ANATOMY OF

SPINE

Dr. Joy Saha

MD Resident, Phase-A
Physical Medicine & Rehabilitation
Dhaka Medical College Hospital
 Vertebral Column
 Vertebral column is the central, longitudinal bony pillar of
the body
 Length: Male – 70 cm
Female – 60 cm
 Composition:
33 Vertebrae divided into 5 sections & intervening
intervertebral discs
Cervical – 7
Thoracic – 12
Lumbar – 5
Sacral – 5 (Fused to form Sacrum)
Coccygeal – 4 (Fused to form Coccyx)
 Functions of Vertebral Column
 Forms the axis of the trunk
 Supports the trunk & transmits the body weight to the
pelvis & lower limbs
 Its intervertebral discs act as a shock-absorber during
running & jumping
 Supports the skull
 Provides protection to the delicate spinal cord & passage
to the spinal nerves
 Serves as surface for the attachment of the muscles
 Provides attachment to the ribs, shoulder & pelvic girdles
 Curves Of Spine
 Four natural curves  Pathologic curves

 Cervical & Lumbar spine  Scoliosis: Abnormal lateral

are Lordotic curvature
 Thoracic & Sacral spine  Kyphosis: Abnormal forward
are kyphotic curvature
 Lordosis: Abnormal backward
curvature
 Kyphoscoliosis: Abnormal
curvature both in coronal &
sagittal plane
 Line of Gravity

Line of gravity passes

↓
Odontoid process of the axis
↓
Anterior to the sacrum
↓
Posterior to the center of the hip joints
↓
Anterior to the center of knee and ankle joints

So, when the body is in standing position, the

greater part of its weight falls in front of the
vertebral column
 Spinal Mobility
Region Movement Range of Motion
Cervical Flexion 80◦
Extension 50◦
Lateral Flexion 45◦
Rotation 80◦
Thoracic Flexion 45◦
Extension 25◦
Lateral Flexion 30◦
Rotation 40◦
Lumbar Flexion 60◦
Extension 35◦
Lateral Flexion 30◦
Rotation 5◦
 Vertebrae
 General components of a vertebrae are
following……
a. Vertebral body
b. Vertebral arch
c. Foramen between body and arch
 Arch consists of….
a. Pair of pedicles
b. Pair of lamina
c. Seven processes-
1 spinous, 4 articular, 2 transverse
 Cervical Vertebrae
 Typical: C3 - C6
 Atypical: C1 (Atlas), C2 (Axis),
C7 (Vertebrae Prominens)

Typical Cervical Vertebrae

(C3 - C6)
 Foramen Transversarium present
 Small body
 Short & bifid spine
 Triangular vertebral foramen
 Atypical Cervical Vertebrae

Atlas (C1)

 Ring shaped
 Absence of body & spine
 Has short anterior arch, long
posterior arch & transverse
processes
 Axis (C2)

 Presence of dens or odontoid

process
 Transverse processes are small and
lacks anterior tubercle
 Foramen transversarium is
directed supero-laterally
 Vertebrae Prominens (C7)

 Spinous process is strong, long & not

bifid
 Transverse processes are relatively
long
 Foramen transversarium is relatively
small
 Thoracic Vertebrae
 Typical: T2 – T8
 Atypical: T1, T9 – T12

Typical Thoracic Vertebrae

 Heart shaped body

 Bears costal facets
 Small, circular vertebral foramen
 Spine is long & inclined downwords
Atypical Thoracic Vertebrae
 Lumbar Vertebrae
 Typical: L1 – L4
 Atypical: L5

Typical Lumbar Vertebrae

 The body is large & kidney shaped

 Presence of accessory & mammillary processes
 Absence of costal facets on body
 Absence of foramen transversarium
 Triangular vertebral foramen
 Thick quadrilateral spinous process
 Atypical Lumbar Vertebrae (L5)

 Body is largest
 The transverse processes are thick, short and
pyramidal in shape and attached to body and
pedicle
 Spine is short and rounded at the tip
 Sacrum

 Consists of five rudimentary vertebrae

 Fused together to form a wedge-shaped bone
 Concave anteriorly
 Have four foramina on each side
 Transmit anterior and posterior rami of the upper four
sacral nerves
 Coccyx

