3/12/2020 The Vertebral Column - Joints - Vertebrae - Vertebral Structure

The Vertebral Column

Home / The Back / Bones of the Back / The Vertebral Column

Original Author(s): Oliver Jones

Last updated: September 28, 2019
Revisions: 58

The vertebral column is a series of approximately 33 bones called vertebrae, which are separated by intervertebral discs.

The column can be divided into five di erent regions, with each region characterised by a di erent vertebral structure.

In this article, we shall look at the anatomy of the vertebral column – its function, structure and clinical significance.

Functions
The vertebral column has four main functions:

Protection – encloses and protects the spinal cord within the spinal canal.

Support – carries the weight of the body above the pelvis.

Axis – forms the central axis of the body.

Movement – has roles in both posture and movement.

© By TeachMeSeries Ltd (2020)

Fig 1 – The vertebral column viewed from the side. The five di erent regions are shown and labelled.

Structure of a Vertebrae
All vertebrae share a basic common structure. They each consist of an anterior vertebral body, and a posterior vertebral arch.

Vertebral Body
The vertebral body forms the anterior part of each vertebrae.

It is the weight-bearing component, and vertebrae in the lower portion of the column have larger bodies than those in the upper portion (to better support
the increased weight).

The superior and inferior aspects of the vertebral body are lined with hyaline cartilage. Adjacent vertebral bodies are separated by a fibrocartilaginous
intervertebral disc.

https://teachmeanatomy.info/back/bones/vertebral-column/ 1/5
3/12/2020 The Vertebral Column - Joints - Vertebrae - Vertebral Structure

© By TeachMeSeries Ltd (2020)

Fig 2 – The general structure of a vertebrae.

Vertebral Arch
The vertebral arch forms the lateral and posterior aspect of each vertebrae.

In combination with the vertebral body, the vertebral arch forms an enclosed hole – the vertebral foramen. The foramina of the all vertebrae line up to form
the vertebral canal, which encloses the spinal cord.

The vertebral arches have several bony prominences, which act as attachment sites for muscles and ligaments:

Spinous processes – each vertebra has a single spinous process, centered posteriorly at the point of the arch.

Transverse processes – each vertebra has two transverse processes, which extend laterally and posteriorly from the vertebral body. In the thoracic
vertebrae, the transverse processes articulate with the ribs.

Pedicles – connect the vertebral body to the transverse processes.

Lamina – connect the transverse and spinous processes.

Articular processes – form joints between one vertebrae and its superior and inferior counterparts. The articular processes are located at the intersection
of the laminae and pedicles.

© By TeachMeSeries Ltd (2020)

Fig 3 – Superior view of a lumbar vertebrae, showing its characteristic features.

+
Clinical Relevance: Intervertebral Disc Herniation
The intervertebral disc is a fibrocartilaginous cylinder that lies between the vertebrae, joining them together. They permit the flexibility of the spine,
and act as shock absorbers. In the lumbar and thoracic regions, they are wedge–shaped; supporting the curvature of the spine.

Each vertebral disc has two parts; the nucleus pulposus and annulus fibrosus. The annulus fibrosus is tough and collagenous, and it surrounds the
jelly-like nucleus pulposus.

Herniation of an intervertebral disc occurs when the nucleus pulposus ruptures, breaking through the annulus fibrosus. The rupture usually occurs in
a posterior-lateral direction, after which the nucleus pulposis can irritate nearby spinal nerves – resulting in a variety of neurological and muscular
symptoms.

https://teachmeanatomy.info/back/bones/vertebral-column/ 2/5
3/12/2020 The Vertebral Column - Joints - Vertebrae - Vertebral Structure

© Medical gallery of Blausen Medical 2014. WikiJournal of Medicine [CC BY 3.0], from Wikimedia Commons

Fig 4 – Herniation of an intervertebral disc.

Classifications of Vertebrae
Cervical Vertebrae
There are seven cervical vertebrae in the human body. They have three main distinguishing features:

Bifid spinous process – the spinous process bifurcates at its distal end.
Exceptions to this are C1 (no spinous process) and C7 (spinous process is longer than that of C2-C6 and may not bifurcate).

Transverse foramina – an opening in each transverse process, through which the vertebral arteries travel to the brain.

