ANATOMY 1st Semester

2.1 DEEP BACK SY 2013-2014

DR. CALILAO
JULY 23, 2013
OUTLINE
I. Back
II. Vertebra
A. Typical Vertebra
B. Cervical Vertebra
C. Thoracic Vertebra
D. Lumbar Vertebra
E. Sacrum
F. Coccyx
III. Joints and Ligaments
IV. Muscles
A. Extrinsic
B. Intrinsic
C. Suboccipital and Deep Neck
V. Nerve Supply
VI. Blood Supply
A. Arterial Supply
B. Venous Drainage
II. VERTEBRAE
C. Lymphatic Drainage
 Encompasses the neck and back to which the head,
neck, and limbs are attached (from the cranium to
OBJECTIVES
coccyx)
 Demonstrate knowledge and understanding of the  33 vertebrae (24 movable) arranged in five regions:
anatomy of the deep back by:
o 7 cervical
o Describing the general structure of the
o 12 thoracic
vertebral column.
o 5 lumbar
o Identifying the distinguishing o 5 sacral-fuse to form the sacrum
characteristics of a representative vertebra o 4 coccygeal-fuse to form the coccyx
from the cervical, thoracic, lumbar and  Size of vertebral bodies progressively increases in
sacral regions. size as it descends towards sacrum, from the sacrum,
o Identifying the deep back musculature, it decreases progressively
including the muscles in the suboccipital  From the column, weight is transmitted to the pelvic
region as to their general attachments, girdle, which transmits it to the lower limbs
innervation, actions, blood supply and  Maximal size is at L5
lymphatic drainage. FUNCTIONS
 Protects spinal cord and spinal nerves
References:  Supports the weight of the body superior to the level
Specific books, journals, etc. Please cite properly. of the pelvis
 Provides a partly rigid and flexible axis for the body
Legend: Italicized – quoted from the lecturer; bold – emphasis, or  Plays an important role in posture and locomotion
from references

I. BACK
 Skin and subcutaneous tissue
 Muscles
o Superficial layer : upper limbs
o Deeper layers / “true back muscles” : posture
 Vertebral column
o Vertebrae, IV discs, associated ligaments
 Ribs in thoracic region
 Spinal cord and meninges
o Membranes that cover the spinal cord)
 Nerves and vessels

CURVATURES
Transcribers: Page 1 of 16
Group 2: Malimban, Manalili, Manarang, Mandac, Maniulit, Manuel, Maramba, Margate, Martin, Martinez MEDICINE CLASS 2017
 ANA 2.1
 Primary curvature – at birth (concave anteriorly,  7 processes
convex posteriorly) o 3 for muscle attachment (spinous and transverse
o Thoracic processes)
o Sacral o 4 participate in synovial joints(superior and
 Secondary curvature (convex anteriorly, concave inferior articular processes/facets)
posteriorly)
o Cervical curvature PEDICLES - Pedicle comes from the Latin term pediculus
 1st of secondary to appear meaning little foot. This is the diminutive form of the
 Forms when the baby learns to Latin pes or foot. It is applied to processes that resemble a
hold its head up foot or act as a foot or stem. These are thick stems of
o Lumbar curvature bones that project posteriorly from the body of the
 2nd of secondary to appear vertebra. They form the medial wall of the transverse
 Forms when toddler begins to foramen and the lateral wall of the vertebral foramen.
walk Their superior surfaces are covered by the superior
*Four curvatures are well established in adults articular facets.

LAMINA - The term lamina is Latin for plate, leaf, or thin

scale. It describes thin plate-like structures, typically
bone. These are thickened plates of bone between the
transverse and spinous processes. They are vertically
flattened and provide attachment for many muscles and
ligaments. Etymology

A. Typical Vertebra
 Vertebral body  Regional Characteristics of Vertebrae

 Vertebral arch

B. Cervical Vertebra
 Body: small and wide
 Vertebral foramen: large and triangular
 Nearly horizontal articulation of articular facets
 Relative thickness of IV discs
 Small amount of surrounding body mass
*Greatest range and variety of movement: flexion,
extension, lateral flexion, and limited rotation

C3-C6 Typical Cervical Vertebrae

 Body: Superolateral projection (uncus)
 Foramen:

