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ANATOMY OFSPINE
Dr Pankaj N Surange
MBBS, MD, FIPPInterventional Pain and Spine
speialist
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A!P "!ra# o$ asolioti spinein t%e oronalplane&
T%e CORONAL PLANE,
also alled t%e FRONTALPLANE, is a vertial ut t%atdivides t%e 'od# into $rontand 'ak setions& P%#siianslook at t%e oronal plane(%en t%e# vie( an A!P)anterior!posterior* +!ra# o$t%e spine to evaluatesoliosis&
Anatoial Planes
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-ateral "!ra#
o$ a k#p%otispine in t%esagittalplane&
T%e SAGITTALor MEDIAN
PLANEis a vertial ut t%atdivides t%e 'od# into le$tand rig%t setions& T%esagittal vie( is seen '#surgeons on a lateral +!ra#o$ t%e spine&
Anatoial Planes
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.T San o$ at%oraiverte'ra in t%ea+ial plane&
T%eAXIALor TRANSVERSEPLANEis a %ori/ontal utt%at divides t%e 'od# intoupper and lo(er setions& To'est vie( t%e a+ial plane o$
t%e spine, surgeons (illo$ten o'tain a .T san (it%a+ial uts&
Anatoial Planes
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Protetion o$
spinal ord and nerve roots
0 internal organs
Funtions o$ t%e Spine
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Fle+i'ilit# o$ otion in si+ degrees o$ $reedo
-e$t and 1ig%tSide Bending
Fle+ion and E+tension -e$t and 1ig%t1otation
Funtions o$ t%e Spine
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To achieve these fuctios! the s"ie
#ust have$ 1esistaneto a+ial loading
$ores, aoplis%ed '#2
3#p%oti and lordoti sagittal
plane urves
Inreased asso$ ea%verte'ra $ro .4 to t%esaru
Elastiit#aoplis%ed '#2
Alternating lordoti andk#p%oti urves
MultipleMOTION SEGMENTS
Funtions o$ t%e Spine
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5 Priar# .urves
Sagittal Plane .urves
5 Seondar#.urves
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.ervial -ordosis678! 978
Saral3#p%osis
-u'ar -ordosis :78! ;78
T%orai 3#p%osis 678! 978
Sagittal Plane .urves
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.ervial
$used verte'rae in t%esaru and o#+&
5 T%orai2T4!T46
5 -u'ar2 -4!-;
1egions o$ t%e Spine
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-ine o$ gravit# Aurile o$ t%e
earOdontoid
Bod# o$
.=Anterior to t%oraispine
Posterior to-:
Mid $eoral%eads
1egions o$ t%e Spine
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Basi ?erte'ral StruturesBasi ?erte'ral Strutures
.ervial
T%orai
-u'ar
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T%ere are t(o t#pes o$ 'one tissue2
.ortial 'one2 dense, outer s%ello$ t%e verte'ra
Detai& of Co'tica&
(oe
)ave'sia S*ste#
Detai& of Cace&&ous
(oe
5 .anellous 'one2 inner, spong#'one
T#pes o$ Bone Tissue
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Ve'te+'a&
(o,*
Pe,ic&e
La#iaSu"e'io'A'ticu&a'P'ocess
S"iousP'ocess
T'asve'se
P'ocess
Ve'te+'a&Fo'a#e
?erte'ral Strutures
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Su"e'io'
A'ticu&a'P'ocess
Ife'io'A'ticu&a'P'ocess
-*.a"o"h*sea&/oit
0Facet /oit1
Pa's
?erte'ral Strutures
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T%e Atlas ).4*
T'asve'se
P'ocess
T'asve'seFo'a#e
Ate'io'Tu+e'c&e
A'ticu&a' Facetfo' Des
Late'a&Mass
La#iaPoste'io'
Tu+e'c&e
Su"e'io'
A'ticu&a'Facet
SuperiorView
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T%e A+is ).6*
O,otoi,
P'ocess
0Des1
(o,*
T'asve'se
P'ocess
Ife'io'
A'ticu&a'
Facet
Su"e'io'
A'ticu&a'
Facet
Anterior Posterior
Late'a&Mass
S"ious
P'ocess
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-o(er .ervial ?erte'rae
.: to .= Ma# 'e re$erred to
as t%e su+a2ia&'e.io
Dis at ever# level
?erte'ral struturesare siilar
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-o(er .ervial ?erte'rae.: ! .=
T'asve'seP'ocess(o,*
Su&cus fo'S"ia& Ne've
Late'a&
Mass
La#ia
Pe,ic&e
Su"e'io'A'ticu&a' Facet
Ve'te+'a&Fo'a#e
(ifi, S"ious P'ocess
T'asve'seFo'a#e
Axial View
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Su&cus fo'S"ia& Ne've
%ciateP'ocess
%cove'te+'a& /oit
0/oit of Lusch3a1
-o(er .ervial ?erte'rae.: ! .=
Anterior ?ie(
T%e verte'ral 'odies o$ t%e su'a+ial ervial spine %ave up(ardprojetions on t%e lateral argins alled %NCINATE PROCESSES&
T%ese proesses artiulate (it% t%e level a'ove to $or t%e%NCOVERTE(RAL /OINT& T%ese are also alled /OINTS OF L%SC)4A&
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?erte'ra Proinens ).=*
S"iousP'ocess
Axial View
.= is re$erred to as t%eVERTE(RA PROMINENS'eauseit %as a longer and largerspinous proess t%an t%e ot%er
ervial verte'rae&
T%is spinous proess is notusuall# 'id&
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T%orai ?erte'rae
Bod#! progressive inrease inass $ro T4 to T46
5 Pediles! sall diaeter
5 -ainae! vertial, (it% roo$tileC arrangeent
5 Spinous proesses! long,
overlapping, projeteddo(n(ard
5 Interverte'ral $oraen!larger, less inidene o$ nerveopression
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T%orai ?erte'rae, T4!T46 Bod#! %eart s%aped (%en