Triangular vertebral foramen

Two cervical vertebrae that are unique. C1 and C2 (called the atlas and axis respectively), are specialised to allow for the movement of the head.

© By TeachMeSeries Ltd (2020)

Fig 5 – Characteristic features of a cervical vertebrae

Thoracic Vertebrae
The twelve thoracic vertebrae are medium-sized, and increase in size from superior to inferior. Their specialised function is to articulate with ribs, producing
the bony thorax.

Each thoracic vertebra has two ‘demi facets,’ superiorly and inferiorly placed on either side of its vertebral body. The demi facets articulate with the heads of
two di erent ribs.

On the transverse processes of the thoracic vertebrae, there is a costal facet for articulation with the shaft of a single rib. For example, the head of Rib 2
articulates with the inferior demi facet of thoracic vertebra 1 (T1) and the superior demi facet of T2, while the shaft of Rib 2 articulates with the costal facets of
T2.

The spinous processes of thoracic vertebrae are oriented obliquely inferiorly and posteriorly. In contrast to the cervical vertebrae, the vertebral foramen of
thoracic vertebrae is circular.

https://teachmeanatomy.info/back/bones/vertebral-column/ 3/5
3/12/2020 The Vertebral Column - Joints - Vertebrae - Vertebral Structure

© By TeachMeSeries Ltd (2020)

Fig 6 – Lateral view of a thoracic vertebrae.

Lumbar Vertebrae
There are five lumbar vertebrae in most humans, which are the largest in the vertebral column. They are structurally specialised to support the weight of the
torso.

Lumbar vertebrae have very large vertebral bodies, which are kidney-shaped. They lack the characteristic features of other vertebrae, with no transverse
foramina, costal facets, or bifid spinous processes.

However, like the cervical vertebrae, they have a triangular-shaped vertebral foramen. Their spinous processes are shorter than those of thoracic vertebrae
and do not extend inferiorly below the level of the vertebral body.

Their size and orientation allows for clinical access to the spinal canal and spinal cord between lumbar vertebrae (which would not be possible between
thoracic vertebrae). Examples include epidural anaesthesia administration and lumbar puncture.

Sacrum and Coccyx

The sacrum is a collection of five fused vertebrae. It is described as an inverted triangle, with the apex pointing inferiorly. On the lateral walls of the sacrum
are facets for articulation with the pelvis at the sacro-iliac joints.

The coccyx is a small bone which articulates with the apex of the sacrum. It is recognised by its lack of vertebral arches. Due to the lack of vertebral arches,
there is no vertebral canal.

Separation of S1 from the sacrum is termed “lumbarisation”, while fusion of L5 to the sacrum is termed “sacralisation”. These conditions are congenital
abnormalities.

© By TeachMeSeries Ltd (2020)

Fig 7 – Diagram of the sacrum and coccyx, articulating with the pelvic bones.

Joints and Ligaments

The mobile vertebrae articulate with each other via joints between their bodies and articular facets:

Left and right superior articular facets articulate with the vertebra above.

Left and right inferior articular facets articulate with the vertebra below.

Vertebral bodies indirectly articulate with each other via the intervertebral discs.

The vertebral body joints are cartilaginous joints, designed for weight-bearing. The articular surfaces are covered by hyaline cartilage, and are connected by
the intervertebral disc.

Two ligaments strengthen the vertebral body joints: the anterior and posterior longitudinal ligaments, which run the full length of the vertebral column. The
anterior longitudinal ligament is thick and prevents hyperextension of the vertebral column. The posterior longitudinal ligament is weaker, and prevents
hyperflexion.

The joints between the articular facets, called facet joints, allow for some gliding motions between the vertebrae. They are strengthened by several ligaments:

Ligamentum flavum – extends between lamina of adjacent vertebrae.

Interspinous and supraspinous – join the spinous processes of adjacent vertebrae. The interspinous ligaments attach between processes, and the
supraspinous ligaments attach to the tips.

https://teachmeanatomy.info/back/bones/vertebral-column/ 4/5
3/12/2020 The Vertebral Column - Joints - Vertebrae - Vertebral Structure

Intertransverse ligaments – extends between transverse processes.

