VERTEBRAE

Introduction
The vertebrae are individual bones that make up the vertebral column, also known as the
spine or backbone. This column provides structural support for the body, allows for
movement, and protects the spinal cord. The vertebral column consists of 33 vertebrae,
categorized into different regions based on their location:

1. Cervical vertebrae (C1-C7): Located in the neck, these vertebrae support the head and
allow for its movement.

2. Thoracic vertebrae (T1-T12): These vertebrae are located in the upper and mid-back and
are attached to the ribs.

3. Lumbar vertebrae (L1-L5): Found in the lower back, these are the largest and most robust
vertebrae, supporting the weight of the body.

4. Sacral vertebrae (S1-S5): These vertebrae are fused to form the sacrum, part of the pelvis.

5. Coccygeal vertebrae (Co1-Co4): These small vertebrae form the coccyx or tailbone.

1. C1 (Atlas): The first cervical vertebra is called the atlas. It supports the skull and allows for
the nodding motion of the head (such as when you nod "yes"). The atlas has a ring-like
structure without a vertebral body, and it articulates with the second cervical vertebra, the
axis, allowing for rotation.

2. C2 (Axis): The second cervical vertebra is known as the axis. It has a peg-like projection
called the odontoid process or dens, which fits into the atlas and allows the head to rotate
(such as turning the head side to side to indicate "no"). The axis is key to enabling the
rotation of the cervical spine.
3. C3 to C6: These vertebrae have similar structures. They are more typical in shape, with a
vertebral body, a spinous process (the bony protrusion you can feel on the back of your neck),
and transverse processes for muscle attachment. These vertebrae are designed to support the
weight of the head while allowing for flexibility and a range of motion in the neck.

4. C7: The seventh cervical vertebra is known as the vertebra prominens due to its long,
prominent spinous process, which is easily felt at the base of the neck. It is the transition
point between the cervical and thoracic regions of the spine.

2. Structure:

This Photo by Unknown Author is licensed under CC BY

Vertebral body: The thoracic vertebrae have medium-sized vertebral bodies compared to the
cervical and lumbar regions. These bodies are designed to bear the weight of the upper body.
Spinous process: The spinous processes of thoracic vertebrae are typically long, sloping
downward, and are easily felt along the back. This shape helps to provide stability to the
spine
Transverse processes: These project outward from the sides of the vertebrae and provide
attachment points for muscles and ligaments.
3. Limited Range of Motion: Due to the rib attachments, the thoracic spine is less flexible
than the cervical and lumbar regions. It allows for some degree of rotation and lateral
bending, but its primary function is to support the rib cage and protect the internal organs.
4. T1: The first thoracic vertebra, T1, is unique because it connects with the first rib and
shares some features with the cervical vertebrae. It also plays a part in linking the cervical
and thoracic regions.
5. T12: The twelfth thoracic vertebra, T12, is at the transition point between the thoracic and
lumbar regions. Its structure is a blend of features from both the thoracic and lumbar
vertebrae, helping to support the lower back while still articulating with the ribs.

Key Characteristics of Lumbar Vertebrae:

This Photo by Unknown Author is licensed under CC BY-SA

1. Size and Structure:

The lumbar vertebrae have larger vertebral bodies compared to the cervical and thoracic
vertebrae. This size reflects their role in supporting the weight of the upper body, especially
when standing, walking, and lifting.

The vertebral bodies are thick and sturdy to handle the compressive forces generated by the
weight of the body and the activities of daily life.
2. Spinous Processes:

The spinous processes of the lumbar vertebrae are short, thick, and blunt, extending
horizontally. This shape provides better leverage for muscles and ligaments attached to them,
which helps stabilize the lower back and aid in movement.

3. Transverse Processes:

The transverse processes are long and project laterally from each vertebra. They provide
attachment points for muscles and ligaments that help with bending, twisting, and stabilizing
the lower back.

4. Flexibility and Movement:

The lumbar region is the most flexible section of the spine in terms of flexion (bending
forward), extension (leaning backward), and lateral bending (side to side). It is designed to
allow for a good range of motion while still maintaining stability.
The intervertebral discs between the lumbar vertebrae act as cushions, allowing for smooth
movement and reducing friction between the bones.