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 ANA 2.1
o Large and triangular (to accommodate the
enlargement of spinal cord)
 Enlargement due to brachial
plexus which innervates the upper
limb
 Presence of transverse foramen
o Vertebral artery passes through the
transverse foramen of cervical vertebrae
except for C7
o Transverse foramen of C7 is either small or
absent
o Artery goes up, except at C1 where its
course is horizontal
 Spinous process:
o Bifid
 Uncus (aka uncinate process): C2 Vertebra/AXIS
o Elevated superolateral projections of the  Strongest
body  2 large superior articular facets
 Carotid Tubercle  Dens (odontoid process)
o Same as anterior tubercle of C6 o Tooth-like in feature
o Area where you can compress the common  Large bifid spinous process
carotid artery during cases of trauma to  2 large superior facets
control bleeding  Articulation of C1 and C2
o Permits rotation, turn head side to side
C7 o Dens as pivot
o Joint involved in saying “NO”(Atlanto-axial)
 Spinous process
 Held in socket formed:
o Long and not bifid
o Anteriorly: posterior portion of the anterior
 Aka vertebra prominens
arch of C1
o Can be seen when neck is flexed in 70% of
o Posteriorly: Transverse ligament of atlas
population)
 Vertebral artery does not pass here
o Transmit only accessory veins

C. Thoracic Vertebra
C1 Vertebra/ATLAS General Characteristic:
 No body, no spinous process COSTAL FACETS - articulate with the ribs
 Ring-shaped with paired lateral masses 1. Superior costal facet - articulates with the head of the rib
 Widest of the cervical vertebrae 2. Inferior costal facet - articulates with the head of the rib
o Has lateral masses 3. Transverse costal facet - articulates with the tubercle of
o Transverse process project from lateral the rib
masses
 Superior articular facet articulate with occipital
condyles
o Similar with the Titan god Atlas who
carried the world on his shoulders as
punishment (world = skull)
 Groove for vertebral artery
o Area where the course of artery is
horizontal
o Artery needs to enter foramen magnum to
enter cerebral circulation

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Figure X. Left: thoracic vertebrae, Right: rib
A. TYPICAL THORACIC VERTEBRA (T5 - T8)
Superior view
Lateral view
 Body : Heart - shaped
 Vertebral Foramen: Circular, smaller
 Articular Facets: Vertically-oriented
 Spinous Process: Long, slope posterioinferiorly, overlapping
 Attachment to the Ribs: Costal attachment
 Movements Permitted:
o rotation (greatest degree is allowed in the thoracic
region)
o limited flexion, extension and lateral flexion
B. ATYPICAL THORACIC VERTEBRA
1. T1 - T4
- characteristics similar to cervical vertebra
T1
 Spinous Process: Long (can be as long as the vertebra
prominens)
 Superior Edge: has complete costal facet for articulation with
the 1st rib
 Inferior Edge: has demifacet (half facet) for articulation with the
2nd rib
ANA 2.1
Figure X. Anterior view of the superior portion of the ribs
highlighting T1
2. T9 - T12
- features similar to lumbar vertebra
- tubercles similar to the accessory and mamillary process of
lumbar vertebra
T12
- transition from thoracic to lumbar is most evident  subjected to
high tensional stress  most commonly fractured vertebrae
 Superior Half: thoracic in character; with costal facets and
articular process that permits rotator movement
 Inferior Half: lumbar in character; devoid of costal facets; with
articular process that permits flexion and extension
Lateral view of T12
D. Lumbar Vertebra
L1 - L5:
- biggest unfused vertebra of the vertebral column
- strong and capacitated for weight-bearing and protection of
spinal cord
- highly flexible for movement (flexion, extension, rotation)
L5
- largest of all movable vertebra
- carries the weight of the whole upper body
Characteristics of the Parts:
 Body: large, kidney-shaped
 Vertebral Foramen: triangularly-shaped; larger than thoracic v.
but smaller that cervical v.
 Transverse Processes: long and slender
o Accessory Process on posterior surface of base of
each process
 Articular Processes: well-defined
o Superior Facets: concave, directed posteromedially
o Inferior Facets: convex, directed anterolaterally
o Mamillary Process: posterior to superior articular
process
 Spinous Processes: thick, broad, hatchet-shaped, short, sturdy
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 ANA 2.1
 Between hip bones
 Forms roof of the posterosuperior wall of the posterior
half of the pelvic cavity
 S1-S5: vertebral bodies progressively decrease because it
is not for weight bearing
 Pelvic girdle
o bony ring formed by the hip bones and sacrum
o where lower limbs are attached

