Download Vertebral Column: Overview

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Vertebral Column: Overview
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).
Fig. 1.1 Vertebral column
Left lateral view.
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A Regions of the spine.
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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).
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A
2
B
C
B Bony vertebral column.
Left lateral view.
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1 Bones, Ligaments & Joints
Fig. 1.2 Normal anatomical position of the spine
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A Line of gravity. The line of gravity passes
through certain anatomical landmarks,
including the inflection points at the cervicothoracic 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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B Midsagittal section through an adult male.
3
Back
Vertebral Column: Elements
Fig. 1.3 Bones of the vertebral column
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Fig. 1.4 Palpable spinous processes
as landmarks
Posterior view. The easily palpated spinous
processes provide important landmarks during physical examination.
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A Anterior view.
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B Posterior view.
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Fig. 1.5 Structural elements of a vertebra
Fig. 1.6 Typical vertebrae
Left posterosuperior view. With the exception of the atlas (C1) and axis
(C2), all vertebrae consist of the same structural elements.
Superior view.
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A Cervical vertebra (C4).
1 Bones, Ligaments & Joints
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B Thoracic vertebra (T6).
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C Lumbar vertebra (L4).
Table 1.1
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D Sacrum.
Structural elements of vertebrae
Vertebrae
Body
Vertebral foramen
Transverse processes
Articular processes
Spinous process
Cervical vertebrae
C3*–C7
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–T12
Medium (heartshaped); 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 posteroinferiorly; tip extends to level
of vertebral body below
Short and broad
Median sacral crest
Lumbar vertebrae
L1–L5
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
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 sacrumauricular surface
*C1 (atlas) and C2 (axis) are considered atypical (see pp. 6–7).
5
Back
Cervical Vertebrae
The seven vertebrae of the cervical spine differ most conspicuously from the common vertebral morphology. They are specialized 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.
Fig. 1.7 Cervical spine
Left lateral view.
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Fig. 1.8 Atlas (C1)
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A Left lateral view.
Fig. 1.9 Axis (C2)
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A Bones of the cervical spine, left lateral view.
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A Left lateral view.
Fig. 1.10 Typical cervical vertebra (C4)
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B Radiograph of the cervical spine, left lateral view.
6
A Left lateral view.
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Clinical
The cervical spine is prone to hyperextension injuries, such as
“whiplash,” which can occur when the head extends back much farther
than it normally would. The most common injuries of the cervical spine
are fractures of the dens of the axis, traumatic spondylolisthesis (ventral
slippage of a vertebral body), and atlas fractures. Patient prognosis is
largely dependent on the spinal level of the injuries (see p. 600).
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This patient hit the dashboard of his car while not
wearing a seat belt. The resulting hyperextension
caused the traumatic spondylolisthesis of C2 (axis)
with fracture of the vertebral arch of C2, as well as
tearing of the ligaments between C2 and C3. This
injury is often referred to as “hangman’s fracture.”
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1 Bones, Ligaments & Joints
Injuries in the cervical spine
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C Superior view.
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C Superior view.
7
Back
Thoracic & Lumbar Vertebrae
Fig. 1.11 Thoracic spine
Fig. 1.12 Typical thoracic vertebra (T6)
Left lateral view.
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Fig. 1.13 Lumbar spine
Left lateral view.
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Fig. 1.14 Typical lumbar vertebra (L4)
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1 Bones, Ligaments & Joints
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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.
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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.
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9
Back
Sacrum & Coccyx
The sacrum is formed from five postnatally fused sacral vertebrae. The base of the sacrum articulates with the fifth lumbar
vertebra, and the apex articulates with the coccyx, a series of three or
four rudimentary vertebrae.
Fig. 1.15 Sacrum and coccyx
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A Anterior view.
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10
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1 Bones, Ligaments & Joints
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C Left lateral view.
Fig. 1.16 Sacrum
Superior view.
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11
Back
Intervertebral Disks
Fig. 1.17 Intervertebral disk
in the vertebral column
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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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Fig. 1.18 Structure of
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an external fibrous ring (anulus fibrosus) and a
gelatinous core (nucleus pulposus).
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Fig. 1.19 Relation of intervertebral
disk to vertebral canal
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Fig. 1.20 Outer zone of the anulus fibrosus
Anterior view of L3–L4 with intervertebral disk.
Fourth lumbar vertebra, superior view.
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12
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Disk herniation in the lumbar spine
As the stress resistance of the anulus fibrosus declines with age, the tissue
of the nucleus pulposus may protrude through weak spots under loading.