Key Characteristics of Sacral Vertebrae:

This Photo by Unknown Author is licensed under CC BY

1. Fusion into the Sacrum:

The five sacral vertebrae (labeled S1 to S5) fuse together during early adulthood, usually by
the age of 25 to 30, to form a single triangular-shaped bone known as the sacrum.

This fusion provides strength and stability to the pelvis and supports the weight of the upper
body when standing and moving.

2. Anatomy of the Sacrum:

The sacrum has a curved shape, which helps to distribute weight from the spine to the pelvis
and legs. It fits between the two pelvic bones (the iliac bones) to form the pelvic ring.

The sacral promontory, located at the top of the sacrum, is an important anatomical landmark,
especially in obstetrics, as it is the point where the sacrum projects forward.

3. Sacral Foramina:

The sacrum has four pairs of sacral foramina (holes) on either side. These openings allow for
the passage of nerves and blood vessels from the spinal cord to the lower body and pelvis.

4. Sacral Canal:

The sacrum contains a sacral canal that is the continuation of the vertebral canal, which
houses and protects the spinal cord. In the sacrum, the spinal cord has typically ended, but the
canal still contains nerve roots that branch out to the legs and lower body.

Common Issues:

Sacroiliac joint dysfunction: Misalignments or inflammation of the sacroiliac joints can lead
to pain in the lower back or pelvis.
Sacral fractures: Trauma to the sacrum, such as from a fall or injury, can result in fractures.
Spondylolisthesis: This condition can occur when one vertebra (like L5) slips over the
sacrum, causing instability.
The coccyx (often referred to as the tailbone) is the final segment of the vertebral column,
located at the very bottom of the spine. It consists of 3 to 5 vertebrae that are fused together
to form a single triangular-shaped bone. The coccyx is small and has a relatively minor role
compared to the other vertebrae, but it still serves important functions.

Key Characteristics of the Coccyx:

1. Structure:

The coccyx typically consists of 3 to 5 fused vertebrae, and the number of vertebrae can vary
slightly from person to person.

It has a triangular shape, with the base facing upward toward the sacrum and the apex
pointing downward.

2. Function:

The coccyx is a vestigial structure, meaning it is a remnant of a tail that was present in the
evolutionary ancestors of humans. While it no longer serves as a functional tail, it still serves
important roles in the body.

Muscle and ligament attachment: The coccyx serves as an attachment point for various
muscles, tendons, and ligaments, including those involved in the pelvic floor. It helps support
the muscles that control functions like bowel movements and urinary control.

It also serves as a point of attachment for the gluteal muscles (the muscles of the buttocks),
contributing to movements like sitting and standing.
3. Articulation:

The coccyx articulates with the sacrum at the sacrococcygeal joint. This joint is slightly
movable, allowing for limited movement of the coccyx, especially during sitting or activities
that place pressure on the pelvis.

5. Common Issues:

Coccydynia: This is a condition characterized by pain in the coccyx area, often due to trauma,
prolonged sitting on hard surfaces, or childbirth. The pain may be sharp or dull and can
worsen when sitting or standing after long periods of sitting.

Coccyx fractures: Trauma, such as falling on a hard surface, can result in a fractured or
dislocated coccyx, leading to pain and discomfort, particularly when sitting.

1. Intrinsic (Deep) Muscles of the Back

These muscles are primarily responsible for movements of the spine and maintaining its
stability. They are located deeper in the back, directly surrounding the vertebrae.
Erector Spinae Group: The erector spinae is the main group of muscles that extend along the
length of the vertebral column. It plays a key role in maintaining posture and controlling
movements such as bending backward or rotating the spine. The group consists of three
muscles:
Iliocostalis: The outermost part of the group, helping with lateral flexion and extension of the
spine.
Longissimus: The middle muscle, which helps extend and laterally flex the spine and head.
Spinalis: The closest to the vertebrae, responsible for extending the spine and helping with
posture.
Transversospinalis Group: These muscles lie deeper and connect each vertebra to the next,
helping with rotation and extension of the spine. This group includes:
Semispinalis: Extends from the thoracic region to the cervical region, helping with rotation
and extension of the spine and head.
Multifidus: Located along the spine, this muscle plays a critical role in stabilizing the
vertebrae and allowing for controlled movement.
Rotatores: These are the deepest muscles in the back and are responsible for aiding in rotation
and stabilizing the spine.
Interspinales and Intertransversarii: These are small muscles located between adjacent
vertebrae, helping with fine motor control and stabilization during movement.

