1. The Back

2. Bony anatomy of the vertebral column or spine
General vertebral joints or articulations
Specific vertebral articulations
Physiological curves of the back
Muscles of the back
Suboccipital Region

3. Vertebral column Total vertebrae Movable vertebrae Fused vertebrae
Sacrum
Coccyx
Total: 33
Movable 24
Fused: 9

4. Numbers of vertebrae Cervical: Thoracic: Lumbar: Sacral: Coccygeal:

5. Variations in numbers of vertebrae
Number of cervical vertebrae is very constant in all mammals, including man
Variations in numbers of thoracic, lumbar and sacral vertebrae occur in about 5% of otherwise average people

6. Common variations Sacralization of the 5th lumbar vertebrae
The 5th lumbar vertebrae is partly or completely incorporated into the sacrum
X-Ray: only 4 lumbar vertebrae
L5/S1 joint is strong
L4/L5 level can degenerate – often producing painful symptoms

7. Lumbarization of the 1st sacral vertebrae
1st sacral vertebrae is separated from the sacrum, and incorporated into the lumbar spine
In general, the relationship between these variations and back symptoms in the clinic is NOT clear

8. Intervertebral discs Resilient fibrocartilaginous structures
Type of joint – Secondary cartilaginous joint
Anterior articulation
Connect presacral vertebrae (C2 to S1)
No disc between:
Occiput and C1
C1 and C2
No discs in sacrum or coccyx

9. Role of discs Strongest connection between vertebrae
Important role in shock absorption

10. Posterior connection between vertebrae
For presacral vertebrae
Zygapophyseal joints
Gliding/sliding/planar type synovial joints
Zygo: yoke
-apo-: upon
-physeal: growth

11. Ligaments of the spine
There are ligaments that strengthen the connections between the vertebrae
Some extend all or most of the length of the vertebral column
Some are specific to certain joints between select vertebrae

12. Ligaments that extend the length of the vertebral column
Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Interspinous ligaments
Ligamentum nuchae and supraspinous ligament
Intertransverse ligaments

13. Anterior Longitudinal Ligament
Anterior 1/3 to ½ of anterior surface of body of vertebrae
Runs length of vertebral column from:
Sacrum
C1 (atlas) anterior tubercle
Occipital bone of skull, anterior to the foramen magnum

17. Broader and stronger than posterior longitudinal ligament Function
Firmly attached to the intervertebral discs and the periosteum of the vertebral bodies
Broader and stronger than posterior longitudinal ligament
Function
Maintain stability of joints between vertebral bodies
Help prevent what movement of vertebral column?

18. Posterior Longitudinal Ligament
Wraps around 1/3 to ½ of posterior surface of vertebral body
Runs along posterior aspect of vertebral bodies within the vertebral canal
Thicker than ALL, but narrower and weaker

19. Attachment of posterior longitudinal ligament
sacrum to C2 C1
Superiorly is continuous with tectorial membrane, which attaches to occipital bone on internal part of foramen magnum

23. Function
Help prevent posterior protrusion of the nucleus pulposus of the intervertebral discs
What movement of the vertebral column will this ligament limit?

24. Ligamentum Flavum Yellow ligament Location of ligament Function
Yellow = Elastin
Location = adjacent lamina
Functions
maintain curvature of spine
return spine after flexion

26. Interspinous ligament
Location
What is the ligament like?
Between spinous processes
Thin and membranous

28. Ligamentum nuchae and the supraspinous ligament
Attachments
Strength
Location
Ligamentum nuchae
Superior extension of supraspinous ligament
Supraspinous
Tips of spinous processes
Strong
From c7 to sacrum
Ligamentum nuchae
From Inion to c7

30. Intertransverse ligaments
Location
Description
Lumbar region
Location – between transverse processes
Cervical – few scattered fibers
Thoracic – cords with deep muscles of the back
Lumbar – thin and membranous

31. Anatomy of the vertebrae
Body - anterior
Vertebral Arch - posterior
Pedicle
Lamina
7 Processes
AKA Neural arch

34. The body of the vertebrae
Anterior part of vertebrae
AKA centrum (anatomical center)
Primary function of the body is to bear weight

35. Vertebral Arch On posterior part of the vertebrae
Function: Protect the spinal cord from injury
Formed from:
2 pedicles (little feet) – attach to body
2 lamina (thin plates) – attach to pedicles. Attach to each other at posterior

36. Vertebral Foramen Vertebral arch encloses the vertebral foramen
Vertebral canal: formed by the successive vertebral foramen
Contents of vertebral canal
Spinal cord
Meninges
Nerve roots
Blood vessels

38. Pedicles Anterior attachment Posterior attachment
Superior vertebral notch
Inferior vertebral notch
Intervertebral foramen

39. How are neural structures located within the vertebral canal and intervertebral foramen
Dorsal and ventral roots
Dorsal root ganglia
Spinal nerve

40. Processes on vertebral arch
3 lever-like
1 spinous process
2 transverse processes
4 articular processes
2 superior articular processes and facets
2 inferior articular processes and facets

41. Processes
Serve as attachment sites for muscles and ligaments to facilitate and help movement of the vertebrae
Spinous processes
Project :
From union of:
Transverse processes
Project:

