ANATOMY 1

Neck, Back and Spine

College of Rehabilitation Science
De La Salle-Health science Institute

OSTEOLOGY

Vertebral Column
The spine or vertebral column
Protects the spinal cord
Supports the head and body
26 bones
24 vertebrae, the sacrum, and the coccyx

Vertebra

The Vertebral Column

Vertebrae
The neck
Seven cervical vertebrae

The upper back

12 thoracic vertebrae
Each articulates with one or more pair of ribs

The lower back

Five lumbar vertebrae

The Vertebral Column

The Sacrum and Coccyx
The fifth lumbar vertebra articulates with the
sacrum
The sacrum articulates with the coccyx

 Four Curvatures of the Vertebral Column

Cervical curve
Thoracic curve
Lumbar curve
Sacral curve

SPINAL CURVES
Thoracic and sacral curves
Are called primary curves (present during fetal
development)

Or accommodation curves (accommodate internal organs)

Lumbar and cervical curves

Are called secondary curves (appear after birth)
Or compensation curves (shift body weight for upright

posture)

The Vertebra
Structure of a Vertebra
The vertebral body (centrum)
Transfers weight along the spine

The vertebral arch

Posterior margin of vertebral foramen

The articular processes

Lateral projections between laminae and pedicles

Typical Vertebra

Typical Vertebra

 Structure of a Vertebra
The vertebral arch
Pedicles:
walls of the vertebral arch

Laminae:
roof of the vertebral arch

Spinous process:
projection where vertebral laminae fuse

Transverse process:
projection where laminae join pedicles

 Structure of a Vertebra
The articular processes
Superior articular process
Inferior articular process:
have articular facets on articular faces

 Vertebral Foramina
Intervertebral foramina
Gaps between pedicles of adjacent vertebrae
For nerve connections to spinal cord

Vertebral canal
Formed by vertebral foramina
Encloses the spinal cord

Intervertebral Discs
Are pads of fibrous cartilage
Separate the vertebral bodies
Absorb shocks

The Vertebral Column

 The Cervical Vertebrae

Small body (support only head)
Large vertebral foramen (largest part of spinal
cord)
Concave superior surface
Slopes posterior to anterior
C1 (atlas) has no spinous process
All others have short spinous processes
tip of each spinous process is notched (bifid)

CERVICAL VERTEBRA

 The Cervical Vertebrae

Transverse processes
Are fused to costal processes
Which encircle transverse foramina (protect arteries
and veins)

Atlas (C1)
Articulates with occipital condyles of skull
Has no body or spinous process
Has a large, round foramen within anterior and
posterior arches

 The Cervical Vertebrae

Axis (C2)
Supports the atlas
Has heavy spinous process
To attach muscles of head and neck
Axis and atlas bodies fuse during development to form the dens
Vertebra prominens (C7)
Transitions to thoracic vertebrae
Has a long spinous process with a broad tubercle
Has large transverse processes
Ligamentum nuchae (elastic ligament) extends from C7 to skull

 Thoracic vertebrae (T1T12)

Have heart-shaped bodies
Larger bodies than in C1C7
Smaller vertebral foramen than in C1C7

Long, slender spinous processes

Dorsolateral surfaces of body have costal facets:
Which articulate with heads of ribs

 Thoracic vertebrae (T1T12)

T1T10
Have transverse costal facets
On thick transverse processes for rib articulation

Ribs at T1T10
Contact costal and transverse costal facets

T1T8 articulate with two pairs of ribs

At superior and inferior costal facets

T9T11 articulate with one pair of ribs

T10T12 transition to lumbar vertebrae

Thoracic Vertebra

 Lumbar vertebrae (L1L5)

Largest vertebrae

Oval-shaped bodies
Thicker bodies than T1T12
No costal or transverse costal facets
Triangular vertebral foramen
Superior articular processes
Face up and in

Inferior articular processes

Face down and out

 Lumbar vertebrae (L1L5)

