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General Structure - approx 33 vertebrae - cervical vertebrae small in size, foramen in transverse processes - thoracic vertebrae have 12 articulated ribs (via synovial joints) - lumbar vertebrae large size - sacral vertebrae 5 fused vertebrae = sacrum - coccygeal vertebrae fuse into small bone called coccyx - vertebrae formed from somites, specifically sclerotome - spinal cord usually ends between LII and LIII but can end as high as TXII and as low as between LII and LIII - vertebral canal runs from CI to SV Curvatures - primary thoracic and sacral - secondary cervical and lumbar Extrinsic muscles - move the upper limbs and ribs - innervated by anterior rami of spinal nerves or cranial nerve XI (not originating in the back) Trapezius Latissimus dosri Rhomboid major Rhomboid minor Levator scapule Serratus posterior superior Serratus posterior inferior Intrinsic muscles - maintain posture - move vertebral column flexion (bending forward at waist) extension (leaning back at waist) lateral flexion (bending side to side) rotation - true back muscles innervated by posterior rami of spinal nerves Splenius

 Erector spinae o Longissimus o Ilocostalis o Spinalis o Suboccipital Movement of head - nodding of head = extension and flexion on CI (atlas) - rotation of head CI (atlas) moves on CII (axis) Intervertebral foramen borders Superior and inferior notches on pedicles Posterior articular processes (and corresponding zygapophysial joint) of adjacent vertebrae Anterior intervertebral disc Blood to brain - vertebral arteries travel through foramen of transverse processes (foramen transversarium) of CVI to CI then pass through the foramen magnum to supply blood to the brain Joints - a typical vertebra has a total of 6 joints with adjacent vertebrae 4 synovial and 2 symphsis (btw vertebral bodies and include vertebral discs) - intervertebral disc consist of outer annulus fibrosus limits rotation of between vertebrae inner nucleus pulposus gelatinous and absorbs compression forces between vertebrae from notochord - zygapophysial joints synovial planar between superior and inferior articular processes on adjacent vertebrae in cervical region, the joints slope inferiorly (on a downward angle) o facilitates extension and flexion in thoracic region, the joints are oriented vertically o limits flexion and extension but facilitates rotation

 in lumbar region, the joint surfaces are curved and adjacent processes interlock o flexion and extension are still major movements even though they are limited Ligaments - anterior longitudinal ligament attaches superiorly to base of skull and runs length of anterior portion of vertebral column bodies attaches anteriorly to surface of sacrum - posterior longitudinal ligament lines anterior surface of the vertebral canal tectorial membrane upper part of pll that connect CII to the intracranial aspect of the base of the skull - ligamenta flava pass between the laminae of adjacent vertebrae predominatly elastic tissue form part of posterior surface of the vertebral canal resists separation of the laminae in flexion and assist in extension of the back - ligamentum nuchae triangular sheet like structure running from CVII to the skull attaches to skull from external occipital protuberance to foramen magnum supports head; resists flexion and facilitates - interspinous ligament pass between adjacent spinous processes

NERVES - 31 pairs of spinal nerves 8 cervical (C1 C8) 12 thoracic (T1 T12) 5 lumbar (L1 L5) 5 sacral (S1 S5) 1 coccygeal - all spinal nerves exit the vertebral canal between the pedicles of adjacent vertebrae - dorsal (posterior) roots contain sensory neurons carrying info into the CNS

- ALL cell bodies of dorsal roots arise from neural crest cells and reside in the dorsal root ganglion - ventral (anterior) roots contain motor nerve fibers which carry signals away from the CNS - cell bodies of ventral roots are in the anterior region of the spinal cord (gray matter/ventral horn) - dorsal and ventral roots join in the spinal nerve * now the nerve is both motor and sensory! - anterior and posterior rami leave from spinal nerve (*still both motor and sensory) - each spinal nerve is attached to the spinal cord by an anterior and posterior root - anterior rami form the major somatic plexuses of the body (somatic plexuses network of anastomosing (or interlacing) nerves) - upper limbs innervated by anterior rami of cervical vertebrae - lower limbs innervated by anterior rami of lumbosacral vertebrae - *any pathology that affects intervertebral foramen can affect the function of the associated spinal nerve; examples: herniated disc dislocation of zygapophysial joint bone loss

