1. Vertebral Column & Thoracic Cage

2. A. Vertebral column – functions: 1. Vertical support for head and trunk 2. Houses & protects spinal cord 3. Enables turning and bending of the body

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4. General Characteristics B. Four curvatures – give resiliency to the back: 1) Cervical curvature – develops when a baby begins to hold its head up 2) Thoracic curvature 3) Lumbar curvature – develops when a child begins to stand 4) Sacral curvature

5. C. Typical Vertebra 1. Body – Thick, anterior portion of the bone. Longitudinal row of these bodies support the weight of the head and trunk. Form the anterior wall of the vertebral foramen 2. Pedicles – form the sides of the vertebral foramen 3. Lamina – arise from the pedicles to form the posterior aspect of the vertebral foramen. 4. Vertebral foramen – opening through which the spinal cord passes. Together the vertebral foramina form the vertebral canal, which contains the spinal cord. 5. Spinous process – formed by the fusion of the two laminae and extends posteriorly.

6. C. Typical Vertebra 6. Transverse process - located between the pedicle and the lamina and projects laterally. Muscles and ligaments attach to the spinous process and transverse processes. 7. Superior and inferior articular processes – project upward and downward from each vertebral arch; have cartilage- covered facets by which each vertebra is jointed to the vertebra above and the vertebra below.

7. C. Typical Vertebra 8. Intervertebral foramina – openings formed by notches on the inferior surface of the pedicles that align with adjacent vertebrae. These openings provide passageways for spinal nerves to exit. 9. Intervertebral discs – located between adjacent vertebrae. Consists of a tough, fibrocartilage disc (Annulus fibrosus) filled with gel-like material (Nucleus pulposus) that functions as a shock absorber. Firmly attached to the roughened upper and lower surfaces of the vertebral bodies

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9. 9 Copyright  The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Seven bones - smallest of the vertebrae, (and the densest), that comprise the neck and support the head. 1. Atlas – 1 st vertebra. Appears as a bony ring and supports the head (articulates with occipital condyles on the skull) 2. Axis - 2 nd vertebra. Has a tooth-like dens that projects upward and lies within the ring of the atlas. As the head turns side to side, the atlas pivots (rotates) around the dens. 3. Vertebra prominens – spinous process of 7 th cervical vertebra is longer and protrudes = useful landmark for locating other vertebral parts. 4. Features that distinguish cervical vertebrae from the rest are the bifid spinous processes and transverse foramina (through which arteries pass to the brain) D. CERVICAL VERTEBRAE

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11. 11 Twelve vertebrae. 1. Facets on transverse processes articulate with the ribs 2. These bones are larger and stronger than the cervical vertebrae E. THORACIC VERTEBRAE

12. F. LUMBAR VERTEBRAE The five massive lumbar vertebrae; support most of the body’s weight. 1. Have blunt spinous processes.

13. G.Sacrum 13 A triangular structure at the base of the vertebral column made up of five vertebrae fused into one bone.

14. H. COCCYX 14 The lowermost portion of the vertebral column and is composed of four fused vertebrae. 1.Moves forward when you sit down – acts as a shock absorber. 2. Auricular surface – articulates with the pelvis

15. 1. Kyphosis Exaggerated thoracic curvature (hunchback)

16. 2. Lordosis Exaggerated lumbar curvature (swayback)

17. 3. Scoliosis Abnormal lateral curvature

18. Surgical correction of scoliosis

19. 4. Herniated disc = Bulging intervertebral disc Nucleus pulposus rupturing through the annulus fibrosus Annulus fibrosis Nucleus pulposus

20. Compression of spinal cord and spinal nerves that branch out from cord – Extremely painful! 5. Laminectomy – Surgical removal of the lamina to relieve Pressure on the spinal cord.