Transverse processes
Slender
Project dorsolaterally

Spinous process:
Short, heavy
For attachment of lower back muscles

Vertebra

Vertebra

Vertebra

SACRUM
The sacrum
Is curved, more in males than in females

Protects reproductive, urinary, and digestive organs

Attaches
The axial skeleton to pelvic girdle of appendicular skeleton

Broad muscles that move the thigh

The adult sacrum

Consists of five fused sacral vertebrae

Fuses between puberty and ages 2530

Leaving transverse lines

SACRUM
The sacrum
Sacral canal
Replaces the vertebral canal

Sacral cornua
Horn shaped
Formed by laminae of the fifth sacral vertebra
Which do not meet at midline

Sacral hiatus
Opening at the inferior end of the sacral canal

Formed by ridges of sacral cornua

Covered by connective tissues

SACRUM
Median sacral crest
Fused spinous processes

Four pairs of sacral foramina open to either side

Lateral sacral crest

Fused transverse processes
Attach to muscles of lower back and hip

SACRUM
Auricular surface
Thick, flattened area

Articulates with pelvic girdle (forming sacroiliac joint)

Sacral tuberosity
Rough area
Attaches ligaments of the sacroiliac joint

SACRUM
Four regions of the sacrum
Base:
the broad superior surface

Ala:
wings at either side of the base
to attach muscles

Sacral promontory:
at the center of the base

Apex:
the narrow inferior portion
articulates with the coccyx

 The coccyx
Attaches ligaments and a constricting muscle of the anus
Mature coccyx
Consists of three to five fused coccygeal vertebrae

First two coccygeal vertebrae:

Have transverse processes
Have unfused vertebral arches

Coccygeal cornua
Formed by laminae of first coccygeal vertebra

Vertebral Regions

Thoracic Cage
The skeleton of the chest
Supports the thoracic cavity
Consists of:
thoracic vertebrae
ribs

sternum (breastbone)

The Rib Cage

Formed of ribs and sternum

Thoracic Cage

Thoracic Cage

Thoracic Cage
Functions of the Thoracic Cage
Protects organs of the thoracic cavity
Heart, lungs, and thymus

Attaches muscles
For respiration
Of the vertebral column
Of the pectoral girdle
Of the upper limbs

Thoracic Cage
Ribs
Are mobile
Can absorb shock
Functions of ribs
Rib movements (breathing):
affect width and depth of thoracic cage
changing its volume

The Thoracic Cage

The Thoracic Cage

Ribs (costae)
Are 12 pairs of long, curved, flat bones
Extending from the thoracic vertebrae
Ribs are divided into two types
True ribs
False ribs

The Thoracic Cage

Ribs 17 (true ribs)
Vertebrosternal ribs
Connected to the sternum by costal cartilages

Ribs 812 (false ribs)

Do not attach directly to the sternum
Vertebrochondral ribs (ribs 810)
Fuse together
Merge with cartilage before reaching the sternum

Floating or vertebral ribs (ribs 1112)

Connect only to the vertebrae and back muscles
Have no connection with the sternum

Thoracic Cage

Thoracic Cage
Structures of the Ribs
The head (capitulum)
At the vertebral end of the rib
Has superior and inferior articular facets

The neck
The short area between the head and the tubercle

Thoracic Cage
Structures of the Ribs
The tubercle (tuberculum)
A small dorsal elevation

Has an auricular facet that contacts the facet of its

thoracic vertebra (at T1T10 only)

The tubercular body (shaft)

Attaches muscles of the pectoral girdle and trunk

Attaches to the intercostal muscles that move the ribs

Thoracic Cage

Thoracic Cage

Thoracic Cage
The sternum
A flat bone
In the midline of the thoracic wall
Three parts of the sternum
The manubrium
The sternal body

The xiphoid process

Thoracic Cage
Manubrium
The superior portion of sternum
Broad, triangular shape
Articulates with clavicles (collarbones)
Articulates with cartilages of first rib pair
Has a jugular notch, a shallow indentation

between clavicular articulations

Thoracic Cage
The sternal body
Is tongue-shaped
Attaches to the manubrium

Attaches to costal cartilages of ribs 27

The xiphoid process

Is the smallest part of the sternum
Attaches to the sternal body
Attaches to diaphragm and rectus abdominis muscles

