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Anatomy Made
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part 3
Done By :Fadi Al-Ghzawi
Edited by: AWN Academic Team
Vertebral column) the spine , backbone,
spinal column)
 There are 33
vertebrae;some are typical
while others are atypical.
 Inter-vertebral disc form 1/4 of its length.
 The lower aspect of the vertebral column
is fused as one bone,but they are 5
sacrum bones & the 4 coccyx bones
below it.
New
So, the total # of vertebrae during early development
is 33.
Then, by fusions of sacral and coccyx regions , it
reduces to:
Vertebral column
New
o consists of :
a) bones ( vertebrae)
b)connective tissue
o
function:
1) surround and protect the nervous
tissue of spinal cord
2) support the head
3)point of attachment for the ribs ,
pelvic girdle, muscles of the back
and upper limbs.
New
neck region
posterior to the
thoracic cavity
Support the
lower back
Fused to form
1 sacram
Fused to form
1 coccyx
C U RVATURE S OF VERTEBRAL
COLUMN
 Mature
Vertebral column has curves, but
intrauterine baby has virgula shape,
 After that the baby will grow, he will crawl
then stand & walk.
1- Thoracic and sacral curvatures(primary):
Concave anteriorly,Develop during fetal period
due to the deference between ant
and post Thickness of the vertebra.
 II. Cervical
and lumbar :
Concave posteriorly,develop during the fetal
period due to deference in IV disc thickness.
 Cervical:infant hold head.
 Lumbar:infant walk and assume upright
position, prominent in female.
NORMAL vs. PATHOLOGICAL
CURVATURES
mainly in pregnant
woman the lumbar curvature posterior
convexity will increase due to the weight
of the fetus.
 Normal:occurs
 Pathological: normal curvature but
more prominent.
NORMAL CURVATURES
New
• The baby in the uterus create a force of drop
at the level of the abdomen;
>> this bring the lumbar region forward,
and help support axis of vertebral
column.
• It is occurs within the first semester of
pregnancy .
• You have to tell the pregnant women to do
exercises , other wise( if the pregnant
women doesn’t do exercise or walk) the
lordosis will become pathologic )
PATHOLOGICAL CURVATURES
abnormal increase in thoracic curvature
convexity & prominent concavity, it is an erosion of
anterior vertebral part.
 Scoliosis: abnormal lateral curvature & rotation of the
back (deviation to left or right),crooked or curved back
(appears between ages of 10-15).
 Very dangerous condition, surgeons have difficulty in
repairing this condition; because the intervertebral
discs are more compressed at one side than the
other, so they have to replace many discs.
 Lordosis (hollow back):anterior rotation of pelvis, an
abnormal increase in lumber curvature,could be
physiological (pregnancy) or pathological, so both men
& women can have lordosis.
 Kyphosis:
Deviation from
midline
increase concavity
of thoracic region
increase concavity
of thoracic region
General Structure ofTypical Vertebrae
1.
2.
3.
New
4.
5.
6.
Body or centrum (disc shaped):weight-bearing
region.
Vertebral arch:composed of pedicles and laminae
that along with the centrum encloses the vertebral
foramen.
Laminae: the flat continuation of the body
posteriorly.
****laminae has anterior connection with pedicle
pedicle: thick round connection between arch
and body
Vertebral foramina:make up the vertebral canal
through which the spinal cord passes.
Spinous process:2 laminae fuse together & project
posterior and usually downward, some are bifid which
provide muscle insertion.
 Just bifid in the cervical region
7. Transverse processes:pedicle meets with
lamina then projects laterally.
•
New
•
•
They are for muscle attachment of the back.
In the cervical vertebrae, there are vertebral
artery foramen through which vertebral
artery pass.
In thoracic vertebrae, these processes are
present with facets or demi-facet (demi-facet
also present on the body), facets exist on the
apex of the trans. process.
8. Superior and inferior articular processes:
protrude superiorly and inferiorly from the "pediclelamina" junctions.
 All vertebrae have 2 superior & 2 inferior
articular processes except the sacrum &
except
coccyx bones
 The first sacral vertebra has superior one
to actriculate with the 5th lumabar
vertebra..
 These processes depend on the movement range,
they differ in orientation (laterally, anteriorly, more
or less lateral & anterior), so they differ from
region to another,to provide more movement
according to that region.
7.Inter-vertebral foramina:lateral openings
formed from notched areas on the superior and
inferior borders of adjacent pedicles.
 Lacated anterior to the transverse
process and more or less immediately
underneath the pedicle .
 The spinal nerves exist through it from
the spinal cord.
 The
atlas & axis vertebrae are different from all
other vertebrae, although they contain same
features of other vertebrae,but still they have
additional processes so therefore they are
considered atypical vertebrae.
 Sacral and coccyx vertebrae are typical;they
are fused together so we don’t consider them
as atypical
New
** Vertebrae are the same(arch& body), but the
difference from one region to another can be in:
1- the prominence of the spinous process,
2- size of the body
3- the shape in the vertebral canal.
Cervical Vertebrae
 Seven vertebrae (C1-C 7) are the
smallest
& lightest vertebrae.
 C 3-C 7 are distinguished with an
1. Oval body.
2. Long spinous processes.
3. Large and triangular vertebral foramina.
 Each transverse process contains a
transverse foramen which vertebral artery
passes through.
 Superior and inferior articular facets are
oriented superior & inferior.
ATYPI C A L C ERV I C A L V ERTEBRAE
Atlas (C 1):it is nothing but a round arch.
 Has no body and no spinous process.
 Consists of anterior and posterior arches,
and two lateral masses (masses are
elongated more toward lateral aspect).
 The superior and inferior surface of lateral
masses has articular surfaces (depressions) to
articulate with the occipital condyles and with
the axis
 Lateral to the lateral masses there are
transverse processes, and it has
transverse foramen.
1.
New