2. Extrinsic (Superficial) Muscles of the Back

These muscles are more involved in movement of the upper limbs and the trunk. While they
are not directly attached to the vertebrae, they assist in the overall movement and stability of
the spine by influencing the torso and limbs.

Latissimus Dorsi: A large muscle that spans from the lower back to the upper arm. It plays a
role in shoulder movement, but it also contributes to the extension and lateral flexion of the
spine.

Trapezius: Located at the upper back and neck, this muscle helps stabilize the shoulder girdle
and assists in movements such as shrugging and extending the neck. The upper portion can
contribute to neck and upper back extension.

Rhomboid Muscles (Major and Minor): These muscles are located between the scapulae and
help retract and stabilize the shoulder blades, indirectly contributing to posture.

Levator Scapulae: This muscle lifts the scapula and plays a role in neck extension and lateral
flexion.

1. Arterial Blood Supply

The arterial blood supply to the vertebral column is derived from several key arteries that
supply the vertebrae, spinal cord, and surrounding muscles. The major arteries involved in the
blood supply to the vertebral column include:

a) Vertebral Arteries
The vertebral arteries are the primary source of blood supply to the upper cervical spine and
spinal cord. They branch from the subclavian arteries on either side of the body.

The vertebral arteries enter the cervical vertebrae through the transverse foramina (openings
in the transverse processes of the cervical vertebrae) and ascend through the neck.

The vertebral arteries provide blood to the cervical vertebrae and contribute to the blood
supply of the spinal cord, especially the upper spinal cord. They join together to form the
basilar artery, which supplies the brainstem and cerebellum.

b) Segmental Arteries

The segmental arteries branch off the aorta and provide blood to the thoracic, lumbar, and
sacral regions of the vertebral column.

These arteries include:

Intercostal arteries: These arteries supply the thoracic vertebrae. They arise from the
descending aorta and run between the ribs, providing blood to the ribs, intercostal muscles,
and spinal cord.

Lumbar arteries: These arise from the descending aorta and supply the lumbar vertebrae,
muscles of the lower back, and spinal cord.

Sacral arteries: These supply the sacrum and coccyx. The lateral sacral arteries branch from
the internal iliac arteries to provide blood to the sacrum and surrounding tissues.

c) Radicular Arteries
The radicular arteries arise from the segmental arteries and travel along the spinal nerve roots
to supply the spinal cord and the vertebral bodies. These arteries run along the nerve roots
and provide blood to the spinal cord and surrounding tissues.

Notably, the great radicular artery of Adamkiewicz is an important artery that typically arises
from the lower thoracic or upper lumbar segmental artery. It supplies a large portion of the
spinal cord, particularly the anterior spinal artery, which is critical for the blood supply to the
spinal cord's anterior and lateral columns.

2. Venous Drainage

Venous blood from the vertebral column and spinal cord is drained by a system of veins that
typically mirror the arterial supply. The primary veins involved in the venous drainage of the
vertebral column include:

a) Vertebral Veins

The vertebral veins follow the same path as the vertebral arteries and drain blood from the
cervical vertebrae and spinal cord.

These veins empty into the brachiocephalic veins at the base of the neck, which then drain
into the superior vena cava.

b) Segmental Veins

The segmental veins drain blood from the thoracic, lumbar, and sacral regions. They follow
the same path as the arteries, draining into the azygos vein and hemiazygos vein (in the
thoracic region), which ultimately drain into the superior vena cava.

c) Spinal Venous Plexus

The spinal venous plexus is a network of interconnected veins that surrounds the vertebral
column, particularly in the epidural space (the space between the dura mater and the vertebral
bones). This plexus has both anterior and posterior components and helps drain blood from
the spinal cord and vertebrae.

The venous plexus communicates with the vertebral veins and can be a pathway for the
spread of infections or tumors.

3. Epidural Venous System

The epidural venous plexus also plays a role in venous drainage. It is a system of veins that
lies in the epidural space surrounding the spinal cord. This plexus does not have valves,
making it a potential route for infections or metastatic cancer cells to spread from the pelvis
or abdomen into the spinal column.

