Far Eastern University – Nicanor Reyes Medical Foundation

1 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

VERTEBRAL COLUMN AND CONTENTS OF THE VERTEBRAL  ATYPICAL CERVICAL VERTEBRA

CANAL  First cervical vertebra (Atlas)

OSTEOLOGY OF THE VERTEBRAL COLUMN

 VERTEBRAL COLUMN
 Supports the skull, pectoral girdle, upper limbs and
the thoracic cage.
 Within its cavity lie the spinal cord, the roots of the
spinal nerves, the covering-meninges.
o No body.
 Composed of 33 vertebrae: 7 cervical, 12 thoracic, 5
o No spinous process.
lumbar, 5 sacral, 4 coccygeal.
o Has anterior and posterior arch.
o Lateral mass- atlanto-occipital joint
o Lower surface- atlanto-axial joint.

 Second cervical vertebra (Axis)

o Has a peg like odontoid process (dens) that

projects from the superior surface of the body

 Seventh cervical vertebra (vertebra prominens)

 VERTEBRAE
 General characterisctics: o It has the longest spinous
o Rounded body anteriorly process, and the process is
o Vertebral arch posteriorly not bifid.
 Vertebral foramen: where spinal cord and meninges o The transverse process is
run large, but the foramen
 Vertebral arch: gives rise to processes transversarium is small and
o Spinous transmits the vertebral vein.
o Transverse
o Articular (zygapophyses)

 TYPICAL CERVICAL VERTEBRA  TYPICAL THORACIC VERTEBRA (T2-T8)

 The body is medium-sized and

heart shaped.
 The vertebral foramen is small and
circular.
 The spines are long and inclined
downward.
 Two pairs of semilunar costal facet.
 Costal facet is also present on the
transverse process for articulation
with the tubercles of the ribs.
 The transverse process has transverse foramina.  Superior articular processes bear
 The spines are small and bifid. facets that face backward and lateral
 The body is small and broad from side to side. inferior process face forward medial.
 Vertebral foramen is large and triangular.
 Superior articular facet faces upward backward while
inferior articular facet faces downward forward.

Soar High, FEUture MDs!

Batch 2021
 Far Eastern University – Nicanor Reyes Medical Foundation
2 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

 ATYPICAL THORACIC VERTEBRA ARTHROLOGY OF THE VERTEBRAL COLUMN

 T1- with pair of circular costal facet and 1 pair of  ATLANTO-OCCIPITAL JOINTS
smaller semilunar facet.
o long thick, horizontal spine.
 T9- often with no inferior pair of demifacets.
 T10, T11- no inferior demifacets; no facets on the
transverse processes.
 T12- same as 11; with some features of lumbar
vertebra.

 LUMBAR VERTEBRA
 Synovial joints between the occipital condyles and
the facets of atlas.
 Movements: flexion, extension, lateral flexion, no
rotation.

 ATLANTO-AXIAL JOINTS

 The body is large and kidney shaped.

 The pedicles are strong and directed backward.
 The laminae are thick.
 The vertebral foramina are triangular.  Synovial joints
 The transverse process is long and slender.  Movements: extensive rotation of the atlas and thus
 The spinous process is short, flat, and quadrangular of the head on the axis.
and project backward.
 The articular surface of the superior articular  JOINTS BELOW THE AXIS
process face medially and those of the inferior  Intervertebral disc form cartilaginous joints between
articular processes face laterally. vertebral bodies.
 Joint between two vertebral arches consists of
 SACRUM synovial joint.
 The intervertebral discs are responsible for one-
fourth of the length of the vertebral column.
 The sacrum consists of five
vertebrae fused together to form a  INTERVERTEBRAL DISCS
wedge-shaped bone, which is concave
anteriorly.
 Laterally, the sacrum articulates
with the two iliac bones
 Subarachnoid space down to the
second sacral vertebra.

 COCCYX
The coccyx consists of four
vertebrae fused together to
form a single, small triangular
bone
 Each disc consists of a peripheral part, the anulus
fibrosus, and a central part, the nucleus pulposus.
LIGAMENTS OF THE VERTEBRAL COLUMN
 Spines, laminae and transverse processes are united by
ligaments forming fibrous syndesmosis joints between
them.
 Supraspinous ligament
 Interspinous ligament
 Intertransverse ligament
 Ligamentum flavum

Soar High, FEUture MDs!

