OVERVIEW

1. Spine Bones (Cervical to Lumbar Regions)

● Cervical Spine (C1-C7):

○ C1 (Atlas): Supports the skull; allows head nodding.
○ C2 (Axis): Provides rotation of the head; has the odontoid process (dens).
○ C3-C7: Characterized by smaller vertebral bodies and larger vertebral foramina; have
transverse foramina for vertebral arteries.
● Thoracic Spine (T1-T12):
○ T1-T12: Larger vertebral bodies compared to cervical; each has facets for rib articulation.
● Lumbar Spine (L1-L5):
○ L1-L5: Largest vertebral bodies; support most of the body's weight. Have large, robust
processes for muscle attachment.

2. Blood Vessels of the Spine

● Vertebral Artery: Supplies the cervical part of the spine and the brainstem. Runs through the
transverse foramina of cervical vertebrae.
● Segmental Arteries: Supply the thoracic and lumbar regions. These include the posterior intercostal
arteries (for thoracic region) and lumbar arteries (for lumbar region).
● Great Radicular Artery (Artery of Adamkiewicz): Supplies the anterior portion of the spinal cord,
especially in the lumbar region.
● Spinal Venous Plexus: A network of veins within the vertebral canal; drains blood from the spinal cord
and vertebrae. Includes the internal and external venous plexuses.

3. Nerves Innervating the Back Muscles

● Dorsal Rami of Spinal Nerves: Innervate the intrinsic back muscles, including:
○ Erector Spinae Group (Iliocostalis, Longissimus, Spinalis)
○ Transversospinalis Group (Semispinalis, Multifidus, Rotatores)
○ Splenius Muscles (Splenius capitis, Splenius cervicis)
○ Levator Scapulae (partially)
● Thoracodorsal Nerve: Innervates the latissimus dorsi muscle. Originates from the posterior cord of the
brachial plexus (C6-C8).
● Dorsal Scapular Nerve: Innervates the rhomboid major and minor muscles. Originates from the C5
root of the brachial plexus.
● Long Thoracic Nerve: Innervates the serratus anterior muscle. Originates from the C5-C7 roots of the
brachial plexus.
● Suprascapular Nerve: Innervates the supraspinatus and infraspinatus muscles. Originates from the
upper trunk of the brachial plexus (C5-C6).
● Subscapular Nerves: Innervate the subscapularis muscle. Originates from the posterior cord of the
brachial plexus (C5-C6).

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BONES
CERVICAL VERTEBRAE [C1-C7]
● The vertebral column is composed of 33 vertebrae organized in five regions - 7 cervical, 12 thoracic, 5
lumbar, 5 sacral, and 4 coccygeal.
● The cervical vertebrae form the skeleton of the neck and they are the smallest of the 24 movable
vertebrae and are located between the cranium and thoracic vertebrae
● Their smaller size means they bear less weight than do the larger inferior vertebrae
● The most distinctive feature of each cervical vertebra is the oval foramen transversarium (transverse
foramen) in the transverse process
● The transverse processes of cervical vertebrae end laterally in two projections: an anterior tubercle and
a posterior tubercle
○ Tubercles provide attachment for a laterally placed group of cervical muscles (levator scapulae
and scalenes)

Atypical Vertebrae Characteristics [C1, C2, and C7 have atypical characteristics]

C1 - Atlas
● Does not possess a body or a spinous process
● It has an anterior and posterior arch
● It has a lateral mass on each side with articular surfaces on its upper surface for articulation with the
occipital condyles (atlanto-occipital joints) and articular surfaces on its inferior surface for articulation
with the axis (atlantoaxial joints)
C2 - Axis
● It has a peglike odontoid process (dens) that projects from the superior surface of the body
(representing the body of the atlas that has fused with the body of the axis)
C7 - Vertebra Prominens
● It has the longest spinous process and process is not bifid
● The transverse process is large but the foramen transversarium is small and transmits the vertebral
vein or veins

Typical Vertebrae Regional Characteristics [C3-C6]

The typical cervical vertebra has the following characteristics:
● The transverse process possess a foramen transversarium for the passage of the vertebral artery and
veins
○ Note that the vertebral artery passes through the transverse processes of C1-C6 but not
through C7
○ No costal facet
● The spines are short, bifid, and inclined inferiorly
● The body is small and transversely broad; no costal facets
● The vertebral foramen is large and triangular to accommodate the cervical enlargement of the spinal
cord
● The articular processes are relatively flat facets
○ Facets on superior articular processes face superiorly and posteriorly
○ Facets on inferior processes face inferiorly and anteriorly
● The interlaminar space is small

