Dr.

Mostafa Kandil
MSKL-311 (2012 – 2013)
Lecture: Vertebral Column: Introduction

Dr. Mostafa Kandil

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 Learning Objectives
General anatomical organisation of the vertebral colum - from cervical vertebra to coccyx.

Aim
To understand the general structure and function of the vertebral column and intrinsic back muscles

Content
• To understand regions and curvatures of the vertebral column and the number of vertebrae in each region
• To understand the basic components of a typical vertebrae and their function
• To understand and recognise the differences between cervical, thoracic and lumbar vertebrae
• To describe and classify the joints associated with the vertebral column
• To describe the location and general function of ligaments
• To name the true back muscles and understand their relative positions and actions
• To understand the relationships of neural structures and meninges to the vertebral column, including the points of exit of spinal nerves

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 INTRODUCTION

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 Vertebral Column
Vertebral column (spine) is built of 26
vertebrae.
Five vertebral regions:-
– cervical vertebrae (7) in the neck
– thoracic vertebrae ( 12 ) in the thorax
– lumbar vertebrae ( 5 ) in the low back
region
– sacrum (5, fused)
– coccyx (4, fused)

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Functions of the vertebral column:-

– Supports weight of head and trunk

– Transmits body weight to the lower limb
– Protects the spinal cord
– Gives exit to the spinal nerves from the spinal cord
– Provides site for muscle attachment
– Permits movement of head and trunk

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Movements of the vertebral column:-

• Flexion& extension: extensive in the cervical and lumbar regions, but

restricted in the thoracic region.

• Lateral flexion: extensive in the cervical and lumbar regions but restricted
in the thoracic region.

• Rotation: mainly in the thoracic region.

• Circumduction: combination of the above movements.

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Normal Curves of the Vertebral Column:-

Four major curvatures in adults

Cervical: anterior
Thoracic: posterior
Lumbar: anterior
Sacral and coccygeal: posterior
At birth, column is C shaped
When head is raised, cervicalMcSuKr3v1e1 VaEpRTpEeBEaRrAsL 7
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When sitting and walking begin, lumMObSaTArFcAuKArvNeDLI develops.
Normal curves (cont.):-

Front Back

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Abnormal curves of the vertebral column:-

1) Kyphosis:-is an exaggeration in the sagittal curvature present in the thoracic part of the
vertebral column.
Causes:1- muscular weakness
2 Structural changes in the vertebral bodies (osteoporosis)
3Degeneration of intervertebral discs (senile kyphosis)
2)Lordosis:-is an exaggeration in the sagittal curvature present in the lumbar region.
Causes:1-pregnancy
2-disease of the vertebral column, as spondylolithesis (the body of L5 moves
forward on the body of the lower vertebra).
3)Scoliosis:-is a lateral deviation of the vertebral column.
Causes:1-muscular defects (poliomyelitis)
2-vertebral defects (congenital hemivertebra).

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 Abnormal curves of the vertebral column

Normal

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Line of gravity:-

Line of gravity Because the greater part

of the body weight lies
anterior to the vertebral
column, the deep muscles
of the back are important
in maintaining the normal
postural curves of the
vertebral column in the
standing position.

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 Spinal Cord and Spinal Nerves

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 • Extends from foramen magnum to second
lumbar vertebra
• Segmented
Spinal Cord – Cervical
– Thoracic
– Lumbar
– Sacral
• Connected to 31 pairs of spinal nerves
– All are mixed nerves; I.e., contain both
sensory and motor fibers
• Not uniform in diameter throughout length
– Cervical enlargement: supplies upper
limbs
– Lumbar enlargement: supplies lower
limbs
• Conus medullaris: tapered inferior end.
• Cauda equina: origins of spinal nerves
extending inferiorly from lumbosacral
enlargement and conus medullaris.
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 LP (lumbar puncure) = spinal tap
(needle introduced into subdural space to collect CSF)
Lumbar spine needs
to be flexed so can
go between spinous
processes
Originally thought to be a narrow fluid
-filled interval between the dural and
arachnoid; now known to be an artifici
al space created by the separation of
the arachnoid from the dura as the
result of trauma or some ongoing patho
logic process; in the healthy state, the
arachnoid is attached to the dura and a
naturally occurring subdural space is
not present.
http://cancerweb.ncl.ac.uk/cgi-
bin/omd?subdural+space

