1. Vertebral Column

2. Osteology 7 C, 12 T, 5 L, 5 S (Fused as Sacrum), 4 coccygeal
Primary Curves
Secondary Curves
Anterior/Posterior alignment

3. Primary Curve

4. Vertebral Segments

5. A-P View

6. Secondary Curves Lateral

7. Vertebral Column

8. Osteology Typical Vertebrae Body Vertebral Arch Spinal Foramen
Superior and inferior surfaces of body (plateaus)
Thickened around the rim, location of epiphyseal plates
Cartilaginous end-plates
Vertebral Arch
Pedicles, Laminae
Transverse Processes
Spinous Process
Facets – superior articular and inferior articular
Spinal Foramen
Intervertebral Foramen

9. Typical Vertebrae

10. Typical Vertebrae

11. Typical Lumbar

12. Typical Thoracic

13. Typical C

14. Sacrum and Coccyx

15. Vertebral Relationships

16. Arthrology Intervertebral Discs Fibrocartilaginous joints
Increase in size from C to L (3mm to 9 mm)
Ratio remains the same
Make up 20-30% of length of column

17. Intervertebal Discs

18. Discs

19. Discs

20. Arthrology Two Components
Outer rim of fibrocartilage called the anulus fibrosus (attaches to cartilaginous end plate)
Connects vertebral bodies in a fibrocartilaginous joint (no capsule, little motion)

21. Arthrology Anulus encloses a central mass called the nucleus pulposus
About 80-90% water, less with increased age
Contains a mucopolysaccharide matrix
Changes shape, releases and absorbs water. Thicker in AM than PM
Neither blood vessels or nerves penetrate nucleus

22. Arthrology
Structure deforms when pressure is put on vertebral column as in weight bearing
Acts as a shock absorber
Annulus totally encloses the nucleus and keeps it under constant pressure
As you get older, the H2O content decreases and the nucleus becomes more fibrocartilaginous, therefore less easily deformable and more easily damaged

23. Arthrology
Nucleus, when under extreme pressure, can herniate or extrude from the disc in a posterior or posterior-lateral direction
Usually occurs in cervical or lumbar region
Nucleus can put pressure on spinal nerve causing refereed symptoms (motor and sensory)
Can cause pressure on cord itself if true posterior

24. Vertebral Relationships

25. Arthrology Facet Joints (Typical)
Superior articular facets of one vertebrae with inferior facets of vertebrae above
Synovial gliding joints
Surrounded by joint capsule and small capsular ligaments
The type and amount of motion in any given part of the spine is dictated by the orientation of the articular facets as well as the fluidity, elasticity and thickness of the intervertebral discs

26. Facet Joints (C and T)

27. Facets L

28. Arthrology Typical movements in sections of the spine Lumbar Thoracic
Cervical

29. Major Ligaments of the Spine
Anterior Longitudinal Ligament
Dense band along anterior and lateral surface of the vertebral bodies from C2 to sacrum
Superficial - bridge several vertebrae
Deep – short, run from V to V, blends with fibers of anulus fibrosus
Limits extension of V column
From C1 to skull, called Atlanto-Occipital Membrane

30. ALL

31. Atlanto-Occipital Membrane

32. A and P Longitudinal Ligament

33. Major Ligaments Posterior Longitudinal Ligament
Runs along posterior surface of vertebral bodies (anterior to spinal canal)
C2 to Sacrum
Short fibers attach ligament to posterior disc, reinforce disc posteriorly
Superiorly, continues to occiput, called Tectorial Membrane
Limits flexion

34. PLL

35. Tectorial Membrane

36. Ligaments Supraspinous Limits flexion
Spinous process to spinous process – tip to tip
C7 to sacrum
Limits flexion
In cervical region, becomes much thicker with a greater elastic content
Called Ligamentum Nuchae

