Vinci Villafuerte

Medical Board Review

The Anatomy Road Map
• Central pillar of the body
• Protects the spinal cord
• Supports weight of the
head and trunk
• Transmits to hip bones
and lower limbs
• Flexible, Segmented
• Vertebrae
• Intervertebral discs (1/4th
of column)
 Intervertebral
foramina
 between vertebrae
 distribution of spinal
nerves
 How vertebrae are
there in the vertebral
column?
a. 12
b. 21
c. 31
d. 33
 Curvatures (4)
 Cervical: Posterior
concavity (Lordosis)
 Thoracic: Posterior
convexity (Kyphosis)
 Lumbar: Posterior
concavity (Lordosis)
 Sacral: Posterior
convexity (Kyphosis)
 Pregnant women
 Posterior concavity
(lordosis)
 Old Age
 Posterior convexity
(kyphosis)
 Atrophy of intervertebal
discs
 General characteristics
 Anteriorly: rounded
body
 Posteriorly: vertebral
arch
 Vertebral foramen
▪ Space enclosed by body of
arch
 General characteristics
 Vertebral arch
▪ Consisting of paired
▪ Cylindrical pedicles (sides)
▪ Laminae (posterior)
▪ 7 processes
▪ Spinous (1)
▪ Transverse (2)
▪ Articular (4)
 Spinous process
 Directed posteriorly
▪ Junction of two laminae
 Transverse process
 Directed laterally
▪ Junction of laminae and
pedicles
Both serve as
 levers
 attachment for muscles,
ligaments
 Articular Process
 Vertically arranged
▪ Two superior
▪ Two inferior
 Pedicles are notched on
upper and lower borders
▪ Superior vertebral notch
▪ Inferior vertebral notch
Forming
Intervertebral foramen
▪ Transmit spinal nerves
▪ And blood vessels
 Characteristics
 Vertebral foramen
▪ Large
▪ Triangular
 Superior articular
processes
▪ Small
▪ Flat
▪ Face backward, & upward
 Inferior articular
processes
▪ Face downward & forward
 Characteristics
 Foramen transversarium
▪ Transverse process
▪ Passage of the vertebral
artery and veins
 Spines
▪ Small
▪ Bifid
 Body
▪ Small
▪ Broad
▪ Two synovial joints on each
side
First cervical vertebra
(Atlas)
No body, No spinous
process
 Anterior arch
 Posterior arch
 Lateral mass (each side)
▪ Articular surfaces
▪ Upper aspect (Occipital
condyles of skull)
▪ Lower aspect (Axis)
 Second cervical
vertebra (Axis)
 Odontoid process
▪ peg-like
▪ Projects upward from
superior surface of body
▪ Represents body of atlas
that has fused with the axis
 Seventh cervical
vertebra
 Longest spinous process
 NOT bifid
 Large transverse process
 Small foramen
transversarium
▪ DOES NOT transmit
vertebral artery
 Characteristics
 Body
▪ Medium sized, heart-
shaped
 Vertebral Foramen
▪ Small, circular
 Spines
▪ Long, inclined downward
 Characteristics
 Costal facets
▪ Present on sides, and on
transverse process
▪ T11, T12 ~ no facets on
transverse process
 Superior articular
process
▪ Facets face backward,
laterally
 Inferior articular process
▪ Facets face forward,
medially
 Characteristics
 Body
▪ Massive, kidney shaped
 Pedicles
▪ Strong
 Laminae
▪ Thick
 Vertebral foramina
▪ Triangular
 Transverse processes
▪ Long, slender
 Characteristics
 Spinous processes
▪ Short, flat, quadrangular,
project backward
 Superior articular
processes
▪ Facets face medially
 Inferior articular processes
▪ Factes face laterally
No rib facets, no foramina
in the transverse
processes
 Sacrum
 Five rudimentary
vertebrae fused
together
 Single wedge shaped
bone
 Characteristics
 Sacral promontory
▪ Anterior upper margin of
1st sacral vertebrae
▪ Bulges forward into pelvic
cavity
▪ Important obstetric
landmark
 Characteristics
 Sacral canal
▪ Formed from sacral
foramina
▪ Contains:
▪ Part of cauda equina
▪ Meninges (up to lower
border S2)
▪ Lower sacral nerve roots
▪ Coccygeal nerve roots
