PA601: 09/16/2016

ANATOMY OF THE BACK & SPINAL CORD

Learning Objectives:
- Be able to describe and identify the osteology of the following:
-The vertebral column:
-Anatomy of a typical vertebra
-Variations between vertebrae in different regions/ specialised vertebrae
-Joints and ligaments between vertebrae
-Surface projections of specific vertebrae
-What are the normal curvatures of the spine? When & how do they develop?
-Movements of the vertebral column as a whole and in each region. Which region of the
vertebral column has the most mobility? Why?
- Intrinsic musculature of the back (innervation?, identification, actions)
-The erector spinae
-Splenius
-The contents of the vertebral canal
-The spinal cord
-Anatomy: where is it enlarged? Where does it terminate in the newborn? In the adult?
-Blood supply: what is the clnical significance of the internal vewrtebral venous plexus?
-Meninges: dura, arachnoid, pia
-Which of the meninges function to anchor the spinal cord laterally? Inferiorly?
-Describe the epidural, subdural, subarachnoid spaces? What is located in each of them?
BACK, LAMINECTOMY CHECK LIST: 14 th ed.: 1-14; 15-19 15 th ed.: 1-13; 15-18

(many of the structures in the dissector are not included on this check list – they will be studied with the upper limb,
but must be carefully dissected today)

Not everyone will perform a laminectomy, we will inform you in lab if your table will do this dissection.

OSTEOLOGY: MUSCLES:
skull Splenius m.
- external occipital protuberance Erector spinae mm.
- Foramen magnum Iliocostalis
- Occipital condyles Longissimus
General vertebra: Spinalis
-body, pedicle, lamina
-transverse processes OTHER:
-spinous process Thoracolumbar fascia
-vertebral foramen Dorsal ramus (pl. = rami)
-superior/inferior vertebral notches (intervertebral foramina)
-Superior/inferior articular processes/ facets LAMINECTOMY:
Spinal cord
Cervical: Conus medullaris
-Atlas (no body)
-Axis with dens Pia mater
-Transverse foramen Denticulate ligaments
Filum terminale
Thoracic: Subarachnoid space
-Rib facets (on bodies/ transverse processes) Lumbar cistern
Arachnoid mater
Lumbar: Dura mater (dural sac)
- short, posteriorly projecting spinous processes Epidural space
Subdural (potential) space
Sacrum: Dorsal root & ramus
-Superior articular facets Ventral root & ramus
-Anterior/posterior sacral foramina Cauda equina
-Superior/inferior sacral hiatus Spinal nerve
Dorsal Root ganglion
Coccyx
 OSTEOLOGY

OSTEOLOGY: LIGAMENTS of VERTEBRAL COLUMN

-Pectoral Girdle -Anterior/ Posterior longitudinal
- Scapula, Clavicle -Ligamenta flava (elastic)
-Vertebral column: -Supraspinous/ Ligamentum nuchae
-Typical vertebra -Interspinous
-Body; Arch (pedicle, lamina); Processes
(spinous, transverse (2), superior articular (2),
inferior articular (2)), Superior/ Inferior
vertebral notches; Vertebral foramen
-7 Cervical vertebrae
-Atlas (C1) (no body)
-Axis (C2) (dens)
-Vertebra proiminens (C7)
-12 Thoracic vertebrae
-5 Lumbar vertebrae
-Sacrum (5 fused sacral vertebrae)
-Coccyx (3 or 4 fused coccygeal vertebrae) (no
canal)
-Curvatures
-Primary (kyphosis), Secondary (lordosis)
 OSTEOLOGY of VERTEBRAL COLUMN
Vertebral levels are commonly used to
designate the location of internal structures. External occipital protuberance
& superior nuchal line of occipital bone
It is important to know how to determine the
vertebral level when looking at the surface
of a body. VERTEBRAL COLUMN:
This is one aspect of (33 vertebrae in 5 regions)
surface anatomy
Cervical vertebrae (C1-C7)
C1 - atlas
C7 – vertebra prominens C2 – axis
(most prominent spinous
process)

T3 spinous process at root Thoracic vertebrae (T1-T12)

of scapular spine - Articulate with ribs

T12 spinous process

(midway between inferior angle
of scapula and highest point of
iliac crests)

Costovertebral angle Lumbar vertebrae (L1-L5)

L4 spinous process at
highest point of iliac
crests
Sacrum
- 5 fused sacral vertebrae

Coccyx
- 4 fused coccygeal vertebrae
 TYPICAL VERTEBRAE

Parts: Functions:
 REGIONAL VERTEBRAE
Concave vertebral body
transverse process has a
transverse foramen
CERVICAL

Sup./ inf. Articular

facets almost in
transverse plane

Triangular vertebral foramen

spinous process is often Bifid
THORACIC

Costal Facets for ribs:

