Chapter 8

Structure and Function

of the Vertebral Column
Copyright 2014, 2009 by Mosby, an imprint of Elsevier Inc.
Normal Curvatures
Human vertebral column is composed of a set of
natural, reciprocal curves, responsible for neutral
posture of spine
Cervical and lumbar regions display natural
lordosisor slightly extended posturein sagittal
plane
In contrast, thoracic and sacro-coccygeal regions
exhibit natural kyphosisor slightly flexed posture
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Normal Curvatures contd
Anterior concavity of thoracic and sacral regions
provides space for important, vital organs within
chest and pelvis
Natural curvatures not fixed, but dynamic and flexible
Normal curvatures of spine provide strength and
stability to entire axial skeleton


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Normal Curvatures contd
When these natural curvatures are maintained,
compressive forces can be shared by stretched
connective tissues and muscles
Spinal curves allow vertebral column to give slightly
under a load, rather than support large compression
forces statically

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Normal Curvatures contd
Disease, trauma, genetically loose ligaments, or
habitual poor posture can lead to an exaggeration (or
reduction) of normal spinal curvatures
These variations stress local muscles and joints, as
well as reduce thorax volume
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Line of Gravity
Passes through mastoid process, anterior to second
sacral vertebrae, posterior to hip, and anterior to
knee and ankle
In ideal posture, gravity helps maintain optimal spinal
curvature, significantly increasing efficiency of static
postures
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Osteology: Cranium
Occipital protuberance
Located at midpoint of posterior skull that serves as an
attachment for ligamentum nuchae and upper trapezius
Superior nuchal line
Ridge of bone extending laterally from occipital protuberance
to mastoid process
Mastoid process
Serves as cranial attachment for numerous muscles in head
and neck
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Osteology: Cranium contd
Inferior nuchal line
Near base of skull; provides cranial attachments for
numerous muscles and ligaments of posterior cervical region
Foramen magnum
Located at base of skull, providing a passage for spinal cord
to meet brain
Occipital condyles
Project from anterior-lateral margins of foramen magnum;
form atlanto-occipital joint

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Typical Vertebrae
Body
Cylindrical bone mass serving as primary weight bearer
throughout vertebral column
Intervertebral disc
Thick ring of fibrocartilage serving as vertebral column shock
absorber
Interbody joint
Formed by two vertebral bodies and interposed
intervertebral disc
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Typical Vertebrae contd
Vertebral canal
Posterior to body of each vertebra; houses and protects
spinal cord
Pedicles
Short thick projections of bone connecting body of vertebrae
to each transverse process
Laminae
Thin plates of bone forming posterior wall of vertebral canal;
connect each transverse process to spinous process base
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Typical Vertebrae contd
Superior and inferior articular facets
Inferior facets of one vertebra articulate with
superior facets of vertebra below it, composing
apophyseal joints that help guide vertebral motion
Intervertebral foramina
Between adjacent vertebrae; forming
passageways for nerve roots entering or exiting
vertebral column

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Intervertebral Discs
Nucleus pulposus
Gelatinous center of the disc dissipating and transferring
forces between consecutive vertebrae
Annulus fibrosus
10-20 concentric rings of fibrocartilage that encase nucleus
pulposus
Vertebral end plate
Connects intervertebral disc to vertebrae above and below,
and helps provide the disc with nutrition
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Specifying Vertebrae
and Intervertebral Discs
Individual vertebrae are numbered by region in
cranial to sacral direction
Intervertebral discs are described by their position
between two vertebrae
Spinal nerves are described in much the same way
as vertebrae
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Cervical Vertebrae
Seven cervical vertebrae are smallest and most
mobile of all vertebrae
First two cervical vertebrae, called the atlas (C1) and
the axis (C2), are unique within cervical region
Rest of cervical vertebrae (C3-C7) are considered
typical
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Typical Cervical Vertebrae (C3-C7)
Transverse foramina
Holes within transverse processes serving as conduits for
each vertebral artery coursing toward brain
Cervical vertebrae are bordered posterior-laterally by
uncinate processes making them appear like
stackable shelves
Most of spinous processes in cervical region are bifid
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Atlas (C1)
Two large lateral masses connected by anterior and
posterior arches
Two large concave superior facets sit on top of these
lateral masses to accept occipital condyles, forming
atlanto-occipital joint
Largest transverse processes in cervical region
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Axis (C2)
Functions as vertical axis of rotation for rotary
movements between head and cervical region
Superior facets of axis (C2) are relatively flat and
allow atlas to freely rotate over axis
Bifid spinous process of C2 is very broad and
palpable
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Thoracic Vertebrae
Characterized by sharp, inferiorly projected spinous
processes and large posterior-laterally projected
transverse processes
Body and transverse processes of most have costal
facets for articulation with posterior aspect of ribs
Ribs, thoracic vertebrae, and sternum define volume of
thoracic cavity
Apophyseal joints are aligned nearly in frontal plane
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Lumbar Vertebrae
Lumbar vertebrae have massive, wide bodies
Spinous processes connected to body of vertebrae
through laminae and pedicles
Facet joints of upper lumbar region are oriented close
to sagittal plane, but transition toward frontal plane in
lower regions
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Sacrum
Triangular bone transmitting weight of vertebral
column to pelvis
Sacral promontory articulates with L5, forming
lumbosacral junction
Sacral canal
Houses and protects cauda equina
Dorsal sacral foramina transmit dorsal rami of sacral nerves;
ventral sacral foramina transmit ventral rami of spinal nerves

