Anatomy of Spine

Anatomy of Spine
The vertebral column is a series of approximately 33 bones called vertebrae,

which are separated by intervertebral discs. It extends from the foramen magnum to

the sacral hiatus. It is formed by the dorsal spine, pedicles and lamina of successive

vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccyx). Vertebrae are held

together by a series of overlapping ligaments namely the anterior and posterior

longitudinal ligaments, ligamentum flavum, interspinous ligament, supraspinous

ligament and the intervertebral discs.

The spinal cord, a direct continuation of the medulla oblongata begins at the

upper border of the atlas and terminates distally in the conus medullaris. The

distaltermination, because of the differential growth rates between the bony

vertebralcanal and central nervous system varies from L3 in the infant, to the lower

border of L1 in the adult. Surrounding the spinal cord in the bony vertebral column

arethree membranes (from within to the periphery), the piamater, arachnoid mater

and duramater. Between the two innermost membranes is the subarachnoid space.

SUBARACHNOIDSPACE: Contents: 1) CSF; 2) Spinal nerves; 3) Atrabecular

network between the two membranes; 4) Blood vessels that supply the spinal cord; &

5) Lateral extentions ofthe pia mater – the dentate ligaments ( these ligaments supply

lateral support from the spinal cord to the duramater.)

EPIDURALSPACE:

Boundaries: the space extends from the foramen magnumtos acrococcygeal

membrane. It is triangular in cross section in lumbar region, its base anterior. It is

very thin anteriorly and upto 5mm wide posteriorly. It lies external to the duramater of

spinal cord and internal to the ligamentum flavum and vertebral lamina posteriorly.

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 Anatomy of Spine

Contents: These include extradural fat, extradural veins (Batson’s plexus),

lymphatics and spinal nerve roots. Lumbar puncture is routinely done below the L2

vertebrae down to the L5-S1interspace to avoid damaging the spinal cord which ends

at the lower border of L1inadults.

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 Anatomy of Spine

ANATOMICALCHANGES OF SPINE IN PREGNANCY BONY CHANGES—

1) It is difficult for a pregnant woman to achieve flexion because there is

progressive accentuation of lumbar lordosis alters the relationship of surface
anatomy to the vertebral column.
2) A pregnant woman’s pelvis rotates on the long axis of the spinal column; thus
the line joining the iliac crests (TUFFIER’S LINE) assumes a more cephalad
relationship to the vertebral column.
3) Less space exists between adjacent lumbar spinous processes during
pregnancy. It may be more difficult to use the midline approach to identify the
epidural or subarachnoid space in them.
VERTEBRAL LIGAMENTS–
The hormonal changes due to progesterone, increased intracellular fluid

volume & increased water content in the ligaments during pregnancy affect the

perivertebral ligamentous structures, including the Ligamentum Flavum. The

ligamentum flavum may feel less dense and “softer” in pregnant women.

BLOOD SUPPLY

Persistent aortocaval compression due to graviduterus causes engorgement

Of vertebral plexus, leading to inadvertent intravenous administration of local

anaesthetics.

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