Sup/ inf. Articular processes On body & Transverse Processes
almost in coronal plane

Long, inferiorly projecting spinous process

Massive kidney-shaped body

LUMBAR

Long & slender

transverse processes
Articular facets/processes
almost in sagittal plane

Short & thick spinous process

 HIGHLY SPECIALISED VERTEBRAE
C1 (Atlas)
dens
anterior arch C2 (Axis)

1st TWO
CERVICAL

posterior arch

SACRUM

Posterior sacral
Auricular surface foramina for
for articulation with posterior/dorsal rami
pelvic girdle

Sacral canal

COCCYX
 JOINTS OF THE VERTEBRAL COLUMN
SYMPHYSES (amphiarthroses/ secondary cartilaginous joints):
- Anterior intervertebral joints between vertebral bodies and containing intervertebral discs (IV
disks)
- Relative thickness of the IV disks determines possible range of movement
- each IV disk has:
- outer anulus fibrosus
- inner nucleus pulposus

SYNOVIAL JOINTS (diarthroses):

- Posterior intervertebral / Zygapophyseal joints) (plane synovial joints)
-between superior articular facets of one vertebra and the inferior facets of the preceding vertebra
-Shape and disposition of facets determines direction of movement (and may limit movement)

Craniovertebral Joints:
Atlanto-occipital Joint:
-between superior articular facets of atlas and occipital condyles of the cranial base
-Condyloid type of synovial joint allowing primarily for flexion/extension
Atlanto-axial Joints:
-Three joints that allow for rotation of skull and atlas on C2 (around dens)
Right & Left Lateral atlanto-axial joints:
-between inferior facets of C1 and superior facets of C2
- Plane synovial joint
Median atlanto-axial joint:
-Between anterior arch of C1 and dens of C2
-Pivot type of synovial joint
 SYMPHYSEAL JOINTS
- INTERVERTEBRAL DISCS -
SYMPHYSES (secondary cartilaginous joints):

-intervertebral joints between vertebral bodies

and containing intervertebral discs (IV discs).
Nucleus pulposus
-There is no IV disc between C1 &C2

- each IV disk is composed of: Anulus fibrosus

-Nucleus pulposus, a gelatinous core that
is derived from the embryonic notochord
-Anulus fibrosus, concentric layers of
densely fibrous connective tissue that
restrain the spread of the nucleus
pulposus when the disc is enduring
compressive forces

-Connective tissue structure that allows for

intervertebral motion and can sustain
compressive loads.

-Creates a symphyseal joint between adjacent

vertebral bodies allowing for movement in 6
directions. Relative thickness of the IV disks
determines possible range of movement
CURVATURES OF THE VERTEBRAL COLUMN
Primary curvature (1°)

Secondary curvatures
(lordoses) develop as a
result of
anteroposterior
variations in IV disk
thickness
 SYNOVIAL JOINTS
C
Sup./ inf. Articular
facets almost in
transverse plane

Sup/ inf. Articular processes

almost in coronal plane

L Articular
processes almost
in sagittal plane

Median atlanto-axial joint

(between dens of axis and anterior arch of atlas)
Superior articular facet of
atlas articulates with
occipital condyles at atlanto-
occipital joint
Right lateral atlanto-axial joint

Left lateral atlanto-axial joint

MOVEMENTS OF THE VERTEBRAL COLUMN

Cervical* Cervical Cervical

*Lumbar Lumbar Thoracic
 PRIMARY LIGAMENTS OF VERTEBRAL COLUMN
The anterior longitudinal ligament is taut in extension of the vertebral column,
all other listed ligaments are taut in flexion

Ligamentum
flavum
(between laminae)

Ligamentum
nuchae
(superior extension of
supraspinous lig. –
cervical region)

Interspinous
(between adjacent
spinous processes)

Supraspinous
(connects tips of spinous processes) Posterior Anterior
Anterior longitudinal longitudinal
longitudinal (Connects posterior (Connects anterior
aspects of vertebral aspects of vertebral
bodies) bodies)
 MUSCLES OF THE BACK

-Back muscles:
-Superficial Group (Posterior thoracoappendicular muscles):
-Primarily involved in movements of the upper limb
-Hypaxial
-Trapezius, Latissimus dorsi, Rhomboideus major, Rhomboideus minor, Levator scapulae

-Intermediate Group:
-Attach to ribs (may have a respiratory function)
-Hypaxial
-Serratus Posterior Superior
-Serratus Posterior Inferior

-Deep Group (intrinsic muscles of the back):