© By TeachMeSeries Ltd (2020)

Fig 8 – Ligaments of the lumbar vertebrae

+
Clinical Relevance: Abnormal Morphology of the Spine
There are several clinical syndromes resulting from an abnormal curvature of the spine:
© By TeachMeSeries Ltd (2020)

Kyphosis – excessive thoracic curvature, causing a hunchback deformity.

Lordosis – excessive lumbar curvature, causing a swayback deformity.

Scoliosis – lateral curvature of the spine, usually of unknown cause.

Cervical spondylosis – decrease in the size of the intervertebral foramina, usually due to degeneration of
the joints of the spine. The smaller size of the intervertebral foramina puts pressure on the exiting nerves,
causing pain.

Fig 9 – Radiograph of scoliosis of the spine.

https://teachmeanatomy.info/back/bones/vertebral-column/ 5/5
3/12/2020 The Spinal Cord - Meninges - Vasculature - TeachMeAnatomy

The Spinal Cord

Home / The Back / Nerves of the Back / The Spinal Cord

Original Author(s): Mike Bath

Last updated: September 28, 2019
Revisions: 29

The spinal cord is a tubular bundle of nervous tissue and supporting cells that extends from the brainstem to the lumbar vertebrae. Together, the spinal cord
and the brain form the central nervous system.

In this article, we shall examine the macroscopic anatomy of the spinal cord – its structure, membranous coverings and blood supply.

For information regarding the internal structure of the spinal cord, see the grey matter of the spinal cord.

Anatomical Position and Structure

The spinal cord is a cylindrical structure, greyish-white in colour. It has a relatively simple anatomical course:
© By TeachMeSeries Ltd (2020)

The spinal cord arises cranially as a continuation of the medulla oblongata (part of the brainstem).

It then travels inferiorly within the vertebral canal, surrounded by the spinal meninges containing
cerebrospinal fluid.

At the L2 vertebral level the spinal cord tapers o , forming the conus medullaris.

As a result of the termination of the spinal cord at L2, it occupies around two thirds of the vertebral canal. The
spinal nerves that arise from the end of the spinal cord are bundled together, forming a structure known as
the cauda equina.

During the course of the spinal cord, there are two points of enlargement. The cervical enlargement is
located proximally, at the C4-T1 level. It represents the origin of the brachial plexus. Between T11 and L1 is the
lumbar enlargement, representing the origin of the lumbar and sacral plexi.

The spinal cord is marked by two depressions on its surface. The anterior median fissure is a deep groove
extending the length of the anterior surface of the spinal cord. On the posterior aspect there is a slightly Fig 1.0 – The external structure of the spinal cord.

shallower depression – the posterior median sulcus.

+
Clinical Relevance: Cauda Equina Syndrome
The cauda equina is a bundle of spinal nerves that arise from the distal end of the spinal cord. They run in the subarachnoid space, before exiting at
their appropriate vertebral level.

Compression of these nerves produces a range of signs and symptoms collectively termed cauda equina syndrome. There are many causes of
compression, including intervertebral disc prolapse, extrinsic or primary cord tumours, spinal stenosis, trauma and abscess formation.

Suspected cauda equina patients should be assessed with a full lower limb neurological assessment. The main signs to assess for are:

Saddle-area anaesthesia.

Incontinence / retention of urine or faeces.

Reduced anal tone.

Paralysis ± sensory loss.

If su icient clinical evidence exists, an MRI is required immediately for diagnosis. Any confirmed case must be sent for surgery within 36 hours of first
presentation of the symptoms for surgical decompression.

Spinal Meninges
The spinal meninges are three membranes that surround the spinal cord – the dura mater, arachnoid mater, and pia mater. They contain cerebrospinal fluid,
acting to support and protect the spinal cord. They are analogous with the cranial meninges.

Distally, the meninges form a strand of fibrous tissue, the filum terminale, which attaches to the vertebral bodies of the coccyx. It acts as an anchor for the
spinal cord and meninges.

https://teachmeanatomy.info/back/nerves/spinal-cord/ 1/3
3/12/2020 The Spinal Cord - Meninges - Vasculature - TeachMeAnatomy

Dura Mater

The spinal dura mater is the most external of the meninges. It extends from the foramen magnum to the filum terminale, separated from the walls of the
vertebral canal by the epidural space. This space contains some loose connective tissue, and the internal vertebral venous plexus.