If the fibrous ring of the anulus ruptures completely, the herniated material
may compress the contents of the intervertebral foramen (nerve roots and
blood vessels). These patients often suffer from severe local back pain. Pain
is also felt in the associated dermatome (see p. 600). When the motor part of
the spinal nerve is affected, the muscles served by that spinal nerve will show
weakening. It is an important diagnostic step to test the muscles innervated by
a nerve from a certain spinal segment, as well as the sensitivity in the specific
dermatome. Example: The first sacral nerve root innervates the gastrocnemius
and soleus muscles; thus, standing or walking on toes can be affected (see
p. 398).
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1 Bones, Ligaments & Joints
Clinical
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B Midsagittal T2-weighted MRI (magnetic
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Posterior herniation (A, B) In the MRI, a conspicuously herniated disk at the
level of L3–L4 protrudes posteriorly (transligamentous herniation). The dural
MFK>I
ARO>J>QBO
sac is deeply indented at that level. *CSF (cerebrospinal fluid).
RO>IP>@
MLKAVILMEVQB
LPQBOLI>QBO>I
EBOKF>QFLK
R@IBRP
MRIMLPRP
RO>IPIBBSB
TFQEPMFK>IK’
LJMOBPPBA
KBOSBOLLQP
LPQBOLI>QBO>I
EBOKF>QFLK
KQBOSBOQB?O>IAFPH
BOQB?O>I>O@E
ªMBAF@IBAFSFABA«
RO>IPIBBSBTFQEPMFK>IK’
C Superior view.
Posterolateral herniation (C, D) A posterolateral herniation may compress
the spinal nerve as it passes through the intervertebral foramen. If more
D Posterior view, vertebral arches removed.
medially positioned, the herniation may spare the nerve at that level, but
impact nerves at inferior levels.
13
Back
Joints of the Vertebral Column: Overview
Table 1.2
Fig. 1.21 Joints of
the vertebral column
Joints of the vertebral column
Craniovertebral joints
A
Atlanto-occipital joints
Occiput–C1
S
Atlantoaxial joints
C1–C2
Joints of the vertebral bodies
D
Uncovertebral joints
C3–C7
F
Intervertebral joints
C1–S1
Joints of the vertebral arch
G
Zygapophyseal joints
C1–S1
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.
O>KPSBOPB
MOL@BPP
RMBOFLO>OQF@RI>O
MOL@BPP
KQBOFLO
QR?BO@IB
MFKLRPMOL@BPP
LPQBOFLO
QR?BO@IB
VD>MLMEVPB>I
GLFKQ
RI@RPCLO
PMFK>IK’
O>KPSBOPB
CLO>JBK
KCBOFLO>OQF@RI>O
MOL@BPP
RMBOFLO
>OQF@RI>OC>@BQ
LPQ>IC>@BQ
A Cervical region, left lateral view. The zygapophyseal joints lie
45 degrees from the horizontal.
VD>MLMEVPB>IGLFKQ
BOQB?O>ICLO>JBK
RMBOFLO
>OQF@RI>OMOL@BPP
O>KSBOPB
MOL@BPP
O>KSBOPB
MOL@BPP
VD>MLMEVPB>I
GLFKQ
MFKLRPMOL@BPP
KCBOFLO>OQF@RI>O
C>@BQ
B Thoracic region, left lateral view. The joints lie in the coronal plane.
KCBOFLO
>OQF@RI>OMOL@BPP
C Lumbar region, posterior view. The joints lie in the sagittal plane.
14
Fig. 1.23 Uncovertebral joints
BKP
>QBO>I
>QI>KQL>UF>I
GLFKQ
Clinical
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.
QI>Pª«
UFPª€«
BOQB?O>I>’
FKQO>KPSBOPB
CLO>JBK
PMFK>IK’
QI>Pª«
UFPª€«
K@FK>QB
MOL@BPPBP
BOQB?O>I>’
BOQB?O>I?LAV
O>KP¦
SBOPB
MOL@BPP
LPQBOFLO
QR?BO@IB
KQBOFLO
QR?BO@IB
1 Bones, Ligaments & Joints
Anterior view. Uncovertebral joints form during childhood between the
uncinate processes of C3–C6 and the vertebral bodies immediately superior. 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).
