Limitation of Hypertrophie Spur Formation by the Costovertebral Articulations

Publisher Website
Google Scholar
Abstract
Hypertrophic spurring of the thoracic vertebral margins is so frequently encountered in asymptomatic individuals that its presence is accepted as normal in persons over thirty years of age. The occasional patient with radicular pain in the thoracic area who concomitantly shows spur formation is more difficult to evaluate. If it is assumed that radicular pain at any level may be due to spur formation on the vertebral body, it must be postulated that the spur lies in apposition to the nerve root or its surrounding soft tissues and thereby produces pressure. In viewing roentgenograms of the thoracic spine with extensive spur formation, the radiologist may not realize the anatomic relation of the rib head, intervertebral disk, and neural foramen, and may possibly conclude that a large spur encroaching on the neural foramen is the cause of symptoms. In Gray's Anatomy the costovertebral articulation is described as a double joint with the rib head containing two facets for articulation with the depressions on the bodies of two adjacent thoracic vertebrae. These structures are held in apposition by the radial and interarticular ligaments, the latter merging with the annulus fibrosus of the intervertebral disk. The interarticular ligament attaches to the crest between the facets of the rib and divides the joint space into its upper and lower portions (Fig. 1). The position of the corresponding facets on the vertebral bodies, laterally and far posteriorly, makes radiographic demonstration difficult. Posterior extension of lateral hypertrophic spurring is likewise hard to assess. Method and Observation To test the assumption that the costovertebral articulation prevents spur formation in the posterolateral aspect of the vertebra, the right half of a thoracic spine specimen was sectioned serially from the lower half of the first thoracic vertebra through the intervertebral disk between the tenth and eleventh vertebrae (Fig. 2). Radiographs were made of the serial sections in a cephalad-caudad direction. Sections through the intervertebral foramen, the costovertebral joint, and intervertebral disk show that at no time is the intervertebral disk in direct apposition with the neural foramina. The anatomic relation from the level of the intervertebral disk below the first thoracic vertebra to that below the ninth thoracic vertebra is such that at these levels the rib heads articulate with adjoining vertebrae. Figure 3 shows the anterior level reached by the head of the second rib. Lateral spurring arising anterolaterally and terminating at the level of the rib head is seen in Figures 4 and 5, with bony deposition in the lateral aspect of the intervertebral disk in Figure 5.

This publication has 0 references indexed in Scilit: