ANATOMY OF

SPINE
Dr Pankaj N Surange
MBBS, MD, FIPP
Interventional Pain and Spine specialist
 Anatomical Planes
The CORONAL PLANE, also
A-P X-ray of a called the FRONTAL PLANE, is a
scoliotic spine in vertical cut that divides the body
into front and back sections.
the coronal plane. Physicians look at the coronal plane
when they view an A-P (anterior-
posterior) x-ray of the spine to
evaluate scoliosis.
 Anatomical Planes
Lateral X-ray of a The SAGITTAL or MEDIAN
PLANE is a vertical cut that
kyphotic spine in
divides the body into left and right
the sagittal sections. The sagittal view is seen
plane. by surgeons on a lateral x-ray of
the spine.
 Anatomical Planes
CT Scan of a The AXIAL or TRANSVERSE
PLANE is a horizontal cut that
thoracic vertebra divides the body into upper and
in the axial plane. lower sections. To best view the
axial plane of the spine, surgeons
will often obtain a CT scan with
axial cuts.
 Functions of the Spine
• Protection of
– spinal cord and nerve roots
– internal organs
 Functions of the Spine
• Flexibility of motion in six degrees of freedom

Flexion and Extension Left and Right Left and Right Rotation
Side Bending
 Functions of the Spine
• Structural support and
balance for upright posture
The spine is the axle bearing the load
of the head, shoulders and thorax. The
upper body weight is then distributed
to the lower extremities through the
sacrum and pelvis.
This reduces the amount of work
required by the spinal muscles and can
eliminate muscle fatigue and back pain.
 Functions of the Spine
To achieve these functions, the spine
must have:
• Resistance to axial loading forces,
accomplished by:
– Kyphotic and lordotic sagittal plane
curves
– Increased mass of each vertebra
from C1 to the sacrum
• Elasticity accomplished by:
– Alternating lordotic and kyphotic
curves
– Multiple MOTION SEGMENTS
 The Motion Segment
• The FUNCTIONAL UNIT of the spine
• Composed of:
– Two adjacent
– vertebrae
The intervertebral disc
– Connecting ligaments
– Two facet joints and
capsules
 Sagittal Plane Curves
• Primary Curves • Secondary Curves
 Sagittal Plane Curves
Cervical Lordosis 20°- 40°

Thoracic Kyphosis 20°- 40°

Lumbar Lordosis 30°- 50°

Sacral Kyphosis
 Regions of the Spine
• Cervical
– Upper cervical: C1-C2
– Lower cervical: C3-C7

• Thoracic: T1-T12

• Lumbar: L1- L5

• Sacrococcygeal: 9 fused
vertebrae in the sacrum and
coccyx.
 Regions of the Spine
• Line of gravity
Auricle of the ear
Odontoid
Body of C7

Anterior to thoracic
spine

Posterior to L3

Mid femoral heads

 Basic Vertebral Structures

Cervical Thoracic Lumbar

 Types of Bone Tissue
There are two types of bone tissue:
• Cortical bone: dense, outer shell of the
vertebra
• Cancellous bone: inner, spongy bone
Haversian System

Detail of Cortical Detail of Cancellous

Bone Bone
 Vertebral Structures

Vertebral
Body
Pedicle Vertebral
Foramen
Transverse
Process
Lamina
Superior
Spinous Articular
Process Process
 Vertebral Structures
Superior
Pars Articular
Process

Zygapophyseal
Inferior
Joint
(Facet Joint) Articular
Process
 Vertebral Structures

• Pedicle notches
Slight
Notch

• INTERVERTEBRAL FORAMEN Deep

through which the spinal nerve Notch
roots leave the spinal cord

Intervertebral
Foramen
 Vertebral Arches
• Anterior Arch
Comprised of:
– Vertebral body
– Anterior 1/3 of the pedicles
• Posterior Arch
Comprised of:
– Posterior 2/3 of the pedicles
– Lamina
– Processes
 The Atlas (C1)
Anterior
Articular Facet
Tubercle
for Dens
Transverse
Process
Superior
Articular
Facet