K@FK>QB
MOL@BPP
KQBOSBOQB?O>I
AFPH
O>KPSBOPB
MOL@BPP
RI@RPCLO
PMFK>IK’
MFK>IK’
FKPRI@RP
…PMFK>IK’
KCBOFLO
>OQF@RI>OC>@BQ
BOQB?O>I?LAVª…«
A Cervical spine, anterior view.
A Uncovertebral joints in the cervical spine of an 18-year-old man,
anterior view.
MFKLRP
MOL@BPP
>JFK>
BOQB?O>I
CLO>JBK
MFK>I
@LOA
RMBOFLO
>OQF@RI>OC>@BQ
MFK>IK’
LPQBOFLOOLLQ
ªPMFK>I«D>KDIFLK
BOQB?O>I>’
B Uncovertebral joint (enlarged), anterior view of coronal section.
O>KPSBOPB
CLO>JBK
O>KPSBOPB
MOL@BPP
BOQB?O>I
?LAV
K@FK>QB
MOL@BPP
B Fourth cervical vertebra, superior view.
C Split intervertebral disk, anterior view of coronal section.
15
Back
Joints of the Vertebral Column: Craniovertebral Region
Fig. 1.24 Craniovertebral joints
UQBOK>IL@@FMFQ>I
MOLQR?BO>K@B
RMBOFLO
KR@E>IIFKB
@@FMFQ>I@LKAVIB
>PQLFAMOL@BPP
ªQBJMLO>I?LKB«
BKPLC>UFPª€«
BAF>K
>QI>KQL>UF>IGLFKQ
QI>Pª«
QVILFAMOL@BPP
ªQBJMLO>I?LKB«
UFPª€«
RMBOFLO>OQF@RI>O
C>@BQªI>QBO>IJ>PP
LC>UFP«
BKPLC>UFPª€«
A Posterior view.
OLLSBCLO
SBOQB?O>I>’
O>KPSBOPB
MOL@BPP
MFKLRPMOL@BPP
B Atlas and axis, posterosuperior view.
Fig. 1.25 Dissection of the craniovertebral joint ligaments
Posterior view.
UQBOK>IL@@FMFQ>I
MOLQR?BO>K@B
R@E>II’
R@E>II’
QI>KQL¦L@@FMFQ>I
GLFKQ
QVILFAMOL@BPP
LPQBOFLO>QI>KQL¦
L@@FMFQ>IJBJ?O>KB
VD>MLMEVPB>I
GLFKQª@>MPRIB«
QI>Pª«
UFPª€«
LPQBOFLO
>QI>KQL¦
L@@FMFQ>I
JBJ?O>KB
MFKLRPMOL@BPP
FD>JBKQ>CI>S>
A Nuchal ligament and posterior atlantooccipital membrane.
16
B Posterior longitudinal ligament. Removed:
Spinal cord; vertebral canal windowed.
LPQBOFLO>O@E
LC>QI>P
B@QLOF>IJBJ?O>KB
ªMLPQBOFLO
ILKDFQRAFK>II’«
BOQB?O>I>O@E
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).
RMBOFLO
>OQF@RI>OC>@BQ
BAF>K
>QI>KQL>UF>I
GLFKQ
KQBOFLO
QR?BO@IB
I>OII’
I>OII’
MF@>II’
LCQEBABKP
O>KPSBOPBI’
LC>QI>P
O>KPSBOPB
MOL@BPP
BKP
>QBO>IJ>PP
LCQEB>QI>P
BOQB?O>ICLO>JBK
LKDFQRAFK>IC>P@F@IBP
LPQBOFLOQR?BO@IB
LCQEB>QI>P
MFKLRPMOL@BPP
LC>UFP
MF@>II’
LCQEBABKP
LKDFQRAFK>I
C>P@F@IBP
RMBOFLO
>OQF@RI>O
C>@BQ
B@QLOF>IJBJ?O>KB
O>KPSBOPBI’
LC>QI>P
>MPRIBLC
I>QBO>I>QI>KQL¦
L@@FMFQ>IGLFKQ
1 Bones, Ligaments & Joints
Fig. 1.26 Ligaments of the craniovertebral joints
O>KPSBOPBMOL@BPP
KQBOQO>KPSBOPBI’
OLLSBCLO
SBOQB?O>I>’
LPQBOFLO
>QI>KQL¦L@@FMFQ>I
JBJ?O>KB
LPQBOFLO>O@E
LC>QI>P
R@E>II’
MFKLRPMOL@BPP
A Ligaments of the median atlantoaxial joint,
superior view. The fovea of the atlas is hidden by the joint capsule.
