The Back

Vertebrae, Ligaments, Joints and Deep Muscles of the Back

Vertebrae
Vertebral Column
7 cervical vertebra
12 thoracic vertebra
5 lumbar vertebra
5 sacrum vertebra
4 coccyx vertebra
Round vertebral body anteriorly
Vertebra arch posteriorly
Pedicle
Lamina
7 processes
Spine process (1)
Transverse process (2)
Articular process (4)
Vertebral foramen


Foramen transversarium - for the passage of the
vertebral artery and veins (C1 to C6 only)
The spines are small and bifid.
The body is small and broad from side to side.
The vertebral foramen is large and triangular.
The superior articular processes have facets that
face posteriorly and superiorly
The inferior processes have facets that face
inferiorly and anteriorly.
1
st
Cervical Vertebra
(Atlas)
No body
No spinous sprocess
Anterior and posterior arch
Lateral mass on each side for
articulation with the occipital
condyles (atlantooccipital joints)
Articular surface on the inferior
side for articulation with the 2
nd

cervical vertebra (axis)
Odontoid process (Dens)
Has the longest spinous process
No bifid
Has large transverse process
Small foramen transversarium
Does not transmit the vertebral artery
or vein

The body is medium size and heart shaped.
The vertebral foramen is small and circular.
The spines are long and inclined downward.
Costal facets are present on the sides of the bodies for articulation
with the heads of the ribs.
Costal facets are present on the transverse processes for articulation
with the tubercles of the ribs (T11 and 12 have no facets on the
transverse processes).
The superior articular processes bear facets that face posteriorly and
laterally
The inferior articular processes face anteriorly and medially.
The inferior articular processes of the 12th vertebra face laterally, as
do those of the lumbar vertebrae.
The body is large and kidney shaped.
The pedicles are strong and directed backward.
The laminae are short in a vertical dimension (important when
performing a spinal tap.)
The vertebral foramina are triangular.
The transverse processes are long and slender.
The spinous processes are short, flat, and quadrangular and project
posteriorly.
The articular surfaces of the superior articular processes face
medially, and those of the inferior articular processes face laterally.
Sacrum
5 rudimentary vertebra fused
together
Wedges shaped, concave
anteriorly
Upper base articulates with L5
Lower apex articulates with coccyx
Articulates with the Iliac bone on
the lateral sides
S1 anterior border forms the
sacral promontory

Sacrum
Sacral canal formed by vertebral
foramina
Sacral hiatus due to absence of
4
th
/5
th
lamina
Sacral canal contain the anterior
and posterior roots, filum
terminale and fibrofatty material
Subarachnoid space goes down as
low as the S2 vertebra
4 foramina on each side, on both
anterior and posterior surface
Coccyx
4 fused vertebra to form one
small triangular bone.

Important Variations

Cervical rib
1
st
lumbar vertebra may
have a rib
5
th
lumbar vertebra may be
fused with the sacrum
Partial fusion of the S1
Spines of Sacrum may fail to
fuse

Joints and Ligaments of the Vertebrae
Synovial joints
Between occipital condyles and lateral mass of atlas
Ligaments
Anterior atlanto-occipital membrane
Continuation of ALL and connects the anterior arch to the anterior
margin of the foramen magnum
Posterior atlanto-occipital membrane
Similar to ligamentum flavum
Continues to the posterior arch to the posterior margin of the
foramen magnum
Movement
Flexion, extension and lateral flexion.
1 - alar ligament
2 - occipital bone
3 - occipital condyle
4 - atlantooccipital joint
5 - the transverse process of atlas
6 - the lateral mass of atlas
7 - Atlanta cruciate ligament
8 - Lateral atlantoosevoy joint
9 - the body of cervical vertebra II
Synovial joint
Between odontoid process and
anterior arch of the atlas
Between the lateral masses of
the bones
Encapsulated
Ligaments
Apical ligaments apex of
odontoid process to the anterior
margin of the foramen magnum
Alar ligaments odontoid
process to medial sides of the
occipital condyles
Atlantoaxial Joint

