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. The vertebral column in human is divided into five regions:

- cervical

- thoracic

- lumbar

- sacral

- coccyx

The body of cervical vertebra is small, thoracic vertebra has large body whereas lumbar vertebra has the largest body.
Cervical vertebra has slender and bifid spinous process. Thoracic vertebra has thick and long spinous process. Lumbar vertebra has short and blunt spinous process.
Cervical vertebra contains large triangular vertebral foramina. Thoracic vertebra contains circular vertebral foramina. Lumbar vertebra contains small triangular vertebral foramina.
2. Intervertebral foramen is the foramen between the two vertebra formed anteriorly by vertebral body and the intervertebral disc, superiorly and inferiorly by vertebral pedicles and posteriorly by facet joint.
The contents of vertebral canal are spinal cord, spinal nerve root, spinal artery, intervertebral veins, intermeningeal nerves and transforaminal ligament.
3. There are eight cervical nerves. C1 nerve comes out from between the occipital bone and C1; C2 nerve from C1 and C2 vertebra ; C3 nerve from C2 and C3 vertebra ; C4 nerve from C3 and C4 vertebra ; C5 nerve from C4 and C5 vertebra ; C6 nerve from C5 and C6 vertebra ; C7 nerve from C6 and C7 vertebra ; C8 nerve from C7 and T1 vertebra.
There are 12 pair thoracic vertebra, five pair lumbar, five pair sacral and one pair coccygeal spinal nerve which are numbered by the vertebra above them.

4. Mr Chayne has pain and sensory loss over the deltoid and biceps and lateral side of thumb. These areas are supplied by the sensory and motor division of C5-C6 nerve. So compression of C5 -C6 nerve root has resulted in these symptoms.