vie(ed superiorl#&
5 ?erte'ral $oraen!round
5 Pediles! sall indiaeter
5 Spinous proesses!
long and projeteddo(n(ards
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Artiular proesses
Su"e'io' A'ticu&a'P'ocess
Ife'io' A'ticu&a'P'ocess
T%orai ?erte'rae, T4!T46
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5 Bod#! -4 to -; progressiveinrease in ass
5 Pediles! longer and (idert%an t%orai oval s%aped
5 Spinous proesses!%ori/ontal, suare s%aped
5 Transverse proesses!saller t%an in t%orai
region5 Interverte'ral $oraen!large, 'ut (it% inreasedinidene o$ nerve rootopression
-u'ar ?erte'rae, -4!-;
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T%e SaruSac'a& )o's
Sac'a& A&a
Pe,ic&esDo'sa&Fo'a#ia
Sac'a&)iatus
Cocc*2Posterior
View
Ive'te, t'ia.&e sha"e
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Cocc*2Lateral View
Sac'a&P'o#oto'*
Sac'a& Ti&t5678967
Sac'a& Caa&
:;
5
ithC: su"e'io'
facets
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A&so ca&&e, -BGAPOP)BSEAL /OINTS
The facet ?oits a'e fo'#e, +* the
a'ticu&a' "'ocesses of a,?acet ve'te+'ae
The ife'io' a'ticu&a' "'ocessof a ve'te+'a
a'ticu&ates >ith the su"e'io' a'ticu&a'"'ocessof the ve'te+'a +e&o>
These a'e s*ovia& .&i,i. ?oits
Facet ?oits a'e o'iete, i ,iffe'et"&aes ,e"e,i. o thei' aato#ic
&ocatio
T%e Faet oints
< ' l i
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ith theife'io'! &ate'a& as"ect of the ve'te+'a
a+ove to fo'# the %NCOVERTE(RAL
/OINTS! a&so 3o> as the /OINTS
OF L%SC)4A These a'e fi+'ous ?oits
%ciateP'ocess
. ' l i
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The T;8T tho'acic ve'te+'a
have facets su"e'io'&* a, ife'io'&*
at the "oste'io' as"ect of the
ve'te+'a& +o,* that fo'# the
COSTOVERTE(RAL?oits
.ostoverte'ral ointsCostove'te+'a&
?oits
Ri+
Costot'asve'se
?oits
A2ia& Vie>
I the tho'acic s"ie! the RI(S
a'ticu&ate >ith the ve'te+'ae at +oth the +o,*
a, the t'asve'se "'ocesses
At a&& tho'acic &eve&s the'e is a
facet >he'e the 'i+ a'ticu&ates >ith
the t'asve'se "'ocess These a'e
ca&&e, the COSTOTRANSVERSE
?oits
The T: a, T:68T:; ve'te+'a&
+o,ies have o&* oe costa& facet
Ri+
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Late'a& Vie>
Costove'te+'a&?oits
Costot'asve'se?oit
Ri+
.ostoverte'ral oints
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Saroilia oint
Sac'oi&iacLi.a#ets
Sac'u#
I&iu#
The su"e'io' &ate'a& su'face oeithe' si,e of the sac'u# a'ticu&ates
>ith the ie' as"ects of the "e&vis
This a'ea fo'#s the ca"su&a'! s*ovia&
SACROILIAC /OINT
I so#e cases the
sac'oi&iac ?oit is a
hi,,e sou'ce of +ac3"ai
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Ite't'asve'se&i.a#ets
Costa&&i.a#ets
-o(er .ervial,T%orai, and
-u'ar -igaents
The INTERTRANSVERSE
LIGAMENTSe2te, f'o# the
ife'io' su'face of the eti'e
&e.th of the t'asve'se "'ocess
to the su"e'io' su'face of the
a,?acet t'asve'se "'ocess
The COSTAL LIGAMENTScoect the hea,s of the 'i+s to
the ve'te+'ae
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Poste'io' &o.itu,ia& &i.a#et
-o(er .ervial,T%orai, and
-u'ar -igaentsPOSTERIOR LONGIT%DINALLIGAMENT0PLL1Is >ea3e' tha the ALL
It 'us f'o# the a2is 0C;1 cau,a&&* to
the sac'u#
The PLL is a''o> at the &eve&s of the
ve'te+'ae! +ut the fi+e's e2te, &ate'a&&* at
the ,isc &eve&s These fi+e's #a* he&" to
cotai he'iate, ,isc #ate'ia&