Batch 2021
 Far Eastern University – Nicanor Reyes Medical Foundation
3 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

 MAJOR LIGAMENTS OF THE SPINE  Ligamentum Flavum

 Anterior Longitudinal Ligament

o Connects lamina of one to lamina of the other

o Found from axis to sacrum
o Dense band along anterior and lateral surface of o Limit flexion
the vertebral bodies from C2 to sacrum o Continuation to the skull is called Posterior
o Limits extension Atlanto-Occipital membrane
o From C1 to skull, called Atlanto-Occipital
Membrane  Intertransverse
o Only well-developed in Lumbar Region
 Posterior Longitudinal Ligament o Between transverse processes
o Limit lateral flexion

CURVES OF THE VERTEBRAL COLUMN

o Runs along posterior surface of vertebral bodies

(anterior to spinal canal) from C2 to Sacrum
o Reinforce disc posteriorly
o Limits flexion
o Superiorly, continues to occiput, called Tectorial
Membrane

 OTHER LIGAMENTS OF THE SPINE  In the fetus the vertebral column has one continuous
 Supraspinous anterior concavity; as development proceeds, the
lumbosacral angle appears.
 In the adult position, the vertebral column exhibits in the
o Spinous process to sagittal plane the following regional curves:
spinous process – tip to tip
from C7 to sacrum
o Limits flexion
o In cervical region,
becomes much thicker with
a greater elastic content
called Ligamentum Nuchae

 Interspinous

 Cervical-posterior concavity
 Thoracic-posterior convexity
 Lumbar- posterior concavity
 Sacral- posterior convexity
o Found between spinous processes
o Most well developed in lumbar region

Soar High, FEUture MDs!

Batch 2021
 Far Eastern University – Nicanor Reyes Medical Foundation
4 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

MOVEMENTS OF THE VERTEBRAL COLUMN

 Flexion/ Extension
 Both are extensive in the cervical and lumbar
regions, but restricted in the thoracic region.
 Atlanto-occipital joints extensive flexion and
extension of the head.
 Cervical region: flexion by longus cervicis, scalenus
anterior, and SCM muscle. Extension by the
postvertebral muscle.
 Lumbar region: flexion is by the rectus abdominis and
psoas muscles. Extension by the postvertebral
muscles.
 Lateral flexion- extensive in the cervical and lumbar
regions, but restricted in the thoracic region.
 Neck: by scalenus anterior and medius, trapezius, and
SCM muscle.
 Lumbar region: by the postvertebral muscles,  Medullary cone (conus medullaris) = tapered tip of cord
quadratus lumborum, and oblique muscles of the  Cauda equinae is L2 to S5 nerve roots resemble horse’s
abdominal wall. tail
 Rotation-extensive in the lumbar region.
 Atlanto-axial joints wide range of rotation of the MENINGES OF THE SPINAL CORD
atlas (head on the axis).  3 Fibrous layers enclosing spinal cord
 Neck: by the SCM muscle on one side and the
splenius on the other side.
 Thoracic region: by the semispinalis and rotatores
muscle, assisted by the oblique muscle.
 Circumduction- is a combination of all these movements.

CONTENTS OF THE VERTEBRAL CANAL

OVERVIEW OF SPINAL CORD

 Information highway between brain and body
 Extends through vertebral canal from foramen magnum
to L1
 Each pair of spinal nerves receives sensory information  Dura mater
and issues motor signals to muscles and glands o tough collagenous membrane surrounded by
 Spinal cord is a component of the Central Nervous epidural space filled with fat and blood vessels
System while the spinal nerves are part of the Peripheral o (epidural anesthesia)
Nervous System  Arachnoid mater
o layer of simple squamous epithelium lining dura
FUNCTIONS OF THE SPINAL CORD mater and loose mesh of fibers filled with CSF
o (creates subarachnoid space)
 Conduction
 Pia mater
 bundles of fibers passing information up and down
o delicate membrane adherent to spinal cord
spinal cord
 Locomotion
Cross-Sectional Anatomy of the Spinal Cord
 repetitive, coordinated actions of several muscle
groups
 central pattern generators are pools of neurons
providing control of flexors and extensors (walking)
 Reflexes
 involuntary, stereotyped responses to stimuli
 involves brain, spinal cord and peripheral nerves

ANATOMY OF THE SPINAL CORD

 Cylinder of nerve tissue within the vertebral canal
 Vertebral column grows faster so in an adult the
spinal cord only extends to L1
 31 pairs of spinal nerves arise from cervical, thoracic,  Central area of gray matter shaped like a butterfly and
lumbar and sacral regions of the cord surrounded by white matter in 3 columns

Soar High, FEUture MDs!