21. Herniated intervertebral disc

22. Thoracic Cage

23. Thoracic Cage – Ribs, thoracic vertebrae, sternum, costal cartilages 23 Copyright  The McGraw-Hill Companies, Inc. Permission required for reproduction or display. A. Function: 1.Supports the pectoral girdle and arms 2.Functions in breathing 3.Protects viscera (thoracic and upper abdominal organs)

24. 24 Copyright  The McGraw-Hill Companies, Inc. Permission required for reproduction or display. B. Ribs - 12 pairs of ribs that articulate with the thoracic vertebrae. 1. true ribs – rib pairs 1-7: articulate directly with the sternum 2. false ribs – rib pairs 8-12: do not articulate with the sternum: a. Ribs 8-10 – articulate with costal cartilage of rib 7 b. floating Ribs 11-12 – no articulation on anterior end

26. 26 Copyright  The McGraw-Hill Companies, Inc. Permission required for reproduction or display. 3. Features of a typical rib: Shaft, costal groove, anterior (sternal) end, head, neck, and tubercle. 4. Articulations: a. Head articulates with the thoracic vertebra body b.Tubercle articulates with the transverse process of the thoracic vertebrae.

27. Shaft Anterior (sternal) end

28. 28 Copyright  The McGraw-Hill Companies, Inc. Permission required for reproduction or display. C. Sternum (breastbone) 1. Located along the anterior midline of the thoracic cage. 2. Three Parts: a. Manubrium (superior end)- articulates with clavicle and costal cartilage of rib 1 b. Body (middle part) – articulates with costal cartilage of ribs 2-7 c. Xiphoid process (inferior end)

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31. Flail Chest Life-threatening injury in which a part of the rib cage becomes detached from the rest of the chest wall due to multiple fractures of at least two adjacent ribs. Results in paradoxical breathing – affected portion of chest wall moves inward in inspiration and outward on expiration, (opposite of what should occur). Causes hypoxia (poor oxygenation). Requires stabilization of the affected ribs.

32. Thoracentesis (Chest Tap) The removal of fluid or air from the chest cavity using a needle or catheter. Take care to insert the needle just above the superior margin of the rib to avoid laceration of the costal (rib) artery.

34. 1. cervical curvature 2. thoracic curvature 3. lumbar curvature 4. sacral (pelvic) curvature 5. vertebra prominens 6. rib facet 7. intervertebral disc 8. intervertebral foramina 9. sacrum 10. coccyx 11. cervical vertebrae 12. thoracic vertebrae 13. lumbar vertebrae

36. 14. cervical vertebra 15. thoracic vertebra 16. lumbar vertebra 17. bifid spinous process 18. transverse foramen 19. spinous process 20. facet that articulates with rib tubercle 21. lamina 22. body 23. pedicle

37. 24. body 25. transverse process 26. vertebral foramen 27. facet that articulates with rib head 28. superior articular facet

39. 29. Atlas 30. Axis 31. Dens of the Axis 32. Occipital condyles (skull) 33. Dens 34. Dens 35. Atlas

41. 36. Sacrum 37. coccyx 38. Sacral promontory 39. Sacral canal 40. Auricular surface 41. Ilium (hip bone)

43. 42. true ribs 43. false ribs 44. floating ribs 45. sternum 46. manubrium 47. body 48. xiphoid process 49. costal cartilage

45. 50. rib tubercle 51. shaft 52. costal groove 53. costal artery 54. neck 55. head

47. Review What passes through each of these openings: 1. Vertebral foramen 2. Transverse foramen 3. Intervertebral foramen 4. Sacral canal

48. Review Know the articulations (what connects with what): With what does the superior articular facet on a vertebra, (and the sacrum) articulate? The facets on the superior aspect of the atlas? The dens of the axis? The auricular surface on the sacrum? The tubercle of the rib? The head of the rib? The anterior end of ribs 1-7? The anterior end of ribs 8-10? The anterior end of ribs 11-12?

49. Review What is located between the bodies of adjacent vertebrae? What is their function? What is exaggerated curvature of the thoracic spine called? Exaggerated lumbar curvature? Lateral curvature of the spine? Describe a herniated (ruptured) disc. What symptoms can it cause? What is a laminectomy?

50. Review What is flail chest? What is paradoxical breathing? Why is it life-threatening? What can you do to help stabilize this out in the field? What is thoracentesis? Describe where you should guide the needle when performing a thoracentesis and why.