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Coccyx
Sometimes referred to as tailbone
A small triangular bone consisting of four fused
vertebrae
Base of coccyx articulates with inferior sacrum,
forming sacro-coccygeal joint
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Major Ligaments of the Vertebral
Column
Ligamentum flavum
Attaches between anterior surface of one lamina and
posterior surface of lamina below
Limits flexion
Superspinous and interspinous ligaments
Attaches between adjacent spinous processes from C7 to
sacrum
Limits flexion
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Major Ligaments
of Vertebral Column contd
Intertransverse ligaments
Between adjacent transverse processes
Limits contralateral flexion
Anterior longitudinal ligament
Between basilar part of occipital bone and entire length of
vertebral bodys anterior surface
Adds stability to vertebral column
Limits extension or excessive lordosis
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Kinematics of Vertebral Column
Movement at any spinal region is described by
direction and plane of motion of point on anterior side
of vertebrae
Movement occurs relative to an associated axis of
rotation coursing through vertebral body
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Craniocervical Region
Craniocervical region (neck) refers to combined set of
three articulations
Atlanto-occipital joint, atlanto-axial joint, and
intracervical region
Craniocervical region is most mobile area of entire
vertebral column
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Craniocervical Region:
Flexion and Extension
Occipital condyles roll backward during extension
and forward during flexion
Flexion mechanics are reverse of extension
Atlanto-axial joint allows about 5 degrees of flexion
and 10 degrees of extension
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Craniocervical Region:
Flexion and Extension contd
Flexion and extension result in an arc of motion
determined by cervical facet joints oblique plane
During extension, inferior facets of the superior
vertebra slide posteriorly and inferiorlyrelative to
vertebra below it
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Axial Rotation
Rotation of head and neck in horizontal plane is
important motion; integral to vision and hearing
Allows visual field to approach 360 degrees without
moving trunk
Atlanto-axial joint is responsible for about half of
rotation that occurs in this region
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Axial Rotation contd
Rotation of head is result of C1and attached
craniumrotating as a fixed unit relative to axis
Rotation of C2-C7
Guided primarily by oblique orientation of facet joints
Combined motion of these joints allows about 45 degrees of
rotation in either direction
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Lateral Flexion
Craniocervical region allows about 40 degrees of
lateral flexion to each side
Most motion occurs between C2 and C7
Motion is guided by incline of facet joints; some
horizontal plane rotation is mechanically coupled
with lateral flexion
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Thoracolumbar Region:
Flexion and Extension
Combined motion of thoracic and lumbar vertebrae
allows about 85 degrees of forward flexion
Large amount (about 50 degrees) of flexion occurs in
lumbar region; is linked to facet joint orientation
Large amounts of flexion are important for activities
such as bending forward to pick an object off the floor
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Thoracolumbar Region:
Axial Rotation and Lateral Flexion
Thoracolumbar region permits only about 35 degrees
of horizontal plane rotation in either direction, most of
which occurs at thoracic region
Lateral flexion of thoracolumbar region is typically
limited to about 45 degrees in either direction
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Functional Considerations:
Potential Intervertebral Disc Migration
With time or excessive pressure, nucleus pulposus
may ooze through cracks created in annulus fibrosis,
causing a herniated nucleus pulposus
Herniated nucleus pulposus may cause local and/or
radiating pain down into buttocks and leg

