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1. HOSAM M ATEF;MD
1H
Spinal Anatomy

2. H 2
Overview: Gross Spinal Anatomy
• Bony elements
• Spinal ligaments and joints
• Intervertebral discs
• Neural elements
• Blood supply

6. Spinal Column

7. H 7
Vertebral Column
• 24 separate vertebrae plus
two composite vertebrae:
– 7 cervical
– 12 thoracic
– 5 lumbar
– Composites:
• Sacrum: 5 pieces
• Coccyx: 4 pieces

8. Lumbar Vertebral Body

9. Spinous process

13. Pars Defect:
Spondylolysis and Spondylolisthesis

18. Thoracic Vertebral Body

19. Spinous Process
Vertebral body
Transvers
e
costal
facet

20. Vertebral costal facet

21. Cervical Vertebral Column

22. Spinous process

23. C1

24. C2

26. Spinal Motion Segment

28. Ligaments
and
Spinal Joints

29. Posterior
Longitudinal
ligament
Supraspinous
ligament
Interspinous
ligament
Ligamentum
flavum

30. Posterior
Longitudinal
Ligament

33. Zygapophyseal Joints

34. Zygapophyseal joints
• True synovial joints:
– Covered by fibrous capsule
– Filled with synovial fluid
– Hyaline cartilage lining bony surfaces
– Innervated with nociceptive fibers
• Posterior spinal structures
– Nerve root exits anterior to joint
through foramen
H 34

35. H
Zygapophyseal joints
• Lumbar joints:
– oriented obliquely at L5-S1
– Oriented increasingly more in the sagittal
plane up to thoracic levels
• Cervical joints are tilted cephalocaudad
• Joints are curved structures

36. HERNIATING DISC VIDEO.AVI

40. Spinous processes
Zygapophyseal
joints
Articular pillars
Intervertebral
foramina
Rib articulations

41. Atlanto-axial
and
Atlanto-occipital Joints

42. H 42
Atlanto-axial and atlanto-occipital joints
• Anterior spinal structures
– Nerve root exits posterior to joint
– No associated neural foramen
• Do not have typical medial branch
innervation
• True synovial joints

43. Sacroiliac Joint

47. Neural Elements

48. H 48
Spinal cord
• Begins at C1 and ends at L1-2
• Transmits bilateral, segmental spinal
nerves:
– 8 cervical
– 12 thoracic
– 5 lumbar
– 5 sacral

49. L1
Filum terminale
Cervical expansion
Lumbar expansion
S2
Cauda equina
Dura

50. Filum terminale
Lumbar expansion
Cauda equina
Termination of
dural sac
Cervical expansion

51. Spinal Nerves

52. H 52
Spinal nerve
• Originate from a dorsal and ventral root
– Roots originate intra-durally, exit through
dural root sleeve
• Give rise to dorsal and ventral
primary rami

54. Sympathetic Nervous System

55. Ventral ramus
Ventral root
Filum terminale
Dorsal root ganglion
Dorsal root

56. White
rami
Gray
rami

57. Nerve Roots

62. H 62
Cervical nerve roots
• C5 contacts the disc in the proximal
foramen
• C6 and C7 have considerable contact
with their respective discs in the middle
foramen
• C8 has little contact with the C7-T1 disc

63. H 63
Neural foramina
• Transmit spinal nerves
• First and second spinal nerves (C1, C2)
do not exit via a foramen
• First neural foramen is C2-3 which
transmits the C3 spinal nerve
• There are 8 cervical nerves with C8
exiting out the C7-T1 foramen

64. Uncovertebral joint
Uncinate process
Superior
and
inferior
articular
processes
Foramen transversarium
Neural foramen
Disc

65. H 65
Numbering of spinal nerve roots
• In the cervical spine, the last number of
the foramen names the exiting nerve:
– C3 exits the C2-3 foramen
– C7 exits the C6-7 foramen
• C8 exits the C7-T1 foramen
• From T1-2 down, the first number of the
foramen names the exiting nerve:
– L3 exits the L3-4 foramen

66. C5-6, C6-7 joints
C4, C5 and C6
articular pillars
C2 and C3
spinous processes
C2-3 and C3-4
foramina
C4
C3
C5
C6
C8
C7
C6, C7 vertebral
bodies

68. Dorsal Primary Rami
And
Medial Branches

70. C5-6 and C6-7
zygapophyseal
joints
C4, C5 and C6
articular pillars
C2 and C3
spinous processes
C2-3 and C3-4
foramina
TON
Medial branch of C3
Medial branch of C4
Medial branch of C5
Medial branch of C8
C4
C3
C5
C6
C8
C7

71. Intervertebral Discs

72. Lumbar Disc

76. phospholipase A2
prostaglandin E
histamine
inflammatory
polypeptides
Internal Disc Disruption

77. Cervical Disc

79. Vascular Elements

80. Course of the Vertebral Artery

81. Pleura
Stellate ganglion
Vertebral artery
Subclavian
artery

83. Posterior View of Brainstem
Basilar artery
Vertebral
arteries Anterior
spinal
artery

84. Spinal Cord Blood Supply

85. great radicular artery
of Adamkiewicz
thoracic radicular artery
Cervical radicular arteries
L and R vertebral arteries
Ascending sacral radicular artery

86. Meninges
of the
Brain and Spinal Cord

87. H
87
Meninges
• The dura mater surrounds the brain and
spinal cord
• The arachnoid lies just beneath the dura
• Pia mater covers and is adherent to the
brain and spinal cord
• CSF flows between the arachnoid and the
pia mater

88. Arachnoid
granulations
Dura mater
Arachnoid
Choroid plexus
Subarachnoid
space
Pia mater

90. End