42. Articular processes
Superior and inferior articular processes arise from the junction of the lamina and pedicle
The superior articular process of one vertebrae articulates with the inferior articular process of the above vertebrae

43. Processes help prevent forward moving of an upper vertebrae on a lower one, especially in thoracic and lumbar regions
The articular processes allow flexion and extension, as well as varying degrees of lateral bending and rotation in the different regions of the spine

45. How do we tell the vertebrae apart from the different levels of the spinal cord
Size of body
Size and shape of processes
Special features

46. Cervical vertebrae Main distinguishing characteristics
Transverse foramen
Bifid spinous processes
Vertebral foramen - triangular

47. Transverse Foramen Oval foramen Where are they on the vertebrae?
What travels through them?

49. Vertebral artery Comes off subclavian artery
Travels through the transverse foramen of C6 through C1
The artery then bends backward above C1, pierces the meninges, and enters the skull through the foramen magnum
Supplies rostral spinal cord, brainstem, cerebellum, and posterior cerebral cortex

50. Transverse Foramen In C7, smaller and occasionally absent
The vertebral artery DOES NOT travel through the transverse foramen of C7
If the transverse foramen is present, small accessory vertebral arteries will travel through it

51. Bifid Spinous Processes
From C2 to C6, the spinous process is often split at the end into a fork-like structure

52. Atlas First Cervical Vertebrae NO spinous process NO body
Supports the skull (Atlas in mythology)
Superior articular facets
Kidney-shaped
Concave
Articulate with occipital condyles of the skull

54. Axis Second cervical vertebrae Superior articular facets
Atlas rotates on these facets
Dens (odontoid process)

55. Dens Location: Anterior
Articulates with facets on anterior arch of atlas
Held in place
Transverse ligament
Prevents horizontal displacement of atlas
Skull and atlas rotate on axis as a unit

56. 7th Cervical vertebrae Very long spinous process
Recognizable through skin
Neck flexion
AKA vertebrae prominens

57. Review of characteristics of cervical vertebrae
Transverse foramen
Bifid spinous processes
C1 – unique
C2 – unique
C7 – long spinous process

58. Thoracic vertebrae
Long, slender spinous processes which face downward, especially in the midthoracic region
Middle thoracic vertebrae have circular vertebral foramen
All have facets on vertebral bodies for articulation with the head of a rib
Upper 10 have facets on transverse processes to articulate with tubercle of a rib

59. First thoracic vertebrae
Similar to cervical in that the spinous process is almost horizontal
How would you then tell C7 from T1

60. Thoracic vertebral superior articular processes
Face posterior and slightly upward
Would this restrict any movements?
Lateral bending
Flexion/Extension
Rotation
Anterior/Posterior shift

61. Summary of thoracic vertebrae
Spinous processes that face down
Rib facets
All have on sides of body
Upper 10 have on both body and transverse processes
Round vertebral foramen or canal
Heart-shaped body
Superior articular facets that face posterior and slightly upward

62. Lumbar vertebrae Spinous processes which are squared off
Large bodies compared to cervical and thoracic

63. Vertebral canal is more oval-shaped
Where does spinal cord end, and cauda equina begin?
L1/L2 canal more rounded than L5
Articular facets face each other in sagittal plane
How would this affect movement?

64. Sacrum 5 fused sacral vertebrae in the adult
Many of the vertebral structures exist, but they are fused together

65. Foramina
4 pairs on both the ventral and dorsal surfaces of the sacrum
For exit of the anterior and posterior primary divisions of the sacral nerves
Note that the ventral foramina are larger than the dorsal sacral foramina
4 transverse lines on the pelvic (ventral) surface that indicate where fusion of the vertebrae occurred after the 20th year

66. Superior articulating processes of the sacrum
Base of the sacrum
Superior surface of 1st sacral vertebrae
Superior articulating processes of the sacrum
Articulate with inferior articulating facets of the L5
Sacral promontory
Projecting anterior edge of the body of the first sacral vertebrae

67. Sacral hiatus The sacrum Inverted V-shaped structure On dorsal surface
Formed on each side by the sacral cornua (horns)
The sacrum
Supports the vertebral column
Forms the posterior part of the pelvis

68. Articulates with L5 at an angle
Sacrum is tilted
Articulates with L5 at an angle
Lumbosacral angle

69. Coccyx Degenerated remnant of embryonic tail 4 rudimentary vertebrae
Lower three vertebrae are just a body
1st cervical

70. Ribs Usually 12 on each side of the thorax
Each rib has a head, neck, tubercle and shaft
Head
2 facets
Vertebrae of same number
Vertebrae above
Neck – between head and tubercle

71. Ribs 1, 3 and 8

72. Tubercle Posterior surface of rib Facet: which ribs? Articulates with
On which ribs: 1 – 10
Articulates with transverse process of same numbered thoracic vertebrae

73. Shaft
Superior border
Inferior border
Angle of Rib

74. True ribs False Ribs Floating Ribs
True 1 – 7 – attach directly to sternum through their own cartilage
False 8-12 – attach to sternum through cartilage of superior rib or not at all
Floating – 11 and 12 – do not attach to sternum at all