Epidural space is external to dura

Anesthestics are often injected into epidural space Injection
inMtSoK 3c11oVrErReTcEBtEsRApLaCOcLeUMisN vital; mistakes can be
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 Spinal Meninges
– Dura mater: outermost layer; continuous
with epineurium of the spinal nerves
• No firm connections to vertebrae
• Epidural space: external to the dura;
anesthesia injected here in sc. Contains
blood vessels, areolar connective tissue
and fat.
– Arachnoid mater: delicate net-work of
collagen and elastic fibers
• Subarachnoid space: between pia and
arachnoid
• CSF and blood vessels within web-like
strands of arachnoid tissue
• Fluid functions as a shock absorber
– Pia mater: thin layer of elastic and
collagen fibers bound tightly to surface of
brain and spinal cord
• Denticulate ligaments extend from pia
through arachnoid to dura; prevent lateral
movement
• Forms the
filum terminale, which anchors
spinal cord to coccyx and the
denticulate ligaments that attach the
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 Cross Section of Spinal Cord

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Intervertebral Disc :-

Is formed of :
Outer fibrous layer :
(Annulus fibrosus)
where the collagen is arranged in
concentric layers
Inner gelatinous material :
(nucleus pulposus)
Containing large amount of water&
small amount of collagen fibres.
Functions:-
1 absorbs vertical shock
2 Permit various movements of the
vertebral column

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Pressure on the intervertebral disc during movement:

Posterior Anterior

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Intervertebral disc during rotation movement:-

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 Pressure on the intervertebral disc during weight bearing:-

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Pressure on the intervertebral disc during weight bearing (cont.):

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Relation of the intervertebral disc to the spinal nerve :-

Contained prolapse

MSK 311 VERTEBERAL COILnUtrMaNforaminal prolapse

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 Herniated intervertebral Disc:-

• Protrusion of the
nucleus pulposus .
• Most commonly in
lumbar region.
• Exerts pressure on
spinal nerves& causes
pain.

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 Arthroscopy & Arthroplasty

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What is a Disc Prolapse?
 The spinal column consists of multiple blocks of
bones called vertebral bodies.
 Between the vertebral bodies lies the disc.
 These discs are like rubber washers and allow
movement of the spinal column.
 The disc contains jelly-like material surrounded by
a fibrous ring.
 When the fibrous ring becomes diseased due to
injury or any other condition then the jelly like
substance is pushed out or prolapses into the
spinal canal and causes pressure on the spinal cord
and its accompany i n g n e r v e r o ots.
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What are the symptoms?

 Rupture of the disc or prolapse as it is usually

called, can press on the spinal cord and its nerve
roots leading to pain, numbness and weakness in
either or both the arms and legs depending on
where the prolapse occurs.
 If the prolapse is severe it can lead to loss of
function including weakness of either or both
limbs and may also affect the control of bowel
and urinary bladder.
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How is it diagnosed?
 Usually the symptoms of a patient who presents
with back and leg pain, or neck and arm pain with
associated weakness are enough to help the doctor
identify the problem.
 However, other diseases of the spine like infection,
tumour and fracture can also present with similar
symptoms.
 To rule out other conditions, various blood tests, X-
rays, CT scan or MRI scans are advised.
 Once the diagnosis is confirmed the appropriate
treatment can then be started.
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What is the treatment?
 Almost 90% of patients who get disc prolapse will
resolve with medical treatment.
 This includes rest, pain relief and physiotherapy.
 Rest is advised for only 3-4 days after which assisted
physiotherapy is required.
 If the symptoms do not resolve after 6 weeks of
treatment or if any nerve or spinal cord related
symptoms increase like numbness, weakness or loss
of bowel and bladder control, then immediate
surgery may be required.
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How can it be prevented?
 Regular care of the back with toning up
exercises is the most important factor that
helps to prevent further episodes of back
pain.
 The other factors are to learn how to avoid
inadvertent strains to the back.
 Techniques for sitting, driving long distances
and lifting weights must be learnt.

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How should things be lifted?
Do’s:
 Hold heavy objects close to the body rather than
away from it.
 The feet must be about shoulder-width apart. A
wide, solid base of support is important. Holding
the feet too close together will be unstable; too far
apart will make movement difficult.
 Legs must be bent at the knees while lifting
weights from floor level and the back must be kept
straight. The stomach muscles must be pulled in.
This will support the back in a good lifting position
and will help prevent excessive force on the spine.
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 Push up with the legs. The legs are much stronger
than the back muscles.
 If an object is too heavy, or awkward in shape get
someone to help.

Don'ts:
 Avoid sudden and awkward movements
while holding something heavy.
 Never bend the back to pick something up
 Don't twist or bend. Face in the walking direction.
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 Leg Pain or Sciatica

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