GENERAL ANATOMY

• Vertebral Column


  Functions: Supports the head, Important attachment for muscles, Rib attachment, Encloses and protects the spinal cord, Provide flexibility and mobility of the trunk, Ability to transmit weight of head and body to the lower extremities
• Composition of the Vertebral Column

  • Cervical: 7
  • Thoracic: 12
  • Lumbar: 5
  • Sacrum: 5 → 1 (fused in adulthood)
  • Coccyx: 4 → 1 (fused in adulthood)
  • Total: 33 (pediatric), 26 (adult)
• Typical Vertebra

  • C3-C6, T5-T8, L1-L4
• Characteristics of a Typical Vertebra

  • Vertebral Body: Small (Cervical), Medium; Heart-shaped (Thoracic), Largest; Bean/Kidney-shaped (Lumbar)
  • Spinous Process: Short and bifid (Cervical), Long and inclined downwards (Thoracic), Short, flat and quadrilateral (Lumbar)
  • Transverse Process: Transverse foramen (Cervical), Conical (Thoracic)
  • Vertebral Foramen: Largest and triangular (Cervical), Smallest and circular (Thoracic), Triangular (Lumbar)
  • Facet Joints Orientation: Superior: Superior and posterior, Inferior: Inferior and anterior (Cervical), Superior: Posterior and lateral, Inferior: Anterior and lateral (Thoracic), Superior: Medial, Inferior: Lateral (Lumbar)
  • Facet Joints Inclination: 45° (Cervical), 60° (Thoracic), 90° (Lumbar)
• Characteristics of the Atypical Vertebra

  • Cervical: C1 (Atlas), C2 (Axis/Epistropheus), C7
  • Thoracic: T1, T2-T4, T9, T10, T11-T12
  • Lumbar: L5
  • Sacrum
  • Coccyx
• Atlanto-Occipital Joint


  Also known as YES joint, Type: condyloid joint, 50% flexion-extension
• Atlanto-Axial joint


  Also known as NO joint, Type: Pivot/trochoid joint, 50% rotation
• Intervertebral Discs


  • Shock absorbers of the spine, Capable of withstanding compressive torsional and bending loads, Role is to bread and distribute loads in vertebral column and restrain excessive motion in vertebral segment
• Regions of Vertebral Disc

  • Nucleus Pulposus: Gel-like mass in center of disc under pressure such that it preloads disc, 80-90% water, 15-20% collagen, 25% of vertebral column height, Abundant in proteoglycans: imbibes water, absorbs pressure
  • Annulus Fibrosus: 50-60% collagen, Lamellae: protein that crisscross by 30°, Sharpey's fibers (results to herniated disc if damaged)
• Atlanto-occipital Joints

  • Anterior atlanto-occipital membrane:
  • Cont. of the anterior longitudinal ligament, which runs as a band down the anterior surface of the vertebral column
  • The membrane connects the anterior arch of the atlas to the anterior margin of foramen magnum
  • Posterior Atlanto-occipital membrane:
  • posterior surface of the vertebral column from skull to sacrum.
  • Weak and narrow,
  • attached posterior of vertebral body inside spinal canal, prevents flexion; inferior continuation of tectorial membrane
  • Similar to ligamentum flavum, connects the pos. Arch of the atlas to the pos. Arch
• Intrasegmental Ligaments: Segmental Stability

  • Ligamentum Flavum (yellow ligament): connects adjacent lamina
  • Ligamentum Nuchae: connects the tip of spinous process from C7-occiput; superior continuation of supraspinous ligament in cervical region
  • Interspinous Ligament: connects adjacent spinous process
  • Intertransverse Ligament: connect adjacent transverse process
• Other Ligaments (Cervical)

  • Alar Ligaments: attaches from the lateral lip of the foramen magnum to the transverse area of the atlas, limits skull and atlas rotation on axis
  • Anterior Axial Accessory (AAA) Ligament: from transverse process of atlas to the axis; assists the alar ligament
  • Transverse Ligament: holds the dens in place
  • Apical Ligament: from anterior surface of foramen magnum to apex of dens
  • Vertical Ligament: from anterior of foramen magnum to the body and/or base of the dens
  • Cruciform Ligament: cross-shaped; transverse + vertical ligament
• Nerve Supply of Vertebral Joints

  Innervated by the small meningeal branches of each spinal nerve, Joints between the articular processes are innervated by branches from the posterior rami of the spinal nerves
• Muscles of the Back (Superficial Layer)

  • Trapezius: upward rotation of scapula; shawl muscle (upper, middle, lower)
  • Levator Scapulae: elevates the scapula; downward rotation of scapula
  • Latissimus Dorsi: broadest/widest muscle; also known as crutch-walking muscle
  • Rhomboids major/minor: retract shoulder, downward rotator
• Muscles of the Back (Intermediate Layer)

  • Serratus Posterior: Superior - inspiration, Inferior - expiration
• Muscles of the Back (Deep Layer)

