SURFACE ANATOMY AND JOINTS

OF THE VERTEBRAL COLUMN

Dr. Paiman Jamal
Back surface anatomy
• Surface features of the back are used to locate muscle groups for
testing peripheral nerves,
• to determine regions of the vertebral column,
• and to estimate the approximate position of the inferior end of the
spinal cord.
• They are also used to locate organs that occur posteriorly in the
thorax and abdomen.
• When viewed from behind, the normal vertebral column has no
lateral curvatures.
• The vertical skin furrow between muscle masses on either side of the
midline is straight
• When viewed from the side, the normal vertebral column has primary
curvatures in the thoracic and sacral/coccygeal regions and secondary
curvatures in the cervical and lumbar regions .
• The primary curvatures are concave anteriorly.
• The secondary curvatures are concave posteriorly.
 Useful nonvertebral skeletal landmarks
• external occipital protuberance:
• palpable in the midline at the back of the
head just superior to the hairline.
• the scapula:
• The spine, medial border, and inferior
angle of the scapula are often visible and
are easily palpable.
• The iliac crest is palpable along its
entire length, from the anterior
superior iliac spine the posterior
superior iliac spine
• The position of the posterior
superior iliac spine is often visible as
a “sacral dimple” just lateral to the
midline.
How to identify specific vertebral
spinous processes
• The spinous process of vertebra CII can be identified through deep
palpation as the most superior bony protuberance in the midline
inferior to the skull.
• Most of the other spinous processes, except for that of vertebra CVII,
are not palpable because they are obscured by soft tissue.
• The spinous process of CVII is usually visible as a prominent eminence
in the midline at the base of the neck particularly when the neck is
flexed.
• Extending between CVII and the external occipital protuberance of
the skull is the ligamentum nuchae, apparent as a longitudinal ridge
when the neck is flexed
• Inferior to the spinous process of CVII is the spinous process of TI,
• The root of the spine of the scapula is at
the same level as the spinous process of
vertebra TIII,
• the inferior angle of the scapula is level
with the spinous process of vertebra TVII

• The spinous process of vertebra TXII is

level with the midpoint of a vertical line
between the inferior angle of the scapula
and the iliac crest
• A horizontal line between the highest point of the iliac crest on each
side crosses through the spinous process of vertebra LIV.
• The sacral dimples that mark the position of the posterior superior
iliac spine are level with the SII vertebral spinous process
• The tip of the coccyx is palpable at the base of the vertebral column
between the gluteal masses
Visualizing the inferior ends of the spinal cord
and subarachnoid space
• Normally in adults, spinal cord
terminates at the level of the
disc between vertebrae LI and
LII
• The subarachnoid space ends
at approximately the level of
vertebra SII
• The erector spinae muscles are
visible as two longitudinal
columns separated by a furrow
in the midline
Joints between vertebrae in the back
• The two major types of joints between
vertebrae are:
• ■ symphyses between vertebral bodies
• ■ synovial joints between articular
processes
• A typical vertebra has a total of six joints with adjacent vertebrae:
four synovial joints (two above and two below)
• and two symphyses (one above and one below). Each symphysis
includes an intervertebral disc.
• Atlanto-occipital joint:
• involved primarily in flexion, extension , and lateral flexion of the
head.
• Atlantoaxial joints:
• Are involved in rotation of the atlas and head as a unit on the axis.
• Joints between arches
 Joints between vertebral arches
(zygapophysial joints)
• The synovial joints between superior
and inferior articular processes on
adjacent vertebrae.
• The lateral margins of the upper
surfaces of typical cervical vertebrae
are elevated into crests or lips termed
uncinate processes.
• These may articulate with the body of
the vertebra above to form small
“uncovertebral” synovial joints
Ligaments of the Spine

• The major supporting ligaments are the anterior and posterior

longitudinal ligaments that run vertically along the anterior and
posterior surfaces of the bodies of the vertebrae, from the neck to
the sacrum
• The anterior longitudinal ligament is wide and attaches strongly to
both the bony vertebrae and the intervertebral discs.
• Prevents hyperextension of the back (bending too far backward)
• The posterior longitudinal ligament is narrow and relatively weak,
attaches only to the intervertebral discs.
• It helps to prevent hyperflexion (bending the vertebral column too
sharply forward).
• The upper part of the posterior longitudinal ligament that connects
CII to the intracranial aspect of the base of the skull is termed the
tectorial membrane
Ligamenta flava
• The ligamenta flava, on each side, pass between the laminae of
adjacent vertebrae
• The ligamenta flava resist separation of the laminae in flexion and
assist in extension back to the anatomical position.
Supraspinous ligament and ligamentum
nuchae
• The supraspinous ligament connects and
passes along the tips of the vertebral
spinous processes from vertebra CVII to the
sacrum.
• From vertebra CVII to the skull, the
ligament becomes structurally distinct and
is called the ligamentum nuchae.
Interspinous ligaments

• Interspinous ligaments pass between adjacent

vertebral spinous processes.
• They attach from the base to the apex of each
spinous process and blend with the
supraspinous ligament posteriorly and the
ligamenta flava anteriorly on each side.
Intervertebral Discs
• Intervertebral disc is a cushion like pad composed of an inner nucleus pulposus
and an outer the anulus fibrosus.
• nucleus pulposus is gelatinous and enabling the spine to absorb compressive
stress.
• Herniated Disc
• Degenerative changes in the anulus fibrosus can lead to herniation of
the nucleus pulposus. Posterolateral herniation can impinge on the
roots of a spinal nerve in the intervertebral foramen.
• Severe or sudden physical trauma to the spine—for example, due to
lifting a heavy object—may cause one or more herniated discs (also
called prolapsed discs