Question

Case Scenario

Mr. Chan (40 years old) is a computer programmer and needs to spend long periods on computer work during daily work. He went to the clinic and complaint that he has neck pain over the past two months. He also had the feeling of pain and numbness radiate from the neck into the right shoulder and right arm, and numbness over his thumb.

Physical examination revealed pain and numbness was mainly over right deltoid and biceps brachii muscles, and over the lateral side of the thumb. Report from the magnetic resonance imaging showed that the spinal canal in his cervical vertebral column was narrowed. After initial management, the doctor sent Mr. Chan to your team for further follow up. Your supervisor told you to give Mr. Chan an introduction of the spinal structure at neck region.

Please answer according to the following guidance:

1. List the name and numbers of vertebral column in 5 regions. Compare and contrast three main characteristics of typical cervical vertebra, thoracic vertebra, and lumbar vertebra.

2. How does the intervertebral foramen formed and what contents can be found in the vertebral canal?

3. How many cervical spine nerves do we have? When a cervical spinal nerve exits the spinal cord through the intervertebral foramen, what’s the relationship of this nerve with its corresponding vertebra? How about the relationship of the spinal nerves in thoracic and lumbar regions with their corresponding vertebrae?

4. In Mr. Chan’s case, name the nerve roots which were compressed that resulted in the pain and numbness. State the reasons that support your answer.

Answer 1

1. Cervical vetebrae- 7 C1 to C7.

Thoracic vertebrae: 12 T1 to T12.

Lumbar vertebrae: 5 L1 to L5.

Sacrum vertebrae: 5 fused vertebrae S1 to S5.

Coccygeal vertebrae: can vary from 3 to 5.

2. Cervical vertebrae- contains small body, one vertebral and two transverse foramina, small transverse process.

Thoracic vertebrae: contains larger body, only one vertebral foramina, fairly large Transverse process.

Lumbar vertebrae: contains the largest body, only one vertebral foramina, large and blunt transverse process.

3. Intervertebral foramen is formed superiorly and inferiorly by vertebral pedicles, anteriorly by vertebral body and intervertebral disc and posteriorly by articular process laterally by fascia and medially by dural sleeve.

4. Comtents of vertebral foramen are root pf spinal nerve, spinal artery, communicating veins between internal and external plexus, transforaminal ligaments and recurrent meningeal nerves.

5.There are 8 pairs of cervical spinal nerves.