Thoracic and Lumbar Spine Review

Thoracic and Lumbar Spine Review

The spinal trauma covered in this tutorial is limited to that at the thoracic and lumbar levels. Therefore, this brief review only covers the thoracic and lumbar spine. For complete coverage of the cervical spine, please refer to the Imaging Evaluation of the Cervical Spine self tutorial.

There are 12 thoracic vertebrae and 5 lumbar vertebrae. Each vertebrae can be divided into several parts.

A=Body B=Pedicle C=Superior articulating facet D=Inferior articulating facet E=Transverse process F=Spinous process G=Lamina

It may be valuable to draw a thoracic vertebra to better understand its anatomy. The drawings below show simple schematics of superior and lateral views of a thoracic vertebra.
Also note the 4 major ligaments that contribute the the stability of the spine: anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, and interspinous ligament.

One should consider the three columns of the spine for assessment of stability. The anterior column consists of the anterior longitudinal ligament and the anterior part of the vertebral body. The middle column includes the posterior vertebral body and the posterior longitudinal ligament. The posterior column consists of the pedicles, the ligamentum flavum and ther interspinous ligaments. Fractures involving only one column are stable and those involving all three are unstable.
It is important to remember that thoracic and lumbar nerve roots exit from the upper portion of the neural foramen from the vertebral level below (e.g., L4 root exits at the L4-L5 foramen).
Reference:http://www.med-ed.virginia.edu/courses/rad/ext/index.html