FUNCTION
 Provides strength and stability to the pelvis and transmits
weight of body to the pelvic girdle
Superior view of L2  Supports vertebral column

PARTS

 Base of Sacrum
o Superior surface of S1
 Apex of Sacrum
o Tapering inferior end
o Has an oval facet for articulation with the coccyx
 Sacral Promontory
o Anterior projecting edge of the body of S1
o Important obstetric landmark
Lateral view of lumbar vertebra
 Sacral Foramina
o For exit of posterior and anterior rami of the
spinal nerves

Posterior view of L3-L4

E. Sacrum

o Anterior sacral foramina:

4 pairs, larger
o Posterior sacral foramina:
4 pairs, smaller

DESCRIPTION
 Wedge-shaped
 Composed of sacral vertebrae (S1-S5)
o From birth, sacral vertebrae are connected by
hyaline cartilage and separated by IV discs
o Fusion starts after age 20
o Most of IV discs remain unossified until or
beyond middle life
 Auricular surface
o Superolateral surface
o Looks like an auricle (external ear)
o Articulates with ilium to form sacroiliac joint
o Covered with hyaline cartilage
Dorsal Surface (rough, convex)
 Facets of the superior articular processes
o Articulate with inferior articular facets of L5 and
for the lumbosacral angle
 5 Prominent Longitudinal Ridges
o Median sacral crest:

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Fused rudimentary spinous processes of
superior 3-4 sacral vertebra
o Intermediate sacral crest:
Fused rudimentary articular processes
o Lateral sacral crest
Tips of transverse processes of the fused sacral
vertebrae
ANA 2.1
 Only coccygeal vertebrae that has transverse processes
which are connected to the sacrum
 Rudimentary articular process form coccygeal cornua
which articulate with sacral cornua
COCCYGEAL VERTEBRAE 2-4
 Fuse during middle life and resemble beak of bird
II. JOINTS AND LIGAMENTS
LIGAMENTS

A. PRIMARY/MAIN LIGAMENTS:
1. Anterior Longitudinal Ligament (ALL)*
 Sacral Hiatus a. Anterior Atlanto-axial Ligament
o Absence of the laminae and spinous processes of b. Anterior Atlanto-occipital Ligament
S5 (sometimes S4) 2. Posterior Longitudinal Ligament (PLL)
o Leads to sacral canal
 Sacral Cornua B. ACCESSORY LIGAMENTS
o Inferior articular processes of S5 vertebra 1. Ligamentum Flavum/ Ligamentum Flava (Plural)
o Project inferiorly on each side of sacral hiatus 2. Interspinous Ligaments
o Important landmark in locating sacral hiatus 3. Supraspinous Ligaments
4. Intertransverse Ligaments
 Sacral Canal
5. Ligamentum Nuchae
o Continuation of vertebral canal in the sacrum
o Cauda Equina:
A. PRIMARY/MAIN LIGAMENTS
 Found in the sacral canal
The ALL and PLL are continuous bands that run from the top to
 Roots emerging below the level of L1
the bottom of the spinal column along the vertebral bodies.
vertebra
They prevent excessive movement of the vertebral bones.
 Descend past termination of the spinal
cord
 “Horse tail”