Thoracic Cage

The Thoracic Cage

Development of the Sternum
The developing sternal body
Consists of four unfused bones
Completes fusion about age 25

Leaving transverse lines

The xiphoid process

Is the last part of sternum to fuse
Can easily be broken away

RADIOLOGIC CORRELATION

OPEN MOUTH

AP Open
Mouth

Odontoid Process
Occipital condyles

Lateral Masses C1

Posterior Arch C1
Transverse Process C1

C2 Spinous Process

C3 Spinous Process

AP Open
Mouth

Lateral View

Neutral
Lateral
Cervical

C1 Anterior Tubercle

C1 Posterior Arch
and Tubercle

Odontoid Process

C2

C3

Vertebral Bodies

Spinous Processes
C4

C5

Intervertebral Discs
C6

C7

Articular Processes

Neutral
Lateral
Cervical

OBLIQUE VIEW

Oblique
Cervical

C1 Posterior Arch
and Tubercle
C1 Anterior Tubercle
Intervertebral
Foramina
C3

C4

Articular Processes
C5

T1 Transverse
Process

C6
C7
T1

Pedicles

1st Ribs

Oblique
Cervical

ANTERO POSTERIOR VIEW

AP
Lower
Cervical

Spinous Processes

C4

Articular Processes or
Pillars

C5

Uncinate Processes

C6

C7 Transverse
Process
T1 Transverse
Process

1st Rib
C7

T1

AP
Lower
Cervical

THORACIC AP VIEW

AP
Thoracic

T1

Posterior Ribs

Pedicles

T6

Transverse
Processes

Intervertebral Discs

T12

AP
Thoracic

LATERAL VIEW

Lateral
Thoracic

Superior Articular
Processes

Pedicles

T6

Vertebral Bodies

Intervertebral
Foramina

Intervertebral Discs

Spinous Processes

T12

Lateral
Thoracic

LUMBAR AP VIEW

AP
Lumbar

LUMBAR AP VIEW

Superior Articular
Processes

Inferior Articular
Processes

Pedicles

Transverse
Processes

Median Sacral Crest

Spinous Processes

Sacroiliac
Joints

AP
Lumbar

LATERAL VIEW
Lateral
Lumbar

Pedicles

Superior Articular
Processes

Vertebral Bodies
Spinous Processes

Intervertebral Discs

L5

Intervertebral
Foramina

Inferior Articular
Processes

Sacral Canal
Sacrum

Lateral
LATERALLumbar
VIEW

LUMBAR OBLIQUE VIEW

Oblique
Lumbar

Transverse
Processes

Inferior Articular
Processes
Superior Articular
Processes

Pedicles

Partes Interarticulares

Scotty Dog
Appearance
Sacroiliac Joint

LUMBAR
OBLIQUE VIEW

Oblique
Lumbar

Arthrology

Intervertebral Joints

Intervertebral Disc
Intervertebral disk make up 20-30% of the
height of the column and thickness varies
from 3mm in cervical region, 5mm in
thoracic region to 9 mm in the lumbar
region.
Ratio between the vertebral body height
and the disk height will dictate the mobility
between the vertebra
Highest ratio in cervical region allows for
motion
Lowest ratio in thoracic region limits motion

Disc Structure
Nucleus Pulposus (NP) is located in the center
except in lumbar lies slightly posterior.
Gelatinous mass rich in water binding PG
(proteoglycan) AKA (glycoaminoglycos) GAG-protein
molecule.
Chondrotin-4 sulfate in PG molecule gives the disc a
fluid maintaining capacity (hydrophyllic) - decreases
with age.
Hydration of the disc will also decrease with
compressive loading - this loss of hydration
decreases its mechanical function.

Disc Structure
80-90% is H2O decreases with age.
Disc volume will reduce 20% daily (reversible)
which causes a loss of 15-25 mm of height in
the spinal column.
Acts as a hydrostatic unit allowing for uniform
distribution of pressure throughout the disc.

Disc Structure
Compressive stresses on the disc translate into
tensile stresses in the annulus fibrosis
This makes the disc stiffer which adds stability and
support to the spine.

Bears weight and guides motion.

Avascular - nutrition diffusion through endplate.

