ANATOMY

OF THE SPINE
Reported By

MARIA THERESA M. NAVARRO, M.D.

 OVERVIEW
THREE MAJOR COMPONENTS

 THE SPINAL COLUMN (bones and discs)

 NEURAL ELEMENTS (spinal cord and nerve
roots)
 SUPPORTING STRUCTURES (muscles and
ligaments)
VERTEBRAE
CORTICAL BONE

CANCELLOUS
Typ ic al VER TE BRA
1. VERTEBRAL BODY

2. SPINOUS PROCESS

3. TRANSVERSE FACET

4. PEDICLE

5. CENTRAL SPINAL
CANAL

6. LAMINA

7. COSTOVERTEBRAL
FACET
ATL AS AND AXI S
 Cervical Spine X-ray

1 VERTEBRAL BODY
1
2 SPINOUS PROCESS 3
4
3 SUPERIOR
ARTICULAR PROCESS 2

4 INFERIOR
5
6
ARTICULAR PROCESS

5 PEDICLE

6 TRANSVERSE
PROCESS
 Cervical Spine (Lateral view)
VERTEBRAL BODY

SPINOUS PROCESS

FACET JOINT

INTERVERTEBRAL
DISC

FORAMEN
TRANSVERSARIUM

SUPERIOR
ARTICULAR FACET

INFERIOR
ARTICULAR FACET
THO RAC IC VER TE BRA
Thoracic Spine
Thoracic Spine Lateral View
Thoracic CT scan (axial view)
LUMBAR VER TEB RA
LUMBAR SPINE X RAY
LUMBAR SPINE (LATERAL VIEW)
SCOTTIE DOG
PEDICLE

SUPERIOR ARTICULAR
PROCESS

INFERIOR ARTICULAR
PROCESS

FACET JOINT

PARS INTERARTICULARIS

TRANSVERSE PROCESS
SACRUM AND COCCYX
 SPI NAL
CU RVES

CERVICAL 20-40 degrees

THORACIC 20-40 degrees
LUMBAR 40-60 degrees
SACRAL sacrum fused in a
kyphotic curve
FUNCTIONS OF THE VERTEBRAL
COLUMN
PROTECTION
BASE FOR ATTACHMENT
STRUCTURAL SUPPORT
FLEXIBILITY AND MOBILITY
OTHERS – production of red blood
cells mineral storage
INTERVERTEBRAL DISCS
THREE COMPONENTS

1. CARTILAGINOUS ENDPLATE
- attaches firmly to the osseous
endplate by means of numerous
collagenous fibers (Sharpey’s fibers)
- strengthens the osseous endplate,
which contains multiple perforations
- within the pores of the vertebral
endplate are numerous vascular
channels (major source of nutrients)

2. ANNULUS FIBROSUS
- complex fibrous and fibrocartilaginous structure that
consists of 12 to 15 layers, each with well developed dense
parallel fibrous bands.
- composed of collagen and proteoglycans
 INTERVERTEBRAL DISCS
THREE COMPONENTS

3. NUCLEUS PULPOSUS
- composed of fibrocartilage
- mucopolysaccharide gel gives the disc
its high intrinsic pressure, which allows it to
resist compressive forces.
- contains realtively more proteoglycans
giving it a looser gelatinous texture.
BASIC PRINCIPLES IN MRI
IMAGING
T1 WI - water is black
fat is white
bone is black
T2 WI – water is white
fat is white
bone is black

color is referred to as increased or decreased

signal or hypo or hyperintense
MRI IN FOR MAT ION

Spinal alignment
Disc height and hydration
Vertebral body configuration
Evaluation of intervertebral disc
Spinal canal size
Nerves
Abnormalities
T1 FAST SPIN ECHO OF THE T2 FAST SPIN ECHO OF THE
LUMBAR SPINE LUMBAR SPINE
DEGENERATIVE DISEASES
OF THE SPINE
DISC DISEASE
 DISC DEGENERATION

DEGENERATION
CRACKS OR DECREASED
LOSS OF BOUND
FISSURES IN CAPACITY
WATER
THE INNER FOR SHOCK
MOLECULES
LAYERS OF THE ABSORPTION
ANNULUS
FIBROSUS
LOSS OF DISC
HEIGHT
GREATER
ALTERATIONS IN FORCES
THE TRANSMITTED
DIMINISHED INTO
PROTEOGLYCAN TURGOR
MATRIX ADJACENT
AND VERTEBRAL
ELASTICITY BODIES
OSTEOPHYTES
SCLEROSIS
MRI OF DEGENERATIVE DISC
DISEASE
decrease in disc
space vertical
height
decrease signal
intensity on T2
weighted images
diffuse disc bulging
may or may not be
present
 MARR OW CHA NG ES
(I NTERV ERT EB RAL
OS TEOC HON DROS IS)

alterations of the adjacent vertebral

body architecture
Edema pattern (TYPE I)
 decreased signal on T1WI
 increased signal on T2WI
Infiltration by fat (TYPE II)
 increased signal on T1WI
 Isointense or slightly hyperintense signal on
T2WI
Degenerative discogenic sclerosis (TYPE
III)
dense bone devoid of marrow
 decreased signal on T1WI
 decreased signal on T2WI
 DISC HERNIATION
 CHRONIC REPETITIVE STRESS OR ACUTE
INJURY MAY RESULT IN MARGINAL
DISPLACEMENTS OF DISC MATERIAL
DISC BULGE
CIRCUMFERENTIAL
EXTENSION OF THE DISC
MARGIN BEYOND THE
VERTEBRAL BODY
MARGINS
DISC HERNIATION

