Chapter 39: The vertebral column

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Chapter 39: The vertebral column
Vertebral column

Curvatures (fig. 39-1)

Vertebral column in general
Parts of a Vertebra (fig. 39-2)
The vertebral column usually consists of 33 vertebrae: 24 presacral vertebrae (7 Relationship of Spinal Nerves to
cervical, 12 thoracic, and 5 lumbar) followed by the sacrum (5 fused sacral Vertebrae
vertebrae) and the coccyx (4 frequently fused coccygeal vertebrae). The 24 Regional characteristics of vertebrae
presacral vertebrae allow movement and hence render the vertebral column Cervical Vertebrae
flexible. Stability is provided by ligaments, muscles, and the form of the bones. The Atlas (fig. 39-3)
abbreviations C., T., L., S., and Co. are used for the regions, and these are Axis (fig. 39-4)
sometimes followed by V. for vertebra or N. for nerve. Remaining cervical vertebrae (fig.

39-5)
Curvatures. Thoracic Vertebrae (figs. 39-5, 39-6

and 39-7)
The adult vertebral column presents four anteroposterior curvatures: thoracic and
Lumbar Vertebrae (figs. 39-8 and 39-
sacral, both concave anteriorly, and cervical and lumbar, both concave posteriorly
9)
(fig. 39-1). The thoracic and sacral curvatures, termed primary, appear during the
Sacrum (figs. 39-10 and 39-11)
embryonic period proper, whereas the cervical and lumbar curvatures, termed
Development of vertebrae (figs. 39-12
secondary, appear later (although before birth) and are accentuated in infancy by
and 39-13)
support of the head and by the adoption of an upright posture.
Surface anatomy (fig. 39-15)

Additional reading
Parts of a Vertebra.
Questions

A typical vertebra consists of (1) a body and (2) a vertebral arch, which has Figure legends

several processes (articular, transverse, and spinous) for articular and muscular
attachments. Between the body and the arch is the vertebral foramen: the sum of the vertebral foramina constitutes the
vertebral canal, which houses the spinal cord (fig. 39-2). In addition to the transverse and spinous processes, which serve
as short levers, the 12 thoracic vertebrae are connected by joints with paired, long levers, namely the ribs.

The bodies of the vertebrae are separated from each other by intervertebral discs. The body is mainly spongy bone and
red marrow, but the margins of the upper and lower surfaces consist of a ring of compact bone, the vertebral end-plates.
The body is marked on its sides by vascular foramina.

The vertebral arch consists of right and left pedicles (which connect it to the body) and right and left laminae. The
transverse processes emerge laterally at the junction of the pedicles and laminae, and the spinous process proceeds
posteriorly from the union of the laminae. The superior and inferior articular processes project vertically from the vertebral
arches on each side and bear articular facets. When vertebra are in their anatomical position, notches between adjacent
pedicles form intervertebral foramina, each of which typically transmitsneural structures including a spinal ganglion and a
ventral root of a spinal nerve.

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Chapter 39: The vertebral column

Relationship of Spinal Nerves to Vertebrae.

The first cervical nerve emerges between the skull and the atlas, and cervical nerves C2 to 7 continue to leave the vertebral
canal above the correspondingly numbered vertebrae. C8 emerges between the C7 and T1 vertebrae, and the remaining
spinal nerves leave below the correspondingly numbered vertebrae.

Regional characteristics of vertebrae

The vertebrae of each region have special characteristics, which are now described.

Cervical Vertebrae.

The seven vertebrae of the neck are characterized by an opening in each transverse process known as a foramen
transversarium. The upper six pairs of foramina transversaria transmit the vertebral artery. The C1 vertebra, which
supports the skull, is termed the atlas, and C2, which serves as a pivot for the atlas, is termed the axis.

Atlas (fig. 39-3).