Annulus Fibrosis
Collagen arranged in sheets called lamellae (outer layers).
These lamellae are arranged in concentric rings -10-12
layers that lessen in number with age and thicken
(fibrose).
Enclose the nucleus and oriented in opposite directions at
an angle of 120 degrees (or 45-65 degrees).
Controls the tensile loading from shear, accessory motions
in the anterior compartment and disc forces which can be
up to 5x the external compression force.

Annulus Fibrosis
Mostly avascular and lacking innervation but
the outermost layers are probably innervated
(sinovertebral nerve).
Thickest anteriorly.
Outermost 1/3 connects to vertebral body via
Sharpies fibers.
Outer 2/3 connect to the end plate.

Longitudinal Ligaments
Supraspinous

Anterior longitudinal

Posterior longitudinal

Ligamentum flavum (elastic)

PLL diverts herniation posteriolaterally

Posterior Structures (Elements) of Motion

Segment
Pedicles and lamina form the neural arch.
Facet joints between the superior and inferior
articulating surfaces.
Transverse and spinous processes.
Interspinous and supraspinous ligaments.
Ligamentum lavum.
Intervertebral foramina.

Facet Joint
Articulation between
the superior (concave)
and inferior (convex)
facets.
Guide intervertebral
motion through their
orientation in the
transverse and frontal
planes.

Facet Joint Capsule

Limit motions.
Strongest in thoracolumbar and
cervicothoracic regions where the curvatures
change.
Resist flexion and undertake tensile loading
in the superior portion with axial loading or
extension.
Resists rotation in lumbar region.

Intervebral Foramina
Exit for nerve root.
The size is dictated by the
disc heights and the
pedicle shape.
Will lose space with
osteophytic formation,
hypertrophy of ligaments
and loss of disc height
with aging lateral
stenosis.
Decreases by 20% with
extension and increases
24% with flexion

UNCOVERTEBRAL (LUSCHKAS) JOINTS

Uncinate process Elevations at the lateral
margins of the upper surface
Articulation with the
body of the vertebra
above
commonly between unci of
the bodies of C3 or 4-C6 or 7
vertebrae
the lateral & posterolateral
margins of the intervertebral
discs
94

Joints between vertebrae

reinforced & supported by numerous ligaments

95

Ligaments of the Vertebral Column

TRUNK
MUSCLES
NECK
MUSCLES

TRUNK
MUSCLES

Back Muscles
Abdominal
Muscles

TRUNK MUSCLES: Back

Superficial Layer
Intermediate Layer
Deep Layer

ERECTOR
SPINAE
Spinalis
Longissimus
Iliocostalis

iliocostalis

longissimus

Spinalis

Longissimus

Iliocostalis

TRANSVERSOSPINAL
Semispinalis
Multifidus
Rotatores

semispinalis

mulitifidus

rotatores

Multifidus

Semispinalis

Rotatores

SHORT
SEGMENTAL
Interspinalis
Intertransversarius

TRUNK MUSCLES: Abdominal

Rectus Abdominis
Internal Oblique
External Oblique
Transversus Abdominis

NECK
MUSCLES
Antero-Lateral
Muscles
Posterior
Muscles

NECK MUSCLES: Antero-Lateral

Sternocleidomastoid
Scalenes (anterior,
medius, posterior)
Longus colli & capitis
Rectus capitis (anterior,
lateralis)

NECK MUSCLES: Posterior

Superficial
Splenius cervicis
Splenius capitis

NECK MUSCLES: Posterior

Deep
Rectus capitis posterior
(minor/major)
Obliquus capitis
superior & inferior

LAND MARKS

 C3 level of the hyoid

bone
C4-C5 thyroid cartilage
C6 cricoid cartilage (only
complete ring)

 T2 superior angle of
scapula
T3 spine of scapula
T4-T5 sternal angle of
Louise (where the trachea
terminates)

 T7 inferior angle of
scapula
T10 xiphoid process
L1-L2 Spinal cord ends
at adult

 L4 Iliac crest/ level of

spinal tap
S2 ASIS anteriorly; PSIS
posteriorly, SI joint,
Dimples of Venous