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Vertebral Column: Overview
Back
Fig. 1.1 Vertebral column
Left lateral view.
The vertebral column (spine) is divided into four regions: the
cervical, thoracic, lumbar, and sacral spines. Both the cervical
and lumbar spines demonstrate lordosis (inward curvature); the thoracic
and sacral spines demonstrate kyphosis (outward curvature).
A Regions of the spine.
B Bony vertebral column.
Clinical
Spinal development The characteristic curvatures of the adult spine appear over the course of postnatal development, being only partially present in a newborn. The newborn has a “kyphotic” spinal curvature ( A ); lumbar lordosis develops later and becomes stable at puberty ( C ).
A B C
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1 Bones, Ligaments & Joints
B Midsagittal section through an adult male.
Fig. 1.2 Normal anatomical position of the spine
Left lateral view.
A Line of gravity. The line of gravity passes
through certain anatomical landmarks,
including the inflection points at the cervi-
cothoracic and thoracolumbar junctions.
It continues through the center of gravity
(anterior to the sacral promontory) before
passing through the hip joint, knee, and
ankle.
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1 Bones, Ligaments & Joints
Fig. 1.5 Structural elements of a vertebra
Left posterosuperior view. With the exception of the atlas (C1) and axis
(C2), all vertebrae consist of the same structural elements.
Fig. 1.6 Typical vertebrae
Superior view.
A Cervical vertebra (C4).
B Thoracic vertebra (T6).
C Lumbar vertebra (L4). D Sacrum.
Table 1.1 Structural elements of vertebrae
Vertebrae Body Vertebral foramen Transverse processes Articular processes Spinous process
Cervical vertebrae C3*–C
Small (kidney-shaped)
Large (triangular)
Small (may be absent in C7); anterior and posterior tubercles enclose transverse foramen
Superoposteriorly and inferoanteriorly; oblique facets: most nearly horizontal
Short (C3–C5); bifid (C3–C6); long (C7)
Thoracic vertebrae T1–T
Medium (heart- shaped); includes costal facets
Small (circular)
Large and strong; length decreases T1–T12; costal facets (T1–T10)
Posteriorly (slightly laterally) and anteriorly (slightly medially); facets in coronal plane
Long, sloping postero- inferiorly; tip extends to level of vertebral body below
Lumbar vertebrae L1–L
Large (kidney-shaped)
Medium (triangular)
Long and slender; accessory process on posterior surface
Posteromedially (or medially) and anterolaterally (or laterally); facets nearly in sagittal plane; mammillary process on posterior surface of each superior articular process
Short and broad
Sacral vertebrae (sacrum) S1–S5 (fused)
Decreases from base to apex
Sacral canal
Fused to rudimentary rib (ribs, see pp. 44–47)
Superoposteriorly (SI) superior surface of lateral sacrum- auricular surface
Median sacral crest
*C1 (atlas) and C2 (axis) are considered atypical (see pp. 6–7).
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Cervical Vertebrae
Back
Fig. 1.7 Cervical spine
Left lateral view.
A Bones of the cervical spine, left lateral view.
B Radiograph of the cervical spine, left lateral view.
Fig. 1.8 Atlas (C1)
Fig. 1.9 Axis (C2)
Fig. 1.10 Typical cervical vertebra (C4)
A Left lateral view.
A Left lateral view.
A Left lateral view.
The seven vertebrae of the cervical spine differ most conspicu-
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ized to bear the weight of the head and allow the neck to move in
all directions. C1 and C2 are known as the atlas and axis, respectively.
C7 is called the vertebra prominens for its long, palpable spinous process.
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Fig. 1.11 Thoracic spine
Left lateral view.
Fig. 1.12 Typical thoracic vertebra (T6)
A Left lateral view.
B Anterior view.
C Superior view.
Thoracic & Lumbar Vertebrae
Back
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Fig. 1.13 Lumbar spine
Left lateral view.
Fig. 1.14 Typical lumbar vertebra (L4)
A Left lateral view.
B Anterior view.
C Superior view.
Clinical
Osteoporosis The spine is the structure most affected by degenerative diseases of the skeleton, such as arthrosis and osteoporosis. In osteoporosis, more bone material gets reabsorbed than built up, resulting in a loss of bone mass. Symptoms include compression fractures and resulting back pain.
A Radiograph of a normal lumbar spine, left lateral view.
B Radiograph of an osteoporotic spine. The vertebral bodies are decreased in density, and the internal trabecular structure is coarse. Lower and upper end plates are fractured.
1 Bones, Ligaments & Joints
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1 Bones, Ligaments & Joints
Fig. 1.16 Sacrum
Superior view.
B Transverse section through second sacral vertebra demonstrating
anterior and posterior sacral foramina, superior view.
A Base of sacrum, superior view.
C Left lateral view.
D Radiograph of sacrum, anteroposterior view.
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Fig. 1.20 Outer zone of the anulus fibrosus
Anterior view of L3–L4 with intervertebral disk.
Intervertebral Disks
Back
Fig. 1.18 Structure of
intervertebral disk
Anterosuperior view with the anterior half of
the disk and the right half of the end plate
removed. The intervertebral disk consists of
an external fibrous ring (anulus fibrosus) and a
gelatinous core (nucleus pulposus).
