Disclosure Statement of Financial
Interest
I, Dr. Tom Kwasigroch,
DO NOT have a financial
interest/arrangement or affiliation with
one or more organizations that could be
perceived as a real or apparent conflict of
interest in the context of the subject of
this presentation.
Vertebral Column, Back and Spinal
Nerve Objectives –we will discuss:
Disclosure Statement of
Unapproved/Investigative Use
I, Dr. Tom Kwasigroch,
DO NOT anticipate discussing the
unapproved/investigative use of a
commercial product/device during this
activity or presentation.
•
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Configuration of the vertebral column
Characteristics of types of vertebrae
Intervertebral discs and ligaments
Muscles of the back
– Extrinsic
– Intermediate
– Intrinsic (superficial, intermediate and deep)
• Central Nervous System components
• Spinal cord and spinal nerve blocks
1
Pre Test Item 1
How does the configuration of the vertebral
column in the newborn differ from the adult??
Vertebral Column
Secondary
Curvature
Spinous
Process
Transverse
Process
Pedicle
Primary
Curvature
Transverse
Process
Pedicle
Secondary
Curvature
Body
Spinous
Process
Body
Primary
Curvature
Superior and Inferior Articular Processes
2
CV1:
No Spinous Process
No Vertebral Body
Dens on CV2
7 Cervical vertebrae
All Cervical Vertebrae:
Bifid Spinous Processes
Nearly Horizontal
Articular Processes
Transverse Foramen
(Vertebral a)
Vertebral artery
coursing through
transverse foramina of
CV 6 – CV 1
3
Thoracic Vertebrae:
12 Thoracic vertebrae
Long, Sharp, Oblique
Spinous Proces
Articular Processes for Ribs
(on TP and side of body)
5 Lumbar vertebrae
4
Lumbar Vertebrae:
Large Vertebral Bodies
Large, Block-like
Spinous Processes
Vertically-oriented
Articular Processes
Anterior Sacral
Foramina
(Ventral Rami)
5 fused Sacral vertebrae
5
Posterior Sacral Foramina
(Dorsal Rami)
Posterior Sacral Foramina
Anterior Sacral Foramen
Sacral Hiatus
Pre Test Item 2
If the LV4/5 disk herniates what is most at risk
of damage??
4 Fused
coccygeal
elements
6
Vertebral Column Cross Section
with Intervertebral Disc
Annulus
Fibrosis
Nucleus
Pulposus
Annulus Fibrosis
Subarachnoid
Space
Nucleus pulposus
Epidural
Space
Intervetebral Disc
Intervetebral Foramen
PLL
(Posterior Longitudinal Ligament)
ALL
(Anterior Longitudinal Ligament)
7
Back Muscles
Lig. Flavum
Supraspinus Lig.
Interspinous Lig.
Spinal Accessory nerve - CNXI
Extrinsic muscles:
Extrinsic muscles (cont):
Thoracodorsal nerve - C6,7,8
8
Extrinsic muscles (cont):
Levator scapulae – C3,4
Rhomboideus minor
Rhomboideus major
Dorsal Scap n. – C5
Extrinsic muscles (cont):
Serratus Anterior
Long Thoracic n. – C5,6,7
Intermediate muscles
Ventral Root (Motor)
Spinal nerve (Sensory + Motor)
Ventral Ramus (S + M)
(supply extrinsic mm. –
usually via Brachial Plexus)
Dorsal Root (Sensory) (w DRG)
Dorsal Ramus (S + M)
9
Ventral Root
Ventral Root
Ventral Ramus
Ventral Ramus
(Intermediate back mm., usually
through Intercostal nn.)