1. Spinal Nerves

The spinal nerves originate from the spinal cord, which is protected by the vertebral column.
There are 31 pairs of spinal nerves, each emerging from the spinal cord through openings
between the vertebrae known as intervertebral foramen. These nerves serve as the primary
source of innervation for the body, including the muscles and tissues surrounding the
vertebral column.

Cervical Nerves (C1-C8): The cervical spinal nerves provide innervation to the muscles and
skin of the neck, upper back, and shoulders. They also supply the muscles of the upper limbs
and the diaphragm (via the phrenic nerve).

Thoracic Nerves (T1-T12): These nerves primarily innervate the muscles and skin of the
chest and abdomen. The thoracic spinal nerves contribute to the intercostal nerves, which
innervate the intercostal muscles and provide sensation to the skin over the ribs and chest.

Lumbar Nerves (L1-L5): These nerves supply the muscles and skin of the lower back, hips,
and legs. They contribute to nerves that control the lower limbs, including the femoral nerve
and obturator nerve.
Sacral Nerves (S1-S5): These nerves innervate the pelvic region, lower limbs, and perineum.
The sciatic nerve, one of the largest nerves in the body, emerges from the sacral region and
extends down the back of the leg, providing sensation and motor control for the lower limbs.

Coccygeal Nerve (Co1): The coccygeal nerve supplies the skin over the coccyx (tailbone) and
is responsible for providing sensation to the area.

2. Dorsal and Ventral Roots

Each spinal nerve has two main roots:

Dorsal root: This contains sensory fibres that carry information from the body to the spinal
cord (e.g., touch, pain, temperature).

Ventral root: This contains motor fibres that carry signals from the spinal cord to the muscles,
allowing for movement.

Together, the dorsal and ventral roots join to form the mixed spinal nerve, which carries both
sensory and motor signals.

3. Rami Communicants (Autonomic Nerve Supply)

The rami communicants are small nerve branches that connect the spinal nerves to the
sympathetic trunk, which is part of the autonomic nervous system. The sympathetic nervous
system helps regulate involuntary functions such as heart rate, blood pressure, and digestion.

The sympathetic trunk runs alongside the vertebral column, and the rami communicants
allow for communication between the spinal nerves and the sympathetic nervous system.

4. Sympathetic Nerve Supply

The sympathetic nerves play an important role in regulating autonomic functions and are
connected to the vertebral column through the sympathetic chain or sympathetic trunk. This
chain runs from the base of the skull to the coccyx, alongside the vertebral column.

The sympathetic fibres are involved in processes like fight-or-flight responses,

vasoconstriction (narrowing of blood vessels), and the regulation of certain internal organs.

5. Meningeal Branches (Recurrent Meningeal Nerve)

These branches are small nerves that arise from the dorsal root of the spinal nerves and travel
back toward the vertebrae to provide sensory innervation to the meninges (the protective
layers surrounding the spinal cord) and intervertebral discs. They are responsible for carrying
pain sensations from the spine, which is why conditions like herniated discs or spinal injuries
can cause significant back pain.

6. Nerve Plexuses

Several major nerve plexuses emerge from the spinal nerves and provide motor and sensory
innervation to the limbs and torso. These include:

Cervical Plexus: Formed by the first four cervical nerves (C1-C4), this plexus supplies the
skin and muscles of the neck and diaphragm (via the phrenic nerve).

Brachial Plexus: Formed by the lower cervical and upper thoracic nerves (C5-T1), this plexus
innervates the upper limbs.
Lumbar Plexus: Formed by the first four lumbar nerves (L1-L4), this plexus supplies the
lower abdomen, thighs, and legs.

Sacral Plexus: Formed by the lumbar and sacral nerves (L4-S4), this plexus provides motor
and sensory innervation to the pelvis and lower limbs, including the sciatic nerve.

7. Autonomic Nervous System (ANS) Supply

Parasympathetic fibres: These fibres arise from the sacral region (S2-S4) of the spinal cord
and contribute to the parasympathetic nervous system. These fibres help regulate rest-and-
digest activities, such as slowing heart rate and promoting digestion.