  • Splenius: bandage muscle (Capitis, Cervicis)
  • Erector Spinae: longitudinal muscle, chief erector of spine (Iliocostalis, Longissimus, Spinalis)
  • Transversospinalis/Oblique Muscles (SaMuRai): Semispinalis, Multifidus (strongest from forward flexion to neutral), Rotatores = Obliques
  • Interspinalis: connects the spinous process
  • Intertransversarii: connects the transverse process
• Blood Supply of the Back

  • Arteries: Cervical (branches from occipital, vertebral, deep cervical), Thoracic (branches from posterior intercostal), Lumbar (branches from subcostal and lumbar), Sacral (branches from iliolumbar and lateral sacral)
  • Veins: External vertebral venous plexus, Internal vertebral venous plexus (drained by intervertebral veins)
• Lymph Drainage of the Back

  • Deep lymph vessels follow the veins and drain into the deep cervical, posterior mediastinal, lateral aortic, and sacral nodes
  • Lymph vessels from the skin of the neck drain into the cervical nodes
  • Those from the trunk above the iliac crests drain into the axillary nodes
  • Those from below the level of the iliac crests drain into the superficial inguinal nodes
• Nerve Supply of the Back

  • Skin and muscles supplied by posterior rami of 31 pairs of spinal nerves
  • Posterior rami of C1, C6, C7, C8, L4, L5 supply deep muscles but not skin
  • Posterior ramus of C2 (greater occipital nerve) supplies skin of scalp
• Spinal Cord


  • Cylindrical mass of neural tissue, occupying the upper 2/3 of Vertebral Canal, Starts: Foramen magnum, Ends L1-L2 vertebrae, External Structures: Conus Medullaris, Filum Terminale, Cauda Equina
• Roots of the Spinal Nerves

  • 31 pairs of spinal nerves attached by anterior/motor roots and posterior/sensory roots, Unite to form a spinal nerve
• Blood Supply of the Spinal Cord

  • Branches from vertebral artery: Anterior Spinal Artery (anterior upper 2/3), Posterior Spinal Artery (posterior upper 1/3), Radicular Artery (reinforcement), Artery of Adamkiewicz (largest radicular artery T8-L4), Watershed Area (poorest blood flow T4-T6)
• Meninges of the Spinal Cord

  • Dura Mater: Outermost layer, thick and durable, Extends from foramen magnum to S2
  • Arachnoid Mater: Middle layer, web-like, Encloses subarachnoid space with CSF
  • Pia Mater: Innermost layer, thin and delicate, Adheres to spinal cord surface
• Spaces Associated with Meninges

  • Epidural Space: Between dura mater and vertebral wall, Contains fat and small blood vessels
  • Subdural Space: Potential space between dura mater and arachnoid mater
  • Subarachnoid Space: Between arachnoid mater and pia mater, Filled with cerebrospinal fluid (CSF)
• Cerebrospinal Fluid


  Clear, colorless body fluid in brain and spinal cord, Produced primarily in choroid plexus of brain's ventricles, Functions: Protection, Buoyancy, Chemical Stability, Intracranial Pressure Regulation
• Conus Medullaris

  Conical inferior end
• Filum Terminale


  Filament extending from the conus and attaches to 1st segment of the coccyx
• Cauda Equina

  Horsetail composed of rootlets of lumbosacral plexus
• Types of Bone Marrow

  • Red bone marrow
  • Yellow bone marrow
• Red bone marrow

  Where hematopoiesis or the production of RBCs take place
• Yellow bone marrow

  Contains adipose tissue, triglycerides stored in the adipocytes of this tissue can be released to serve as a source of energy for the other tissues of the body
• Atlanto-occipital joint

  Condyloid joint<|>50% flexion-extension<|>Enclosed by a capsule
• Anterior atlanto-occipital membrane

  Continuation of the anterior longitudinal ligament, which runs as a band down the anterior surface of the vertebral column<|>Connects the anterior arch of the atlas to the anterior margin of foramen magnum
• Posterior Atlanto-occipital membrane


  Weak and narrow<|>Attached posterior of vertebral body inside spinal canal, prevents flexion<|>Inferior continuation of tectorial membrane<|>Similar to ligamentum flavum, connects the posterior arch of the atlas to the posterior arch
• Atlantoaxial Joints


  Pivot/trochoid joint<|>50% rotation<|>Three synovial joints: one between the odontoid process and the anterior arch of the atlas, the other two between the lateral masses of the bones<|>Joints are enclosed by capsules
• Apical Ligament


  From anterior surface of foramen magnum to apex of dens
• Alar Ligaments


  Lie on each side of the apical ligament and connect the odontoid process to the medial sides of the occipital condyles<|>Attach from the lateral lip of the foramen magnum to the transverse area of the atlas, limits skull and atlas rotation on axis
• Cruciform Ligament

  Cross-shaped; transverse + vertical ligament
• Cruciate Ligaments

  Consist of a transverse part and a vertical part<|>The vertical part runs from the posterior surface of the body of the axis to the anterior margin of the foramen magnum
• Membrana Tectoria


  Upward continuation of the posterior longitudinal ligament<|>Attached above to the occipital bone just within the foramen magnum