The atlas (C1), which has neither body nor spinous process, consists of two lateral masses connected by a short anterior
and a longer posterior arch. Each lateral mass presents upper and lower facets, for the occipital condyle of the skull and for
the axis, respectively. The transverse processes are long and are vaguely palpable in vivo immediately below the auricle. The
anterior arch presents an anterior tubercle in front (for the anterior longitudinal ligament) and a facet posteriorly (for the
dens of the axis). The posterior arch is grooved above for the vertebral artery and the small C1 nerve on each side, and it
presents a posterior tubercle behind.

Axis (fig. 39-4).

The axis (C2) is characterized by the dens (or odontoid process), which projects upward from the body and articulates with
the anterior arch of the atlas. The dens is anchored to the occipital bone (by apical and alar ligaments) and is limited
behind by the transverse ligament of the atlas (fig. 39-3). It is frequently claimed that the dens represents the body of the
atlas, but this is doubtful. *

Remaining cervical vertebrae (fig. 39-5).

The lower cervical vertebrae, C2 to 6 are typical and present short, bifid spinous processes. The bodies are small and oval in
shape. There are superiorly-projecting lips at the superolateral borders of the vertebral bodies. These closely match
indentations in the lateral border of inferior aspect of the vertebral body above. Each transverse process, pierced by a
foramen transversarium, ends laterally in anterior and posterior tubercles, which are connected by an "intertubercular
lamella" or bar. # The bars are grooved by the ventral primary rami of the spinal nerves, which pass posterior to the
foramina transversaria. The anterior tubercles of C6 vertebra are large and are termed the carotid tubercles, because the
common carotid arteries can be compressed against them. C7 vertebra has a long, non-bifid spinous process and is known
as the vertebra prominens. (The spinous processes of C6 and 7 and T1 are usually visible in vivo when the neck is flexed.)

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Chapter 39: The vertebral column

The anterior tubercles (costal processes) of C7 vertebra may develop separately as cervical ribs. (Lumbar ribs are less
frequent.)

Thoracic Vertebrae (figs. 39-5, 39-6 and 39-7).

It should be noted that all vertebrae are dorsal, although only 12 are thoracic. The 12 vertebrae of the thorax bear the ribs.
The T1 vertebra (like C.V.7) is transitional in appearance. T2 to 8 vertebra are typical thoracic vertebrae with a kidney
shaped body (fig. 39-5). Demifacets for the heads of the ribs (see fig. 20-3) are found supeiorly and inferiorly at the
junction of the body and pedicle. The transverse processes of T1 to 10 have costal facets for the tubercles of the ribs. The
spinous processes are long, slender, and sloping: their tips lie opposite the subjacent body or even at the level of the
intervertebral disc below the subjacent body. The various facets for the ribs on T1 and on T9 to 12 veertebral bodies are
arranged differently. T11 and 12 are transitional in form, i.e., partly resembling lumbar vertebrae. A humped back is termed
kyphosis.

Lumbar Vertebrae (figs. 39-8 and 39-9).

The five vertebrae between the thorax and sacrum are large and present neither foramina transversaria nor costal facets
(fig. 39-5). The body is kidney shpaed, and the pedicles and laminae are short and thick. The part of the lamina between
the superior and inferior articular processes is known as the pars interarticularis and is liable to injury in some people
(resulting in spondylolisthesis, i.e., a slipping forward of the body of one vertebra on the vertebra or sacrum below it). A
mamillary process projects posteriorward from the superior articular process. The transverse process, which corresponds
to a rib, is long and thin, and an accessory process may project inferiorward from its root. The spinous processes are
quadrilateral and project horizontally backward. The fifth lumbar vertebra, usually the largest vertebra, is mainly
responsible for the lumbosacral angle (between the lumbar part of the column and the sacrum). Excessive "hollowing" of
the back is termed lordosis.

Sacrum (figs. 39-10 and 39-11).

