VERTEBRAL COLUMN

DR N SATYANARAYANA

Vertebral column
Made up of 33 vertebrae, forms the major part of axial skeleton Extends from skull to the pelvis Contains spinal cord Functions: Transmits weight to pelvis and lower limbs Protects spinal cord Permits movements Muscle attachments - muscles of back, head and neck, upper extremity and thorax

Vertebral column

 Vertebrae are grouped into 5 types depending on the region where they are present Cervical vertebrae (7) Thoracic vertebrae (12) Lumbar vertebrae (5) Sacral vertebrae (5) Coccygeal vertebrae (4)

Parts of typical vertebra

Typical vertebra
Parts of typical vertebra: Has mainly 2 parts Body (anterior part) Vertebral arch (posterior part) Contains vertebral foramen Parts of vertebral arch: Pedicle Lamina Spine Transverse processes Superior articular processes Inferior articular processes
Body Superior articular process

Pedicle

Transverse process

Vertebral foramen

Lamina

Spine

Superior articular process Superior surface of body

Superior articular facet

Superior vertebral notch

Transverse process Body Inferior vertebral notch Inferior vertebral notch

Anterior surface of body

Spine

Inferior surface of body Inferior articular facet

Inferior articular process

Intervertebral disc

Intervertebral foramen

 Body: Cylindrical part which lies anterior to vertebral foramen Has 4 surfaces superior, inferior, anterior and posterior Superior and inferior surfaces are related to inter-vertebral discs Posterior surface is related to the posterior longitudinal ligament and has basivertebral foramen for nutrient artery and basivertebral vein Anterior surface related to anterior longitudinal ligament

 Vertebral arch: Situated on the lateral aspect and posterior aspect of vertebral foramen Pedicle: Lies lateral to vertebral foramen Upper margin presents superior vertebral notch Lower margin presents inferior vertebral notch These notches get converted into inter-vertebral foramen when the vertebrae articulate with each other Inter-vertebral foramen transmits spinal nerve Lamina: Lies behind the vertebral foramen Joins the lamina of opposite side in the midline and continue as spine

Give attachment to ligamentum flavum

Spine: Situated on the posterior aspect Formed by the union of laminae Gives attachment to supraspinous and interspinous ligaments Transverse processes: one on each side Directed laterally from the junction of pedicle and lamina Superior articular process: one on each side Extend upwards from the junction of lamina and pedicle Has a smooth area called superior articular facet which articulates with inferior articular facet of upper vertebra

 Inferior articular process: one on each side Extend downwards from the junction of lamina and pedicle Has a smooth area called inferior articular facet which articulates with superior articular facet of lower vertebra Vertebral foramen: Is surrounded by body, lamina and pedicle Contains spinal cord, spinal meninges, vertebral venous plexus

Cervical vertebrae

Cervical vertebrae

Cervical vertebrae
7 in number 1st, 2nd and 7th vertebrae are atypical cervical vertebrae 3rd, 4th, 5th and 6th vertebrae are typical cervical vertebrae Typical cervical vertebrae: Body: Small and broader from side to side than before backwards Vertebral foramen: Larger than body and triangular in shape

Typical cervical vertebra

Anterior root Body Foramen transversarium

Anterior tubercle
Costotransverse bar Posterior tubercle

Transverse process

Posterior root

Vertebral foramen

Spine - bifid

 Transverse process: Contains a foramen foramen transversarium which transmits the vertebral artery and veins Has anterior and posterior roots which ends in anterior and posterior tubercles The 2 roots are connected by costotransverse bar Anterior tubercle of 6th cervical vertebra is large and called carotid tubercle because common carotid artery can be compressed against it Anterior tubercles give attachment to scalenus anterior muscle Posterior tubercles give attachment to scalenus medius and posterior muscles Spine: Short and bifid, the notch is filled with ligamentum nuchae

Atlas vertebra

Atlas vertebra
Anterior tubercle Anterior arch Lateral mass Transverse process

Superior view
Foramen transversarium Groove on superior surface of posterior arch Posterior arch Posterior tubercle Superior articular facet Anterior arch

Inferior view
Vertebral foramen Inferior articular facet Dens of axis vertebra Transverse ligament of atlas