Notice the anterior & posterior tubercle made by
meeting of arches posteriorly & anteriorly.

Atlanto-occipital joint:
 an important joint, only flexion & extension
movement occurs ;
 where at the rest of the joints in vertebrae such as
(atlanto-axial, axial-c3),the movement is rotation.

The superior articular facets are divided into 2 facets
separated by a ridge ;
 this ridge is important in the flex.& ext. maneuver.
 It will stop the posterior sliding of condyles of the
occipital bone on atlas.
 The ridge will limit the movement anterior &
posterior.
 With
age the flex. & ext. maneuver will be
reduced;
 because the intervertebral layer (hyaline
cartilage) in the joint is eroded,it won't
be moving like before,
 exercise will help in keeping good
movement.
 The inferior articular facets are more
rounded and more medially oriented to fit the
superior aspect of the axis.
 On the anterior arch, notice the fovea dentis
which is the facet for the dens, odontoid
ligament holds the dens to lateral borders of
fovea dentis.
2.Axis (C 2):
 The axis has a body (very small) ,spine,
and vertebral arches as do other cervical
vertebrae.
 Unique to the axis is the dens,or
odontoid process,which projects
superiorly from the body and is attached
to the anterior surface of the arch of the
atlas.
 The dens is a pivot for the rotation of the
atlas.
 Transvers
processes comes from similar
masses (pedicles & laminae), they are very
small with transverse foramen where
vertebral artery passes.
 Masses in axis are called pedicles &
laminae while in atlas called lateral masses
The pedicles are more or less connected directly;
 because of the presence of the masses, the transverse
process comes out before the pedicle,that when you
go down to C 3 it is pushed anteriorly & the pedicle is
more posterior.
 That's why we call it more or less atypical vertebra;
because it doesn't present the typical aspect of any
vertebra.
 The spinous process is posterior & it is bifidic.
 Irregular vertebral canal.
 The atlanto-occipital joint has limited movement due to
the ridge on the facets & the spinous processes all the
way down in the cervical region.