 The word ‘Coccyx’ is derived from the Greek word

‘Cuckoo’ - as its shape resembles ‘the bird’s beak’
 Consists of four vertebrae, fused together to form a
single bone
 Small triangular bone
 Articulates at its base with the lower end of the sacrum
 Also called Tailbone
 Intervertebral Disc
 Main structures that bind the vertebral
bodies together
 Extend from C2 to the sacrum (C1 has no
vertebral body)
 Responsible for one quarter of the length of
the vertebral column
 Each disc consists of:
Inner nucleus pulposus : A hydrophilic
gel made of protein-polysaccharide, collagen
fibres, chondroid cells and water(70%-90%)
Outer annulus fibrosus : Composed of
fibrocartilage
 Functions of Intervertebral Disc

 To keep the vertebrae separate from each other

 Act as shock absorber
 Restricted intervertebral joint motion
 Contribution to stability
 Resistance to axial, rotational and bending load
 Prolapsed Disc

 Protrusion:
The nucleus of the disc bulges against an intact annulus
 Extrusion:
The nucleus of the disc bulges through the annulus
however remains within the posterior longitudinal
ligament
 Sequestration:
The nucleus of the disc breaks through all barriers and is
free within the spinal canal
 Ligaments of Spine

 Anterior longitudinal ligament

 Posterior longitudinal ligament
 Ligamentum flavum
 Supraspinous ligament
 Interspinous ligament
 Intertransverse ligament
 Ligamentum nuchae
 Anterior Longitudinal Ligament
 Passes from the anterior surface of the body of one
vertebrae to another
 Its upper end reaches the basilar part of the occipital bone
Posterior Longitudinal Ligament
 Present on the posterior surface of the vertebral bodies
within the vertebral canal
 Its upper end reaches the body of the axis vertebrae
beyond which it is continuous with the membrana tectoria
Ligamentum Flavum
 Connect the laminae of adjacent vertebrae
 They are made up mainly of elastic tissue
 Supraspinous Ligament
 Connect the tips of the spines of vertebrae from the C7 to
the sacrum
Interspinous Ligament
 Connect the adjacent spinous processes

Intertransverse Ligament
 Connect the adjacent transverse processes

Ligamentum Nuchae
 Cervical thickening of the supraspinous & interspinous
ligaments
 Paraspinal Muscles

 The paraspinal muscles, sometimes called the erector

spinae are three muscle groups
 They are responsible for both moving & stabilizing the spine
 The erector spinae has aponeurotic attachment to the back
of the sacrum, adjacent iliac crest & lumbar spinous
processes
 As it ascends, it splits into three columns – lateral,
intermediate & medial, known as iliocostalis, longissimous
& spinalis respectively
 Joints of Spine

 Atlanto-Occipital joint
 Atlanto-Axial joint
 Intervertebral joint
 Costo-Vertebral joint
 Costo-Transverse joint
 Lumbo-Sacral joint
 Sacro-Iliac joint
 Sacro-Coccygeal joint
 Atlanto-Occipital Joint

 Articular surfaces:
Above: Convex articular surface of occipital
condyles
Below: Concave superior articular facets of
atlas
 Type: Synovial joint of ellipsoidal variety
 Movements:
Flexion ‘Yes’ movement
Extension
Lateral flexion
 Atlanto-Axial Joint