As the spinal nerves exit the vertebral canal, they pierce the dura mater, temporarily passing in the epidural space. In doing so, the dura mater surrounds the
nerve root, and fuses with the outer connective tissue covering of the nerve, the epineurium.

Arachnoid Mater

The spinal arachnoid mater is a delicate membrane, located between the dura mater and the
© By TeachMeSeries Ltd (2020)
pia mater. It is separated from the latter by the subarachnoid space, which contains
cerebrospinal fluid.

Distal to the conus medullaris, the subarachnoid space expands, forming the lumbar cistern.
This space accessed during a lumbar puncture (to obtain CSF fluid) and spinal anaesthesia.

Pia Mater

The spinal pia mater is the innermost of the meninges. It is a thin membrane that covers the
spinal cord, nerve roots and their blood vessels. Inferiorly, the spinal pia mater fuses with the
filum terminale.

Between the nerve roots, the pia mater thickens to form the denticulate ligaments. These Fig 1.1 – The expanded sub-arachnoid space, forming the lumbar cistern.
ligaments attach to the arachnoid mater, suspending the spinal cord in the vertebral canal.

Formation of the Spinal Nerves

The spinal nerves are mixed nerves that originate from the spinal cord, forming the peripheral nervous system.

Each spinal nerve begins as an anterior (motor) and a posterior (sensory) nerve root. These roots arise from the spinal cord, and unite at the intervertebral
foramina, forming a single spinal nerve.

The spinal nerve then leaves the vertebral canal via the intervertebral foramina, and then divides into two:

Posterior rami – supplies nerve fibres to the synovial joints of the vertebral column, deep muscles of the back, and the overlying skin.

Anterior rami – supplies nerve fibres to much of the remaining area of the body, both motor and sensory.

The nerve roots L2-S5 arise from the distal end of the spinal cord, forming a bundle of nerves known as the cauda equina.

© Adapted from work by Cancer Research UK [CC BY-SA 4.0)], via Wikimedia Commons

Fig 1.2 – The origin of the spinal nerves from the spinal cord.

Vasculature
The arterial supply to the spinal cord is via three longitudinal arteries – the anterior spinal artery and the paired posterior spinal arteries.

Anterior spinal artery – formed from branches of the vertebral arteries. They travel in the anterior median fissure.

Posterior spinal arteries – originate from the vertebral artery or the posteroinferior cerebellar artery. They anastamose with one another in the pia mater.

https://teachmeanatomy.info/back/nerves/spinal-cord/ 2/3
3/12/2020 The Spinal Cord - Meninges - Vasculature - TeachMeAnatomy

Additional arterial supply is via the anterior and posterior segmental medullary arteries – small vessels which enter via the nerve roots. The largest
anterior segmental medullary artery is the artery of Adamkiewicz. It arises from the inferior intercostal or upper lumbar arteries, and supplies the inferior 2/3
of the spinal cord.

Venous drainage is via three anterior and three posterior spinal veins. These veins are valveless, and form an anastamosing network along the surface of
the spinal cord. They also receive venous blood from the radicular veins. The spinal veins drain into the internal and external vertebral plexuses, which in turn
empty into the systemic segmental veins. The internal vertebral plexus also empties into the dural venous sinuses superiorly.

© By TeachMeSeries Ltd (2020)

Fig 1.3 – The external and internal vertebral venous plexuses.

+
Clinical relevance: Spinal Cord Infarction
Spinal cord infarction (also known as a spinal stroke) refers to the death of nervous tissue, which results from an interruption of the arterial supply.

Clinical signs of spinal cord infarction include muscle weakness and paralysis with loss of reflexes. The most common causes of infarction are
vertebral fractures or dislocations, vasculitic disease, atheromatous disease, or external compression (e.g. abdominal tumours).

