Spine Anatomy (Integrated with Surgery)

Aamir Raoof Memon

Spinal Column
Spinal column or Vertebral Column consists of:
7 cervical vertebrae 12 thoracic vertebrae 5 lumbar vertebrae 5 Sacral vertebrae (fused) 4 sacral vertebrae (fused)

Motion Segment Consist of:

2 adjacent vertebrae Intervertebral disc Ligamentous restrains

Three column concept

Anterior Middle Posterior

Spinal Segments
Upper Cervical Segment
Facilitate motion & stability Atlus & Axis C3-C7 Vertebrae have same anatomy

Cervicothoracic Junction
Transition from mobile to fixed(prone to injury)

Thoracic Segment
Rigid (provide stabilization) Associated with Vascular & Visceral injury

Thoracolumbar Junction
Most common area of injury

Spinal Curves
Primary Spinal Curves (Kyphotic ): Concave anteriorly and convex posteriorly
Cervical Lordosis 20-40 degrees Lumbar Lordosis 40-60 degrees decrease with age Most at L5 and S1

Secondary Spinal Curves (Lordotic ): Convex anteriorly and concave posteriorly

Thoracic Kyphosis 20 -40 degrees increase with age Sacral Kyphosis Sacrum fused in a kyphotic curve

Spinal Cord
Spinal Cord extends from Foramena Magnum to T12/L1 Junction
Ends as Conus Medularis which has an extension called Cauda Equina, terminating as filum terminale covered with Pia matter and attach inferiorly to coccyx

It is enclosed in spinal canal & encosed by meninges protected by the shield of bony vertebrae Dura and subarachnoid membrane extent upto S2 Central portion/Grey matter (neuronal cell bodies) Peripheral portion/White matter (axons) Lateral Spinothalamic tract for pain & temperature sensation Lateral Corticospinal tract for motor function Posterior column for position,vibration & deep pressure sensation

Spinal Nerves
Spinal Nerve Roots
8 cervical 12 thoracic 5 lumbar 5 sacral 1 cocygeal

Dorsal+Ventral root = Spinal nerve Ventral root+Dorsal root ganglion are encosed in IV foramen Neural Foramen Boundries
Anteriorly Disc Posteriorly Facet Joint Superiorly & Inferiorly Pedicles

Blood supply to spinal cord

Blood supply to spinal cord is from:
Vertebral artery Deep cervical artery Intercostal artery Lumbar artery

Main arteries are:

One Anterior Spinal artery (br: of Vertebral A) Two Posterior Spinal arteries

Radicular arteries enter via foramen & supply spinal arteries

Disorders
Upper cervical spine (skull-C2)
Craniocervical dislocation Atlantoaxial instability Occipital condyle fracture Jefferson fracture (C1 ring) Odontoid fracture Type-I,II,III Hangmans fracture Wedge fracture Burst fracture Tear-drop fracture Facet subluxation/dislocation

Thoracic and Thoracolumbar

Type A,B & C Osteoporotic wedge compression fracture (T1-T10)

Thoracolumbar (T11-S1)
Burst fracture Chance fracture

Subaxial Cervical Spine (C3-C7)

Referrences
Short Practice of Surgery by Bailey & Love