Sympathetic fibres: As mentioned, sympathetic fibres travel from the spinal cord to various
organs via the sympathetic trunk, affecting functions like heart rate, blood pressure, and
digestion.

This Photo by Unknown Author is licensed under CC BY

Clinical Anatomy of the Vertebral Column

The vertebral column is a critical structure that supports the weight of the body, protects the
spinal cord, and provides flexibility and mobility. Several clinical conditions and pathologies
can affect the vertebral column and its associated structures, including the vertebrae,
intervertebral discs, spinal cord, nerves, and muscles. Understanding the clinical anatomy of
the vertebral column is crucial for diagnosing and treating these conditions. Below are some
key clinical aspects related to the vertebral column:

1. Back Pain
Back pain is one of the most common clinical complaints associated with the vertebral
column. The causes of back pain are diverse and can include:

Muscular Strain: Overuse or improper posture can lead to muscle strain, which affects the
muscles of the back.

Herniated Disc (Disc Prolapse): A herniated or slipped disc occurs when the nucleus pulposus
(the gel-like centre of an intervertebral disc) bulges out through a tear in the annulus fibrosus
(the tough outer ring). This can compress the spinal nerves and cause pain, numbness, or
weakness, especially in the lower back or neck.

Degenerative Disc Disease: Over time, intervertebral discs can lose water content and
elasticity, leading to disc degeneration, which can cause back pain, stiffness, and limited
range of motion.

Spondylosis: This is a general term for age-related changes in the spine, including the
formation of osteophytes (bone spurs) and disc degeneration, which can lead to narrowing of
the intervertebral foramen (space where spinal nerves exit) and compression of the nerves.

Spondylolisthesis: A condition in which one vertebra slips forward over the vertebra beneath
it, causing potential compression of the spinal cord or nerves.

2. Spinal Cord Injuries

The vertebral column provides protection to the spinal cord, which is responsible for
transmitting nerve signals to and from the brain. Spinal cord injuries (SCI) can occur due to
trauma, such as a fall, motor vehicle accident, or sports injury. The severity of the injury
depends on the location and extent of damage to the spinal cord:

Cervical SCI: Injuries to the cervical region (neck) of the spinal cord can result in
quadriplegia (tetraplegia), where there is paralysis of all four limbs, and loss of function in
the respiratory muscles if the injury is high (C1-C4). A phrenic nerve injury can impair
breathing.

Thoracic SCI: Injuries to the thoracic region can lead to paraplegia, where the lower limbs
and sometimes the trunk are paralyzed, but the arms are usually preserved.

Lumbar and Sacral SCI: These injuries often affect the lower limbs and may result in partial
or complete paralysis of the legs, as well as bowel and bladder dysfunction.

3. Vertebral Fractures

Fractures of the vertebrae are often caused by trauma (e.g., motor vehicle accidents, falls) or
conditions like osteoporosis, where bones become brittle and more prone to fractures.

Compression Fracture: A type of fracture where the vertebral body collapses, often due to
osteoporosis or a fall. This can lead to pain, deformity (such as a kyphosis or "hunchback"),
and potentially nerve compression.

Burst Fracture: A more severe fracture in which the vertebral body shatters, potentially
causing damage to the spinal cord. This type of fracture can be life-threatening.

Fracture-Dislocation: A fracture in which the vertebra is displaced out of alignment, often

leading to compression or injury to the spinal cord or nerves.

आयुर्वेद में अस्थि (हड्डी) का महत्वपूर्ण िान है , क्योंकक यह शरीर की स्थिरता, सोंरचना और गकतशीलता
के कलए आर्वश्यक है। हकड्डययों कय आयुर्वेद में शरीर के कठयर अोंगयों के रूप में जाना जाता है , जय शरीर
के कर्वकिन्न अोंगयों कय सहारा दे ती हैं। आयुर्वेद में अस्थि का र्वर्णन और इसके प्रकार कय धातु (tissues) के
रूप में समझा जाता है , और यह शरीर के अन्य तत्वयों से जुडी हयती है। आयुर्वेद में अस्थि के प्रकार कय
सात प्रकारयों में बाोंटा गया है , कजनका र्वर्णन नीचे ककया गया है :

1. स्निग्धा अस्थि (Sneha Asthi)