Five (sometimes six) vertebrae are fused in the adult to form the sacrum, which can be felt below the "small of the back."
The sacrum articulates above with L5, laterally with the hip bones, and inferiorly with the coccyx. It has a roughly
triangular appearance with a pelvic and dorsal surface, a lateral mass on each side, and a base and apex. The pelvic surface,
concave and facing antero-inferiorly, presents four paired sacral foramina for the ventral primary rami of sacral nerves 1 to
4. The dorsal surface, convex and facing posterosuperiorly, presents a modified series of spinous processes termed the
median sacral crest and four paired sacral foramina for the dorsal primary rami of sacral nerves 1 to 4. Below, the sacrum
shows right and left sacral cornua, which bound a variable gap termed the sacral hiatus. An anesthetic for the spinal nerves
may be injected extradurally through the sacral hiatus (caudal analgesia). The cornua articulate with corresponding horns
on the coccyx. The lateral part or mass of the sacrum, lateral to the sacral foramina, consists of the fused transverse
processes (including their costal elements). Its superior surface is frequently termed the ala. The superolateral part of the
lateral mass presents the auricular (ear-shaped) surface for articulation with the hip bone (sacro-iliac joint). The surface is
limited behind by an area (sacral tuberosity) for interosseous ligaments. The base, formed by the suprior part of the first
sacral vertebra, presents a prominent anterior margin termed the promontory (fig. 39-11). Superior articular processes
articulate with the fifth lumbar vertebra. The sacral canal (which contains the dura, cauda equina, and filum terminale)

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Chapter 39: The vertebral column

extends from the base to the sacral hiatus. The apex of the sacrum may be fused with the coccyx.

Coccyx (fig. 39-10).

The vertebrae (usually four) below the sacrum are variably fused in the adult to form the coccyx, which resembles a
miniature sacrum in shape.

Development of vertebrae (figs. 39-12 and 39-13)

Vertebrae develop in mesenchyme and cartilage during the embryonic period proper, and most begin to ossify during fetal
life. Typically, a vertebra at birth shows three ossific areas, one for the centrum (defined in fig. 39-14) and one for each half
of the neural arch. At about puberty, ossific centers appear in the margins of the upper and lower surfaces of the body (ring
epiphyses) and at the tips of the various processes. Developmental failure of half a vertebra (hemivertebra) is one cause of
lateral curvature (scoliosis).

Failure of fusion of the halves of one or more neural (future vertebral) arches is termed spina bifida. The meninges
alone (meningocele), or the spinal cord and meninges (meningomyelocele), may protrude through the defect (spina bifida
cystica). When the defect is skeletal rather than neural, it may be concealed by the skin (although sometimes marked by a
tuft of hair) and is termed spina bifida occulta. In the sacrum, this is quite common.

Surface anatomy

The spinous processes of the vertebrae are palpable in the median furrow of the back. The external occipital protuberance is
palpable in adults. The spines of vertebrae C6, C7, and T1 are usually prominent and palpable, and they are made more
conspicuous by flexion of the neck and trunk. In the thoracic region, the spinous process of each vertebra extends to the
level of at least the body of the vertebra below. The inferior angle of the scapula is frequently at the level of the spinous
process of T7. A horizontal plane between the highest points of the iliac crests (supracristal plane) is usually at the level of
the spinous process of L4, and this is used as a landmark for lumbar puncture. A needle introduced here should enter the
subarachnoid space after 4 to 6 cm. The posterior superior iliac spine is commonly marked by a skin dimple (fig. 39-15).

Additional reading

Kohler, A., and Zimmer, E. A. Borderlands of the Normal and Early Pathologic in Skeletal Roentgenology, 3rd ed"
trans, by S. P. Wilk, Grone & Stratton, New York, 1968. This classic study of the entire skeleton is available in a more recent
edition in German.

Schmorl, G., and Junghanns, H., The Human Spine in Health and Disease, 2nd ed., trans. by E. F. Besemann, Grone &
Stratton, New York, 1971. This well known work is an important account of the normal and abnormal vertebral column.

Questions

39-1 How many vertebrae are movable?

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Chapter 39: The vertebral column

39-2 Which curvatures first appear in the vertebral column?

39-3 How many processes characterize a vertebral arch?

39-4 Where are the intervertebral foramina and what do they contain?

39-5 Between which vertebrae does the C8 nerve emerge?

39-6 What are the key features of the cervical, thoracic, lumbar, and sacral vertebrae?

