Vertebral Column

Nicole M. Reeves, Ph.D.

Department of Anatomy

[email protected]

Recommended Reading
COA : 7th Edition
Pages: 4-11, 47-60, 440-482, 496-507

*Practice questions can be found on Canvas*

 Learning Objectives
• Describe the features of a typical vertebra and differentiate between cervical, thoracic,
lumbar, sacral and coccygeal vertebrae
• Describe the pattern of rib articulation with thoracic vertebrae
• Compare movements at the atlanto-occipital & atlanto-axial joints
• Describe the composition & placement of intervertebral discs
• Define normal vertebral curvatures
• Explain the ligaments that stabilize the vertebral column, their attachments, and what
movements they prevent
• Describe blood drainage of the vertebral column
• Explain normal changes in spinal cord length relative to the vertebral column through
development
• Distinguish between the 3 meninges, and describe the real and potential spaces
between the vertebral canal, meninges and spinal cord, and list their contents

2
 Learning Objectives
• Describe the organization and distribution of the spinal cord & spinal nerves,
particularly in relation to vertebral level
• Describe the termination of the spinal cord and associated structures in the vertebral
and sacral canal
• Relate the anatomical details to these clinical conditions: Vertebral fractures, abnormal
spinal column curvatures, whiplash, epidural anesthetic injection, lumbar puncture,
herniated IV disc (cervical, thoracic and lumbar regions)
• Link the anatomical and clinical information provided from the lecture to the applicable
gross anatomy laboratory
• Use the information provided from the lecture, along with the learning objectives from
the applicable laboratory, as your knowledge base required for practical examinations

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 Osteology of the back overview

CLAVICLE

VERTEBRAE
SCAPULA

FUNCTIONS
• Protect spinal cord & nerves RIBS

• Supports the trunk as a rigid

yet flexible axis for the body;
important for posture &
locomotion
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 Vertebral column (n = 33)
CERVICAL n=7
VERTEBRAE

Intervertebral (IV) THORACIC

n = 12
discs VERTEBRAE

LUMBAR n=5
VERTEBRAE

SACRUM n = 5 fused segments

COCCYGEAL n = 4 (fused after age 30)
VERTEBRAE segments 5
 Movements of the vertebral column

Flexion & Extension Lateral Flexion & Extension Rotation

• mostly cervical & lumbar (bending) • mostly cervical & thoracic
• mostly cervical & lumbar

6
 General vertebral anatomy

C4 T2 L2

VERTEBRAL BODY
(derived from centrum)
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 General vertebral anatomy

C4 T2 L2

EPIPHYSEAL RIM
(derived from anular epiphysis)
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 General vertebral anatomy
C4 T2 L2
VERTEBRAL ARCH

PEDICLES
LAMINA
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 General vertebral anatomy

C1 C4 T2 L2

VERTEBRAL FORAMEN
(through which spinal cord passes)
VERTEBRAL CANAL
(series of vertebral foramina, through which spinal cord passes)
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 General vertebral anatomy
C4 T2 L2
ARTICULAR PROCESS

SPINOUS PROCESS

TRANSVERSE PROCESS 11
General vertebral anatomy
SUPERIOR VERTEBRAL NOTCH

INFERIOR VERTEBRAL NOTCH

INTERVERTEBRAL (IV) FORAMEN

(spinal n.)

VERTEBRAL BODY
PEDICLE
SUPERIOR ARTICULAR PROCESS
TRANSVERSE PROCESS
INFERIOR ARTICULAR FACET
(feature on INFERIOR ARTICULAR PROCESS) 12
 Zygapophysial (facet) joint: synovial, plane joint

• Articulation of inferior articular

facet of one vertebra with the
superior articular facet of the next
vertebra in sequence

• Note the proximity to intervertebral

foramen (& spinal nerves)

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Cervical vertebrae (n = 7)

C1 – atlas

TRANSVERSE C2 – axis
FORAMEN
(vertebral a.) C3
C4
C5
C6
SPINOUS C7
PROCESS “vertebra prominens”
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 Typical cervical vertebrae – C3 – C7

• Small overall size; small bodies

• Large vertebral foramina to accommodate

cervical enlargement of the spinal cord
(think: innervation of the upper limbs)

• Transverse foramen for vertebral a.