 Median Atlanto-Axial joint: Synovial joint of Pivot variety

Articular surfaces-
1. Odontoid process of axis
2. Anterior arch and transverse ligament of
atlas
 Lateral Atlanto-Axial joints: One on each
side, Plane variety
Articular surfaces-
Above: Inferior facet of the lateral mass of the atlas
Below: Superior articular facet of axis
 Movement: Rotation (‘No’ movement)
 Intervertebral Joint
 Joints between vertebral bodies:
1) Secondary cartilaginous (Intervertebral Disc)
between the bodies of adjacent vertebrae
2) Synovial (Joints of Luschka) between lateral
margins of the bodies of adjacent vertebrae
 Joints between vertebral arches:
Plane synovial (Zygapophyseal/Facet joints)
between superior & inferior articular
processes of adjacent vertebrae
 Function: Flexion, extension, lateral flexion
& axial rotation of the vertebral column
 Uncovertebral Joint
 Also called Joints of Luschka
 Lateral margins of vertebral bodies
overlap the sides of intervertebral
disc
 Articulate directly to form small
synovial joints of Plane variety
called Joints of Luschka
 Found from C3 – C7 vertebrae only
 These are not true joints
 The osteophytes commonly occur in
these joints compress cervical nerve roots
 Facet Joint
 Also called Zygapophyseal Joints
 Articular Surfaces: Between superior &
inferior articular processes of adjacent
vertebrae. Articular surfaces are covered
by hyalin cartilage & capsular ligament
surrounds the joints.
 Type: Synovial joints of Plane variety
 Movement: Flexion, extension & twisting
motion of spine
 Osteoarthritis (OA) of the spine involves
the facet joints, commonly in older
people
 Costo-Vertebral Joint Costo-Transverse
Joint
 Articulation of articular facets  Junction at which the neck &
on the head of the ribs & tubercle of a given rib are
costal facets on the body of united with the transverse
thoracic vertebrae process of its corresponding
 Type: Synovial joint of Plane thoracic vertebrae
variety  Type: Synovial joint of Plane
 Movement: Pump-handle or variety
bucket-handle movements  Movement: Gliding movements
during breathing
 Lumbo-Sacral Joint Sacro-Coccygeal
Joint
 Articulation between L5 &  Articulation between sacrum
S1 & coccyx
 An intervertebral disc joint  Type: Secondary
Type: Secondary cartilaginous cartilaginous (Symphysis)
(Symphysis)  Movement:
 Two facet joints Passive flexion & extension
Type: Synovial joint Plane
variety
 Movement: Flexion, extension
& lateral flexion
 Sacroiliac Joint

 Articular surfaces: Between the

articular surfaces of sacrum & iliam
 Type: Synovial joint of Plane variety
 Movement: Slight gliding and rotatory
movements
 Function: Bear the weight of the axial
skeleton & transfer it to the hip bones
 Sacroilitis commonly found in ankylosing
spondylitis
 Clinical Anatomy

Spondylosis

 Refers to degenerative disease of the

intervertebral disc &/or the
zygapophyseal/facet joints.
 The natural lordotic curves of the spinal
column where maximum range of motion
occurs at the C5 to C7 & L3 to L5 level
predispose these segments to accelerated
degenerative changes.
 Spondylosis is the most common cause of neck
& low back pain in patients aged over 40
years.
 Spondylolisthesis

 Refers to anterior displacement of a

vertebral body in relation to the vertebral
body below it.
 Spondylolisthesis is always an abnormal
finding & is pathognomonic of structural &
functional failure of the neural arch & facet
joints, which are responsible for maintaining
normal vertebral alignment.
 Commonest site of spondylolisthesis is
between L5 & S1 vertebrae.
 Retrolisthesis

 Retrolisthesis is the posterior

displacement of one vertebral body with
respect to the subjacent vertebrae
 It occurs in cervical or lumbar spine
 It is a rare joint dysfunction
 Spondylolysis

 Spondylolysis results from nonunion of stress

fractures of the pars interarticularis that are
acquired during childhood & adolescence.
 Spondylolysis most commonly occurs at the
L5 vertebrae, where 70% to 90% of the cases
are found with decreasing frequency at
progressively higher lumbar vertebral levels.
 Spondylolysis is rare in the cervical & thoracic
spine.
 It is more common in males than females.
 Spondylitis

 Literally means inflammation of the

vertebral column, a classic feature of axial
spondyloarthritis.
 The inflammatory lesion of spondylitis
occurs at the vertebral enthesis.
 It is more common in younger patients less
than 40 years old.
 Pott’s Disease