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SCAPULA
● Spine - a prominent ridge on the posterior surface that runs horizontally across the bone. It serves as
an attachment site for the trapezius and deltoid muscles
● Acromion - is an extension of the spine of the scapula that projects laterally and hangs over the
shoulder joint. It articulates with the clavicle at the acromioclavicular joint, providing attachment for the
deltoid and trapezius muscles.
● Coracoid Process - is a hook-like structure which projects anteriorly from the superior border. It serves
as an attachment point for the pectoralis minor, short head of the biceps brachii, coracobrachialis, and
the ligaments that help stabilize the shoulder joint.
● Glenoid Fossa - is a concave surface on the lateral aspect that articulates with the head of the
humerus to form the glenohumeral joint.
● Supraspinous Fossa - is a concave area above the spine on the posterior surface. This is where the
supraspinatus muscle attaches which has a key role in shoulder abduction
● Infraspinous Fossa - is a concave area below the spine on the posterior surface. This is where the
infraspinatus muscle attaches which has a key role in the lateral rotation of the shoulder

THORACIC VERTEBRAE
● There are 12 and normally, it is kyphotic
● Vertebrae from different regions are quite the same but we will discuss briefly how some of the
characteristics of the thoracic vertebrae are different
● Vertebral Body which is medium sized and valentine heart shaped
● Vertebral foramen - small and circular which are all aligned to form a continuous passageway termed
as “vertebral canal” which conveys the spinal cord and its coverings.
● Vertebral Arch - consists of a pair of cylindrical pedicles on the sides of the arch and a pair of
flattened lamina
● Transverse Processes - compared to other vertebrae, the transverse process of the thoracic vertebrae
has no foramen transversarium. All thoracic vertebrae except the lowest 2 have facets.
● Spinous Process - which is angled downward because it has to make room for the ribs. Both the
spinous and transverse processes serve as levers for attachment of muscles and ligaments
● Superior and Inferior Articular Processes - the facets on superior articular processes face posteriorly
and laterally. Facets on the inferior process face anteriorly and medially
● These parts are common to all vertebrae. So how do we identify that this is a thoracic vertebrae? The
key identification feature is that the body of the thoracic vertebrae has superior and inferior costal facets
on each posterior corner for articulation with the heads of the ribs.
● T1 and T11-12 are atypical
● T1 - full costal facet instead of a superior demifacet for the head of the first rib, plus an inferior
demifacet for the superior half of the 2nd rib. Please note the highlighted or colored parts of the pictures
kay that’s what makes them atypical.
● T11 and 12 - full costal facets bc heads of ribs 11 and 12 articulate only with their own individual
vertebrae.
LUMBAR VERTEBRA
● vertebral body is large and kidney shaped
● pedicles are strong since it carries the weight and directed backwards
● vertebral foramen is large and triangular
● transverse process is long and slender
● spinous process is short and flat and quadrangular
● superior facet is medial, facing inside
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 ● inferior facet is facing outside and lateral

BLOOD VESSELS
CERVICAL VEINS
● The vertebral veins are formed in the suboccipital triangle and drain the cervical vertebrae, spinal cord,
and some neck muscles.
● Each descends in a dense plexus around the vertebral artery through the transverse foramina of the
cervical vertebrae, and opens at the root of the neck into the brachiocephalic (innominate) vein (r, l).
● A pair of valves is found at its opening. On the right side, the vertebral vein crosses the subclavian
artery (r, l).
● The vertebral veins receive branches from the occipital veins and from the prevertebral muscles.