किग्धा अस्थि र्वह हड्डी हयती है कजसमें अकधक कचकनाई और लचीलापन हयता है। यह हड्डी अकधक
सोंकुकचत नहीों हयती और इसमें शुद्ध र्वात का प्रिार्व हयता है। यह प्रकार हड्डी की सोंरचना कय लचीला
बनाता है। यह प्रकार सामान्यतः शरीर में कर्वकिन्न कायों के कलए उपययगी हयता है , और शरीर में ताकत
और लचीलापन बनाए रखता है।

2. कटु अस्थि (Katu Asthi)

कटु अस्थि र्वह हड्डी हयती है कजसमें तीव्र और तेज़ गुर् हयते हैं। इसमें कपत्त दयष का प्रिार्व ज्यादा हयता है ,
और यह हड्डी तेज़, मजबूत और सख्त हयती है। यह हड्डी शरीर में अकतररक्त ऊजाण का सोंचार करती है ,
लेककन यह थयडी कम लचीली हय सकती है ।

3. मधुर अस्थि (Madhura Asthi)

मधुर अस्थि र्वह हड्डी हयती है कजसमें कफ दयष का प्रिार्व अकधक हयता है। यह हड्डी मधुर हयती है और
शरीर में ज्यादा स्थिरता और सोंतुलन बनाए रखती है। इसकी सोंरचना ज्यादा मजबूत हयती है और यह
शरीर के ऊतकयों के कलए उपयुक्त हयती है। यह हड्डी अकधक चबी और शारीररक बल कय बढाती है।

4. स्निरुद्ध अस्थि (Viruddha Asthi)

कर्वरुद्ध अस्थि र्वह हड्डी हयती है कजसमें सिी तीन दयषयों (र्वात, कपत्त, कफ) का कमलाजुला प्रिार्व हयता है।
इस प्रकार की अस्थि में सोंतुलन न हयने के कारर् हकड्डययों की ताकत और लचीलापन अस्थिर हय सकता
है, कजससे हकड्डययों में ददण या समस्या उत्पन्न हय सकती है ।

5. शुष्क अस्थि (Shushka Asthi)

शुष्क अस्थि र्वह हड्डी हयती है जय बहुत सुखी और कठयर हयती है। इसमें र्वात दयष का प्रिार्व अकधक
हयता है, कजससे हड्डी में पयाण प्त कचकनाई नहीों हयती और र्वह आसानी से टू ट सकती है। शुष्क हकड्डयााँ
आमतौर पर अकधक मजबूत नहीों हयतीों और इनमें लचीलापन की कमी हयती है ।

6. कटु व्रण अस्थि (Katu Vran Asthi)

कटु व्रर् अस्थि र्वह हड्डी हयती है कजसमें चयट या घार्व के कारर् अकतररक्त ददण और तीव्रता हयती है। यह
हड्डी आमतौर पर व्रर् (घार्व) के कारर् अकधक समस्याओों से ग्रस्त हयती है। इसमें अक्सर तीव्र जलन,
सूजन, या ददण हय सकता है , जय कपत्त दयष से सोंबोंकधत है।

7. पुष्ट अस्थि (Pushta Asthi)

पुष्ट अस्थि र्वह हड्डी हयती है जय सोंतुकलत और मजबूत हयती है , और शरीर कय मजबूती प्रदान करती है।
इसमें कफ दयष का प्रिार्व हयता है, और यह हड्डी शरीर कय स्थिरता और मजबूती दे ती है। यह प्रकार
हड्डी के स्वास्थ्य के कलए सबसे उपयुक्त हयता है और शरीर के पयषर् के कलए जरूरी है।

कनष्कषण:

आयुर्वेद में हकड्डययों कय शरीर के महत्वपूर्ण अोंग के रूप में माना गया है , जय न केर्वल शारीररक सोंरचना
के कलए आर्वश्यक हैं, बस्थि शारीररक और मानकसक स्वास्थ्य कय िी प्रिाकर्वत करते हैं। हकड्डययों के
प्रकारयों के आधार पर आयुर्वेद में इलाज और पयषर् की प्रकिया कनधाणररत की जाती है। हकड्डययों कय स्वि
रखने के कलए उकचत आहार, जीर्वनशैली, और आयुर्वेकदक उपचारयों का पालन करना अत्योंत आर्वश्यक
है।