Pivot joint:
Projection (dens) of axis articulates within ring
of atlas.
Movements: Rotation Around one Axis.
New
the doctor pointed
to all the labeled
parts
Thoracic vertebrae
 H ow
do you know this is a thoracic
vertebra?
 The spinous process is long & inclined
inferiorly, heart shape body.
The body has a mass , that is full of spongy bone).
 The
trans. process has articular facets & the body
have demi facet so that 2 demi facets of adjacent
vertebrae forms one facet which articulate with
the head of rib.That’s why the rib takes the name
of the above vertebrae.
 Superior articular facets are lateral & posterior,
the inferior ones are medially & anterior.
General features
 There are twelve vertebrae (T1-T12) all
of
which articulate with ribs.
 Major markings include two demi-facets on
the heart-shaped body for the head of the rib.
 Circular vertebral foramen, transverse
processes with articular costal facets for the
rib tubercles.
 Long spinous process that is inclined
downward.
 The location of the articulate facets prevent
flexion and extension, but allow rotation of
this area of the spine.
 Superior articular processes are oriented
backward and laterally.
Lumbar Vertebrae
 The
five lumbar vertebrae (L1-L5) are
located in the small region of the back and
have an enhanced weight-bearing function.
 Body is large and kidney-shaped.
 They have short, thick pedicles and lamina.
 Flat hatchet-shaped spinous processes.
 Triangular-shaped vertebral foramen.
 Orientation of the sup. articular facets face
medially to lock the lumbar vertebrae
together to provide stability
*Spinous process is more shorter and more square in
shape.
*The bodies are more bulky than thoracic and cervical
New
**Why it is a lumbar
vertebrae??
1- the spinous
processes are more
shorter
2- The body is more
bulky
**The intervertebral
disc appear as a gap
between the vertebrae.
V ERTEBRAL
C H A R A C T E R I STI CS :
 Below
& above the 2 pedicles, there is a
vertebral notch (sup & inf);it makes the
intervertebral foramen between 2 vertebrae
which spinal nerves exit from it.
 Usually (especially thoracic vertebrae) the
transverse processes will grow longer,they will
incline inferiorly like the wings & this resembles
the ribs, it occurs mainly at the level of C 7 (you
can palpate it at the end of your neck), we call it
cervical rib, it will compress the nerve root
leading to difficulty in moving the upper
extremities.
Cervical rib
 The
arm & forearm muscles will be tired & will
take their tiredness to the shoulder muscle.
 Cervical ribs are very common; because of the
computer, games,driving & desk sitting, we
compress ourselves while sitting, then the
cervical rib will compress the nerve & you will
have headache & shoulder stiffness.
 If someone told you I have headache after
working,you will examine 2 things: blood
pressure & x-ray of cervical region.
 Spinal nerves go to muscles, so any
compression will lead to defects in movement
skeletal muscles.
Inter-vertebral discs
 Cushion-like pad Joint
between 2
bodies of the vertebrae
 It’s composed of two parts
1. Nucleus pulposus: inner gelatinous
nucleus that gives the disc is elasticity
and compressibility
2. Annulus fibrosus:surrounds the
nucleus pulposus with a collar
composed of collagen and Fibro
cartilage.
Pathological condition
 Sometimes, annulus fibrosus bulge or
rupture leading to movement of nucleus
pulposus toward the edge,so it will exit
the concentric layer of the fibrous tissue,
and that's what we call herniation.
 Herniation varies in bulging,so bulging of
annulus fibrosus can lead to reduction in
distance between 2 vertebrae;because you
lose the power of annulus fibrosus.
 The
New
whole vertebrae have longitudinal
ligaments to hold them in place ,but
they cannot help in preventing the
herniation of the nucleus polposus.
 There are anterior and posterior
longitudinal ligament;
Allow them not to move in the
rotational movement, instead,
they will move bending left and
right.

Notice that the posterior ligament is
anterior to the spinal cord>>> give
protection
 Any degeneration of
annulus fibrosus can
lead to herniation.
 Spine surgeon has a ruler to measure
the intervertebral discs or by naked
eye, the measurement will indicate
the age of compression on this disc.
 We have inter-spinous
ligaments
between the spinous processes, which
hold the spinous processes in their
position.
 M O VEM E N T S :occurs at the
vertebral column
level of
New
**when we rotate the hole vertebrae , the
rotation occur at the hip joint, not within the
vertebral column .
In slides
AT L A N TO -O C C IPITA L JOINT

Often considered to be a Hinge joint because of its primary uniaxial
range of movement (as in shaking your head“yes”).

The atlanto-occipital joints occur between the reciprocally curved
surfaces of the two occipital condyles and the articular facets on the
lateral masses of the atlas.