Fig. 1.19 Relation of intervertebral
disk to vertebral canal
Fourth lumbar vertebra, superior view.
Fig. 1.17 Intervertebral disk
in the vertebral column
Sagittal section of T11–T12, left lateral view.
The intervertebral disks occupy the spaces
between vertebrae (intervertebral joints,
see p. 14).
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Joints of the Vertebral Column: Overview
Back
Table 1.2 Joints of the vertebral column
Craniovertebral joints
A Atlanto-occipital joints^ Occiput–C
S Atlantoaxial joints^ C1–C
Joints of the vertebral bodies
D Uncovertebral joints^ C3–C
F Intervertebral joints^ C1–S
Joints of the vertebral arch
G Zygapophyseal joints^ C1–S
Fig. 1.21 Joints of
the vertebral column
Fig. 1.22 Zygapophyseal (intervertebral facet) joints
The orientation of the zygapophyseal joints differs between the spinal
regions, influencing the degree and direction of movement.
A Cervical region, left lateral view. The zygapophyseal joints lie
45 degrees from the horizontal.
B Thoracic region, left lateral view. The joints lie in the coronal plane.
C Lumbar region, posterior view. The joints lie in the sagittal plane.
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1 Bones, Ligaments & Joints
Fig. 1.23 Uncovertebral joints
Anterior view. Uncovertebral joints form during childhood between the
uncinate processes of C3–C6 and the vertebral bodies immediately supe-
rior. The joints may result from fissures in the cartilage of the disks that
assume an articular character. If the fissures become complete tears,
the risk of pulposus herniation is increased (see p. 13).
A Uncovertebral joints in the cervical spine of an 18-year-old man,
anterior view.
B Uncovertebral joint (enlarged), anterior view of coronal section.
C Split intervertebral disk, anterior view of coronal section.
Proximity of spinal nerve and vertebral artery to the uncinate process The spinal nerve and vertebral artery pass through the intervertebral and transverse foramina, respectively. Bony outgrowths (osteophytes) resulting from uncovertebral arthrosis may compress both the nerve and the artery and can lead to chronic pain in the neck.
Clinical
A Cervical spine, anterior view.
B Fourth cervical vertebra, superior view.
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1 Bones, Ligaments & Joints
C Cruciform ligament of atlas (*). Removed:
Tectorial membrane.
D Alar and apical ligaments. Removed: Transverse
ligament of atlas, longitudinal fascicles.
Fig. 1.26 Ligaments of the craniovertebral joints
A Ligaments of the median atlantoaxial joint,
superior view. The fovea of the atlas is hid-
den by the joint capsule.
B Ligaments of the craniovertebral joints,
posterosuperior view. The dens of the axis
is hidden by the tectorial membrane.
The atlanto-occipital joints are the two articulations between the
convex occipital condyles of the occipital bone and the slightly
concave superior articular facets of the atlas (C1). The atlanto-
axial joints are the two lateral and one medial articulations between the
atlas (C1) and axis (C2).
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Vertebral Ligaments: Overview & Cervical Spine
Back
The ligaments of the spinal column bind the vertebrae and enable
the spine to withstand high mechanical loads and shearing
stresses and limit the range of motion. The ligaments are subdivided
into vertebral body ligaments and vertebral arch ligaments.
Fig. 1.27 Vertebral ligaments
Viewed obliquely from the left posterior view.
Fig. 1.28 Anterior longitudinal ligament
Anterior longitudinal ligament. Anterior view with base of skull removed.
Table 1.3 Vertebral ligaments
Ligament Location
Vertebral body ligaments
Anterior longitudinal ligament
Along anterior surface of vertebral body
Posterior longitudinal ligament
Along posterior surface of vertebral body
Vertebral arch ligaments
A Ligamenta flava^ Between laminae
S Interspinous ligaments^ Between spinous process
D Supraspinous ligaments
Along posterior ridge of spinous processes
F Intertransverse ligaments^ Between transverse processes
Nuchal ligament*
Between external occipital protuberance and spinous process of C
*Corresponds to a supraspinous ligament that is broadened superiorly.
Fig. 1.29 Posterior longitudinal ligament
Posterior view with vertebral canal windowed and spinal cord removed.
The tectorial membrane is a broadened expansion of the posterior
longitudinal ligament.
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Back
Vertebral Ligaments: Thoracolumbar Spine
Fig. 1.31 Ligaments of the vertebral
column: Thoracolumbar junction
Left lateral view of T11–L3, with T11–T
sectioned in the midsagittal plane.
Fig. 1.32 Anterior longitudinal
ligament
Anterior view of L3–L5.
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1 Bones, Ligaments & Joints
Fig. 1.33 Ligamentum flavum and
intertransverse ligament
Anterior view of opened vertebral canal at
level of L2–L5. Removed: L2–L4 vertebral
bodies.
Fig. 1.34 Posterior longitudinal
ligament
Posterior view of opened vertebral canal at
level of L2–L5. Removed: L2–L4 vertebral
arches at pedicular level.