 Also known as tuberculous spondylitis

 Refers to vertebral body osteomyelitis &
intervertebral discitis from tuberculosis
 The spine is the most frequent location of
extrapulmonary tuberculosis
 Clinical features includes back pain,
kyphotic deformity of spine, lower limb
weakness & paraplegia
 Prolapsed Intervertebral Disc
 The protrusion of nucleus pulposus through a tear in the
annulus fibrosus is termed as prolapsed disc/slipped disc.
 The prolapse generally occurs posterolaterally but
sometimes it occurs posteriorly.
 Posterior disc prolapse directly presses the spinal cord
whereas posterolateral protrusion presses on the roots of
the spinal nerves & their sensitive covering leading to pain
in the area of distribution of nerve root.
 The disc prolapse is generally seen in cervical & lumbar
regions.
 In cervical disc prolapse C5/C6 & C6/C7 are most
susceptible.
 In lumbar disc prolapse L4/L5 & L5/S1 are most susceptible.
 Cauda Equina Syndrome
 It is caused due to compression of cauda
equina-a leash of nerve roots of L2 to S1
around the filum terminale by central disc
prolapse
 Clinically it presents as:
- Difficulty with micturition
- Fecal incontinence
- Saddle anaesthesia
- Gait disturbance
- Pain, numbness or weakness affecting one or
both legs
 It is a neurosurgical emergency condition
 Spinal Stenosis

 Spinal stenosis is the narrowing of one or more spaces

within the spine
 A tightened space can cause the spinal cord or nerve
roots to become irritated, compressed or pinched
 Spinal stenosis commonly occurs in lumbar & cervical
region
 Common causes are bone overgrowth/arthritic spurs,
herniated discs, facet joint hypertrophy, thickened
ligaments, spinal fractures & injuries, spinal cord cysts or
tumors, congenital
 Vertical Compression Fractures

 Occurs in the cervical & lumbar regions

 In the cervical region, with the neck
straight, an excessive vertical force applied
from above will cause the ring of the atlas
to be disrupted & the lateral masses to be
displaced laterally (Jefferson’s fracture)
 Non traumatic compression fractures may
occur as a result of severe disease states
such as osteoporosis or tuberculosis
 Hangman’s fracture

 Fracture of the pedicles of the axis vertebra

 Severe extension injury of the neck that
occurs from automobile accident or a fall
from height
 So named because during execution of
hanging, the knot of Hangman’s rope beneath
the chin causes sudden severe extension
injury of the neck
 Vertebral canal is enlarged due to forward
displacement of the body of the axis, the
spinal cord is rarely compressed
Fracture of Odontoid Process of Axis

 Relatively common
 Usually occurs due to fall or blow on the head
 During judicial hanging, the odontoid process
usually breaks associated with rupture of the
transverse ligament of atlas, hit upon the vital
center in the medulla oblongata
 Occipitalization of Atlas
 The congenital fusion of ring of atlas vertebrae to the
base of the occiput
 One of the most common abnormalities of upper cervical
vertebrae
Klippel-Feil Syndrome
 Clinical condition in which cervical vertebrae are fused &
deformed congenitally
Carotid Tubercle
 The anterior tubercle of the transverse process of sixth
cervical (C6) vertebrae is large & called carotid tubercle
because the common carotid artery can be compressed
against it
 Cervical Rib

 The costal element of C7 vertebrae may get enlarged to

form a cervical rib
 A cervical rib is an additional rib arising from C7 vertebrae
and usually gets attached to the 1st rib near the insertion
of scalenus anterior
 If the rib is more than 5cm long, it usually displaces the
brachial plexus & subclavian artery upwards
 The symptoms are tingling pain along the inner border of
the forearm & hand including weakness & even paralysis
of the muscles of the palm
 Spina Bifida

 The two halves of the neural arch may fail to fuse

leaving a gap in the midline. It is called spina bifida.
 Meninges & spinal cord may herniate out through the
gap.
 When no protrusion through the spina bifida & thereby
no swelling present it is called spina bifida occulta.
 Protrusion of meninges alone results in formation of a
cystic swelling, filled with CSF. This swelling is called
meningocoele.
 When the spinal cord is also present in the swelling, the
condition is called meningomyelocoele.
 Lumbarization

 In this condition the first sacral vertebrae (S1) is

separated from the sacrum & fused with the fifth
lumbar vertebrae (L5)
 As a result the number of sacral foramina is
reduced to three pairs
 Sacralization

 The fifth lumbar vertebrae (L5) or its transverse process

may be fused on one or both sides with the sacrum
 Sometimes the transverse process may articulate with the
ala of the sacrum or with the ilium
 In sacralization the number of sacral foramina is increased
unilaterally or bilaterally
 Coccydynia

 It is a clinical condition characterized by

pain in the coccygeal region
 It occurs following a fall directly on the
coccyx or by persistent irritation usually
from sitting
References