Movements:

◦ While the primary axis of movement is the nodding movements
(flexion and extension of the head) in the antero-posterior plane,a
small amount of side to side bending (lateral flexion),and rotation
is possible at this joint surface.
Ligaments of the joint:
◦ Are the fibrous membrane of the joint capsule (Ant and Post), the
anterior atlanto-occipital membrane,and the posterior atlantooccipital membrane.
L I G A M E N T S O F T H E JOINT In slides
 Most
important are anterior & posterior
longitudinal ligament,they will hold the atlas
with the occipital bone.
 Anterior atlanto-occipital membrane goes
from anterior arch of the atlas into the base
of the occipital bone anteriorly.
In slides
In slides
In slides
 Posterior
longitudinal ligament doesn't
appear from posterior view because it is
anterior to posterior atlanto-occipital
membrane & below inferior nuchal line.
 At the lateral aspect you will be able to
see an articular capsule (image above).
 There is always a capsule between the 2
joints, especially synovial joints (most of
joints are synovial).
In slides
 The
bodies of the vertebrae are articulated
with a separate articular joint rather if you
compare it with the superior & inferior
articular surface,so whenever you look at
any slide you will be able to see that
articular capsule for the atlanto-occipital
joint in the lateral aspect, because this
articular capsule is surrounding the
outer area of the condyles and the
superior articular surface.
In slides
 Ligaments between the
atlas & the axis
are important, one of them is the
cruciate ligament,it has 2 branches one
superior & one inferior,they are called
superior & inferior longitudinal band & 2
transverse ligaments.
In slides
Cruciate
ligament of
atlas
In slides
 In the
above image we have removed the
posterior aspect of the occipital bone & the
spinous processes, in the posterior surface
of the dens after the annular ligament of the
dens you will be able to see this.
 Parcticaly you will be able to see the
anterior arch & dens & the body of the
vertebrae then posterior to that the annular
ligament & posterior to that & anterior to
the spinal cord you will be able to see the
cruciate ligament,and lateral to it we have
alar ligament.
In slides
Alar ligaments:
◦ They connect the sides of the dens (on the axis, or the
second cervical vertebra) to the tubercles on
the medial side of the occipital condyle.
Legamentum flavum:

◦ They connect the laminae of adjacent vertebrae,
extending from the second CERVICAL vertebra, the axis,
to the first segment of the sacrum

◦ Cruciform ligament of atlas (cruciform):
◦ is a cruciate ligament in the neck forming part of
the atlanto-axial joint.
Cruciate = Cruciform = ‫صليب‬
In slides
nuchae:comes from the
occipital protubrance extending down till
the level of the spinous process of C 7,it
is a very tough membrane seperating the
right & left sides of the neck
 Ligamentum
In slides
Sacrum and Coccyx
 Sacrum :
- 5 fused bones
1
2
3
4
5
Cont Sacrum
-
shape the posterior wall of the pelvis
- It articulates with L5 superiorly (by the only two
superior processes), and with the auricular
surfaces of the hip bones
- Major markings include the sacral promontory,
transverse lines, alae,dorsal sacral foramina, sacral canal,
and sacral hiatus
- Upper anterior aspect of the body protrose
New
anteriorly, create the concavity of sacrum
convexity

Anterior :
- Sacral promontory
-concave curve
- vertebral bodies
-anterior/ventral
sacral foraminae
- transverse lines

laterally :
-Ala : formed by
fused transverse
processes.
- (here the transverse processes
are more bulk and tortious
compared with the thoracic one)
New
• the posterior aspect of ala articulate
with the ilium of the hip
• at the inferior part of the median
crest divided into two right and left
processes
• Dorsal sacral foramina continuated
to the anterior sacral foramina(they
are lateral to the bodies).

Posterior :
-superior
articular
process ( betw S1-L5)
-Sacral canal (contain
fillum Terminale , open
in Sacral hiatus at S5)
- Median sacral crest
- Lateral sacral crest
Between them is :
-Intermediate crest.
-Dorsal Sacral
foramina (betw lateral
and intermediate)
-sacral cornuae :
belong to S4 ,near
thesacral hiatus
Coccyx
S1
S2
S3

Coccyx (Tailbone)
 The coccyx is made up of
four (in some cases three
to five) fused vertebrae
that articulate directly
Superiorly with the sacrum
S4
S5
Coccyx
1
2
3
4
Disk problems
 At
the level of the vertebra :
- Fractures of the vertebra
 At
the level of the intervertebral disk :
- 1.D isk Herniation
- 2.D egeneration (slipped)