▪ Filum terminale
 Characteristics
 Sacral Hiatus
▪ Failure of the 5th and
sometimes 4th sacral
vertebra to meet in the
midline
 Anterior & Posterior
sacral foramina
▪ Passage of anterior and
posterior rami of the upper
four spinal nerves
 Articulations
 Upper border (base)
▪ 5th lumbar vertebrae
 Narrow inferior end
▪ Coccyx
 Laterally
▪ Two hip bones
▪ Sacroiliac joints
 Coccyx
 Four (4) fused together*
 Single
 Small
 Triangular

* first coccygeal vertebra

commonly not fused
with 2nd
 Atlanto-occipital joints
 Atlantoaxial joints
 Joints of the Vertebral
Column below the Axis
 Joints between two
vertebral bodies
 Intervertebral Discs
 Joints between two
Vertebral Arches
 Synovial joints
 between
 Occipital condyles (on
both sides of foramen
magnum) and
 Facets on the superior
surfaces of the lateral
masses of the atlas
 Enclosed by capsule
 Ligaments
 Anterior Atlanto-occipital
membrane
▪ Anterior arch of atlas to
▪ Anterior margin of foramen
magnum
 Posterior Atlanto-occipital
membrane
▪ Posterior arch of atlas to
▪ Posterior margin of foramen
magnum
 Movements
 Flexion
 Extension
 Lateral flexion
NO rotation ~ Nod “YES”
 Synovial joints
1. Odontoid process and
anterior arch of atlas (1)
2. Lateral masses of
bones (2)
 Enclosed by capsules
 Movement
 Rotation if atlas w/
head on axis

*side-to-side “NO”
 Ligaments
 Apical ligament
▪ Apex of odontoid process
to
▪ Anterior margin of
foramen magnum
 Alar ligament
▪ Odontoid process (Lie on
each side of apical
ligament) to
▪ Medial sides of the
occipital condyles
 Ligaments
 Cruciate ligament
▪ Transverse part – odontoid
process to anterior arch of
atlas
▪ Vertical part – body of axis
to anterior margin of
foramen magnum
 Membrana tectoria
▪ Upward continuation of
the posterior longitudinal
ligament
▪ Attached to occipital bone
 Cartilaginous Joints
 Between vertebral
bodies
 Synovial Joints
 Between articular
processes
 Bodies of adjacent
vertebrae
 Covered by thin plate of
hyaline cartilage
 Intervertebral disc of
fibrocartilage in
between
▪ Stongly unites bodies of
two vertebrae
 Ligaments
 Anterior and posterior
longitudinal ligaments
▪ Continuous bands down
the anterior and posterior
surface of the vertebral
column
▪ from the skull to the
sacrum
 Characteristics
 1/4th of length of
vertebral column
 Thicker in cervical and
lumbar regions
 Annulus fibrosus forms
periphery of the disc
▪ Fibrocartilage
▪ Collagen fibers arranged in
alternating concentric
layers
 Characteristics
 Nucleus pulposus forms
central part of disc
▪ Ovoid mass of gelatinous
material
▪ Normally under pressure
▪ With advancing age,
▪ decrease in water content
▪ Replaced by fibrocartilage
 No discs
▪ between first two cervical
vertebrae
▪ In sacrum
▪ In coccyx
 Herniation of the nucleus
pulposus
 Frequently occurs in the
▪ Lower lumbar region (Most
common)
▪ Lower cervical region
 Due to ie. sudden increase in
compression load on
vertebral column
 Rupture of annulus fibrosus
 Nucleus pulposus herniates
posteriorly into vertebral
canal
 Compression of spinal nerve
roots, spinal nerve, or spinal
cord
 Synovial joints
 Between adjacent superior
and inferior articular
processes
 Surrounded by capsule
 Ligaments
 Supraspinous ligament
▪ Connect adjacent spines
 Interspinous ligament
▪ Connect adjacent spines
 Ligamentum flavum
▪ Connect adjacent laminae

*Ligamentum Nuchae
▪ Cervical region
▪ Thickening of supraspinous and
infraspinous ligaments
 Type and range in regions
depend on
 Thickness of intervertebral
discs
 Shape and direction of the