37. Supraspinous

38. Ligamentum Nuchae

39. Ligaments Interspinous Found between spinous processes
Most well developed in lumbar region
support

40. Interspinous

41. Interspinous

42. Ligaments Ligamentum Flavum
Connects lamina of one to lamina of the other
Found from axis to sacrum
Limit flexion
Continuation to the skull is called Posterior Atlanto-Occipital membrane

43. Ligamentum Flavum

44. Atlanto-Occipital Membrane-Posterior

45. Ligaments Intertransverse Only well-developed in Lumbar Region
Between transverse processes
Limit lateral flexion

46. Special Joints of Spine
Lumbo-Sacral
L5 and S1 (or sacrum)
Drastic change from lordotic to kyphotic curve
Strong “shearing forces”
The sacral segment is inclined anteriorly and inferiorly forms an angel with the horizontal called the lumbo-sacral angle
Angle can be increased significantly with an increase in lumbar curve
During flexion/extension the greatest mobility of the spine occurs between L5 and S1

47. L5/S1

48. Lumbo-Sacral Jt.

49. L5/S1
Spondylolysis – a developmental anomaly of the lamina wherin a bony defect separates the sup. and inf. Articular processes thus separating the post. Part of the neural arch from the ant. Arch and the vertebral body
Usually asymptomatic, very common in males

50. S and S

51. L5/S1
Spondylolistheses – an anterior movement of the L5 vertebral body and can cause compression of the cauda equina which rests posteriorly

52. Sacralization
Where 5th lumbar vertebrae takes on characteristics of the sacrum and may be partially or completely fused with sacrum

53. Lumbarization
Superior aspect of the sacrum assumes characteristics of the 5th lumbar vertebrae

54. S-I Joint Review Hip Bone AKA Innominate AKA Os Coxae
Ilium, Ischium and Pubis
Fuse at Puberty
Acetabulum
Pelvis = 2 coxal bones the sacrum and coccyx

55. Innominate Bone AKA Hip

56. Sacrum

57. Pelvis

58. Female Pelvis

59. S-I
Auricular surface of ilium with auricular surface of sacrum-Little movement
Joint under relatively constant pressure to rotate anteriorly based on anatomical design
Upper part of joint is not synovial, is fibrous held in place by tough Interrosseous S-I ligaments – helps limit anterior motion

60. S-I Joint

61. S-I Joint

62. S-I Joint

63. S-I – Synovial Aspect of Joint
Major Ligaments – mostly designed to prevent ant. motion
Posterior S-I – runs down and medially from ilium to sacrum
Iliolumbar – L4 and 5 transverse processes to posterior iliac crest
Anterior S-I – ilium to sacrum
Sacrotuberous – iliac tuberosity and post. Surface of lower sacrum to ischial tuberosity
Sacrospinous – lateral borders of lower sacrum and coccyx to attach to the spine of ischium

64. S-I Joint

65. S-I Joint

66. Pubic Symphysis Anterior connection of pelvis Fibrocartilaginous joint
Limited motion
Motion increase dramatically during pregnancy, especially at the time of birth
Similar increase in SI joint mobility at this time

67. Pubic Symphysis

68. Atlanto-Axial Joint Atlas and Axis Pivot
Two convex superior facets of axis with two concave inferior facets of the atlas
Atlas also posses a facet on the internal surface of the anterior arch which articulates with the dens of the axis
Major ligaments form spine support – Ant. Atlanto-Occipital, Tectorial Membrane, Post. A-O

69. C1/C2

70. C1/C2

71. C1/C2

72. A-A Joint Alar – from dens to occiput Transverse - around dens
Cruciate
Sup. Longitudinal Band
Inferior Longitudinal Band
Transverse

73. Atlanto-Occipital Joint
Two concave superior facets of atlas articulate with two convex surfaces of occipital condyles of the skull
Supported by major ligaments
Small saddle joint
Very limited motion – nodding type motions in all directions.

74. Atlanto-Occipital

75. Atlanto-Occipital