• Uncinate process

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 Clinical: Proximity of spinal nerve & vertebral artery to the uncinate
process on cervical vertebrae
• Bony outgrowths (osteophytes) on the uncinate process may compress both the nerve & the
vertebral artery & can lead to chronic pain in the neck
• common in elderly patients, results in “mini-stroke”
• Remember: spinal nerves pass through the IV foramina, & vertebral arteries pass through the
transverse foramina

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 Cervical vertebrae – C1 (atlas)
FACET FOR DENS of C2 SUPERIOR
ANTERIOR ARTICULAR
ARCH FACET

LATERAL MASSES
TRANSVERSE
GROOVE FOR FORAMEN
VERTEBRAL A.

POSTERIOR
ARCH POSTERIOR TUBERCLE
*atlas has no body 17
 Cervical vertebrae – C2 (axis)
POSTERIOR ARTICULAR
DENS FACET for transverse
(odontoid process) ligament of atlas

INFERIOR SUPERIOR
ARTICULAR ARTICULAR
FACET FACET
TRANSVERSE
ANTERIOR FORAMEN
ARTICULAR
FACET BODY
(articulates with
C1)
BIFID SPINOUS PROCESS
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 Atlanto-axial joint

ATLANTO-AXIAL JOINT SUPERIOR

DENS ARTICULAR
of axis FACET of atlas
(articulates with
occipital condyle of
cranium)
GROOVE
FOR
TRANSVERSE
VERTEBRAL A.
PROCESS

POSTERIOR ARTICULAR
FACET for transverse SPINOUS
ligament of atlas PROCESS 19
 Atlanto-occipital & Atlanto-axial joints
ATLANTO-OCCIPITAL JOINT
• head flexion & extension – nod head
yes

ATLANTO-AXIAL JOINT
• rotation – shake head no

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 Clinical: Fracture & dislocation of atlas

Burst (Jefferson) fracture (C1)

• compressive loading along the cervical spine results in the occipital condyles being driven into
the lateral masses (LM) of C1
• often a 4 part fracture with double fractures through anterior & posterior arches
• occurs when diving head first into shallow water or after falling from a tall building

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 Clinical: Fracture & dislocation of axis (C2)
Hangman’s fracture (C2)
• pedicles fractured posterior to superior articular
facets due to abrupt hyperextension; fracture at
pars interarticularis
• common result of falls & motor vehicle accidents
(hitting chin on steering wheel)
• this injury would occur during judicial hanging,
hence the colloquial name

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 Thoracic vertebrae (n = 12)
SUPERIOR T1
& INFERIOR
COSTAL
FACETS

TRANSVERSE
COSTAL
FACET

Ex: RIB #10

ARTICULATES
T12
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 Thoracic vertebrae (n = 12)
TRANSVERSE
COSTAL COSTAL
FACET OF TUBERCLE OF RIB
VERTEBRA
HEAD OF RIB
SUPERIOR
• provide attachment for ribs (costal facets) → stability
COSTAL
of the trunk → less injury in this region
FACET OF
VERTEBRA • larger than cervical bodies

• Smaller vertebral foramen (compared to cervical &

lumbar vertebrae)

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Lumbar vertebrae (n = 5)

L1

L2

L3

L4

L5
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 Lumbar vertebrae (n = 5)

• LARGE vertebral bodies, which bear the most weight

• orientation of articular facets permits flexion & extension L1
and lateral flexion, while rotation is prohibited
• vertebral foramen large to accommodate lumbar
L2
enlargement of spinal cord

L3

L4

L5
BODY

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 Sacrum (5 fused segments) SUPERIOR ARTICULAR
SACRAL CANAL AURICULAR SURFACE FACET
(continuation of (articulates with pelvis forming SACRAL CANAL
vertebral canal) sacroiliac joint)

S1
S2
S3
S4
S5

ANTERIOR SACRAL POSTERIOR SACRAL SACRAL

FORAMINA FORAMINA HIATUS

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 Coccyx (4 fused segments)
• Coccygeal vertebrae are highly variable and can range from 3-5
• “tail bone”

Co1
Co2
Co3
Co4

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 Normal vertebral curvatures
• Primary (1º) curvatures develop during the fetal
period; newborn spine is kyphotic CERVICAL LORDOSIS
2 curvature

