The Back and Vertebral Column

R.R. Schmidt, Ph.D.

Sidney Kimmel Medical College
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Learning Objectives
Describe the region of the back and its
various components.
Be able to describe the anatomy of the
vertebral column and its individual
components
Be able to describe various functions of
the vertebral column
Be able to recognize the complications
involved with back pain and back injury

Region of the Back

Definition
Posterior aspect of the trunk

Includes the following:

Vertebral Column
Definition
Vertebrae, IV disks, ligaments

Skin and subcutaneous tissue

Functions:

Extrinsic muscles

Protection

Intrinsic muscles

Support

Vertebral column

Axis for body

Ribs

Extended base for head

Spinal cord and meninges

Posture

Segmental nerves and vessels

Locomotion
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Backache and Back Pain

Annual visits to physician/chiropractor with complaint
of back pain

Backache

How many individuals experience back pain?

Low back pain
Back injuries
Handling of patients with suspected back injuries
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Vertebrae of the Vertebral Column

Five regions: 33 vertebrae
Fused vertebrae:
5 sacral = sacrum
4 coccygeal = coccyx

Lumbosacral angle
Vertebral size varies with region
Movement of vertebral column
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Regions and
Normal Curvatures

Primary Curvatures:
Thoracic
Sacral/Coccygeal

Secondary Curvatures:
Cervical
Lumbar

Vertebral Column as an Axis

and a Base for the Skull

Articulations
Lumbosacral angle
Variation in Size

Abnormal Curvatures
Humpback or hunchback
- excessive thoracic kyphosis
- Dowager s hump (osteoporosis)
Hollow back or sway back
- excessive lumbar lordosis
Scoliosis
- abnormal lateral curvature
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Typical Vertebra
Lamina

Spinous process

Articular
facet

Superior articular process

Inferior articular process
Transverse process

Vertebral
arch

Vertebral
Foramen

Pedicle

Body

Vertebral Terminology

Vertebral arch
Vertebral foramen
Vertebral canal
Vertebral notches
Intervertebral
foramina

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Laminectomy
Surgical excision of one or more spinous processes
together with adjacent lamina
Procedure may be done in different regions of
vertebral column
Permits access to vertebral canal
Relieve pressure on spinal cord/nerve roots due to
herniated IV disc, tumor or bone hypertrophy
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Vertebra Characteristics by Region

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Cervical Region
Skeleton of neck

Transverse foramen*

Smallest of movable

Tubercles (A/P)

Uncus of the vertebral

vertebrae
IV discs thin
Facet orientation

body

Greatest range and

variety of movement of
vertebral column

C3-C6 spinous
processes bifid

Vertebra prominens
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CV1 Vertebra (atlas)

Widest of the cervical vertebrae

No body and no spinous process

Lateral masses support weight of

head and give rise to transverse
processes

Superior articular facets articulate with

occipital condyles---atlanto-occipital
joint

Movement indicates the affirmative

Anterior/Posterior arches

Anterior/Posterior tubercles

Groove for vertebral artery

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CV2 Vertebra (axis)

Strongest of cervical
vertebrae
Atlanto-axial articulation
Movement indicates
negative
Dens or odontoid process
Transverse ligament of
atlas
- prevents posterior displacement of
dens and anterior displacement of CV1

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Rupture of Transverse Ligament of Atlas

versus Fracture of Dens
Atlantoaxial subluxation

Fracture of Dens

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Thoracic Region
Provide attachment for ribs
Costal facets *
Vertically oriented articular
processes
Coronally oriented articular
facets (A/P)
Long spinous processes which
slope posteroinferiorly
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Lumbar Region

Massive bodies

Vertical articular processes

Facets oriented sagittally on LV1;

then become more coronal

Large transverse processes

Accessory and mammillary

processes for muscle attachment

LV5 largest of all movable vertebrae

Transmits weight to base of sacrum

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Sacrum
Large, triangular and wedgeshaped
Fusion of five sacral vertebrae
Only upper portion is weightbearing
Transmits weight to pelvic girdle
which articulates with lower
limbs
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Sacrum
Four pairs of sacral foramina (A/P)
Ala
Sacral canal
Sacral hiatus
Sacral cornua
Articular surface for ilium, i.e.,
auricular surface
Promontory
Apex