F. Coccyx

 Small triangular bone

 Fusion of the 4 rudimentary coccygeal vertebrae
 Remnant of skeleton of the embryonic tale-like caudal
eminence, which is present in human embryos from the
end of 4th wk until the beginning of the 8th wk
 May flex anteriorly when sitting indicating that is
receiving some weight
FUNCTION
 Provides attachment for the gluteus maximus, coccygeal
muscles and anococcygeal ligament(the median fibrous
band of the pubococcygeus muscles )
COCCYGEAL VERTEBRA 1
 Usually not fused with the other coccygeal vertebrae and
would sometimes fuse with sacral bone
 Largest and broadest
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 ANA 2.1
 Found posterior to the vertebral bodies
1. ANTERIOR LONGITUDINAL LIGAMENT  Narrower and weaker band extending from C2 to sacrum
 Attaches mostly to the IV discs and to a lesser extent to the
posterior surface of the vertebral bodies
 Well provided with nociceptive (pain) nerve endings
 **If you have bone spurs, it is perceived as back pain **
 Annulus fibrosus that are absent posteriorly in some cervical
regions may be painful sometimes
FUNCTION:
 Weakly resists hyperflexion of the vertebral column
 Prevents herniation of the nucleus pulposus

B. ACCESSORY LIGAMENTS OF INTERVERTEBRAL JOINTS

1.LIGAMENTUM FLAVUM/ LIGAMENTUM FLAVA (Plural)

DESCRIPTION:
 Compact, strong and broad fibrous band which covers the
anterior and lateral surfaces of the vertebral bodies and IV discs
 Extends as a band that goes up from the anterior surface/pelvic
surface of the sacrum up to the level of the anterior tubercle of
C1 and anterior surface of the foramen magnum
FUNCTION:
 Prevents hyperextension of the vertebral column
 Only ligament that limits extension (All other IV ligaments
limit flexion)
BECOMES:
(So named according to structures that they span)
1. Anterior atlanto-occipital ligament-above C1 but below the
skull
2. Anterior atlanto-axial ligament -above C2 but below C1, the
ALL
2. POSTERIOR LONGITUDINAL LIGAMENT

DESCRIPTION:
 Flavus meaning yellow
 Bands of elastic tissue that connects successive lamina from
one another
 Thickest in lumbar region
DESCRIPTION: FUNCTIONS:

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 Resist separation of vertebral lamina by limiting abrupt
flexion of vertebral column
 Help preserve normal curvatures of vertebral column
 Assist with straightening of column after flexing
BECOMES:
1. Posterior Atlanto-Occipital Membrane - – above C1
2.Posterior Atlanto-Axial Membrane– between C2 & C1
2. INTERSPINOUS LIGAMENTS - run between the spines but the
fibers extend from the base to the apex
3. SUPRASPINOUS LIGAMENTS -connects only the tips of the
spinous processes from C7 to sacrum
4. INTERTRANSVERSE LIGAMENTS
Connects the transverse processes
ANA 2.1
5. LIGAMENTUM NUCHAE (Nuchal Ligament)
DESCRIPTION:
 Thick and strong made up of fibroelastic tissue band
 Extends from the occipital protuberance and the posterior
surface of the foramen magnum
 Descends to attach to spinous processes of the cervical vertebra
FUNCTION:
 Attachment of muscles
JOINTS OF THE VERTEBRAL COLUMN
JOINTS OF VERTEBRAL BODIES :
Symphyses (secondary cartilaginous /slightly movable joints) -
designed for weight-bearing; articulating surfaces are connected by
the IV discs
JOINTS OF VERTEBRAL ARCHES :
Zygapophysial Joints (plane synovial joints, surrounded by thin
joint capsule) - permit gliding movements bet. articular processes;
Type of movement permitted in the vertebra: determined by
shape and disposition of articular surfaces
Range of movement: determined by the size of the IV discs
relative to the body of the vertebrae that it connects
**Cervical and lumbar: weight bearing function is carried out by the
IV discs however, in the cervical and lumbar regions, the articular
surfaces are the zygapophysial joints that also have some form of
weight-bearing function. So the articulations at the zygapophysial
joints in the cervical and lumbar region help the IV discs in the
weight-bearing function
*Movements of Vertebral Column (Moore)
The following movements of the vertebral column are possible
flexion, extension, lateral flexion and rotation. The range of
movement of the
Page 8 of 16
 ANA 2.1
vertebral column varies according to the region and the individual. CRANIOVERTEBRAL JOINTS :
The normal range of movement possible in healthy young adults is 1. ATLANTO-OCCIPITAL JOINTS
typically reduced by 50% •synovial joint of the condyloid type
or more as they age. The mobility of the column results primarily  Joint between the atlas and the skull/occipital condyles
from the compressibility and elasticity of the IV discs. The range of  Articulation is between the superior articular surface found at
movement of the vertebral the lateral process of the atlas (shoulders of atlas) and the
column is limited by the: occipital condyles of the skull (globe)
 Thickness, elasticity, and compressibility of the IV discs.  Flexion and extension but to a little degree of lateral flexion
 Shape and orientation of the zygapophysial joints. and rotation
 Tension of the joint capsules of the above joints.  YES joint
 Resistance of the back muscles and ligaments (such as the  Ligaments that reinforce:
ligamenta flava and the posterior longitudinal ligament).  Anterior atlanto-occipital membrane from anterior longitudinal
 Attachment to the thoracic (rib) cage. ligament between atlas and occiput
 Bulk of the surrounding tissues.
FUNCTION:
Prevent excessive movement of atlanto-occipital joints
MOVEMENTS PERMITTED: FLEXION AND EXTENSION,
LATERAL FLEXION, ROTATION