• Secondary (2º) curvatures result from extension

from the flexed fetal position; cervical lordosis
develops when infants begin to hold their heads
up; lumbar lordosis develops when toddlers begin THORACIC KYPHOSIS
1 curvature
standing & walking; set at puberty

LUMBAR LORDOSIS
2 curvature

SACRAL KYPHOSIS
1 curvature
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 Clinical: Abnormal curvatures of the vertebral column
Excessive thoracic kyphosis (A)
• term shortened clinically to kyphosis
• colloquially known as hump or hunch back

Excessive lumbar lordosis (B)

• term shortened clinically to lordosis
• colloquially known as sway or hollow back

Scoliosis (C)
• abnormal lateral curvature of the spine
A B C

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 Intervertebral (IV) discs
• IV discs comprise 20% of vertebral column INTERVERTEBRAL
length DISC (cross-section)
• No IV discs between atlanto-occipital joint,
atlanto-axial joint, sacral segments,
coccygeal segments
• composed of anulus fibrosus (concentric
rings of fibrocartilage that connect
adjacent vertebral bodies) & nucleus
pulposus (semi-gelatinous mass that acts
as shock absorber)

Functions:
• strong attachment between vertebrae;
forms cartilaginous joint
• weight bearing, shock absorption
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 Clinical: Herniation/Protrusion of intervertebral discs
• Herniation occurs when the nucleus pulposus
protrudes (herniates) through the annulus fibrosis &
compresses the spinal nerves exiting the IV
foramen [or the vertebral artery exiting the
transverse foramen]
• Most common in cervical & lumbar; 95% of lumbar
disc protrusions occur at L4/L5 or L5/S1
• Many discs herniate – most will resolve on their own
or with PT
• Typically occurs posterolaterally, where anulus
fibrosis is relatively thin & does not receive support
from posterior longitudinal ligament
• stress resistance of the anulus fibrosus declines
with age

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 Ligaments of the vertebrae
INTERVERTEBRAL
DISC (cross-section) POSTERIOR
LONGITUDINAL
ANTERIOR LIGAMENT
LONGITUDINAL • narrower, somewhat weaker (than
anterior longitudinal lig.)
LIGAMENT • runs within the vertebral canal along
• strong, broad fibrous band
posterior aspect of vertebral bodies & IV
• runs along anterior vertebral
discs
bodies
• prevents hyperflexion
• prevents hyperextension
LIGAMENTUM
FLAVUM
• elastic, yellow bands of tissue
INTERTRANSVERSE connecting laminae of adjacent
LIGAMENTS vertebrae
• limits flexion
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*remember: ligaments connect bone to bone
 Ligaments of the vertebrae
INTERVERTEBRAL
DISC (cross-section) POSTERIOR
LONGITUDINAL
LIGAMENT
ANTERIOR LIGAMENTUM
LONGITUDINAL FLAVUM
LIGAMENT
SUPRASPINOUS
LIGAMENT
• runs along tips of spinous
processes from C7 to sacrum

INTERTRANSVERSE
LIGAMENTS INTERSPINOUS
LIGAMENT
• connects adjoining spinous
34
*remember: ligaments connect bone to bone processes
 Nuchal ligament
• Thick, fibroelastic, median band running
from the external occipital protuberance &
posterior border of the foramen magnum to
C7 spinous process
• Attaches to the spinous processes of
cervical vertebrae
• Allows for attachment of back muscles
where the spinous processes of cervical
vertebrae are shorter

Inferior &
Foramen magnum Superior
Nuchal lines
35
External occipital protuberance
 Clinical: Crush or compression fractures
Crush/compression fractures
• Sudden forceful flexion (as in motor vehicle
accidents or severe blows) results in the fracture
of the body of one or more vertebrae
• Can also be accompanied by dislocation &
fracture of the articular facets between two
vertebrae, with rupture of the interspinous
ligaments

Chance fracture
• Flexion injury of the spine
• Anterior compression fracture + fractures across transverse
processes
• Back seat passenger restrained by lap seatbelt involved in MVA or
fall from great height 36
 Clinical: Whiplash injury
Severe hyperextension of the neck (“whiplash” injury)
• anterior longitudinal ligament is severely stretched & may be torn
• can be accompanied by hyperflexion injury of vertebral column, as head “rebounds” after
the hyperextension
• Hangman’s fracture is one severe example
• Common as a result of MVA