39-7 How many dorsal vertebrae are present in the body?

39-8 What is the pars interarticularis?

39-9 What are the chief contents of the sacral canal?

39-10 What is the ossific status of a typical vertebra at birth?

39-11 How is surgical access to the spinal cord achieved?

39-12 What is spina bifida?

39-13 Which Latin and Greek roots are used with reference to the vertebral column?

Figure legends

Figure 39-1 The primary (1, thoracic; 2, sacral) and secondary (3, cervical; 4, lumbar) curvatures of the vertebral
column.

Figure 39-2 The parts of a vertebra (T.V.6) seen from above and from the right side. Adjacent intervertebral notches
form intervertebral foramina for the transmission of nerves.

Figure 39-3 The atlas from above. Muscle origins and the superior vertebral artery are shown on the right side. (After
Frazer.)

Figure 39-4 lateral and posterosuperior views of the axis.

Figure 39-5 Various vertebrae from lateral, superior, and posterior aspects.

Figure 39-6 The positions, lengths, and directions of (A) the spinous processes and (B) the transverse processes. The
vertebrae in black mark the levels at which a change in direction of curvature occurs.

Figure 39-7 Thoracic vertebrae (and C7 and L1). Note the bodies, pedicles, transverse and spinous processes, and
costrotransverse joints. (Courtesy of V.C. Johnson, M.D., Detroit, Michigan.)

Figure 39-8 Lumbar vertebrae and female pelvis.

Figure 39-9 Oblique view of the lumbar vertebrae. Note the very small twelfth rib, the joints between the articular
processes ofthe lumbar vertebrae (the arrow indicates the joint between L1 and L2), and the sacrum. In this view the

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Chapter 39: The vertebral column

outline of a Scotch terrier is formed by the transverse process (snout, overlapping the vertebral body), the superior articular
process (ear), and the inferior articular process (forepaw). The neck of the dog corresponds to the important pars
interarticularis, injury to which may result in spondylolisthesis.

Figure 39-10 Female sacrum and coccyx. A, Pelvic and, B, dorsal aspects showing muscular and ligamentous
attachments. C, Right lateral aspect in the anatomical position.

Figure 39-11 Female and male sacra from above. The superior aspect of the lateral part is the ala.

Figure 39-12 Scheme of horizontal sections of vertebrae, showing what are thought to be corresponding parts. Note
that the costal element forms a part of the transverse process of a cervical vertebra. It forms the rib in the thoracic region,
most of the transverse process in the lumbar region, and the greater portion of the lateral part of the sacrum. In the cervical
vertebra, the posterior tubercle of the transverse process should probably also be shaded as part of the costal element.

Figure 39-13 Variations in vertebrae. B shows the common arrangement. In A, "cranial shift," a cervical rib articulates
with C7 and rib 12 is small. In B, L5 is partially "sacralized" and S5 is partially freed. In C, "caudal shift," rib 12 is large and
a small lumbar rib is present. S1 vertebra is partially "lumbarized" and Co.1 is incorporated into the sacrum. (After Schinz
et al.)

Figure 39-14 The neural arch and centrum (left half of figure), and the vertebral arch and body (right half). The terms
centrum and neural arch refer to those parts of a vertebra ossified from primary centers. The terms vertebral arch and body
are descriptive terms generally applied to adult vertebrae. The body of a vertebra includes the centrum and part of the
neural arch. The vertebral arch, therefore, is less extensive than the neural arch. Note that the rib articulates with the neural
arch and not with the centrum.

Figure 39-15 Some surface landmarks of the back. (From Royce, L Surface Anatomy, Davis, Philadelphia, 1965,)

* See F. A. Jenkins, Anat. Rec., 164:173-184, 1969.

# The part of a cervical vertebra that corresponds to a rib is probably the transverse process lateral to the foramen
transversarium and including the anterior and posterior tubercles as well as the "intertubercular lamella" (or so-called
costotransverse bar). See A. J. E. Cave, J. Zool., 177:377-393, 1975. Only the anterior tubercle is shaded in figure 39-12.

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