Transverse Lateral
Foramen Mass
Posterior Lamina
Tubercle
Superior View
 The Axis (C2)
Lateral
Body Odontoid Mass
Process
(Dens)

Superior
Articular
Facet

Inferior
Articular Spinous
Transverse
Facet Process
Process
Anterior View Posterior View
 Lower Cervical Vertebrae
• C3 to C7
– May be referred to as
the subaxial region
– Disc at every level
– Vertebral structures
are similar
 Lower Cervical Vertebrae
C3 - C7

Sulcus for Transverse

Body Process
Spinal Nerve
Transverse
Foramen
Pedicle

Superior
Lateral Articular Facet
Mass

Vertebral
Lamina Foramen

Axial View Bifid Spinous Process

 Lower Cervical Vertebrae
C3 - C7
The vertebral bodies of the subaxial cervical spine have upward projections on
the lateral margins called UNCINATE PROCESSES.
These processes articulate with the level above to form the UNCOVERTEBRAL
JOINT. These are also called JOINTS OF LUSCHKA.

Uncinate
Process

Uncovertebral Joint
Sulcus for
(Joint of Luschka)
Spinal Nerve

Anterior View
 Vertebra Prominens (C7)

C7 is referred to as the VERTEBRA

PROMINENS because it has a longer
and larger spinous process than the
other cervical vertebrae.
This spinous process is not usually bifid.

Spinous
Process

Axial View
 Thoracic Vertebrae
• Body - progressive increase in mass
from T1 to T12

• Pedicles - small diameter

• Laminae - vertical, with “roof tile”
arrangement

• Spinous processes - long,

overlapping, projected downward

• Intervertebral foramen - larger, less

incidence of nerve compression
 Thoracic Vertebrae, T1-T12
• Body - heart shaped when viewed
superiorly.

• Vertebral foramen - round

• Pedicles - small in diameter

• Spinous processes - long and

projected downwards
 Thoracic Vertebrae, T1-T12
• Articular processes

Superior Articular
Process

Inferior Articular
Process
 Lumbar Vertebrae, L1-L5
• Body - L1 to L5 progressive increase
in mass
• Pedicles - longer and wider than
thoracic; oval shaped
• Spinous processes - horizontal,
square shaped
• Transverse processes - smaller than
in thoracic region
• Intervertebral foramen - large, but
with increased incidence of nerve
root compression
 The Sacrum
Inverted triangle shape Sacral Horns

Sacral Ala
Dorsal
Pedicles Foramina

Sacral
Hiatus
Coccyx
Posterior View
 The Sacrum
Sacral Tilt
30°-60°

Sacral 1
Promontory 2

Sacral Canal 3
Sacral Hiatus
4
5

Coccyx
Lateral View
 Intervertebral Disc
• Intervertebral disc
• End plate
– Cartilaginous layer
– Bony layer
• Apophyseal ring
 Intervertebral Disc
• Fibrocartilaginous joint of the
motion segment
• Make up ¼ the length of the
spinal column
• Present at levels C2-C3 to L5-
S1
• Allows compressive, tensile,
and rotational motion
• Largest avascular structures
in the body
 Intervertebral Disc
Annulus
• Annulus Fibrosus Fibrosus
– Outer portion of the disc
– Made up of lamellae
• Layers of collagen fibers
• Arranged obliquely 30°
Lamellae
• Reversed contiguous
layers
– Great tensile strength
 Intervertebral Disc
• Nucleus Pulposus Nucleus
Pulposus
– Inner structure
– Gelatinous
– High water content
– Resists axial forces
 Intervertebral Disc
Blood Supply

•Intervertebral discs have no

significant vascular structures.
•They receive their blood supply by
diffusion through the vertebral body
endplates.
• A network of vessels located
centrally in the endplate allows
nutrients to diffuse into the nucleus
pulposus and annulus fibrosus.
 Occipitocervical Joint
Occipital
Condyles
Foramen
Magnum
articulate with
C1 superior
facets
 Atlantoaxial Joint
Dens
JOINT between the atlas (C1) and the
axis (C2); has a range of motion in the
transverse plane for rotation.