1. External Jugular Vein (EJV)

● Location: Runs superficially, draining into the subclavian vein.
● Major Tributaries and Drainage:
○ Superficial Temporal Vein: Drains the scalp and parts of the forehead.
○ Maxillary Vein: Drains the deep facial structures and pterygoid plexus.
○ Occipital Vein: Drains the posterior scalp.
○ Posterior Auricular Vein: Drains the posterior auricle and scalp behind the ear.
○ Facial Vein: Drains the face and deep facial structures, including the buccinator and orbicularis
oris muscles.
2. Internal Jugular Vein (IJV)
● Location: Runs deep in the neck alongside the common carotid artery and drains into the subclavian
vein to form the brachiocephalic vein.
● Major Tributaries and Drainage:
○ Sigmoid Sinus: Drains the posterior cranial fossa and gives rise to the internal jugular vein.
○ Inferior Petrosal Sinus: Drains the cavernous sinus and connects to the internal jugular vein.
○ Facial Vein: Contributes to the internal jugular vein, draining the face.
○ Lingual Vein: Drains the tongue and floor of the mouth.
○ Thyroid Veins:
■ Superior Thyroid Vein: Drains the superior portion of the thyroid gland.
■ Middle Thyroid Vein: Drains the middle portion of the thyroid gland.
■ Inferior Thyroid Vein: Drains the inferior part of the thyroid gland.
3. Subclavian Vein
● Location: Lies beneath the clavicle and joins with the internal jugular vein to form the brachiocephalic
vein.
● Major Tributaries and Drainage:
○ External Jugular Vein: Drains into the subclavian vein, contributing to the venous return from
the head and neck.
○ Cephalic Vein: Drains the upper limb and part of the shoulder.
4. Vertebral Vein
● Location: Runs alongside the vertebral artery within the transverse foramina of the cervical vertebrae.
● Major Tributaries and Drainage:
○ Deep Cervical Vein: Drains the deep neck muscles and adjacent structures.
○ Intervertebral Veins: Drain the spinal venous plexuses and vertebral bodies.
5. Deep Cervical Veins
● Location: Accompanies the deep cervical arteries and drains into the internal jugular vein.
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 ● Major Tributaries and Drainage:
○ Deep Cervical Vein: Drains the deep muscles of the neck, including the semispinalis and
splenius muscles.
○ Ascending Cervical Vein: Drains the deep muscles and some adjacent structures.

CERVICAL ARTERIES
● The vertebral arteries branch from the subclavian arteries and ascend through the foramina in the
transverse processes of the upper six cervical vertebrae, entering the skull through the foramen
magnum.
● At the lower border of the pons (inside the skull), each unites with the vertebral artery of the opposite
side to form the basilar artery.
● The basilar artery divides into right and left posterior cerebral arteries, which are connected to the
middle cerebral arteries by the posterior communicating arteries.

1. Common Carotid Artery (CCA)

● Location: Originates from the aortic arch on the left side and the brachiocephalic trunk on the right
side.
● Branches:
○ Internal Carotid Artery (ICA): Primarily supplies the brain and does not supply cervical
muscles.
○ External Carotid Artery (ECA): Supplies the majority of cervical muscles through its branches.
2. External Carotid Artery (ECA)
● Branches in the Cervical Region:
○ Superior Thyroid Artery:
■ Supply:
■ Sternohyoid and Sternothyroid Muscles: Provides the main arterial supply to
these muscles.
■ Thyrohyoid Muscle: Receives blood through its branches from the superior
thyroid artery.
○ Lingual Artery:
■ Supply:
■ Mylohyoid Muscle: Partially supplied by branches of the lingual artery.
■ Geniohyoid Muscle: Receives some supply from the lingual artery.
○ Facial Artery:
■ Supply:
■ Platysma Muscle: Receives blood through its branches.
■ Buccinator Muscle: Partial supply through branches of the facial artery.
○ Occipital Artery:
■ Supply:
■ Sternocleidomastoid Muscle (SCM): Receives some supply from the occipital
artery.
■ Trapezius Muscle: The occipital artery contributes to the blood supply, although
the main supply is from the transverse cervical artery.
○ Posterior Auricular Artery:
■ Supply:
■ Occipital Muscles: Contributes to the blood supply of the posterior auricular and
occipital regions.