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 Organization of the spinal cord and spinal nerves 31 pairs of
1 spinal nerves
2
• The spinal cord, with the brain, 3
Cervical 4 8 Cervical!!
forms the Central Nervous System enlargement
5
6
7
(CNS) 1
8
2
3
4
• The 31 pairs of spinal nerves 5
6
12 Thoracic
arising from the spinal cord form 7
8
9
part of the Peripheral Nervous 10
11
System (PNS) 12
Lumbar 1

enlargement 2
• The spinal cord has two 3 5 Lumbar
enlargements, cervical & lumbar, 4

where there are more nerves for 5

innervation of the limbs 3

2
1
5 Sacral
4
5 38
1 1 Coccygeal!!
Spinal cord

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 Meningeal coverings of the spinal cord
3 Meninges
1. Dura mater (“tough mother”) = outermost layer, thick,
fibrous tissue
2. Arachnoid mater = filmy layer deep to dura mater
3. Pia mater = layer covering the spinal cord

Denticulate ligament: anchors spinal cord to dura mater;

found at midpoint between two spinal nerves

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 Meningeal coverings of the spinal cord
3 Associated Spaces
1. Epidural = space between vertebral canal & dura mater; contains fat
2. Subdural (potential space, only seen pathologically) = space between dura mater & arachnoid
mater
3. Subarachnoid = space between arachnoid mater & pia mater; contains cerebrospinal fluid (CSF)

1.

2.
3.

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 Termination of the spinal cord
CENTRA OF VERTEBRAE
SPINOUS PROCESSES OF
CONUS MEDULLARIS VERTEBRAE
L1
as spinal nerves “leave,” the
spinal cord narrows into a cone L2 SPINAL CORD
shape (surrounded by
L3 meninges)
• Adult: ~L1/L2
• Neonate: ~L3/L4
L4

L5

CAUDA EQUINA – “horse’s tail”

spinal nerve roots travel from
conus medullaris down to their
SACRUM
IV foramen exit
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 Termination of the spinal cord

CONUS MEDULLARIS
LUMBAR CISTERN
• enlargement of subarachnoid space
between conus medullaris (~L2) & end of
dural sac (~S2)
• site for lumbar puncture & spinal anesthesia

CAUDA EQUINA
DURA MATER
ARACHNOID MATER
DURAL SAC
• Dura mater surrounds cauda equina,
ending at S2, forming a “sac”

SACRAL HIATUS FILUM TERMINALE

• continues from conus medullaris (~L2) to
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coccyx; tethers spinal cord to coccyx
Spinal nerves & vertebral levels
• Cervical nerves course SUPERIOR to
their corresponding vertebra, while all
others course INFERIOR to their
corresponding vertebra

• C1 spinal nerve courses SUPERIOR to

the C1 vertebra

• NOTE: C8 spinal nerve courses inferior to

the C7 vertebra, superior to the T1
vertebra

• T1 spinal nerve courses INFERIOR to the

T1 vertebra 44
 Intervertebral disc protrusion & spinal nerve compression
• In the cervical & thoracic regions, when an IV disc
protrudes, the spinal nerve coursing through the L4 vertebra
associated IV foramen will be compressed L4 spinal n.
L4 spinal n.
• Example: IV disc herniation between C4 & C5 will compress
spinal nerve C5 (C5 spinal nerve coursing superior to C5
vertebra) L5 vertebra
• Example: IV disc herniation between T4 & T5 will compress L5 spinal n. L5 spinal n.

spinal nerve T4 (T4 spinal nerve coursing inferior to T4

vertebra)

• HOWEVER – this is NOT the case for the lumbar

region!

• L4 spinal nerve EXITS between L4/L5, but sneaks by *Note: In the cervical and lumbar regions, the spinal
against the body of L4 vertebra; Instead, L5 spinal nerve with the number of the inferior vertebra, but by two
nerve is COMPRESSED by a protrusion of the IV disc DIFFERENT mechanisms.
at L4/L5 level **In the lumbar region, there is a difference in where a
spinal nerve EXITS & where it is COMPRESSED**
45
 Clinical: Lumbar Puncture (spinal tap)
& anesthesia during childbirth
Lumbar Puncture – Adults only (1, 2)
• enter into lumbar cistern through L4 level
• typically to collect CSF for evaluating infections of
the CNS (e.g. Meningitis)