articular processes
 Flexion (forward) &
Extension (backward)
 Extensive in cervical and
lumbar regions
 Restricted in thoracic region
(due to ribs)
 Lateral Flexion
 Bending of the body to one or
the other side
 Extensive in cervical and
lumbar regions
 Restricted in thoracic region
to to ribs
 Rotation
 Twisting of the vertebral
column
 Least extensive in the lumbar
region
 Circumduction
 Combination of previously
described movements
 Groupings
 Superficial
▪ Connected with shoulder
girdle
 Intermediate
▪ Involved with movements
of the thoracic cage
 Deep or Postvertebral
▪ Vertebral column
 Well developed in
humans
 Broad, thick column
occupying each side of
spinous processes
 Spines and transverse
processes serve as
levers
 Classification
 Superficially running
muscles
▪ Erector spinae
▪ Iliocostalis
▪ Longissimus
▪ Spinalis
 Classification
 Intermediate oblique
running muscles
▪ Transversospinalis
▪ Semispinalis
▪ Rotatores
▪ Multifidus
 Classification
 Deepest Muscles
▪ Interspinales
▪ Intertransversari
 Muscles of longest
length lie superficially
 From sacrum to rib angles,
transverse processes,
upper vertebral spines
 Intermediate length run
obliquely
 From transverse processes
to the spines
 Shortest and deepest
muscles
 From spines and
transverse processes of
adjacent vertebrae
 Auscultatory triangle
 Site on back where
breath sounds most
easily hear via
stethoscope
 Boundaries
▪ Latissimus dorsi
▪ Trapezius
▪ Medial border of Scapula
▪ Rhomboid major (floor)
 Lumbar Triangle
 Site where pus may
emerge from the
abdominal wall
 Boundaries
▪ Latissiumus dorsi
▪ Posterior border of the
external oblique
▪ Iliac crest
 Cervical region
 Occipital artery
 Vertebral artery
 Deep cervical artery
 Ascending cervical artery
 Thoracic region
 Posterior intercostal arteries
 Lumbar region
 Subcostal arteries
 Lumbar arteries
 Sacral region
 Iliolumbar arterties
 Lateral sacral arteries
 Veins form complicated
plexuses
 Extend along vertebral
column
 From skull to coccyx
 External vertebral
venous plexus
 Lies external to vertebral
column
 Internal vertebral venous
plexus
 Lies within the vertebral
canal
 Free communciation between plexuses and
 veins of neck, thorax, abdomen, pelvis
 Communicate through foramen magnum with
 sinuses of the cranial cavity
 Internal plexus communicates with
 veins draining vertebral bodies (basivertebral vein) and
 veins of the meninges and spinal cord
 Vertebral plexuses are drained into the vertebral,
intercostal, lumbar, and lateral sacral veins
 *Plexuses provide a pathway for the spread of
malignant disease from the pelvis to the skull
 Superficial lymph
 Above iliac crest  axillary
lymph nodes
 Below iliac crest 
superificial inguinal nodes
 Deep lymph
 Deep cervical nodes
 Posterior mediastinal
nodes
 Lateral aortic nodes
 Sacral nodes
 Posterior rami of 31
pairs of spinal nerves
 Segmental supply of
skin and muscles
 Posterior rami of C1,
C6, C7, C8, L4, L5
 Deep muscles of back
 But NOT skin
 Cylindrical in shape
 From Medulla
Oblongata (of brain)
 Begins superiorly at
 Foramen magnum
 End inferiorly at
 Lower border 1st lumbar
vertebrae (Adults)
 Occupies upper 2/3rds
of the vertebral canal
 Surrounded by three
(3) meninges
 Dura mater
 Arachnoid mater
 Pia mater
 Additonal protection
by
 Cerebrospinal fluid
 Subarachnoid space
 Enlargements
 Cervical
▪ Origin of brachial plexus
 Lumbar
▪ Origin of lumbar plexus
 Lower end
 Conus medularis
 Filum terminale
▪ pia mater prolongation
▪ From conus medullaris to
back of coccyx
 Fissures
 Anterior median fissure