Cruciate ligaments
Transverse part odontoid
process to the inner aspect of
the lateral masses
Vertical part posterior surface
of the body of axis to the
anterior margin of the foramen
magnum
Membrana tectoria
Upper continuation of the PLL,
to the foramen magnum
Covers the odontoid process,
apical, alar and cruciate
ligaments
Movements rotation

Between the inferior surface and superior
surface of adjacent vertebrae with
Intervertebral disc of fibrocartilage in between
Between the superior articulating process and
inferior articulating process of the lamina
Starts from C2 to S1
Responsible for of vertebral column
height
Thickest at the cervical and lumbar
regions
Serve as a shock absorber
Two parts
Anulus fibrosus fibrocartilage arrange in
concentric layers
Inclination of the fibers are arranged in
reversed direction at each layer.
Nucleus pulposus ovoid gelatinous
material containing large amount of water.


Intervertebral Disc

Function
Nucleus pulposus allows it to
change shape
Compression load causes it to
flatten and absorb energy
Excessive load causes the rupture
of the annulus fibrosus
Tears in the annulus fibrosus
causes the nucleus pulposus to
herniate and cause impingement
of the roots, spinal nerves or cord.
Losses water content with age
Ligaments
Anterior longitudinal Ligaments
Wide and strongly attached to the front and
sides of the vertebral body and disc
Posterior longitudinal ligament
Weak and narrow and attached to the
posterior border of the disc
Supraspinous Ligament between tips
of adjacent spines
Interspinous Ligament between the
adjacent spines
Ligamentum Nuchae thickened
supraspinous and interspinous ligaments
on the cervical region (occipital
protuberance to the C7)
Intertransverse ligaments between
adjacent transverse processes
Ligamentum flavum between
laminae of adjacent vertebra
Nerve supply of Vertebral
Joints

Small meningeal branches of the
each spinal nerve
Arises from the spinal nerves as it
exits the intervertebral canal
Supplies meninges, ligaments and
intervertebral disc
Posterior rami of spinal nerves
Articular process

As fetus one continuous anterior concavity
At birth cervical lordosis develops as child raises his head
At one year old lumbar lordosis develops as child learns to stand and walk.
Lateral curvatures
Minor curvatures due to predominant use of one limb. With compensatory curves above and below the
curvature.
Muscles of the Back
The superficial muscles connected with the
shoulder girdle.
The intermediate muscles involved with
movements of the thoracic cage.
The deep muscles or postvertebral muscles
belonging to the vertebral column.
The superficial muscles connected with the
shoulder girdle.
The intermediate muscles involved with
movements of the thoracic cage.
The deep muscles or postvertebral muscles
belonging to the vertebral column.
Superficial Vertically Running Muscles
Erector spinae
iliocostalis
longissimus
spinalis
Intermediate Oblique Running Muscles
Transversospinalis
Semispinalis
multifidus
Rotatores
Deepest Muscles
Interspinales
Intertransversarii
Superficial Vertically Running Muscles
Erector spinae
iliocostalis
longissimus
spinalis
Intermediate Oblique Running Muscles
Transversospinalis
Semispinalis
multifidus
Rotatores
Deepest Muscles
Interspinales
Intertransversarii
Splenius capitis
Origin: Lower part of ligamentum nuchae and
upper four thoracic spines
Insertion: Superior nuchal line of the occipital
bone and mastoid process of the temporal
bone
Splenius cervicis
Origin: Lower part of ligamentum nuchae and
upper four thoracic spines
Insertion: transverse process of the upper
cervical vertebrae
Nerve supply: posterior rami of the spinal
nerves
Auscultatory Triangle
Boundaries: latissimus dorsi, trapezius, medial border of scapula
For breath sounds
Lumbar triangle
Boundaries: latissimus dorsi, posterior border of the external
oblique muscle of abdomen and iliac crest
Pus may emerge from abdominal wall
Between 12
th
ribs to the iliac crest
Originate from the transversus abdominis
aponeurosis
Divides into three lamella
Attached to the tips of the spinous process
Covers the deep muscles of the back
Attached to the tips of the transverse process
Between the deep muscles of the back and
quadratus lumborum
Attached to anterior surface of the transverse
process
Anterior to the quadratus lumborum
Cervical region
Occipital artery br. External carotid
Vertebral artery br. Subclavian
Deep cervical artery br. Costocervical
trunk
Thoracic Region from posterior
intercostal arteries
Lumbar Region subcostal and lumbar
arteries
Sacral Region iliolumbar and lateral
sacral arteries (br. Internal iliac artery)
External vertebral venous
plexus
External and surrounds the
vertebral column
Internal vertebral venous
plexus
Within the vertebral canal but
outside the dura mater of the
spinal cord
Receives tributaries from
basivertebral veins
Drained by the intervertebral
veins
Spinal Cord and its Blood Supply
Posterior rami of 31 spinal nerves
C1, C6, C7, C8, L4 and L5 nerves supply by the deep muscle of the back and not the skin
Scalp supplied by C2 (greater occipital nerve)