CLINICAL CORRELATIONS
Spina bifida - vertebral arches fail to fuse during development - 3 different types sb occulta may show tuft of hair over spinous process; asymptomatic patient sb meningocele large outpouching of the meninges containing CSF only sb myelomeningeocele large outpouching of the meninges containing CSF and portion of the spinal cord Vertebroplasty - body of vertebra is filled with bone cement - most commonly used for osteroprotic wedge fractures (vertebral body is crushed on one side, resembling a wedge) - liquid bone cement is injected into a cannula that has been inserted into the pedicle of the fractured vertebral body - bone cement has two fold function

 increases strength of vertebral body and prevents future loss of height generates some heat which may disrupt pain at nerve endings Scoliosis - abnormal lateral curvature of the vertebral column - can be a diagnosing tool for other diseases including muscular dystrophy Kyphosis - abnormal curvature of vertebral column in thoracic region - hunchback deformity - gibbus deformity abnormal curvature at site of tuberculosis infection Lordosis - abnormal curvature of vertebral column in lumbar region - swayback deformity Variation in vertebral numbers - fusion of CI and CII is known as Klippel-Feil syndrome and may be associated with high riding scapula (Sprengels shoulder) and cardiac abnormalities - hemivertebra are vertebra that develop only on one side Osteoporosis - bone quality is normal but quantity of bone is deficient - influenced by many factors in particular estrogen levels Herniated discs - tear in annulus fibrosus is where nucleus pulposus can track through and impinge on nerves - posterolaterl herniated discs will impinge on the descending root ex) herniated disc between L4 and L5, which nerve is pinched? L5 - fully lateral herniation will result in impingement of upper spinal nerve root in pair Vertebral fractures - if a traumatic incident disrupts craniocervial stability the changes of a significant spinal cord injury are extremely high consequences are quadriplegia in short term you may lose breathing function due to injury of phrenic nerve at C3 to C5 innervates diaphragm muscle - below level of C5 respiratory function is unlikely to be compromised Pars interarticularis fractures - fracture that occurs between the superior and inferior articular facet (zygapophysial) joints

- may result in anterior slip of the vertebral body, compressing the vertebral canal - most common sites for this type of fracture are LIV and LV levels - in an oblique view of a lumbar vertebra radiograph, the tell tale Scottie dog is seen o transverse process = nose o pedicle = eye o superior articular process = ear o inferior articular process = front leg o pars interarticularis = neck - a fracture of the pars interarticularis is visible as a break in the neck of the dog or the appearance of a collar Spondylolisthesis - vertebra slips anteriorly onto its inferior counterpart without a pars interarticularis fracture - usually due to abnormal anatomy of the facet joints or facet joint degeneration Spondylolysis - fracture of pars interarticularis Spondylosis - degenerative osteoarthritis of vertebral joints Ankylosing spondylitis - bony growth of vertebral body leading to disfunction Nerve injuries in back - trapezius due to interruption in accessory nerve may appear as drooping of shoulder, inability to raise arm above the head, inability to shrug shoulder against resistance - latissimus dosri injury to thoracodorsal nerve diminished capacity to pull the body upward (do a pull up) - rhomboids injury to the dorsal scapular nerve lateral shift in the position of the scapula affected because ability to hold it in place is lost Lumbar puncture (spinal tap) - needle passes through skin fat layer thoracolumbar fascia erector spinae muscles between adjacent vertebral spinous

processes supraspinous and interspinous ligaments subarachnoid space to get CSF Epidural - injection of anesthesia - needle is placed through skin supraspinous ligament interspinous ligament ligamenta flava arolar tisse and fat around dura matter (epidural space) - anesthetic is injected and diffuses around the vertebral canal to anesthetized the exiting nerve roots and diffuse into the subarachnoid space Herpes zoster - chicken pox virus can lay dormant in cells of spinal ganglia - can become activated and results in painful rash known as shingles - dermatomal distribution of rash rash is over area where neuronal bundles are from affected spinal nerve/ganglia Abdominal aortic aneurysm - can sometimes ause acute back pain in the first instance