 Atlas (1st cervical) vertebra: Ring shaped, has no body and no spine Has - short anterior arch and long posterior arch, right and left lateral masses, transverse processes Anterior arch: Has anterior tubercle on its anterior surface which gives attachment to anterior longitudinal ligament Has facet for dens of 2nd cervical vertebra on the posterior surface Upper margin gives attachment to anterior atlanto-occipital membrane Lower margin gives attachment to anterior longitudinal ligament

 Posterior arch: Has posterior tubercle on its posterior surface which gives attachment to rectus capitis posterior minor muscle and ligamentum nuchae Has a groove on the upper aspect for vertebral artery and first cervical spinal nerve Upper margin gives attachment to anterior atlanto-occipital membrane Lower margin gives attachment to ligamentum flavum

Anterior arch Dens of axis vertebra

Groove

Posterior tubercle

Posterior arch

 Lateral mass: Upper surface presents kidney shaped superior articular facet which articulate with occipital condyles of skull to form atlantooccipital joint Inferior surface presents round, inferior articular facet which articulate with superior surface of body of 2nd cervical vertebra and form atlanto-axial joint Has a tubercle on the medial aspect which gives attachment to transverse ligament of atlas Transverse process: Long and projects laterally from lateral mass Has foramen transversarium which transmits vertebral artery and vein

Axis vertebra

Axis vertebra

 Axis (2nd cervical) vertebra: Superior surface of body presents a projection in the midline called dens or odontoid process Dens on its anterior surface present a facet which articulates with anterior arch of atlas to form median atlantoaxial joint Dens on its posterior aspect related to transverse ligament of atlas Dens gives attachment to apical and 2 alar ligaments Superior articular facet is on the superior surfaces of body and pedicle which articulates with atlas vertebra to form lateral atlanto-axial joint Inferior articular facet articulates with superior articular facet of 3rd cervical vertebra Transverse process is very small and contains foramen transversarium which transmits vertebral artery and vein Spine is large, thick and bifid

Ligaments
Anterior atlanto-occipital membrane Posterior atlanto-occipital membrane Occipital bone Ligamentum nuchae

Anterior arch of atlas

Ligamentum flavum Lamina Anterior of axis longitudinal ligament

Posterior arch of atlas

Vertebral artery

Vertebra prominens cervical vertebra)

th (7

Vertebra prominens (7th cervical vertebra)

Spine is long, thick, horizontal and not bifid
Foramen transversarium Transverse process

Transverse process is large and contains foramen transversarium which transmits accessory vertebral vein
Transverse process has only posterior tubercle
Spine

Posterior tubercle

Thoracic vertebrae

Thoracic vertebrae

Thoracic vertebrae
12 in number Identified by the presence of costal facets on the sides of bodies of vertebrae 1st, 9th, 10th, 11th and 12th vertebrae are atypical thoracic vertebrae 2nd to 8th vertebrae are typical thoracic vertebrae Typical thoracic vertebra: Body: Heart shaped and size increased in the lower vertebrae On each side contains 2 costal facets for the heads of ribs to articulate Vertebral foramen: Is small and circular

Typical thoracic verterba

Body Pedicle Costal facet Transverse process with facet Lamina Body Costal facet Costal facet Transverse process with facet

Vertebral foramen

Spine - oblique

 Transverse process: Large and extend laterally from the junction of the pedicle and lamina Anterior surface near the tip presents a facet for tubercle of rib to articulate Gives attachment to lateral, superior and interior costotransverse ligaments Spine:

Long, oblique, directed downwards and backwards

Atypical thoracic vertebrae

Costal facet (complete)

1st thoracic vertebra Costal demi facet

9th thoracic vertebra

10th thoracic vertebra

11th thoracic vertebra

12th thoracic vertebra

1st thoracic vertebra: Body is not heart shaped and resembles the body of cervical vertebrae Body on the lateral aspect presents 2 facets for the heads of the ribs Upper facet is complete and lower facet is a demifacet Spine is thick, long and horizontal Transverse process on its anterior surface presents a facet for tubercle of the rib 11th thoracic vertebra: Body on the lateral aspect has one single complete costal facet which also extends to the lateral aspect of pedicle No facet on the anterior surface of transverse process Spine is horizontal in position