Cylindrical, grayish, white structure
Begins above the foramen magnum
Continuous with medulla oblongata
Terminates at the level of lower border of first lumbar
vertebra (adult) or upper border of 3
rd
lumbar vertebra
(child)
Cervical and Lumbar enlargements due to brachial and
lumbar plexus
Inferior ends tapers down into conus medullaris
Filum terminale extension of the pia mater to attached
to coccyx
Anterior median fissure
Posterior median sulcus
Motor roots (anterior)
Sensory roots (posterior)
Posterior root ganglion
Spinal Nerves fusion of anterior
and posterior roots and exits thru
the intervertebral foramen.
Becomes longer due to discrepancy
of spinal cord and column lengths
Cauda equina group of spinal
nerves beyond the cords length.

One anterior spinal artery from vertebral
arteries
Two posterior spinal artery from vertebral
arteries
Radicular arteries
Venous drainage into the internal vertebral
venous plexus
Meninges
Dura Mater
Continuous from the meningeal
layer of dura covering the brain
Ends in the filum terminale
Separated from the wall of the
spinal column by the extradural
(epidural space)
Continues on the spinal nerves
as the epineurium
Separated from the arachnoid
mater by subdural space.
Arachnoid Mater
Delicate impermeable
membrane
Between the pia mater and
dura mater
Separated from the pia mater
by the subarachnoid space.
(filled with CSF)
Continuous with above the
foramen magnum and ends in
the filum terminale

Pia mater
Vascular membrane closely
covering the spina cord
Ligamentum denticulatum
thickening on the lateral sides
Suspends the cord in the middle of
the dural sheath.
Conditions involving the Spine
Chance Fracture
A fracture through an entire
vertebra.
During rapid deceleration, the
spine flexes, Fracture plane
begins at the spinous process and
travels through the vertebra.
Ligaments involved includes
Supraspinous
Interspinous
Ligamentum flavum
Posterior longitudinal
Spondylosis
is a congenital defect or an acquired
stress fracture of the lamina that
presents with no slippage of
adjacent articulating vertebrae

Spondylolisthesis
Anterior displacement of the
Superior body and transverse
process while the posterior
fragment (vertebral laminae and
spinous process) remains in
proper alignment over the
sacrum.
This defect has the radiographic
appearance of a Scotty dog with
a broken neck Pressure on spinal
nerves often leads to low back
and lower limb pain.
Scotty Dog Collar
Lumbar Oblique view
Herniated Disc
Potts Disease
Lumbar Puncture and
Spinal Anesthesia
Lumbar puncture
A spinal needle is inserted into
the subarachnoid space of the
lumbar cistern in the midline
between either the L3 to L4 or
L4 to L5 vertebral spinous
processes. Because the spinal
cord ends at approximately L1
or L2, the needle will not
pierce or damage the cord.
Epidural Anesthesia
Administration of an anesthetic
agent into the epidural space
directly affects nerve roots of
the cauda equina and is a
common form of anesthesia
used during childbirth.
Spina Bifida