▪ Midline on the anterior surface of the cord
 Posterior median fissure
▪ Midline on the posterior surface of the cord
 Roots (31 pairs)
 Anterior
▪ Motor
 Posterior
▪ Sensory
▪ w/ posterior root ganglion
 Roots in regions
 Upper cervical region
▪ Short, run almost
horizontally
 Lumbar, Sacral below level
of termination of cord
▪ Vertical leash of nerves
around filum terminale
▪ Cauda equina
 Roots
 Pass though
intervertebral foramina
 Unite to form spinal
nerves which divides
into
▪ Anterior ramus (large)
▪ Posterior ramus (smaller)
Both contain motor and
sensory fibers
 Arteries
 Posterior spinal arteries
▪ Arise directly or indirectly
from the vertebral arteries
▪ Supply posterior 1/3rd of
spinal cord
 Arteries
 Anterior spinal arteries
▪ Arise from vertebral
arteries
▪ Unite to form a single
artery
▪ w/c descends in anterior
median fissure
▪ Supply anterior 2/3rds of
spinal cord
 Arteries
 Radicular arteries
▪ Branches of regional
arteries
▪ Reinforce anterior and
posterior spinal arteries
 Veins
 Drain into internal
vertebral venous plexus
 Dura Mater
 External membrane,
 Dense fibrous tissue
 Encloses spinal cord and
cauda equina
 Above, continuous with
dura covering brain
 Below, dura ends on filum
terminale
▪ at level of lower border of
the 2nd sacral vertebra
 Gives sheaths to all spinal
nerve roots
 Arachnoid Mater
 Delicate, impermeable
membrane
 Lies within the dura,
outside the pia
 Separated from pia
mater by subarachnoid
space (filled with
cerebrospinal fluid)
 Arachnoid Mater
 Above, continuous with
arachnoid covering the
brain
 Below, end on the filum
terminale
▪ At the level of lower
border of the 2nd sacral
vertebra
 Continues along spinal
nerve roots forming
small lateral extensions
of subsrachnoid space
 Pia Mater
 Vascular membrane
 Closely covers spinal cord
 Thickened on either side
between nerve roots
(ligamentum
denticulatum)
 Extends along each nerve
root as far as the spinal
nerve
 Inferiorly prolonged off the
lower end of the spinal
cord as the filum
terminale
 Patient on the side
with vertebral column
well flexed
 Above or Below 4th
lumbar spine
 Lies within imaginary
line between highest
points on iliac crests
 Needle passes through
the following structures
to subarachnoid space
 Skin
 Fascia
 Supraspinous ligament
 Interspinous ligament
 Ligamentum flavum
 Fatty tissue (internal
vertebral venous plexus)
 Dura mater
 Arachnoid mater
Vertebral level Anatomic Structure
c4 Hyoid bone,
Bifurcation of common carotid artery
c5 Thyroid cartilage,
Carotid pulse palpated
C6 Cricoid cartilage,
Start of trachea,
Start of esophagus
T2 Sternal notch,
Arch of aorta,
T4 Sternal angle,
Junction of superior and inferior mediastinum,
Bifrucation of trachea
T5-7 Pulmonary hilum
T8 Inferior vena cava hiatus
Vertebral level Anatomic Structure
T9 Xiphisternal joint
T10 Esophageal hiatus
T12 Aortic hiatus
T12-L1 Duodenumn
T12 Celiac artery,
Upper pole left kidney
L1 Superior mesenteric artery
Upper pole of right kidney
End of spinal cord in adult (conus medullaris)
and pia mater
L2 Renal artery
L3 End of spinal cord in new born
Inferior mesenteric artery
Umbilicus
Vertebral level Anatomic Structure
L4 Iliac crest,
Bifurcation of aorta
S1 Sacral promontory
S2 End of dural sac, dura, arachnoid,
subarachnoid space, and cerebrospinal fluid
S3 End of sigmoid colon
 How vertebrae are  Answer: D (33)
there in the vertebral
column?  Groupings
a. 12  Cervical (7)
b. 21  Thoracic (12)
c. 31  Lumbar (5)
d. 33  Sacral (5 – fused sacrum)
 Coccygeal (3 – fused
coccyx)
 Good luck!