I>OII’
B Ligaments of the craniovertebral joints,
posterosuperior view. The dens of the axis
is hidden by the tectorial membrane.
LKDFQRAFK>I
C>P@F@IBP
B@QLOF>I
JBJ?O>KB
QI>KQL¦
L@@FMFQ>I
@>MPRIB
LKDFQRAFK>I
C>P@F@IBP²
MF@>II’
LCABKP
I>OI’
>QBO>I
J>PPLC
O>KPSBOPBI’
LC>QI>P²
LKDFQRAFK>I
C>P@F@IBP
LPQBOFLOILKDFQRAFK>II’
C Cruciform ligament of atlas (*). Removed:
Tectorial membrane.
BKP—MLPQBOFLO
>OQF@RI>OPROC>@B
D Alar and apical ligaments. Removed: Transverse
ligament of atlas, longitudinal fascicles.
17
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
Table 1.3
Viewed obliquely from the left posterior view.
Vertebral ligaments
Ligament
KQBOFLO
O>KPSBOPB
ILKDFQRAFK>IIFD>JBKQ MOL@BPP
LPQBOFLOILKDFQRAFK>I
IFD>JBKQ
BOQB?O>I
>O@E
BAF@IB
KQBO¦
QO>KPSBOPB
IFD>JBKQ
>JFK>
KCBOFLO>OQF@RI>O
MOL@BPP
RMO>¦
PMFKLRP
IFD>JBKQ
RMBOFLO>OQF@RI>O
MOL@BPP
FD>JBKQRJCI>S>
KQBOPMFKLRPIFD>JBKQ
Location
Vertebral body ligaments
MFKLRP
MOL@BPP
A
Anterior longitudinal ligament
Along anterior surface of
vertebral body
P
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
Nuchal ligament*
Between transverse processes
Between external occipital
protuberance and spinous
process of C7
*Corresponds to a supraspinous ligament that is broadened superiorly.
Fig. 1.28 Anterior longitudinal ligament
Fig. 1.29 Posterior longitudinal ligament
Anterior longitudinal ligament. Anterior view with base of skull removed.
Posterior view with vertebral canal windowed and spinal cord removed.
The tectorial membrane is a broadened expansion of the posterior
longitudinal ligament.
KQBOK>I
L@@FMFQ>I
MOLQR?BO>K@B
QI>KQL¦L@@FMFQ>I
GLFKQª>QI>KQL¦
L@@FMFQ>I@>MPRIB«
QI>Pª«
O>KPSBOPB
CLO>JFK>
UFPª€«
KQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
RI@RPCLO
PMFK>IKBOSB
KQBOSBOQB?O>I
AFPH
18
UQBOK>IL@@FMFQ>I
MOLQR?BO>K@B
@@FMFQ>I
?LKB—
?>PFI>O
M>OQ
KQBOFLO
>QI>KQL¦
L@@FMFQ>I
JBJ?O>KB
O>KPSBOPB
MOL@BPP
>QBO>I
>QI>KQL>UF>I
GLFKQª@>MPRIB«
VD>MLMEVPB>I
GLFKQª@>MPRIB«
QI>KQL¦L@@FMFQ>I
@>MPRIB
LPQBOFLO>QI>KQL¦
L@@FMFQ>IJBJ?O>KB
QI>KQL¦L@@FMFQ>I
GLFKQ
B@QLOF>IJBJ?O>KB
BOQB?O>I>O@E
LPQBOFLO
QR?BO@IB
KQBOFLO
QR?BO@IB
BOQB?O>
MOLJFKBKP
ª…«
LPQBOFLOILKDFQRAFK>I
IFD>JBKQ
Fig. 1.30 Ligaments of the cervical spine
BII>
QRO@F@>
MF@>IIFD>JBKQ
LCQEBABKP
VMLDILPP>I
@>K>I
B@QLOF>I
JBJ?O>KB
@@FMFQ>I?LKB—
?>PFI>OM>OQ
UQBOK>I
L@@FMFQ>I
MOLQR?BO>K@B
KQBOFLO
>QI>KQL¦L@@FMFQ>I
JBJ?O>KB
BKPLC>UFPª€«
KQBOFLO>O@E
LC>QI>Pª«
LKDFQR¦
AFK>I
C>P@F@IBP
>UFII>
LPQBOFLO>O@ELC>QI>P—
MLPQBOFLOQR?BO@IB
>@BQGLFKQ
@>MPRIB
KQBOSBOQB?O>IAFPH
KQBOFLOILKDFQRAFK>I
IFD>JBKQ
LPQBOFLOILKDFQRAFK>I
IFD>JBKQ
O>KPSBOPB
IFD>JBKQLC>QI>P
LPQBOFLO
>QI>KQL¦L@@FMFQ>I
JBJ?O>KB
1 Bones, Ligaments & Joints
MEBKLFAPFKRP
R@E>IIFD>JBKQ
FD>JBKQ>CI>S>
BOQB?O>I>O@E
KQBOSBOQB?O>ICLO>JBK
MFKLRPMOL@BPP
KQBOPMFKLRPIFD>JBKQ
RMO>PMFKLRP
IFD>JBKQ
…SBOQB?O>I?LAV
ªSBOQB?O>MOLJFKBKP«
A Midsagittal section, left lateral view. The nuchal ligament is the
broadened, sagittally oriented part of the supraspinous ligament that
extends from the vertebra prominens (C7) to the external occipital
protuberance.