12th thoracic vertebra

Body on the lateral aspect has single complete facet, which is more on the pedicle than on the body Shape of the body is similar to those of lumbar vetebrae Transverse process is short, has no facet, has 3 tubercles superior, inferior and lateral tubercles Spine is horizontal in position
Superior tubercle Lateral tubercle Inferior tubercle

Body - thick

Costal facet Spine

Lumbar vertebrae

Lumbar vertebrae

Lumbar vertebrae
5 in number These do not have foramen transversarium at the transverse process costal facets on the body 1st to 4th vertebrae are typical lumbar vertebrae 5th vertebra is an atypical lumbar vertebra Typical lumbar vertebra: Body is large, wider from side to side Vertebral foramen is triangular in shape, larger than in thoracic vertebrae, smaller than in cervical vertebrae

Mamillary process on the superior articular process

Accessory process on the transverse process

 Spine is horizontal, thick and quadrangular in shape Transverse process are thin, tapering and arise from the junction between lamina and pedicle Transverse process has an elevation called accessory process Superior articular processes are placed away from the midline, present a rough elevation called mamillary process Inferior articular processes are placed nearer to the midline

Superior articular process

Mamillary process

Accessory process

Spine

5th lumbar vertebra

Body is largest among all the lumbar vertebrae Transverse process is thick, short and pyramidal in shape Transverse process is attached to body and pedicle The distance between superior articular processes is same as that inferior ones Spine is short and rounded at the tip
Spine Mamillary process Transverse process

Superior articular process

Sacrum

Sacrum

Sacrum
Large, flattened, triangular bone formed by the fusion of 5 sacral vertebrae Forms the posterior part of bony pelvis Articulates on either side with ilium of hip bone to form sacroiliac joint Has sacral canal which contains sacral and cocygeal spinal nerves, meninges of spinal cord and filum terminale Has a base, apex, pelvic surface, dorsal surface and 2 lateral surfaces The lateral part of sacrum is called lateral mass Base: Is the upper part, formed by superior surface of 1st sacral vertebra Presents body of S1 vertebra, ala on either side of body, superior articular processes

Sacrum and coccyx

Superior articular process of S1 vertebra Body of S1 vertebra Ala Sacral canal

Sacral promontory Lateral surface Lateral mass Pelvic sacral foramen Coccyx

Apex of sacrum

Pelvic surface

Sacrum and coccyx (dorsal surface)

Sacral canal

Auricular surface Lateral sacral crest

Median sacral crest

Intermediate sacral crest Dorsal sacral foramen

Sacral hiatus

Sacral cornu Coccyx

 Body of S1 vertebra: Articulates with L5 vertebra In males, width of the body of S1 vertebra is more than width of ala In females, width of the body of S1 vertebra is almost equal to the width of ala Anterior margin of body is prominent sacral promontory Ala: Has a smooth medial part and rough lateral part Medial part is related to sympathetic chain, lumbosacral trunk, iliolumbar artery and obturator nerve Lateral part gives attachment to iliacus muscle Superior articular process: Presents superior articular facet which articulates with inferior articular facet of L5 vertebra

 Apex: Is the lower end of sacrum, formed by inferior surface of body S5 vertebra Articulates with the coccyx Pelvic surface: Concave, presents 4 pelvic sacral formaina on each side which transmit ventral rami of upper 4 sacral spinal nerves and lateral sacral arteries Gives attachment to piriformis muscle Dorsal surface: Is rough, irregular and convex Presents Median sacral crest situated at the midline 4 dorsal sacral foramina on either side which transmit dorsal rami of upper 4 sacral spinal nerves

 Sacral hiatus near the apex which transmits 5th sacral spinal nerve, 1st coccyngeal spinal nerve and filum terminale Sacral cornu situated lateral to sacral hiatus, represents the inferior articular process of S5 vertebra Intermediate sacral crest situated medial to dorsal sacral foramina Lateral sacral crest situated lateral to dorsal sacral foramina Lateral surface: Upper part is wide and lower part is narrow Upper part presents L-shaped auricular surface which articulates

Coccyx

Coccyx

Coccyx
Small triangular bone fromed by the fusion of 4 rudimentary coccygeal vertebrae Has a base and apex Base is formed by 1st coccygeal vertebra and articulates with apex of sacrum Apex lies free gives attachment to anococcygeal ligament