FOCAL DISPLACEMENT
OF DISC MATERIAL
(NUCLEUS PULPOSUS
AN/OR ANNULUS)
BEYOND THE MARGINS
OF THE DISC SPACE
A BULGING DISC THAT
IS ECCENTRIC TO ONE
SIDE BUT > 3 mm
BEYOND VERTEBRAL
MARGIN
DISC HERNIATION
DISC PROTRUSION
A DISC HERNIATION THAT EXTENDS BEYOND THE
VERTEBRAL MARGINS BUT RETAINS A BASE AGAINST THE
INTERVERTEBRAL DISC MARGIN THAT IS WIDER THAN THE
MAXIMUM DIAMETER OF THE PROTRUDING DISC
A BULGING DISC THAT IS ECCENTRIC TO ONE SIDE BUT < 3
mm BEYOND VERTEBRAL MARGIN

DISC EXTRUSION
FOCAL HERNIATION ASSOCIATED WITH
EXTENSION OF THE NUCLEAR
MATERIAL COMPLETELY THROUGH
THE OUTER ANNULUS INTO THE
EPIDURAL SPACE
DISC HERNIATION
DESSICATION
LOSS OF DISC WATER

• FREE FRAGMENT

EPIDURAL FRAGMENT OF DISC NO LONGER

ATTACHED TO THE PARENT DISC
DISC HERNIATION
LUMBAR SPINE
90% L4-L5 or L5-S1
the rest L3-L4
disc annulus most frequently falls
posterolaterally where it is weakest
(PARACENTRAL HERNIATION)
DISC HERNIATION
CERVICAL SPINE
disc herniation and degeneration most
common at C5-C6 and C6-C7.
 SPONDYLOSIS
OSTEOARTHRITIS
SPINAL STENOSIS
SPONDYLOSIS DEFORMANS
Most COMMON degenerative process of
the spine
Osteophytes arise secondary to
degenerative disc disease
•When Sharpey’s fibers are torn from their
attachments along the vertebral body margins,
stress is placed on bone as the disc moves and
osteophytes form in reaction to stress
SPONDYLOSIS DEFORMANS

can take the form of marginal end plate

osteophytes, enlarged uncinate
processes, or facet arthrosis.

• Osteophytes are hypointense on

all pulse sequences
OSTEOARTHRITIS
Degenerative arthritis involving synovial
joints
In the spine, affected is the apophyseal
or facet joints
Spondylosis and osteoarthritis are terms used synonymously
because often coexist
 OSTEOARTHRITIS
not all back pain or sciatica is due to
intervertebral disc disease
degeneration of the facet joint can cause facet arthrosis syndrome

Facet joint hypertrphy + osteophyte formation

along the posterior lateral margins of the vertebral
body can encroach upon the lateral recesses of
the spinal canal and neural foramina.
SPINAL STENOSIS
REFERS TO BONY OR SOFT TISSUE
NARROWING OF THE SPINAL CANAL OR
NEURAL FORAMINA
• can compress neural structures
within the spine and cause
neurological symptoms
• can involve the spinal canal, the
lateral recesses or the
neuroforamina.
CAUSES
DEGENERATIVE DISEASE OF THE DISC
SPACE AND FACET JOINTS
SPONDYLISTHESIS
TRAUMA
PAGET’S DISEASE
POST SURGICAL COMPLICATION
LATERAL RECESS STENOSIS
MOST COMMON CAUSE is
Hypertrophy of the superior articular
processes of facet joints
Disc protrusions
Post operative scars
NEURAL FORAMINAL STENOSIS
MOST COMMON CAUSE is
Degenerative hypertrophy of the
uncinate process and posterior facet
joints in the cervical spine
Hypertrophic osteophytes from facet
joints and bulging discs in the lumbar
spine
 SPONDYLOLISTHESIS

Displacement of a vertebra with respect to

the subjacent vertebra
DEGENERATIVE SPONDYLISTHESIS
 Most common type
 Degenerative changes of both the facet joints
and intervertebral disc.
 Most common in the lumbar spine
 SPONDYLOLYSIS
Bilateral pars defect
Most frequently seen in the neural
arch of the 5th lumbar vertebra
C6 is the most common cervical site of
spondylolytic spondylolisthesis
Seen in the oblique views
LUCENCY ACROSS THE NECK OF THE
SCOTTIE DOG
DISC HERNIATION
SPONDYLISTHESIS
Traumatic subluxation of the
cervical spine in a 51-year-
old man with quadriparesis
following an automobile
crash. Spin-density weighted
MRIs show anterior
subluxation of C4 (top arrow)
on C5 (bottom arrow),
associated with marked
narrowing of the spinal canal
and compression of the
thecal sac and spinal cord.
The hyperintensity of the
disc and adjacent
prevertebral and ventral
epidural soft tissues likely
represents a combination of
edema and hemorrhage.
COLLAPSE L5 WITH SPINAL STENOSIS
DEGENERATIVE SPINAL STENOSIS
SPINAL STENOSIS DUE TO TUMOR
POSTEROLATERAL DISC HERNIATION
MULTILEVEL SPINAL STENOSIS
SEVERE LUMBAR SPINAL STENOSIS AND FACET DISEASE
LUMBAR SPINAL STENOSIS AND SYNOVIAL CYST
LATERAL RECESS STENOSIS