MBULCABKP
LAVLC>UFP
BOB?BIILJBARII>OV
@FPQBOK
LPQBOFLOQR?BO@IB
LC>QI>P
R@E>IIFD>JBKQ
LPQBOFLOILKDFQR¦
AFK>IIFD>JBKQ
BOQB?O>I?LAV
KQBOSBOQB?O>I
AFPH
RMO>PMFKLRPIFD>JBKQ
BOQB?O>
MOLJFKBKPª…«
KQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
MFK>I@LOA
R?>O>@EKLFAPM>@B
B Midsagittal T2-weighted MRI, left lateral view. (From Vahlensieck, Reiser. MRT des Bewegungsapparates. 2nd ed. Stuttgart: Thieme; 2001.)
19
Back
Vertebral Ligaments: Thoracolumbar Spine
Fig. 1.31 Ligaments of the vertebral
column: Thoracolumbar junction
BOQB?O>I@>K>I
Left lateral view of T11–L3, with T11–T12
sectioned in the midsagittal plane.
KQBOSBOQB?O>I
AFPH
RMBOFLO>OQF@RI>O
C>@BQ
LPQBOFLOILKDFQRAFK>I
IFD>JBKQ
KRIRP
CF?OLPRP
BOQB?O>I>O@E
R@IBRP
MRIMLPRP
FD>JBKQ>CI>S>
RMBOFLO>OQF@RI>O
MOL@BPP
KQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
MFKLRPMOL@BPPBP
KQBOPMFKLRPIFD>JBKQP
O>KPSBOPBMOL@BPP
BOQB?O>I?LAV
KQBOQO>KPSBOPBIFD>JBKQP
>@BQGLFKQ@>MPRIB
RMO>PMFKLRP
IFD>JBKQ
KCBOFLO>OQF@RI>O
C>@BQ
Fig. 1.32 Anterior longitudinal
ligament
Anterior view of L3–L5.
O>KPSBOPB
MOL@BPP
KQBOSBOQB?O>I
AFPH
BOQB?O>I?LAV
KQBOFLOILKDFQRAFK>IIFD>JBKQ
20
Fig. 1.33 Ligamentum flavum and
intertransverse ligament
1 Bones, Ligaments & Joints
Anterior view of opened vertebral canal at
level of L2–L5. Removed: L2–L4 vertebral
bodies.
RMBOFLO
>OQF@RI>O
MOL@BPP
>JFK>
KQBO¦
QO>KPSBOPB
IFD>JBKQP
FD>JBKQ>
CI>S>
O>KPSBOPB
MOL@BPP
LPQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
RMBOFLO
>OQF@RI>O
MOL@BPP
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.
KQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
KCBOFLO>OQF@RI>O
C>@BQ
MFKLRPMOL@BPP
RQOFBKQ
CLO>JFK>
BAF@IBPLC
SBOQB?O>I>O@EBP
LPQBOFLO
ILKDFQRAFK>I
IFD>JBKQ
KQBOSBOQB?O>I
CLO>JBK
KQBOSBOQB?O>I
AFPH
BOQB?O>I
?LAV
>MFK
IFD>JBKQLRP
OBFKCLO@BJBKQ
LCQEBAFPH
RMBOFLO
>OQF@RI>OC>@BQ
O>KPSBOPB
MOL@BPP
KCBOFLO>OQF@RI>O
MOL@BPP
MFKLRPMOL@BPP
BOQB?O>I@>K>I
21