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 3. Subclavian Artery
● Location: Arises from the brachiocephalic trunk on the right side and directly from the aortic arch on
the left side.
● Branches in the Cervical Region:
○ Thyrocervical Trunk:
■ Transverse Cervical Artery:
■ Supply:
■ Trapezius Muscle: Main arterial supply, critical for the function and
maintenance of the trapezius.
■ Suprascapular Artery:
■ Supply:
■ Supraspinatus Muscle: Supplies blood to the supraspinatus muscle.
■ Infraspinatus Muscle: Provides blood supply to the infraspinatus
muscle.
○ Internal Thoracic Artery:
■ Supply:
■ Upper Intercostal Muscles: Supplies the anterior intercostal branches to these
muscles.
■ Diaphragm: Contributes to the blood supply to the upper part of the diaphragm.
4. Vertebral Artery
● Location: Branches off the subclavian artery and ascends through the transverse foramina of the
cervical vertebrae.
● Supply:
○ Deep Cervical Muscles:
■ Semispinalis Capitis: Receives a portion of its blood supply from the vertebral artery.
■ Longissimus Capitis and Cervicis: Supplied in part by the vertebral artery.
○ Suboccipital Muscles:
■ Rectus Capitis Posterior Major and Minor: Receive blood supply from branches of the
vertebral artery.

MAJOR ARTERIES SUPPLYING THE THORACIC VERTEBRAE

● 1st and 2nd Posterior Intercostal Arteries: Originate from the superior intercostal artery, supply
intercostal muscles, skin, and surrounding tissues.
● 3rd to 11th Posterior Intercostal Arteries: Originate from the thoracic aorta, supply intercostal muscles,
thoracic wall, and deep back muscles.
● 12th Intercostal (Subcostal) Artery: Also originates from the thoracic aorta, supplies lower thoracic
and abdominal walls.
● Segmental Arteries (Thoracic Region): Arise from posterior intercostal arteries, supplying spinal
nerve roots through intervertebral foramina.

MAJOR VEINS DRAINING THE THORACIC VERTEBRAE

1. Azygos Vein
● Anatomy & Course: The azygos vein runs on the right side of the vertebral column, starting from the
level of the T12 vertebra. It ascends in the posterior mediastinum and arches over the root of the right
lung to empty into the superior vena cava.
● Function: The azygos vein collects blood from the posterior walls of the thorax and abdomen. It also
receives blood from the right posterior intercostal veins (except the first one or two), the esophageal
veins, mediastinal veins, and pericardial veins.
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 ● Clinical Relevance: It provides an important collateral pathway between the superior and inferior vena
cava, especially if there’s an obstruction in the vena cava.
2. Hemiazygos Vein
● Anatomy & Course: The hemiazygos vein is on the left side, inferior to the accessory hemiazygos
vein. It starts at the level of the T9 and T12 and ascends on the left side of the vertebral column. It
crosses the vertebral column around the level of the T8 to join the azygos vein.
● Function: The hemiazygos vein collects blood from the left posterior intercostal veins (usually from the
9th to 12th intercostal spaces), the esophageal veins, and mediastinal veins.
3. Accessory Hemiazygos Vein
● Anatomy & Course: The accessory hemiazygos vein is also on the left side, superior to the
hemiazygos vein. It typically starts around the 4th or 5th intercostal space, ascends, and drains the left
4th to 8th posterior intercostal veins. It usually crosses the vertebral column at the level of the 7th or 8th
thoracic vertebra to join the azygos vein.
● Function: The accessory hemiazygos vein drains blood from the left side of the thoracic wall and
usually joins the azygos vein or hemiazygos vein.
● Differences
○ Location:
● Azygos vein: Right side of the vertebral column.
● Hemiazygos vein: Left side, lower thorax.
● Accessory hemiazygos vein: Left side, upper to mid thorax.
○ Course:
● Azygos: Ascends directly on the right side.
● Hemiazygos: Ascends on the left, then crosses to join the azygos vein.
● Accessory hemiazygos: Also ascends on the left but is more superior than the
hemiazygos vein, crossing to the azygos or hemiazygos vein.
○ Drained Areas:
● Azygos: Right posterior thoracic wall, abdomen.
● Hemiazygos: Lower left posterior thoracic wall.
● Accessory hemiazygos: Upper to mid left posterior thoracic wall.
4. Posterior Intercostal Veins
● Right Side: Most of the right posterior intercostal veins drain into the azygos vein.
● Left Side:
○ Upper veins (1st to 3rd) usually drain into the left superior intercostal vein.
○ Middle veins (4th to 8th) drain into the accessory hemiazygos vein.
○ Lower veins (9th to 12th) drain into the hemiazygos vein.
5. Intervertebral Veins (Thoracic Region): Drain the spinal cord, subarachnoid space, epidural space,
and vertebral bodies.