The DENS of C2 acts as a C1

pivot point for the rotation of
C1.

The articulating surfaces of the two C2

vertebrae form ZYGAPOPHYSEAL
(FACET) JOINTS that allow flexion-
extension, side bending, and Zygapophyseal
rotational movements. joints
 The Facet Joints
Also called ZYGAPOPHYSEAL JOINTS.

The facet joints are formed by the

articular processes of adjacent vertebrae.
The inferior articular process of a vertebra
articulates with the superior articular
process of the vertebra below.

These are synovial gliding joints

Facet joints are oriented in different

planes depending on their anatomic
location.
 Uncovertebral Joints
Uncovertebral
The bony elevations on the Uncinate Joint
superior lateral margins of the cervical Process
vertebrae are called UNCINATE
PROCESSES.

These joints articulate with the

inferior, lateral aspect of the vertebra
above to form the UNCOVERTEBRAL
JOINTS, also known as the JOINTS
OF LUSCHKA. These are fibrous joints

The uncovertebral joints are not true

joints
 Costovertebral Joints
In the thoracic spine, the RIBS Costovertebral
articulate with the vertebrae at both the body
and the transverse processes.
joints

The T2-T9 thoracic vertebra

have facets superiorly and inferiorly
at the posterior aspect of the
vertebral body that form the
COSTOVERTEBRAL joints.

At all thoracic levels there is a

facet where the rib articulates with Rib Rib
the transverse process. These are
called the COSTOTRANSVERSE
Costotransverse
joints. joints

The T1 and T10-T12 vertebral

Axial View
bodies have only one costal facet.
 Costovertebral Joints
Costotransverse
Costovertebral joint
joints

Rib

Lateral View
 Sacroiliac Joint
The superior lateral surface on
either side of the sacrum articulates Sacrum
with the inner aspects of the pelvis. Ilium
This area forms the capsular, synovial
SACROILIAC JOINT.

In some cases the

sacroiliac joint is a
hidden source of back
pain.
Sacroiliac
Ligaments
 Upper Cervical Ligaments
Occipitoatlantal
Ligament Complex
Anterior
occipitoatlantal
ligament

Lateral Posterior
occipitoatlantal occipitoatlantal
ligament ligament

Anterior View
 Upper Cervical Ligaments
Occipitoaxial Ligament Complex

Posterior cutaway view Posterior view

Occipitoaxial
ligament
Apical
ligament Alar ligaments (2)
 Lower Cervical, Thoracic,
and Lumbar Ligaments
Anterior Longitudinal
Ligament (ALL)

•Extending from the axis (C2)

anteriorly to the sacrum.
•Is broader at the level of each
vertebral body than at the level of the
discs where the fibers adhere to the
annulus fibrosus.
•Attaches to each vertebral body
superiorly and inferiorly at the levels of
the end plates.
 Lower Cervical, Thoracic,
and Lumbar LigamentsIntertransverse
ligaments
Costal
ligaments

The INTERTRANSVERSE
LIGAMENTS extend from the
inferior surface of the entire
length of the transverse process
to the superior surface of the
adjacent transverse process.

The COSTAL LIGAMENTS

connect the heads of the ribs to
the vertebrae.
 Lower Cervical, Thoracic,
and Lumbar
POSTERIOR LONGITUDINAL
Ligaments
LIGAMENT (PLL)
• Is weaker than the ALL.
• It runs from the axis (C2) caudally to
the sacrum.
•The PLL is narrow at the levels of the
vertebrae, but the fibers extend laterally at
the disc levels. These fibers may help to
contain herniated disc material.
•Like the ALL, the PLL is attached to
the vertebra at the superior and inferior
margins, and to the annular fibers of the
intervertebral disc.
Posterior longitudinal ligament
 Lower Cervical, Thoracic,
and Lumbar Ligaments
The INTERSPINOUS
LIGAMENT connects each adjacent
spinous process.
Interspinous
In the cervical spine the ligament
interspinous ligament becomes part
of the LIGAMENTUM NUCHAE, that
extends cranially to insert into the
occiput.

