Anatomy – Vertebrae
Vertebral column
Intervertebral disc
Secondary cartilaginous; Annulus fibrosis, Nucleus pulposus
Upper and lower surfaces covered by thin plate hyaline
Facet joints
Articulation between sup articular process of one vertebra and
inf articular process of vertebra above
Synovial; Capsule blends with ligamentum flavum
Ligaments
Anterior longitudinal Occiput/ant tub atlas to upper sacrum
Posterior longitudinal Back of body vertebrae (axis - sacrum)
Ligamentum flavum Most important, ant border lamina above
to post border lamina below
Supraspinous Tips spinous processes – down spine (strong)
Interspinous Between spinous processes (weak)
Intertransverse Sheets between transverse processes (weak)
Atlantoaxial joint ligaments
Tectorial membrane Continuation post longitudinal lig, Back
of body axis/margin foramen magnum
Transverse Between lateral masses C1behind peg – strong
Longitudinal Occiput to back of body C2 – weak (with
transverse lig forms cruciate lig)
Apical Apex dens to anterior margin foramen magnum
Alar Oblique on either side apical lig; Sides dens/margins
foramen magnum
Movements of vertebral column
Lumbar Flexion, extension, lateral flexion
Thoracic Flexion, extension, lateral flexion, rotation
Cervical Atlanto-occipital joints – Flexion, extension, lat flexion
Stability: Bony factors (peg, articular facets)
Ligamentous factors (ant longitudinal,
tectorial/cruciform); Apical, alar, nuchal
Muscles
Atlantoaxial joint - Rotation
Other cervical vertebrae – Flexion, extension, lateral flexion
Vertebral blood supply
Arterial Vertebral, Ascending and deep cervical, Intercostal, Lumbar, Sacral arteries
Venous Posterior internal vertebral venous plexus lies inside vertebral canal, outside dura
→ drain into external vertebral venous plexus → Communicate with pelvis to neck – spread malignancy/infection
Vertebral muscles
Extensor muscles run whole length vertebral column, skull to sacrum, innervated by posterior rami spinal nerves
Deep layer Interspinales - Runs with interspinous ligs; Intertransversales - Join transverse processes
Intermediate layer Transversospinalis - Rotatores, Multifidis, Semispinalis, Semispinalis capitis
Superficial layer Erector spinae
Vertebral canal
Borders
Anterior bodies, discs, posterior longitudinal lig
Posterior laminae, ligamentum flavum
Laterally pedicles, intervertebral foramina
Contents
Spinal meninges, Denticulate ligament - Lateral projection of pia on each side of cord
Spinal cord, Nerve roots, Connective tissue, Fat, Internal vertebral venous plexus
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Lumbar puncture
L3/4 or L4/5 spinous processes, level of iliac crests (Cord ends L1)
Skin → Subcut tissue → Supraspinous lig →
Interspinous lig → Ligamentum flavum →
Epidural space → Dura→ Arachnoid
Typical vertebrae
Ventral body
Dorsal neural arch encloses vertebral foramen
Three processes form neural arch
(Spinous process)
Transverse processes - sup/inf facets
Lamina between spinous/ transverse process
Pedicle between transverse process and body
Spinal nerve through intervertebral foramen
Thoracic vertebrae
Changes from upper to lower thoracic vertebrae
Body heart to kidney shape
Spinous process long vertical to short horiz
Facets on transverse process concave to flat
Spinal canal round to triangular
Ventral body concave posteriorly, round vertebral foramen
Each side pair demifacets for articulation with head rib
Lumbar vertebrae
Ventral body increase in size - Kidney shaped, triangular canal
Spinous process (Roughly horizontal)
Superior face medially, Inferior face laterally
L4 longest process; L5 trans process short and thick, joins direct to body - no pedicle
No foramen, no costal facets; Mamillary processes
Cervical vertebrae
Ventral body same size or smaller than vertebral foramen
Spinous process usually bifid, C7 prominent spine not bifid
Foramen transversum in transverse process for vertebral artery
Anterior tubercle and posterior tubercle on transverse process, no costal facets
Joints between adjacent cervical vertebrae = Intervertebral joint, Synovial facet joint
What movements occurs at facet joints
Upper facets face obliquely up and back
Lower facets face down and forwards - Relatively flat facet joints
Flexion/extension, lateral flexion (abduction) - No rotation
Atlas
Anterior arch - Short; Facet for artic with dens (median anlantoaxial joint)
Posterior arch - Long; Thick lat mass on each side, Grooved by vert artery
Lateral mass - Upper articular facet concave for artic with occipital condyle
Lower facet round and flat for lateral atlantoaxial joint
Perforated by vertebral foramen
Axis
Dens Articular facet at front for anterior arch of atlas
Superior and inferior articular facets, Body, Pedicles
Lateral masses - Large, weight bearing
Transverse processes - No ant/post tubercles, oblique foramen
Laminae - Thick and rounded
Spinous process - Large, bifid
Vertebral foramen (sc) and transverse foramen (va)
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Differences between areas
Cervical: Small body, Large canal, Longer thinner, down sloping spinous process, bifid
Facet joints more horizontal → greater movement
Foramen transversum – vertebral artery
Uncinate process, No accessory tubercle or artics for rib
Lumbar: Larger body, kidney shaped
Smaller canal, triangular
Spinous process square and horizontal
No articulations for ribs
No foramen in transverse process
Articular facets lie AP
Mamillary bodies
Radiology of cervical spine
Lateral view
Hyoid bone (level of C3). Larynx. Trachea
Atlas – anterior and posterior arches
Axis – dens, body, spinous process
C3-7 – bodies, pedicle, lamina, spinous, sup/inf artic process
Facet joint
Intervertebral disc space
Anterior vertebral line, Posterior vertebral line, Spinolaminar line
PA
Body, Dens of axis
Lateral mass of atlas
Lateral atlantoaxial joint
Bodies and spinous processes of 3rd to 7th cervical vertebrae
Peg view
Dens, Body, Bifid spinous process of axis
Lateral mass of atlas
Lateral atlantoaxial joint
Mandibular ramus
Posterior arch of atlas
Body of third cervical vertebrae
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