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Functional Considerations:
Anterior and Posterior Pelvic Tilts
Anterior pelvic tilt is short-arc anterior rotation of
pelvis about hip jointswith trunk held stationary
Naturally extends lumbar spine and increases lumbar
lordosis
Posterior pelvic tilt is short-arc posterior rotation of
pelvis
Flexes lumbar spine and therefore decreases lumbar
lordosis
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Lumbosacral Junction
Articulation between L5 and S1, where weight of
entire trunk and upper body is transferred to pelvis at
this area
Facet joints of L5-S1 are typically oriented close to
frontal plane preventing lower spine from translating
downhill
Excessive anterior translation of lumbar spine relative
to sacrum is anterior spondylolisthesis
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Sacroiliac Joints
Formed by articulation of sacrum and iliac bones
Primary function of SI joints is to allow wedge-shaped
sacrum to transfer forces of body weight to pelvis and
lower extremities
SI joints typically allow little motion
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Sacroiliac Joints contd
Nutation
Anterior rotation of sacrum relative to each ilium
Counternutation
Posterior rotation of sacrum relative to each ilium
These movements are described by movement of anterior
edge of sacrum
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Innervation to Craniocervical
and Trunk Musculature
Dorsal rami form short nerves that innervate most
muscles of posterior neck and trunk
Ventral rami form cervical, brachial, and lumbosacral
plexus and innervate most muscles of anterior-lateral
trunk and neck
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Innervation to Craniocervical
and Trunk Musculature contd
Muscle tissue on vertebral columns posterior aspect
coursing between the sixth and twelfth thoracic
vertebrae is likely innervated by multiple dorsal rami
from spinal nerves T6-T12
Muscle tissue of anterior trunk would likely be
innervated by nerves from ventral rami of T6-T12
region
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Sternocleidomastoid
Inferior attachment
Sternal head: superior aspect of manubrium of sternum;
clavicular head: medial 1/3 of clavicle
Superior attachment
Mastoid process of the temporal bone
Innervation
Spinal accessory nerve (cranial nerve XI)
Actions
Flexion of head and neck; contralateral rotation of head and
neck; lateral flexion of head and neck

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Scalenes
Anterior scalene
Superior attachment: transverse processes of C3-C7
Inferior attachment: inner border of first rib
Middle scalene
Superior attachment: transverse processes of C2-C7
Inferior attachment: external surface of the first rib

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Scalenes contd
Posterior scalene
Superior attachment: transverse processes of C5-C7
Inferior attachment: external surface of second rib
Actions of all scalene muscles
Flexion of neck (anterior and middle scalenes)
Assist with inspiration via elevation of first and second ribs
Lateral flexion
Innervation of all three scalenes
Ventral rami (C3-C7)

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Anterior Craniocervical Muscles:
Longus Colli
Inferior attachment
Bodies and transverse processes of C3-T3
Superior attachment
Transverse processes and bodies of C1-C6
Actions
Flexion of neck
Innervation
Ventral rami C2-C8

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Anterior Craniocervical Muscles:
Longus Capitis
Inferior attachment
Transverse processes of C3-C6
Superior attachment
Anterior to foramen magnum (occipital bone)
Actions
Bilateral: flexion of head and neck
Unilateral: lateral flexion of head and neck
Innervation
Ventral rami C1-C3
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Anterior Craniocervical Muscles:
Rectus Capitis Anterior
Inferior attachment
Transverse processes of C1
Superior attachment
Just anterior to occipital condyles
Actions
Flexion of head (atlanto-occipital joint only)
Innervation
Ventral rami (C1-C2)
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Anterior Craniocervical Muscles:
Rectus Capitis Lateralis
Inferior attachment
Transverse processes of C1
Superior attachment
Just lateral to occipital condyles
Actions
Unilateral: lateral flexion (atlanto-occipital joint only)
Innervation
Ventral rami (C1-C2)
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Posterior Craniocervical Muscles:
Splenius Capitis
Inferior attachment
Spinous processes of C7-T4
Superior attachment
Mastoid process and lateral 1/3 of superior nuchal line
Innervation
Dorsal rami (C2-C8)
Actions
Extension, lateral flexion, and ipsilateral rotation of head and
neck
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Posterior Craniocervical Muscles:
Splenius Cervicis
Inferior attachment
Spinous processes of T3-T6
Superior attachment
Transverse processes of C1-C3
Innervation
Dorsal rami (C2-C8)
Actions
Extension, ipsilateral rotation, and lateral flexion of neck
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Functional Considerations: Fine-
Tuning Motions of Head and Neck
Control of head and neck is essential for coordinated
alignment of eyes and ears
e.g., turning to locate and listen to sound
Neurologically, many head and neck muscles are
closely linked to visual and vestibular systems of
brain
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Functional Considerations: Fine-Tuning
Motions of Head and Neck contd
Primary function of numerous deeper craniocervical
muscles is to fine-tune movements of head and neck
Deeper craniocervical muscles are effective at
neutralizing secondary actions otherwise dictated by
plane of facet joints