Spinal anesthesia (1, 2)

• anesthetic inserted in same place as lumbar
puncture (usually L4 level)
• complete anesthesia below the waist
• risks leakage of CSF

Epidural anesthesia (1, 2, 3)

• anesthetic agent inserted in extradural space, either
in same position as lumbar puncture (L4 level), or in
sacral hiatus
46
 Venous drainage of the vertebral column

Spinal veins form plexuses along the vertebral column inside & outside the vertebral canal.
INTERNAL vertebral venous plexuses (epidural
venous plexuses)
• has anterior & posterior components
• *valveless veins → potential path for cancer
metastasis [from breasts, lungs, and prostate
gland to the brain]
• Veins of internal vertebral plexus connect with veins in the
body cavities & are continuous with the cranial dural
venous sinuses through the foramen magnum

EXTERNAL vertebral venous plexuses

• has anterior & posterior components

Basivertebral veins form within the vertebral

bodies 47
 Additional slides:
(These slides are included to help clarify presented concepts or to
provide additional clinical correlates. You are responsible for
understanding these concepts.)

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Transverse section through spinal cord and its meninges – cervical vertebra

49
Ligaments of the vertebrae

50
 Schematics of the vertebral ligaments
Body only Entire vertebrae
ANTERIOR INTERSPINOUS
LONGITUDINAL LIGAMENT
LIGAMENT
INTERVERTEBRAL
DISC

POSTERIOR
LONGITUDINAL
LIGAMENT

LIGAMENTUM FLAVUM
SUPRASPINOUS LIGAMENT 51
 Clinical: Osteoporosis
• In osteoporosis, more bone material
gets reabsorbed than built up,
resulting in a loss of bone mass
• Spine is most affected by degenerative
diseases of the skeleton, such as
osteoporosis
• Symptoms include compression
fractures and resulting back pain

Radiograph of normal lumbar Radiograph of osteoporotic lumbar spine with

spine (L lateral view) a compression fracture at L1 (arrow). Note
that vertebral bodies are decreased in density,
& internal trabecular structure is coarse.
52
 Clinical: Coccygeal injury

Coccydynia
• localized pain & tenderness in tailbone region
• usually caused by trauma to the coccyx
• direct injury during contact sports
• coccyx can fracture during childbirth
• repetitive straining or friction
• fall onto the coccyx in the seated position

53
 Clinical: Disk herniation in the lumbar spine
• Posterior herniation (A,B): In the MRI, a conspicuously herniated disk at the level of L3-L4
protrudes posteriorly (transligamentous herniation). The dural sac is deeply indented at that level;
*CSF - cerebrospinal fluid

54
 Clinical: Disk herniation in the lumbar spine
• Posterolateral herniation (D): A posterolateral herniation may spare the nerve at that level but
impact nerves at inferior levels.

55
 Clinical: Spina bifida
SPINA BIFIDA OCCULTA
• Birth defect where neural arches of L5 and/or S1 fail to develop
normally & fuse posterior to the vertebral canal
• Defect present in up to 24% of the population; most have no
back problems
• Defect is concealed by the overlying skin, but its location is
often indicated by a tuft of hair

SPINA BIFIDA CYSTICA

• More severe form of spina bifida, where one or more vertebral
arches fail to develop completely
• Severe forms of spina bifida result from neural tube defects,
such as defective closure of the neural tube during 4th week of
embryonic development
• Associated with herniation of the meninges (meningocele, a
spina bifida associated with a meningeal cyst) and/or the spinal
cord (meningomyelocele)
• Neurological symtoms usually present in severe cases of
meningomyelocele (e.g. paralysis of the limbs & disturbances in 56
bladder & bowel control)
 Clinical: Lumbar stenosis

• Stenosis (narrowing) of lumbar vertebral

foramen in one or more lumbar vertebrae
• May be hereditary anomaly, making a
person more vulterable to age-related
degenerative changes such as IV disc
bulging
• Surgical treatment of lumbar stenosis
may consist of decompressive
laminectomy

57
 Clinical: Ankylosing spondylitis

• A form of spinal arthritis; it’s an inflammatory disease

• Affects males more often than females
• Causes ankylosis (fusion or fixation) of multiple vertebral and/or vertebral + sacroiliac joints
• Fusion makes the spine less flexible and can result in a “hunched-forward” posture

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