Batch 2021
 Far Eastern University – Nicanor Reyes Medical Foundation
5 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

 Gray matter = neuron cell bodies with little myelin  coccygeal, S4, S5 and Co
 White matter = myelinated axons  The Cervical Plexus

SPINAL NERVE ROOTS AND PLEXUSES

 The Brachial Plexus

 The Spinal Nerves

 31 pairs of spinal nerves (1st cervical above C1)
 Proximal branches
o dorsal root is sensory input to spinal cord
o ventral root is motor output of spinal cord
 Distal branches
o dorsal ramus supplies dorsal skin and muscles
o ventral ramus to ventral skin and muscles and
limbs
 Branches of a Spinal Nerve

 The Lumbar Plexus

o Each has dorsal and ventral ramus.

NERVE PLEXUSES
 Ventral rami branch and anastomose repeatedly to form
5 nerve plexuses
 cervical in the neck, C1 to C5
o supplies neck and phrenic nerve to the
diaphragm
 brachial in the armpit, C5 to T1
o supplies upper limb and some of shoulder and
neck
 lumbar in the low back, L1 to L4
o supplies abdominal wall, anterior thigh and
genitalia
 sacral in the pelvis, L4, L5 and S1 to S4
o supplies remainder of lower trunk and lower limb

Soar High, FEUture MDs!

Batch 2021
 Far Eastern University – Nicanor Reyes Medical Foundation
6 Gross HSB-B
Lecture by: Dr. Mel Anthony Cruz

 The Sacral and Coccygeal Plexuses

CEREBROSPINAL FLUID
 A clear, colorless fluid formed mainly by the choroid
plexuses, within the ventricles of the brain.
 The fluid enters the subarachnoid space through the
three foramina in the roof of the fourth ventricles.
 The fluid enters the bloodstream by passing through the
arachnoid villi into the dural venous sinuses
 Function: Removing waste products associated with
neuronal activity and provides a fluid medium that
surrounds the spinal cord.

CLINICAL APPLICATION
DISC HERNIATION

CUTANEOUS INNERVATION AND DERMATOMES

 Each spinal nerve receives sensory input from a specific
area of skin called dermatome
 Overlap at edges by 50%
 a total loss of sensation requires anesthesia of 3  Protrusion of the nucleus pulposus through the annulus
successive spinal nerves fibrosus
 95% at the L4/5 or L5/S1 level
 Usually posterolateral herniation where annulus is
thinnest
 Herniation into the vertebral canal may compress the
nerve root below the disc and cause pain in the related
dermatome.
 Age-related dehydration of nucleus pulposus contributes
to loss of height and narrowing of IV foramina.

EPIDURAL BLOCK
 An epidural block is anesthetic injected into epidural
space of the sacral canal either via the sacral hiatus
(caudal epidural) using the sacral cornua as landmarks, or
via the posterior sacral foramina (transsacral epidural).
 The anesthetic solution spreads superiorly to act on
spinal nerves S2–Co.
 The height to which the anesthetic ascends is affected by
the amount of solution injected and the position of the
patient.

SPINAL BLOCK
 A spinal block is the introduction of an anesthetic directly
into the CSF (in the subarachnoid space) utilizing a lumbar
puncture.
 Onset of anesthesia is rapid <1 minute (unlike epidural
anesthesia, which may take up to 20 minutes).
 Subsequent leakage of CSF may cause a headache in
BLOOD SUPPLY OF THE SPINAL CORD some individuals.
 The spinal cord receives its arterial supply from three
small, longitudinally running arteries-the two posterior
spinal arteries and the one anterior artery.
References:
VENOUS DRAINAGE OF THE SPINAL CORD  Dr. Cruz’s lecture
 The veins of the spinal cord drain into the internal  Snell Clinical Anatomy
vertebral venous plexus  Netter Atlas

Soar High, FEUture MDs!

Batch 2021