2. ATLANTO-AXIAL JOINTS
•synovial joint with no IV disc
 3 articulations:
o 2 Lateral-gliding type of synovial joint, two articulations
between the inferior articular surface of the atlas and the
superior articular surface of the axis
o 1 Median-pivot type of synovial joint, between the odontoid
process (dens) of the axis and the ring formed by the anterior
arch and the transverse ligament of the atlas
 NO joint
MOVEMENT PERMITTED: ROTATION
LIGAMENTS THAT REINFORCE:
1.Cruciate Ligament – cross-shaped; Superior and Inferior
longitudinal ligament plus the transverse ligament
2. Alar Ligament – strong ligament that stabilize the atlanto-axial
joint
3. Tectorial Membrane – membrane from posterior longitudinal
ligament

a. SUPERFICIAL
IV. MUSCLES (see appendix) Splenius
 Origin: nuchal ligament & spinous process of C7 – T3 or
A. Extrinsic - All are innervated by ventral rami except T4
trapezius which is innervated by cranial nerve 11/spinal  Function: cover and hold deep neck ms. in position
accessory nerve –please refer to the appendix for details) Two parts:
a. Superficial (limb)  Splenius capitis – insertion: temporal bone and
i. Trapezius occipital bone
ii. Latissimus dorsi  Splenius cervicis – i: tubercles of transverse
iii. Levator scapulae processes C1-C3 or C4
iv. Rhomboidius minor and major
b. Intermediate (respiration) b. INTERMEDIATE LAYER
i. Serratus posterior superior – Erector Spinae (from lateral to medial: I love
inspiration (elevates rib) shopping/sports )
ii. Serratus posterior inferior – for  Chief extensors of vertebral column
expiration(anterior rami)
 Posterior rami of spinal n.
 Iliocostalis (cervicalis, thoracis, lumborum)
B. Intrinsic - Innervated by anterior rami
 Longissimus (capitis, cervicis, thoracis)
 For posture & control of vertebral column movement
 Spinalis (capitis, cervicis, thoracis)
 Extend from pelvis to cranium Deep fascia attached:
 Medially – nuchal ligament, spinous process of c. DEEP
vertebra, supraspinous ligament, & median crest of
Transversospinales
sacrum
 Origin: transverse processes
 Laterally – cervical & lumbar transverse processes,
 Posterior Rami of the spinal n.
angles of the ribs
Semispinalis (capitis, cervicis, thoracis)

