Anatomy
Head and Neck
A 20 year old factory worker sustains a crush injury to her vertebral column whilst at work. Imaging shows swelling of the spinal cord. Which of the following structures will be trapped between the dura and the vertebral column:
Answer:
The posterior longitudinal ligament interconnects the vertebral bodies and intervertebral discs posteriorly and runs anterior to the spinal cord within the vertebral canal.Vertebral Column Ligaments
Anatomy / Head and Neck / Vertebral Column
Last Updated: 11th April 2019
Joints between vertebrae are reinforced by numerous ligaments.
Table: Ligaments of the Vertebral Column
| Ligament | Location | Function |
|---|---|---|
| Anterior longitudinal ligament | Extends from base of skull to sacrum, attached along its length to vertebral bodies anteriorly | Limits extension of vertebral column, supports annulus fibrosus anteriorly, resists gravitational pull |
| Posterior longitudinal ligament | Extends from C2 to sacrum, attached along its length to vertebral bodies posteriorly | Limits flexion of vertebral column, supports annulus fibrosus posteriorly, resists gravitational pull |
| Ligamenta flava | Pass between laminae of adjacent vertebrae | Resist separation of laminae in flexion and assist in extension back to anatomical position |
| Supraspinous ligament | Passes between and connects tips of spinous processes, extending from C7 to sacrum | Limits flexion of vertebral column |
| Ligamentum nuchae | Passes between and connects tips of spinous processes, extending from skull to spinous process of C7 | Supports head, resists flexion of neck and helps return head to anatomical position |
| Interspinous ligaments | Pass between spinous processes of adjacent vertebrae | Limit flexion of vertebral column |
Anterior Longitudinal Ligament
The anterior longitudinal ligament is attached superiorly to the base of the skull and extends inferiorly to attach to the anterior surface of the sacrum. Along its length it is attached to the vertebral bodies and intervertebral discs anteriorly. The anterior longitudinal ligament acts to limit extension of the vertebral column, support the annulus fibrosus anteriorly and resist gravitational pull.
Posterior Longitudinal Ligament
The posterior longitudinal ligament is on the posterior surface of the vertebral bodies and lines the anterior surface of the vertebral canal. It is attached along its length to the vertebral bodies and intervertebral discs posteriorly. The posterior longitudinal ligament acts to support the posterior aspect of the vertebral bodies and the annulus fibrosus and limit flexion of the vertebral column.
Ligamenta Flava
The ligamenta flava, on each side, pass between the laminae of adjacent vertebrae, forming part of the posterior surface of the vertebral canal. The ligamenta flava resist separation of the laminae in flexion and assist in extension back to the anatomical position.
Supraspinous Ligament
The supraspinous ligament connects and passes along the tips of the vertebral spinous processes from vertebra C7 to the sacrum. From vertebra C7 to the skull, the ligament is more structurally distinct and referred to as the ligamentum nuchae.
Ligamentum Nuchae
The ligamentum nuchae is attached superiorly to the skull (from the external occipital protuberance to the foramen magnum), inferiorly to the spinous process of C7 and between these two points to the spinous processes of the cervical vertebrae. The ligamentum nuchae supports the head, resists flexion and helps to return the head to the anatomical position. The ligament provides attachment for adjacent muscles.
Interspinous Ligament
The interspinous ligaments pass between adjacent vertebral spinous processes, blending posteriorly with the supraspinous ligament and anteriorly with the ligamenta flava on each side.
![Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2016/07/vertebral-ligaments.png)
Ligaments of the Vertebral Column. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