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Anterior/Posterior Sacral Foramina

Transmission of posterior (dorsal) and anterior
(ventral) rami of spinal nerves

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Coccyx
Small and triangular
Fusion of four rudimentary
vertebrae
remnant of tail-like caudal
eminence (prenatal weeks
4-8)
Coccygeal cornua
Anococcygeal ligament
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Articulations of Vertebral Column

Joints of vertebral bodies
Joints of vertebral arches
Atlantoaxial joint *
Atlanto-occipital joint *
Costovertebral joints *
Sacroiliac joints *
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Joints of the Vertebral Bodies

Symphyses (strength and weight-bearing)
Articular surfaces united by IV discs and ligaments
20-25% vertebral column length = IV discs
- no disc between CV1 and CV2

Anulus fibrosus (fibrocartilage)

Nucleus pulposus (gelatinous central core; more
posteriorly placed within IV disc)
- semifluid nature = flexibility and resilience

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Herniation of Nucleus Pulposus

Common cause for low back
and/or lower limb pain
slipped disc or ruptured
disc
Direction of herniation:
posterolaterally
Anulus thin here; no support
from PLL

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Uncovertebral joints of Luschka

Unci of CV3 CV6 and
bodies vertebrae above
Located at lateral and
posterolateral aspects of
IV discs
Frequent site of spur
formation
May result in neck pain
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Anterior Longitudinal Ligament

Location
Extent
Prevents
hyperextension of
vertebral column
Only ligament to limit
extension
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Posterior Longitudinal Ligament

Body of CV2 to sacrum
Narrower than ALL
Within vertebral canal
Attached mainly to IV discs
Helps prevent/redirect
posterior herniation of nucleus
pulposus
Richly supplied with pain fibers

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Zygapophyseal (facet) Joints

Synovial joints
Location
Thin, loose joint capsule
Permit gliding movements
Innervated by medial
branches of posterior rami
of two adjacent spinal
nerves

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Zygapophyseal (facet) Joints

Stabilized by ligaments
uniting laminae,
transverse processes,
spinous processes
of adjacent vertebrae

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Movements of Vertebral Column

Considerations

Cervical and lumbar

regions are most mobile;
also most at risk for injury
Summation of small
movements leads to

considerable ROM
Typically ROM is reduced

with age

Limiting Features
IV discs (thickness, elasticity,
compresibility)
Shape/orientation of
zygapophysial joints and
tension of the joint capsules
Resistance of back muscles
and ligaments
Rib attachment
Surrounding tissue bulk

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Movements

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Blood Supply and Venous Drainage

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Intrinsic Muscles of Back

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 Extrinsic Back Muscles

Superficial group (upper limb)
Posterior axio-appendicular muscles
Produce and control movements of upper limb
Innervated by anterior rami of cervical nerves

Intermediate group (thoracic wall)

Superficial respiratory muscles/proprioception
Innervated by intercostal nerves

Intrinsic Back Muscles

Maintain posture and control movements of the
vertebral column
Innervated by posterior rami of spinal nerves
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Intermediate
Back Muscles
Serratus posterior
superior
Serratus posterior
inferior

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Intrinsic Back Muscles

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Thoracolumbar
Fascia

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Thoracolumbar Fascia

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Intrinsic Back Muscles

Superficial layer
Splenius muscles

Intermediate layer
Erector spinae muscles

Deep layer
Transversospinalis muscle group
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Splenius
Proximal attachment
Nuchal ligament & Spinous
processes C7-T3

Distal attachment
Splenius capitis:
Mastoid process;
Superior nuchal line

Splenius cervicis:
Transverse processes of C1-C3

Action
Alone: laterally flex neck, rotate
head to active side
Together: extend head and neck

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Transversospinales Muscles
Semispinalis, multifidus, rotatores
Origin:
transverse processes

Insertion:
spinous processes of more superior
vertebrae

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Span 1-2
segments

Span 3-4
segments

Origin: C4-T12
Span 5-6 segments
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Back Strains and Sprains

Avoided by warmup and stretching exercises
Sprain = no fracture; only ligamentous tissue or
attachments involved
Strain = no fracture; stretching or tearing of muscle fibers
Do not use back as a lever!
Spasm = protective mechanism; response to injury or
inflammation
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