extends from head of rib to the 2 vertebral bodies and IVDs

  • Lateral Costotransverse ligament - aka “Ligament of tubercle”

    • Spans from non-articular tubercle of rib to the lateral TP

  • Superior Costotransverse Ligament

    • Absent at T1 rib

    • From neck of rib to TP above

    • Divided into anterior (larger) and Posterior

  • Lumbocostal Ligament

    • From inferior 12th rib shaft inferiorly to L1 TPs

• Ligaments

  • Radiate ligaments

  • Lateral costotransverse ligaments

  • Superior costotransverse ligament

  • Lumbocostal ligament

• Costocorporeal Joints:

  • Large synovial folds protrude into the costocorporeal joints

  • Free nerve endings adn mehanoreceptors in both capsule and synovial folds

  • Pain refers to midline thoracic region and anteriorly along rib

• True vs false ribs

  • 1-7 = true (vertebrosternal)

  • 8,9 and sometimes 10 = false (vertebrochondral)

  • 11, 12 and sometimes 10 = floating

Thoracic cage functions:

• protect vital organs

• Resist negative internal pressures generated be the elastic recoil of the lungs and inspiratory movements

• Provide attachment for and support the weight of the upper limbs

• Provide the anchoring attachment (origin) of many muscles that move and maintain the position of the upper limbs relative to the trunk, as well as provide the attachments for muscles of the abdomen, neck, back and respirations

Joints of the Thoracic Wall -Costovertebral, sternoclavicular

• Costovertebral: Synovial plane joint

  • Joins the head of ribs

  • Costotransverse

  • Heads of 1st, 11th and 12th ribs articulate only with vertebral body of same number

  • 11th and 12th ribs do not articulate with transverse process of vertebrae of same number

• Sternoclavicular: Saddle Type of synovial joint

  • Sternal end of clavicle with manubrium of sternum and 1st costal cartilage

  • Antrior and posterior sternoclavicular; costoclavicular

  • This joint is divided into two compartments by an articular disc

Rib motion:

• middle rotates (turns like a bucket handle)

• lower glides (moves up and Down like a pumping handle)