95% of spinal cord ischaemic events are to the anterior aspect of the spinal cord, with the posterior columns preserved. Treatment is by reversal of
any known cause.

https://teachmeanatomy.info/back/nerves/spinal-cord/ 3/3
3/12/2020 The Superficial Back Muscles - Attachments - Actions - TeachMeAnatomy

The Superficial Back Muscles

Home / The Back / Muscles of the Back / The Superficial Back Muscles

Original Author(s): Oliver Jones

Last updated: September 19, 2019
Revisions: 33

The muscles of the back can be divided into three groups – superficial, intermediate and deep:

Superficial – associated with movements of the shoulder.

Intermediate – associated with movements of the thoracic cage.

Deep – associated with movements of the vertebral column.

The deep muscles develop embryologically in the back, and are thus described as intrinsic muscles. The superficial and intermediate muscles do not
develop in the back, and are classified as extrinsic muscles.

This article is about the anatomy of the superficial back muscles – their attachments, innervations and functions.

The superficial back muscles are situated underneath the skin and superficial fascia. They originate from the vertebral column and attach to the bones of the
shoulder – the clavicle, scapula and humerus. All these muscles are therefore associated with movements of the upper limb.

The muscles in this group are the trapezius, latissimus dorsi, levator scapulae and the rhomboids. The trapezius and the latissimus dorsi lie the most
superficially, with the trapezius covering the rhomboids and levator scapulae.

Trapezius
The trapezius is a broad, flat and triangular muscle. The muscles on each side form a trapezoid shape. It is the most superficial of all the back muscles.

Attachments: Originates from the skull, ligamentum nuchae and the spinous processes of C7-T12. The fibres attach to the clavicle, acromion and the
scapula spine.

Innervation: Motor innervation is from the accessory nerve. It also receives proprioceptor fibres from C3 and C4 spinal nerves.

Actions: The upper fibres of the trapezius elevates the scapula and rotates it during abduction of the arm. The middle fibres retract the scapula and the
lower fibres pull the scapula inferiorly.

+
Clinical Relevance: Testing the Accessory Nerve
The most common cause of accessory nerve damage is iatrogenic (i.e. due to a medical procedure). In particular, operations such as cervical lymph
node biopsy or cannulation of the internal jugular vein can cause trauma to the nerve.

To test the accessory nerve, trapezius function can be assessed. This can be done by asking the patient to shrug his/her shoulders. Other clinical
features of accessory nerve damage include muscle wasting, partial paralysis of the sternocleidomastoid, and an asymmetrical neckline.

Latissimus Dorsi
The latissimus dorsi originates from the lower part of the back, where it covers a wide area.

Attachments: Has a broad origin – arising from the spinous processes of T6-T12, iliac crest, thoracolumbar fascia and the inferior three ribs. The fibres
converge into a tendon that attaches to the intertubercular sulcus of the humerus.

Innervation: Thoracodorsal nerve.

Actions: Extends, adducts and medially rotates the upper limb.

https://teachmeanatomy.info/back/muscles/superficial/ 1/3
3/12/2020 The Superficial Back Muscles - Attachments - Actions - TeachMeAnatomy

© By TeachMeSeries Ltd (2020)

Fig 1.0 – The superficial muscles of the back

Levator Scapulae
The levator scapulae is a small strap-like muscle. It begins in the neck, and descends to attach to the scapula.

Attachments: Originates from the transverse processes of the C1-C4 vertebrae and attaches to the medial border of the scapula.

Innervation: Dorsal scapular nerve.

Actions: Elevates the scapula.

Rhomboids
There are two rhomboid muscles – major and minor. The rhomboid minor is situated superiorly to the major.

Rhomboid Major
Attachments: Originates from the spinous processes of T2-T5 vertebrae. Attaches to the medial border of the scapula, between the scapula spine and
inferior angle.

Innervation: Dorsal scapular nerve.

Actions: Retracts and rotates the scapula.

Rhomboid Minor
Attachments: Originates from the spinous processes of C7-T1 vertebrae. Attaches to the medial border of the scapula, at the level of the spine of scapula.

Innervation: Dorsal scapular nerve.

Actions: Retracts and rotates the scapula.

https://teachmeanatomy.info/back/muscles/superficial/ 2/3
3/12/2020 The Superficial Back Muscles - Attachments - Actions - TeachMeAnatomy

https://teachmeanatomy.info/back/muscles/superficial/ 3/3