ANATOMY AND PHYSIOLOGY OF THE SPINE

The spinal column is one of the most vital parts of the human body, supporting our trunks and
making all of our movements possible. Its anatomy is extremely well designed, and serves many
functions.

All of the elements of the spinal column and vertebrae serve the purpose of protecting the
spinal cord, which provides communication to the brain and mobility and sensation in the body
through the complex interaction of bones, ligaments and muscle structures of the back and the
nerves that surround it.

The normal adult spine is balanced over the pelvis, requiring minimal workload on the muscles
to maintain an upright posture.

Loss of spinal balance can result in strain to the spinal muscles and spinal deformity. When the
spine is injured and its function impaired, the consequences may be painful and even disabling.

Regions of the Spine

Spine Anatomy & Physiology

Humans are born with 33 separate vertebrae. By adulthood, we typically have 24 due to the
fusion of the vertebrae in the sacrum.

·0 The top 7 vertebrae that form the neck are called the cervical spine and are labeled C1-
C7. The seven vertebrae of the cervical spine are responsible for the normal function
and mobility of the neck. They also protect the spinal cord, nerves and arteries that
extend from the brain to the rest of the body.

·1 The upper back, or thoracic spine, has 12 vertebrae, labeled T1-T12.

·2 The lower back, or lumbar spine, has 5 vertebrae, labeled L1-L5. The lumbar spine bears
the most weight relative to other regions of the spine, which makes it a common source
of back pain.

·3 The sacrum (S1) and coccyx (tailbone) are made up of 9 vertebrae that are fused
together to form a solid, bony unit.

Spinal Curvature

When viewed from the front or back, the normal spine is in a straight line, with each vertebra
sitting directly on top of the other. Curvature to one side or the other indicates a condition called
scoliosis.

When viewed from the side, the normal spine has three gradual curves:

·4 The neck has a lordotic curve, meaning that it curves inward.

 ·5 The thoracic spine has a kyphotic curve, meaning it curves outward.

·6 The lumbar spine also has a lordotic curve.

These curves help the spine to support the load of the head and upper body, and maintain
balance in the upright position. Excessive curvature, however, may result in spinal imbalance.

Elements of the Spine

The elements of the spine are designed to protect the spinal cord, support the body and
facilitate movement.
Elements of the Spine

A. Vertebrae

The vertebrae support the majority of the weight imposed on the spine. The body of each
vertebra is attached to a bony ring consisting of several parts. A bony projection on either side of
the vertebral body called the pedicle supports the arch that protects the spinal canal. The
laminae are the parts of the vertebrae that form the back of the bony arch that surrounds and
covers the spinal canal. There is a transverse process on either side of the arch where some of
the muscles of the spinal column attach to the vertebrae. The spinous process is the bony
portion of the vertebral body that can be felt as a series of bumps in the center of a person’s
neck and back.

B. Intervertebral Disc

Between the spinal vertebrae are discs, which function as shock absorbers and joints. They are
designed to absorb the stresses carried by the spine while allowing the vertebral bodies to move
with respect to each other. Each disc consists of a strong outer ring of fibers called the annulus
fibrosis, and a soft center called the nucleus pulposus. The outer layer (annulus) helps keep the
disc’s inner core (nucleus) intact. The annulus is made up of very strong fibers that connect each
vertebra together. The nucleus of the disc has a very high water content, which helps maintain
its flexibility and shock-absorbing properties.
C. Facet Joint

The facet joints connect the bony arches of each of the vertebral bodies. There are two facet
joints between each pair of vertebrae, one on each side. Facet joints connect each vertebra with
those directly above and below it, and are designed to allow the vertebral bodies to rotate with
respect to each other.

D. Neural Foramen

The neural foramen is the opening through which the nerve roots exit the spine and travel to the
rest of the body. There are two neural foramen located between each pair of vertebrae, one on
each side. The foramen creates a protective passageway for the nerves that carry signals
between the spinal cord and the rest of the body.

E. Spinal Cord and Nerves

The spinal cord extends from the base of the brain to the area between the bottom of the first
lumbar vertebra and the top of the second lumbar vertebra. The spinal cord ends by diverging
into individual nerves that travel out to the lower body and the legs. Because of its appearance,
this group of nerves is called the cauda equina – the Latin name for “horse’s tail.” The nerve
groups travel through the spinal canal for a short distance before they exit the neural foramen.