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 Extends head, thoracic, and cervical regions of vertebral
column; rotates contralaterally
 Multifidus – thickest at lumbar
o Stabilize vertebrae during local movement
 Rotatores (brevis, longus)– deepest
o Proprioception
MINOR DEEP MUSCLES
 Posterior Rami of spinal n. (also anterior rami for
intertransversarii)
 Interspinales – bet. spinous processes
o Extension & rotation
 Intertransversarii – bet. transverse processes
o Lateral flexion & stabilization
 Levators Costarum – to ribs
o Elevate ribs, assist in resp. & lateral flexion
C. SUBOCCIPITAL AND DEEP NECK
Suboccipital Muscles – innervated by the posterior ramus
of C1 (suboccipital nerve)
1. Rectus capitis posterior major
 Origin: Spinous process of vertebra C2
 Insertion: Lateral part of the inferior nuchal line
of occipital bone
 Action: Extension of head and atlanto-occipital
joints
2. Rectus capitis posterior minor
 Does not form part of the sub-occipital triangle
 Origin: Posterior tubercle of posterior arch of
vertebra C1
 Insertion: Medial part of inferior nuchal line of
occipital bone
 Action: Extension of head of atlanto-occipital
joints
3. Obliquus capitis inferior
 Origin: Posterior tubercle of posterior arch of
vertebra C2
 Insertion: Transverse process of vertebra C1
4. Obliquus capitis superior
 Origin: Transverse process of vertebra C1
 Insertion: Occipital bone between superior and
inferior nuchal lines
 Action: Extension and lateral flexion of head of
atlanto-occipital joint
V. NERVE SUPPLY
Recurrent Meningeal Branches of the Spinal Nerve
 Supplies the fibroskeletal structure of the vertebral
column and the meninges
ANA 2.1
 Only branches to arise from the mixed spinal nerve,
arising immediately after it is formed and before its
division into anterior and posterior rami, or from the
anterior ramus immediately after its formation
 2-4 of these arise on each side at all vertebral levels
 Receive communicating branches from the nearby gray
rami communicantes
 Most of the meningeal branches run back through the
foramina into the vertebral canal hence the name
recurrent
 First branches to arise from all 31 pairs of spinal nerves
 Initially convey localized pain sensation from the back
produced:
o Acute herniation of an IV disc
o Sprain
o Contusion
o Fracture
o Tumors of the vertebral column
 Transverse, ascending and descending branches:
o Periosteum (covering the surface of the
posterior vertebral bodies, pedicles and laminae
o Ligamentum flava
o Anuli fibrosi of the posterior and posterolateral
aspect of the IV disc
o Posterior longitudinal ligament
o Spinal dura mater
o Blood vessels within the vertebral canal
 Nerve supply to the periosteum, anuli fibrosi and
ligaments supply pain receptors
 Nerve supply to the anuli fibrosi and ligament supply
receptors for proprioception (sense of one’s position)
 Sympathetic fibers to the blood vessels stimulate
vasoconstriction
VI. BLOOD SUPPLY
A. Arterial Supply
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Major Cervical Arteries (Neck Area)
- Vertebral
- Ascending Cervical
Major Segmental Arteries (Trunk Area)
- Posterior Intercostal (Thoracic Region)
- Subcostal and Lumbar (Abdomen)
- Iliolumbar, Lateral and Medial sacral (pelvis)
Periosteal and equatorial branches (major cervical and
segmental arteries) arise from the above arteries as they cross
the external (anterolateral) surfaces of vertebrae
These 2 branches plus their SPINAL BRANCHES supply the
vertebrae.
- Anterior vertebral canal branch
Nutrient arteries - Supply most of the RED MARROW of the central
vertebral body
- Posterior vertebral canal branch
Spinal branches (from parent arteries)
- Give rise to radicular or segment medullary arteries –
distributed to the posterior and anterior roots of spinal
nerves and their coverings and to spinal cord.
ARTERIAL SUPPLY OF THE BACK
CERVICAL REGION
- Occipital a. – from the external carotid
- Vertebral a. – from subclavian
- Deep cervical a. – from the branch of costocervical trunk
THORACIC REGION – posterior intercostal artery
LUMBAR REGION – subcostal and lumbar artery
SACRAL REGION – iliolumbar and lateral sacral artery
ANA 2.1
vertebral venous plexuses. There is also anterolateral drainage
from the external aspects of the vertebrae into segmental
veins.
Vertebral Column Plexuses (Internal and External)
 Extends along vertebral column from skull to coccyx
 Communicate through the foramen magnum (IV
foramina) with occipital and basilar venous sinuses
(within cranial cavity)
 Both densest anteriorly and posteriorly and relatively
sparse laterally
 Walls are thin and channels are valveless
 Form Spinal veins
a) Internal Vertebral Venous Plexus (Epidural venous
plexus)
 lie within the vertebral canal but outside dura
mater of spinal cord
 embedded in areolar tissue
b) External Vertebral Venous Plexus
 Lie external to vertebral column and surround it
Basivertebral Veins
 Form within the vertebral bodies
 Drain into external and especially the anterior internal
vertebral venous plexus
Intervertebral Veins
 Receive veins from the spinal cord and vertebral venous
plexus
 Drain internal plexus
 Joined by tributaries from external vertebral plexus and
drain into the vertebral veins of the neck and segmental
(intercostal, lumbar, sacral) veins of trunk