Most common sites for disc problems:
◦ C5 - C6
◦ L4 - L5
◦ L5 - S1

Laminectomy ( IS a surgical removal vertebral
arch by shaving laminae to access disc)
Cont Disk problems
 At
the level of the vertebra :
* Fractures of the vertebra ,could be :
-Fragmented & nonfragmented
-Complete & incomplete
- distance between the broken vertebrae
and the adjacent one above or below will
be minimized

Cont Disk problems
 At
the level of the intervertebral disk :
- 1.Disk Herniation :complete or
incomplete bulging
- 2.Degeneration :degenerative changes
in the structure of the annulus fibrosis

Thoracic cage
 1) Sternum
 2) Ribs
** The thoracic cage is composed of the
thoracic vertebrae dorsally,the ribs
laterally,and the sternum and costal
cartilages anteriorly
New
**The movement of thorax will be only at the
anterior aspect (during respiration) by action of
cartilages. But posterior part will never move
;because it linked by ligaments to the vertebrae.
Thoracic cage

Functions
◦ Forms a protective cage around the heart,lungs, and
great blood vessels
◦ Supports the shoulder girdles and upper limbs
◦ Provides attachment for many neck,back,chest, and
shoulder muscles
◦ Uses intercostal muscles to lift and depress the
thorax during breathing
Subcostal angle is the angle in
between the two Costal margins
which are the inferior borders of
the 7th & false ribs costal
cartilages
Sternum
 dagger-shaped Flat bone made up of 3
parts :
1 Manubrium
2 Sternal Body
3 Xiphoid process
 Anatomical landmarks include the jugular
(suprasternal) notch, the sternal angle,and
the xiphisternal joint
1- Manubrium
1- Manubrium
 square shape part
that has superior and
inferior articular boarders
 Important landmarks :
** "angle of Louis“ = sternal angle
**superiorly ,and lateral for clavicular
sternal end
**lateral,and inferior for 1st rib
**Jugular notch = suprasternal notch ,
between the two clavicular facets used for
((tracheostomy)) cause behind it no veins or
arteries, & the trachea lies directly under
the skin of this region.
New

Sternal(lewis) angle:
 it lies between manubrium and body
 very important clinically ;
 because you can count the ribs
from the second rib legation .
2- Sternal Body
 The biggest part
 Presents on the lateral sides depressions
serves as an articulation surface for the 2nd
to the 7th rib
 8th to the 10th ribs are false ribs , they don’t
attach to the sternal body directly .
 11 and 12 are floating ribs
 first rib is atypical because it's surfaces
orientations are different from the typical.It
has superiorinferior (horizontal) rather than
anterior posterior surfaces(vertical)
3- Xiphoid process
 Till the age of 17
to 19 it's an flexible
cartilaginous & Elastic tissue
Ribs (12)
 composed
of two parts :
-One anterior "the end" continues to the
sternum as the costal cartilage
-One posterior ,and "the head" articulate
with the lateral surface "2 demifacets" on
the superior and inferior boarders ofthe
body of the adjacent thoracic vertebrae ,as
well as the anterior part of the transverse
processes for the lower vertebra articulate
with the tubercale … so :
the head  with the body
the tubercle  transeverse process
Ribs & sternum articulations:
New
 All ribs are incomplete bones ; because they
need cartilages to connect with lateral
boarder of sternum .
 1-7 ribs : articulate directly with the
sternum by costal cartilages
 False ribs (8-12) :
normal ribs but they
never reach the sternum
 (8-10) ; adhere to the 7th cartilages
 (11-12) ; Floating ribs , they don't
articulate with any thing anteriorly .
Cont Ribs
 All
the typical ribs are oriented anterior &
inferior
 ribs have 2 borders & two surfaces :
-One outer surface "external(lateral) surface".
facing the fascia ,and One inner surface(medial)
facing the pleura
- The superior border is rounded ,andThe
inferior border is more sharp (with subcoastal
groove),contain Subcostal vein,artery & nerve
from superior to inferior respectively on the
internal surface
 (( clinically )) ,Pleural puncture we do it in the
superior border ..If done on inferior border it
may cause nerve injury which is called in medicine
Intercostal neuralgia
the head  with the body
the tubercle  with the transeverse process
So, rib= bowed, flat bone consisting of a head, neck, tubercle, and shaft
Superior facet
Inferior facet
Articular facet
of tubercle