Ligamentum
nuchae
 Lower Cervical, Thoracic,
and Lumbar Ligaments
The SUPRASPINOUS
LIGAMENT is a very strong band
connecting the tips of
contiguous spinous processes. It Supraspinous
extends from C7 to the sacrum. ligament
Above C7 these fibers are
part of the LIGAMENTUM
NUCHAE.

Ligamentum
nuchae
 Lower Cervical, Thoracic,
and Lumbar Ligaments
LIGAMENTUM FLAVUM
Also called the YELLOW
LIGAMENT
Consists of elastic fibers
oriented vertically that extend from
the anterior inferior surface of the
lamina above to the superior
posterior surface of the lamina
below.
The ligamentum flavum tends to
thicken as it progresses down the
spine, beginning at the axis (C2)
and extending to the sacrum.
Ligamentum
flavum
 Lumbosacral Ligaments
The ILIOLUMBAR LIGAMENTS
extend from the transverse
Iliolumbar
processes of L4 and L5 to the iliac
crest. ligaments

Anterior View Posterior View

 Lumbosacral Ligaments
Lumbosacral
ligaments
The LUMBOSACRAL
LIGAMENT is a thick, fibrous band
that extends from the anterior,
inferior aspect of the transverse
process of L5 to the lateral surface
of the sacrum.

Anterior View
 Sacroiliac Ligaments
The SACROILIAC LIGAMENTS are Short sacroiliac
as follows: ligaments
• short sacroiliac ligaments:
composed of horizontal fibers
extending from the sacrum to
the posterior part of the iliac
bone
Long sacroiliac
ligaments
• long sacroiliac ligaments:
composed of fibers extending
vertically from the sacrum to
the posterior superior iliac
spine Posterior View
 Posterior Spinal Muscle Groups
The superficial posterior
muscles are collectively called the
ERECTOR SPINAE, comprising three
groups:
Iliocostalis
Erector Longissimus
Spinae
Spinalis
 Posterior Spinal Muscle Groups
The middle, or intermediate, muscle group of the spine
is called the SEMISPINALIS GROUP:

semispinalis
capitis

semispinalis
cervicis
semispinalis
thoracis
 Posterior Spinal Muscle Groups
The deep muscle layer
consists of the following Rotatores
groups: (longus and brevis)
Levatores costae
(longus and brevis)

Rotatores
cervices
Rotatores
Multifidus thoracis

Rotatores
lumborum
Intertransversarii
attachments
between spinous
processes
 Arteries of the Cranial and Cervical Region
Two VERTEBRAL
ARTERIES, one located on each
side the cervical vertebrae. These
arteries are branches of the right
Foramen
and left subclavian vs. that exit from
lacerum
aorta.
They ascend through the Vertebral
transverse foramen of C6 through artery
C1,entering the skull through the
foramen magnum where they join Carotid
together to form the BASILAR
artery
ARTERY.
Anterior to the cervical
vertebrae are the CAROTID
ARTERIES, which ascend through
the FORAMEN LACERUM and
join with the vertebral arteries to
form the CIRCLE OF WILLIS.
 Arteries of the Cranial and Cervical Region
Circle of Willis

Basilar Internal
artery carotid
arteries

Vertebral
arteries
Arteries of the Thoracic and Lumbosacral Regions
Vertebral
artery Aortic arch
Ascending Descending
aorta aorta
Thoracic
Abdominal segmental
aorta arteries

Bifurcation
of the aorta Lumbar
segmental
External iliac arteries
artery (left &
right) Internal
iliac artery
Femoral artery (left & right)
(left & right)
 Segmental Arteries
At each vertebral level from T4 to the sacrum, a pair
of SEGMENTAL ARTERIES branches posteriorly from
the aorta to supply blood to the vertebral body, posterior
elements, spinal cord, and costal structures.