Dorsal Ramus
Dorsal Root (w DRG)
Intrinsic muscles
Superficial layer:
Splenius
Cervical and
upper thoracic
Dorsal Rami
Dorsal Ramus
Dorsal Root (w DRG)
(Intrinsic back mm., segmentaly)
Intrinsic muscles (cont)
Intermedate layer:
Erector Spinae Muscle Spinalis
Segmental Dorsal Rami
10
Erector Spinae Muscle -
Erector Spinae Muscle -
Longissimus
Iliocostalis
Segmental Dorsal Rami
Segmental Dorsal Rami
Deep layer of Intrinsic muscles:
Transversospinal muscles Semispinalis
Segmental Dorsal Rami
Dorsal Rami
(Supply ALL intrinsic muscles – Erector Spinae and
Transversospinal, etc. )
11
Deep layer of Intrinsic muscles:
Deep layer of Intrinsic muscles:
Transversospinal muscles -
Transversospinal muscles -
Multifidus
Rotatores
Segmental Dorsal Rami
Segmental Dorsal Rami
Dorsal Rami
Dorsal Rami – cutaneous branches
(Supply ALL intrinsic muscles – Erector Spinae and
Transversospinal, etc. )
12
Dorsal Rami Cutaneous Supply
(all else via Ventral Rami)
Cutaneous
branches of Dorsal
Rami (meet up with
cutaneous branches of
vertral rami to form
dermatome pattern)
Central nervous System Components:
•Spinal nerve
•Spinal cord
•Vascular supply
Dorsal Root
Ventral Root
Dorsal Ramus
Ventral Ramus
Spinal Nerve
Spinal Segment
13
Six Spinal Segments –
pairs of spinal nerves
Dura
Arachnoid
Subarach Space (CSF)
Pia
Denticulate Lig
Brain with Attached Spinal Cord
Brain with Attached Spinal Cord
Spinal Cord
Segment (C3)
Roots of Brachial
Plexus (C5-T1)
Roots of Brachial
Plexus (C5-T1)
14
Sensory Innervation to Face??
CN V1
Dermatome – area of skin supplied by
a single spinal segment
CN V2
Spinal Segments:
CN V3
The spinal cord has 31 spinal
segments, giving rise to 31
pairs of spinal nerves 8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
How does that numbering affect the
location of the nerves as they exit the
vertebral column??????????????????
(Remember, 7 cervical vertebrae
and 8 cervical spinal nerves)
Cervical nerves exit ABOVE the
same numbered vertebra
e.g., C1 above CV1,
C4 above CV4
C8 exits below CV7,
since there are only 7
cervical vertebrae and
8 cervical nerves
How does that numbering affect the
location of the nerves as they exit the
vertebral column??????????????????
Cervical nerves exit ABOVE the
same numbered vertebra
e.g., C1 above CV1,
C4 above CV4
Inferior extent of spinal cord:
LV 1-2 in adult,
LV 3 in infant
All other levels nerves exit BELOW
the same numbered vertebra
All other nerves exit
BELOW the same
numbered vertebrae
Inferior extent of dura and
subarachnoid space is SV 3
e.g., L4 below LV4
S5 and Co1 exit through
sacral hiatus
15
Vertebral Column/Spinal Cord Dissection
Spinal Cord
in Dural Sheath
Conus Medularis
(lowest elements of the spinal cord, e.g.,
sacral and coccygeal spinal segments)
Filum Terminale
(Pia continuing off the end of the spinal cord –
tethers the cord to the coccyx as the coccygeal
ligament, after piercing the dura)
Some of the Numerous Spinal Nerves Exiting the Vertebral Column
LV1
Intervetebral Disc
LV2-3 Intervetebral Disc
Intervetebral Foramen
Intervetebral Foramen
Spinal Nerve L4
(LV3-4)
LV 4-5 Disc Herniation
LV4 Pedicle
Spinal Nerve L5!!
Spinal Nerve L4
LV4-5 Disc Herniation??
Spinal Nerve L5!!
16
Blood Supply to the Brain and Spinal Cord
LV4-5 Disc Herniation
Vertebral artery has anterior
(1) and posterior (2) branches
which supply the spinal cord
Brain with Attached Spinal Cord
Ant. Spinal Artery
Post. Spinal Arteries
Segmental Medullary aa.
augment the blood in the spinal aa.
Basilar Artery
(formed by union
of vertebral arteries)
Right Vertebral Artery
Left Vertebral Artery
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