-Primarily involved in movements of vertebral column and head
-Epaxial:
-separated from overlying hypaxial muscles by the thoracolumbar fascia
-innervated by dorsal rami of spinal nerves
-Spinotransversalis muscles (superficial):
-Splenius (capitis & cervicis)
-Erector Spinae (intermediate):
-Spinalis (medial), Longissimus, Iliocostalis (lateral)
-Transversospinalis muscles (deep):
- multifidus, rotatores, semispinalis
 SUPERFICIAL MUSCLES OF THE BACK
- thoracoappendicular muscles -

Levator scapulae
Trapezius
Rhomboid minor
Thoracolumbar fascia:
-Thickening of the deep fascia of
Rhomboid major intrinsic back muscles – located
primarily in thoracic & lumbar
regions (thins out drastically in
Latissimus
cervical region)
dorsi -separates epaxial muscles from
hypaxial muscles
-Origins of Latissimus dorsi and
Thoracolumbar fascia serratus posterior inferior muscles
blend with the thoracolumbar fascia
INTRINSIC (deep) MUSCLES OF THE BACK

Splenius

Spinalis

Longissimus

Iliocostalis

ERECTOR SPINAE
 CONTENTS OF THE VERTEBRAL CANAL
-Spinal cord (with vasculature)
-Roots of spinal nerves (with
vasculature)
-Meninges (dura, pia, arachnoid)
-Fat & internal vertebral venous
plexus (in the epidural space)
-NOTE: spinal nerves, dorsal and
ventral rami and the sympathetic
chain are all external to the
vertebral canal
 THE SPINAL CORD
-The spinal cord begins at the foramen magnum (of occipital bone) as a continuation of the medulla (oblongata) of the brain
-Segments responsible for innervation of the limbs are enlarged (cervical enlargement & lumbosacral enlargement)
-After the lumbosacral enlargement, the spinal cord tapers to it’s end, the Conus medullaris
-The tip of the conus medullaris is located at vertebral level L4/L5 in the newborn; L1/L2 in the adult. Therefore, spinal cord segments do
not correspond, positionally, to vertebral levels and roots of spinal nerves must descend within the vertebral canal to reach their
respective intervertebral foramina.
-Cauda equina - the collection of lumbar, sacral and coccygeal spinal nerve roots within the vertebral canal, inferior to the spinal cord

Cervical enlargement
(spinal segments C5-T1)

pedicles

dorsal root
ganglion

Lumbosacral
enlargement
(Spinal segments L1-S3)
Conus Medullaris
(ends at vertebral level
L1/L2)

Cauda equina
(roots of spinal nerves
travelling distally to reach
their designated
intervertebral foramen)
 VASCULATURE OF SPINAL CORD
- 1 Anterior spinal a. (from vertebral aa. in cranial cavity)
- 2 posterior spinal aa. (from a cerebellar a. in cranial cavity)
- Segmental Spinal arteries (from post. intercostal aa. in the thorax - but, have other origins in different regions)
- Segmental medullary branches (8-10). Reinforce blood flow in the Ant. & Post. Spinal arteries
- an extensive venous network surrounding the spinal cord drains to the internal vertebral venous plexus that lies in the epidural
space (inside vertebral canal but external to dural sac)

post. spinal aa.

Segmental spinal a.

Segmental medullary a.

Anterior spinal a.

Segmental
medullary aa.

internal vertebral venous plexus

 MENINGES
- Pia mater - tightly invests cord
-covers the filum terminale which anchors the spinal cord to the coccyx
-Forms denticulate ligaments that anchor the cord to the dura mater on the sides
-Arachnoid mater
-Connected to pia by fine trabeculae
-Encloses subarachnoid space which contains CSF
-Ends at S2, creating a lumbar cistern between L2 & S2 (location of Spinal/Lumbar Taps)
-Dura mater
-Is fused to bone of foramen magnum
-Forms dural sleeves around spinal nerves before fusing with the epineurium
-Dural sac ends at S2, but dura continues distally as a sleeve over the filum terminale externum and ends
with it at the coccyx

L Conus medullaris
1

L Lumbar
2 Cistern
(contains
L
cauda
equina and
3 filum
Dura mater terminale)
L4

L5

Arachnoid S1
mater
S2
Filum S3
Terminale S4
Internum(pial) S5
Denticulate Externum(dur
ligament al)
(pia mater) coccyx
 CLINICAL CORRELATE:
LUMBAR PUNCTURE/ SPINAL TAP
Conus medullaris

L1

L2 Lumbar
Cistern

L3

L4

L5

S1
S2
S3
Filum Terminale
Internum(pial) S4
Externum(dural) S5

coccyx
 CLINICAL CORRELATE:
HERNIATED IV DISCS

-usually occur posterolaterally (anulus fibrosus is

thinner, posterior longitudinal ligament is
narrower & weaker) between L4 & S1

-Nucleus pulposus herniates into vertebral canal

and may compress spinal cord &/or inferior nerve
roots (the spinal nerve at the associated level will
be spared)