The spinal cord is covered by a protective membrane called the dura mater, which forms a
watertight sac around the spinal cord and nerves. Inside this sac is spinal fluid, which surrounds
the spinal cord.

The nerves in each area of the spinal cord are connected to specific parts of the body. Those in
the cervical spine, for example, extend to the upper chest and arms; those in the lumbar spine
the hips, buttocks and legs. The nerves also carry electrical signals back to the brain, creating
sensations. Damage to the nerves, nerve roots or spinal cord may result in symptoms such as
pain, tingling, numbness and weakness, both in and around the damaged area and in the
extremities.

Spinal Muscles

Many muscle groups that move the trunk and the limbs also attach to the spinal column. The
muscles that closely surround the bones of the spine are important for maintaining posture and
helping the spine to carry the loads created during normal activity, work and play. Strengthening
these muscles can be an important part of physical therapy and rehabilitation.

Nervous System
All of the elements of the spinal column and vertebrae serve the purpose of protecting the
spinal cord, which provides communication to the brain, mobility and sensation in the body
through the complex interaction of bones, ligaments and muscle structures of the back and the
nerves that surround it.

The true spinal cord ends at approximately the L1 level, where it divides into the many different
nerve roots that travel to the lower body and legs. This collection of nerve roots is called the
cauda equina, which means “horse’s tail,” and describes the continuation of the nerve roots at
the end of the spinal cord.

Anatomy and Physiology of Calcaneus

Calcaneus is bone of the hind foot and is the largest tarsal bone. Calcaneus forms the the
prominence of the heel.

Structure of Calcaneus

Calcaneus is roughly cuboidal in shape. It is directed forwards, upwards and laterally.

Calcaneus anatomy

It has six surfaces.

Anterior Surface

The anterior surface is the smallest surface of the bone. It is covered by a concavoconvex,
sloping articular surface to the calcaneocuboid joint and is roughly triangular. It is concave in an
oblique inferolateral plane and convex in a plane perpendicular to this.

Posterior Surface

The posterior calcaneal surface is convex, dome shaped, wider inferiorly, and has 3 distinct areas
– upper, middle and lower.

The upper area is smooth, slopes anteriorly, and supports a bursa, which lies between it and the
Achilles tendon.

The middle part gives insertion to the Achilles tendon

The lower part is covered by fibrofatty tissue of the plantar heel pad

Superior Surface

·7 The superior calcaneal surface of the calcaneus has 2 parts: articular and nonarticular.

·8 The nonarticular part has variable length and extends posteriorly to form the heel. It is
about one third of total superior surface.

·9 It is convex from side to side, is concave in the anteroposterior axis, and supports a fat
pad situated anterior to the Achilles tendon.

·10 Anterior to this nonarticular part is articular which has an oval facet facing superiorly
and is tilted anteriorly. The articular portion of the superior surface is convex in the
 anteroposterior axis and articulates with the posterior calcaneal facet on the
undersurface of the talus.

·11 Calcaneus sulcus is deep groove anterior to posterior facet and directed posteromedially
It matches the inferior similar sulcus on lower surface of the talus, and both these
grooves form a canal in the hindfoot called the sinus tarsi.

·12 Anteromedial to the calcaneal sulcus is an articular area, elongated and concave in its
long axis and directed anterolaterally. A transverse notch divides this into larger middle
facet posteriorly and anterior facet.

·13 The middle facet lies on a medially projecting process of the calcaneus called the
sustentaculum tali. It articulates with the middle calcaneal facet on the under surface of
the talus.

·14 The anterior facet lies on the anterior process of the calcaneus and articulates with the
anterior calcaneal facet on the talus.

·15 The upper rough surface, anterior and lateral to the facets, is rough for the attachment
of ligaments and for the origin of the extensor digitorum brevis.

Plantar surface

The inferior or plantar surface is wider posteriorly and convex from side to side.

It has a prominence at the back, called the calcaneal tuberosity. Calcaneal tuberosity has a
central longitudinal depression dividing it into a smaller lateral and larger broader medial
process.