Anterior spinal
artery
Spinal
branch
Posterior
branch
Intercostal
artery
Segmental
arteries
Anastomoses
Aorta
Veins of the Cervical and Thoracic Region
The most important venous structures in the
cervical spine are the internal and external
JUGULAR VEINS. The internal jugular veins follow
a path similar to the carotid arteries. They should
always be considered during any anterior cervical
spine procedure.

External
jugular
Internal
jugular
Anterior
jugular
Veins of the Thoracic and Lumbar Region
Internal
jugular
Superior
vena cava
Azygos
vein
Thoracic
segmental Hemiazygos
veins vein

Lumbar
Inferior segmental
vena cava veins

Common
iliac veins
 Batson’s Plexus
The AZYGOS SYSTEM is a large
network of veins draining blood from
the intestines and other abdominal Batson’s
organs back to the heart. The
plexus
segmental veins drain into the azygos
vein located on the right side of the
abdomen, or into the hemiazygos vein
located on the left side.
The azygos system also
communicates with a valveless
venous network known as BATSON’S
PLEXUS. When the vena cava is
partially or totally occluded, Batson’s
plexus provides an alternate route for
blood return to the heart.
The vessels of Batson’s plexus
may be referred to as epidural veins
 Batson’s Plexus
Because of the azygos Batson’s
system, patient positioning is plexus
very important in posterior
lumbar spine surgery.
The patient’s abdomen
should always hang free and
without abdominal pressure. An
increase in pressure will
diminish flow through the
azygos system and the vena
cava. This results in an increase
of venous flow into Batson’s
plexus with a corresponding
increase of blood loss.
 Spinal Nerve Structures
Spinal Cord Foramen
• Contained in epidural space magnum
• Network of sensory and motor
nerves
• Firm, cord-like structure
• Extends from foramen magnum to
L1
• Terminates at the Conus
conus medularis medularis
• The cauda equina begins Cauda
below L1 equina
• Filum terminale extends from
conus medularis to the coccyx
 Meninges
Within the spinal canal, the spinal cord is surrounded by the
EPIDURAL SPACE, filled with fatty tissue, veins, and arteries. The fatty
tissue acts as a shock absorber.

The spinal cord is covered by MENINGES which has three layers.

Pia mater Subarachnoid

space: filled
with CSF

Subdural space
Arachnoid
layer
Dura mater
 Spinal Nerve Topography

31 pairs of spinal nerves

• 8 cervical
• 12 thoracic
• 5 lumbar
• 6 sacrococcygeal
 Spinal Nerves
Spinal Epidural
cord space
Dura mater and
Arachnoid layers
Dorsal root
Subarachnoid
space
Dorsal root
ganglion

Ventral Peripheral
root nerve
 Autonomic Nervous System
Independent of voluntary control.

Controls glandular and cardiac

function and smooth muscle such as
that found in the digestive tract.

There are two components:

sympathetic
parasympathetic

The control centers of both

systems are located outside the
spinal cord in structures called
GANGLIA.
 Autonomic Nervous System
The SYMPATHETIC NERVOUS
SYSTEM consists of a series of ganglia
extending from the skull to the coccyx,
lying on each side of the vertebral bodies.
These aligned ganglia look like a chain at
each side of the spine and are often
referred to as the sympathetic nerve chain.
Injury to the sympathetic nerve chain
in the lumbar spine may result in
genitourinary problems for the patient.
Each sympathetic ganglion has fibers
that join to the adjacent spinal nerve.

The PARASYMPATHETIC
NERVOUS SYSTEM has ganglia located
close to the organs they control.
Thank You!