B. Venous Drainage C. Lymphatic Drainage

Lymph Vessels Drain into

Deep Deep cervical
Posterior mediastinal
( Lateral aortic
A Sacral nodes
)
From the Skin of Neck Cervical nodes
From the Trunk
 Above Illiac crests Axillary nodes
 Below Illiac crests Superficial inguinal nodes

(A) The dense plexus of thin-walled vessels within the

vertebral canal, the internal vertebral venous plexus, consists It does not matter how slow you go so long as you do not stop.
of valveless anastomoses between anterior and posterior -Confucius
longitudinal venous sinuses. (B) The venous drainage parallels
the arterial supply and enters the external and internal
Page 11 of 16
 ANA 2.1

APPENDIX
Vertebra Characteristics
Body Vertebral Transverse Processes Articular Processes Spinous Processes
Foramen
Cervical  Small and wider  Large and  Foramina transversarii and  Superior facets directed  Short (C3-C5)
(typical) from side to side triangular anterior and posterior superioposteriorly  Bifid (C3-C6)
than tubercles; vertebral arteries  Inferior facets directed  Process of C6 is long
anteroposteriorly and accompanying venous inferioanteriorly and C7 (vertebra
 Superior surface and sympathetic plexuses  Obliquely placed facets are prominens) longer
concave with pass through foramina mostly nearly horizontal in
uncus of body transversarii of all cervical this region
(uncinate process) vertebrae except C7 w/c
 Inferior surface transmits only small
convex accessory vertebral veins
(Atypical)
C1 (Atlas)  Ring-like; somewhat kidney-shaped when viewed superiorly or inferiorly
 No spinous process or body; consists of two lateral masses connected by anterior and posterior arches
 Concave superior articular facets create atlanto-occipital joints with the occipital condyles; flat inferior facets meet with the C2 vertebra
to create lateral atlanto-axial joints
C2 (Axis)  Strongest cervical vertebra
 Distinguishing feature is the dens, which projects superiorly from its body and provides a pivot around which the atlas turns and
carries the cranium
 Articulates anteriorly with the anterior arch of the atlas and posteriorly with the transverse ligament of the atlas
Thoracic  Heart shaped  Circular and  Long, strong & extend  Superior facets directed  Long
 One or two costal smaller than posterolaterally posteriorly and slightly  Slope
facets for those of  Length diminishes from T1 laterally posteroinferiorly
articulation with cervical and to T12 (T1-10 have facets for  Inferior facets directed  Tips extend to level
head of the rib lumbar articulation with tubercle of anteriorly and slightly of vertebral body
rib) medially below
 Plane of facets lies on arc
centered about vertebral
body
Lumbar  Massive  Triangular  Long and slender; accessory  Superior facets directed  Short and sturdy
 Kidney shaped  Larger than in process on posterior surface posteromedially (or  Thick, broad and
superiorly thoracic and of base of each process medially) hatchet shaped
smaller than  Inferior facets directed
in cervical anterolaterally (or laterally)
 Mammillary process on
posterior surface of each
superior articular process
Sacrum  Wedge-shaped bone; composed of five fused sacral vertebrae
 Base is formed by the superior surface of S1 and the apex is the portion which tapers and articulates with the coccyx
Coccyx  Small triangular bone; formed by fusion of 4 rudimentary coccygeal vertebrae
 Co1 usually not fused with the rest; largest and broadest; only Co v. with transverse process; Rudimentary articular process form
coccygeal cornua which articulate with sacral cornua
 Co 2-4 fuse during midlife and resemble beak of bird

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 ANA 2.1

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 ANA 2.1

Superficial Extrinsic
Muscles

Intermediate Extrinsic
Muscles

Superficial Intrinsic Muscles

Intermediate Intrinsic Muscles

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 ANA 2.1

Deep Intrinsic Muscles

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 ANA 2.1

Suboccipital Muscles and Suboccipital Triangle

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