LUMBAR ARTERIES AND VEINS

● Lumbar Veins: 4 pairs that travel posteriorly along the posterolateral abdominal wall, alongside the
corresponding lumbar arteries.
○ Drain blood from:
● Skin and Muscles of the Posterior Abdominal Wall
● Joints of the Lumbar Spine
● Deep Back Muscles in the Lumbar Region
○ Drain blood into: Ascending Lumbar Vein and Inferior Vena Cava

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 ● Lumbar Arteries: 4 branches on each side.
○ Originate from the posterolateral side of the abdominal aorta
○ Supply blood to:
■ Muscles and Skin of the Lumbar Region (quadratus lumborum, psoas minor, and psoas
major)
■ Lumbar Segments of the Spinal Cord and Posterior Abdominal Wall

VEINS & ARTERIES OF THE SCAPULA

● Major Arteries Supplying the Scapula:
○ Dorsal Scapular Artery: Supplies rhomboid muscles, latissimus dorsi, and trapezius.
○ Suprascapular Artery: Supplies supraspinatus, infraspinatus muscles, and associated joints.
○ Thoracodorsal Artery: Supplies latissimus dorsi, teres major, and serratus anterior.
● Veins Associated with the Scapula:
○ Suprascapular Vein: Drains the supraspinatus muscle.
○ Circumflex Scapular Vein: Drains the infraspinous fossa.
○ Thoracodorsal Vein: Drains the infraspinous fossa, laterally connects to the subscapular vein.

NERVES
1. Dorsal Rami of Spinal Nerves
● Intrinsic (Deep) Back Muscles: These muscles are primarily innervated by the dorsal rami of the
spinal nerves. The dorsal rami are the posterior branches of each spinal nerve and supply the deep
muscles of the back, including:
○ Erector Spinae Group (Iliocostalis, Longissimus, Spinalis)
○ Transversospinalis Group (Semispinalis, Multifidus, Rotatores)
○ Splenius Muscles (Splenius capitis and Splenius cervicis)
○ Levator Scapulae (partially involved in back movement, though more commonly associated
with shoulder movement)
2. Thoracodorsal Nerve
● Latissimus Dorsi: This nerve is a branch of the posterior cord of the brachial plexus (C6-C8) and
supplies the latissimus dorsi muscle.
3. Dorsal Scapular Nerve
● Rhomboid Major and Minor: This nerve arises from the C5 root of the brachial plexus and innervates
the rhomboid major and minor muscles.
4. Long Thoracic Nerve
● Serratus Anterior: This nerve originates from the C5-C7 roots of the brachial plexus and innervates
the serratus anterior muscle.
5. Suprascapular Nerve
● Supraspinatus and Infraspinatus: Although these muscles are primarily associated with the shoulder,
they also contribute to the movement and stabilization of the scapula and the upper back. The
suprascapular nerve originates from the upper trunk of the brachial plexus (C5-C6).
6. Subscapular Nerves
● Subscapularis: This nerve, originating from the posterior cord of the brachial plexus (C5-C6),
innervates the subscapularis muscle, which is involved in shoulder movements.

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LYMPHATIC DRAINAGE
● Nuchal & Shoulder Regions: Cervical Lymph Nodes
● Superficial Region: Axillary Lymph Nodes & Inguinal Lymph Nodes
● Deep Region: Paravertebral, Lumbar, & Intercostal Lymph Nodes
*all these pass through the Jugular Lymphatic Trunk, Lumbar Lymphatic Trunk, Cisterna Chyli, then Thoracic
Duct

DISEASE & RESEARCH

SCOLIOSIS
Siwiec, Andrzej & Domagalska-Szopa, Malgorzata & Kwiecień-Czerwieniec, Ilona & Dobrowolska, Agata &
Szopa, Andrzej. (2024). Impact of Idiopathic Scoliosis on the Cardiopulmonary Capacity of Adolescents.
Journal of Clinical Medicine. 13. 4414. 10.3390/jcm13154414.

Idiopathic Scoliosis affects cardiopulmonary capacity of adolescents.

● Study shows that Children and adolescents with mild-to-moderate scoliosis during Cardiopulmonary
Exercise Testing (CPET) exhibit a lower ventilation capacity and lower peak oxygen uptake than
healthy adolescents matched in age but are not dependent on the angle rotation of the primary spinal
curvature.
● Conclusions: Physical therapy and activity should be recommended to prevent cardiorespiratory
failure in later life in patients with scoliosis.

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