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Anterior Muscles of Trunk
Include matching pairs of rectus abdominis, external
oblique, internal oblique, and transverse abdominis
Often referred to as abdominals, they provide an
important source of mobility and stability to trunk
Decrease distance between xiphoid process of sternum and
pubic bone
Rotate and/or laterally flex trunk
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Anterior Muscles of Trunk:
Rectus Abdominis
Inferior attachment
Crest of pubis
Superior attachment
Xiphoid process and cartilages of ribs 5-7
Innervation
Intercostal nerves (T7-T12)
Actions
Flexion of trunk; posterior pelvic tilt; increase intra-abdominal
and intrathoracic pressure
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Anterior Muscles of Trunk:
External Oblique
Lateral attachment: lateral side of ribs 4-12
Medial attachment: iliac crest and linea alba
Innervation
Intercostal nerves (T8-T12)
Actions
Flexion of trunk; posterior pelvic tilt; increase intra-abdominal
and intrathoracic pressure; rotation of trunk to opposite side;
lateral flexion of trunk
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Anterior Muscles of Trunk:
Internal Oblique
Lateral attachment
Iliac crest, inguinal ligament, and thoracolumbar fascia
Medial attachment
Ribs 9-12, linea alba, and rectus sheath
Innervation: intercostal nerves (T8-T12)
Actions
Flexion of trunk posterior pelvic tilt
Increase intra-abdominal and intrathoracic pressure
Lateral flexion of trunk
Rotation of trunk to same side
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Anterior Muscles of Trunk:
Transverse Abdominis
Lateral attachment
Iliac crest, thoracolumbar fascia, cartilages of ribs 6-12, and
inguinal ligament
Medial attachment
Linea alba, contralateral rectus sheaths
Innervation
Intercostal nerves (T7-T12)
Actions
Increase intra-abdominal pressure
Increase tension in thoracolumbar fascia

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Other Functionally Associated Muscles:
Iliopsoas and Quadratus Lumborum
Iliopsoas is combination of iliacus and psoas major
Muscle is primary hip flexor and also plays role in other
motions of trunk and pelvis
Quadratus lumborum attaches inferiorly to iliac crest,
and superiorly to the twelfth rib and transverse
processes of L1-L4
Bilateral activation of this muscle results in extension of
lumbar spine

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Other Functionally Associated Muscles:
Iliopsoas and Quadratus Lumborum
contd
Quadratus lumborum and psoas major muscles run
nearly vertical on either side of lumbar vertebrae
Strong bilateral contraction of these muscles affords
excellent vertical stability throughout entire base of
spine including L5-S1 junction
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Functional Considerations:
Analysis of Sit-Up
Abdominal muscles bring xiphoid process toward
pubis and flatten lordotic curve of lumbar spine
This phase concludes as scapula clears supporting
surface
Hip flexor muscles rotate pelvis and attached trunk
anteriorly, drawing chest closer to knees
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Synergistic Action of Oblique
Abdominal Muscles
As a set, abdominal muscles frequently contract to
produce combination of movements involving all
three planes
Motions of lateral flexion and rotation are assisted by
muscles of posterior trunk
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Posterior Muscles of Trunk:
Erector Spinae
Large, disorganized group of muscles that run
essentially vertically on either side of spine
Extend and stabilize entire vertebral column and
craniocervical region
Consist of three thin columns of muscles: spinalis,
longissimus, and iliocostalis
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Posterior Muscles of Trunk:
Transversospinal Muscles
Include semispinalis, multifidus, and rotators
Lie deep to erector spinae and course in an oblique
direction, from one verteberas transverse processes
to spinous process of another
Well developed at lumbar and craniocervical regions,
providing stability to these vertebral column regions
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Posterior Muscles of Trunk:
Transversospinal Muscles contd
All transversospinal muscles extend vertebral column
Oblique fiber direction of most of these muscles
equips them to produce contralateral rotation
The more horizontal (and shorter) the muscle, the
greater its potential to produce horizontal plane
rotation
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Posterior Muscles of Trunk:
Short Segmental Group
Intertransversarus and the interspinales muscles
Attach between consecutive transverse processes;
each interspinalis muscle attaches between
consecutive spinous processes
Assists with lateral flexion
Effective at furnishing fine control over vertebral
column vertical stability in sagittal and frontal planes
Provides rich source of sensory feedback, essential
for postural alignment

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Functional Considerations:
Segmental versus Gross Stabilization
Each muscular column crosses many intervertebral
segments and has gross control over extension
Transversospinal muscles course obliquely across
relatively few intervertebral segments and exert more
refined, multi-directional control over vertebral
column
Deep segmental muscles cross only one
intervertebral segment and have the most precise
control over vertebral column
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Functional Considerations:
Correct versus Incorrect Lifting
Optimal lifting allows forces on low back to be shared
by muscles of arms, legs, and trunk
Incorrect lifting concentrates much of force demands
directly on low back region
Lifting incorrectly with flexed or rounded lumbar
spine increases stress on muscles, joints, and
intervertebral discs, increasing risk of injury
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Summary
Vertebral column is involved with many functions that
are essential to normal kinesiology of the body
Damage anywhere along vertebral column can result
in spinal cord injury and subsequent quadriplegia or
paraplegia
Physical therapy is often the first line of conservative
treatment for pain and dysfunction of vertebral
column
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