Lateral process gives rise to part of the abductor digiti minimi whereas medial process that gives
attachment to the abductor hallucis, front to the flexor digitorum brevis and the plantar
aponeurosis.

Lateral Surface

The lateral surface is rough and almost flat, broader posteriorly and narroweranteriorly.
Anteriorly, a small elevation termed the peroneal fibular] tubercle or trochlea is present.

It is a ridge that separates two grooves. Superior groove is for peroneus brevis tendon and
inferior is for peroneus longus tendon.

Av small tubercle in the middle of lateral surface give attachment to, to which the
calcaneofibular ligament.

Medial surface

Medial surface is concave from above downwards. The concavity is accentuated by the presence
of medially oriented shelf-like projection of bone, called the sustentaculum tali, which projects
medially from its anterosuperior border. The sustentaculum tali has an articular surface for the
middle calcaneal facet and is grooved inferiorly to house the flexor hallucis longus tendon Its
lower surface is grooved; and the medial margin is in the form of a rough strip convex from
before backwards.

Attachments and relations of the calcaneus

Attachments on Posterior Surface

The middle rough area on the posterior surface receives the insertion of the tendocalcaneus and
of the plantaris. The upper area is covered by a bursa. The lower area is covered by dense
fibrofatty tissue and supports the body weight while standing.

Attachments on Dorsal or Superior Surface

The lateral part of the nonarticular area on the anterior part of the dorsal surface provides;

·16 Origin to the extensor digitorum brevis

·17 Attachment to the stem of the inferior extensor retinaculam

·18 Attachment to the stem of the bifurcate ligament .

Sulcus calcanei provides attachment to the interosseus talo-calcanean ligament medially, and the
cervical ligament laterally.

Attachments on Plantar Surface

The attachments on the planter surface are as follows;

The medial tubercle

Medially

·19 Origin for the abductor hallucis

·20 Attachment to the flexor retinculum
Antriorly

·21 Flexor digitorum brevis

·22 Attachment to the plantar aponeurosis

The lateral tubercle
 ·23 Origin to the abductor digiti minimi, the origin extending to the front of the tubercle.

·24 The anterior tubercle

·25 Along with the rough area in front – short plantar ligament.

·26 Rough strip between the three tubercle – Long plantar ligament.

Attachments on Lateral Surface

The peroneal tubercle – Slip from the inferior peroneal rentinaculum.

The calcaneofibular ligament is attached about I cm behind the peroneal trochlea.

Attachments on Medial Surface

·27 The groove on the lower surface of the sustentaculum tali is occupied by the tendon of
the flexor hallucis longus.

·28 The medial margin of the sustentaculum tali

·29 Spring ligament

·30 Slip from the tibialis posterior in the middle

·31 Superficial fibers of the deltoid ligament along the length

·32 Medial talocaneal ligament posteriorly.

·33 Below the groove for the flexor hallucis longus ,the medial surface gives origin to the
fleshy fibres of the medial head of the accessory flexor digitorum.

Ossification

·34 One primary and one secondary centre .

·35 Primary centre – During the 3rd month of intrauterine lite.

·36 Secondary center 6-8 years to from a scale-like epiphysis on the posterior surface
·37 Fuses with the rest of the bone by 14-16 years.
Side Determination of Calcaneus

·38 The anterior surface is small and bears a concavocovex articular facet for the cuboid.

·39 The posterior surface is large and rough.

 ·40 The dorsal or superior has a large convex articular surface in the middle.

·41 The plantar surface is large and triangular.

·42 The lateral surface is flat

·43 The medial surface concave from above downwards.

Blood Supply of Calcaneus

Blood supply of calcaneus is by calcaneal branches which arise from deep perforator peroneal
and posterior tibial arteries.

Clinical Significance of Calcaneum

·44 Gastrocnemius, soleus, and plantaris are posterior compartment muscles of the leg and
aid in walking, running and jumping. Their specific functions include plantarflexion of the
foot, flexion of the knee, and steadying the leg on the ankle during standing.

·45 Calcaneal is frequently injured bone especially in fall from height. Most of calcaneal
fractures are treated by non operative means but surgery for displaced fractures is
required.

·46 Calcaneal is surrounded by minimal soft tissue and surgical incisions need to be carefully
planned because of wound healing problems in the area.