Li3e the ALL! the PLL is attache, to
the ve'te+'a at the su"e'io' a, ife'io'#a'.is! a, to the au&a' fi+e's of the
ite've'te+'a& ,isc
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Ite's"ious&i.a#et
Li.a#etu#uchae
-o(er .ervial,T%orai, and
-u'ar -igaentsThe INTERSPINO%SLIGAMENTcoects each a,?acets"ious "'ocess
I the ce'vica& s"ie the
ite's"ious &i.a#et +eco#es "a't
of the LIGAMENT%M N%C)AE! thate2te,s c'aia&&* to ise't ito the
occi"ut
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T%e S%PRASPINO%SLIGAMENTis a ver# strong'and onneting t%e tipso$ ontiguous spinousproesses& It e+tends $ro
.= to t%e saru&
Su"'as"ious&i.a#et
Li.a#etu#uchae
-o(er .ervial,T%orai, and
-u'ar -igaents
A+ove C these fi+e's a'e
"a't of the LIGAMENT%M
N%C)AE
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T%e ILIOL%M(AR LIGAMENTSe+tend $ro t%e transverse
proesses o$ -9 and -; to t%eilia rest&
I&io&u#+a'&i.a#ets
Anterior View Posterior View
-u'osaral-igaents
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-u'osaral -igaents
Anterior View
Lu#+osac'a&
&i.a#etsThe L%M(OSACRALLIGAMENTis a thic3! fi+'ous +a,
that e2te,s f'o# the ate'io'!
ife'io' as"ect of the t'asve'se
"'ocess of L= to the &ate'a& su'face
of the sac'u#
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Saroilia -igaentsSho't sac'oi&iac
&i.a#ets
Posterior View
Lo. sac'oi&iac&i.a#ets
The SACROILIAC LIGAMENTSa'e
as fo&&o>s$ sho't sac'oi&iac &i.a#ets$
co#"ose, of ho'iota& fi+e's
e2te,i. f'o# the sac'u# to
the "oste'io' "a't of the i&iac
+oe
&o. sac'oi&iac &i.a#ets$
co#"ose, of fi+e's e2te,i.
ve'tica&&* f'o# the sac'u# to
the "oste'io' su"e'io' i&iacs"ie
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Posterior Spinal Musle
Groups
I&iocosta&is
The su"e'ficia& "oste'io'
#usc&esa'e co&&ective&* ca&&e, theERECTOR SPINAE! co#"'isi. th'ee.'ou"s$
Lo.issi#usS"ia&is
E'ecto'
S"iae
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Posterior Spinal Musle Groups
se#is"ia&isca"itis
se#is"ia&is
ce'vicisse#is"ia&is
tho'acis
The #i,,&e! o' ite'#e,iate! #usc&e .'ou" of the s"ie
is ca&&e, the SEMISPINALIS GRO%P$
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Posterior Spinal Musle Groups
Mu&tifi,us
Ite't'asve'sa'iiattach#ets+et>ee s"ious"'ocesses
Rotato'es
0&o.us a, +'evis1
Rotato'es
ce'vices
Rotato'es
tho'acis
Rotato'es&u#+o'u#
Levato'es costae0&o.us a, +'evis1
The ,ee" #usc&e &a*e'
cosists of the fo&&o>i.
.'ou"s$
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Arteries o$ t%e .ranial and .ervial1egion
Fo'a#e&ace'u#
Ve'te+'a&a'te'*
Ca'oti,a'te'*
T>o VERTE(RAL ARTERIES!oe &ocate, o each si,e the
ce'vica& ve'te+'ae These a'te'ies
a'e +'aches of the 'i.ht a, &eft
su+c&avia vs that e2it f'o# ao'ta
The* asce, th'ou.h the
t'asve'se fo'a#e of C9 th'ou.hC:!ete'i. the s3u&& th'ou.h the
fo'a#e #a.u# >he'e the* ?oi
to.ethe' to fo'# the (ASILAR
ARTERB
Ate'io' to the ce'vica&ve'te+'ae a'e the CAROTID
ARTERIES! >hich asce, th'ou.h
the FORAMEN LACER%Ma,?oi >ith the ve'te+'a& a'te'ies to
fo'# the CIRCLE OF ILLIS
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Arteries o$ t%e .ranial and .ervial1egion
Ve'te+'a&
a'te'ies
(asi&a'a'te'*
Ci'c&e of i&&is
Ite'a&ca'oti,
a'te'ies
Arteries o$ t%e T%orai and
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Arteries o$ t%e T%orai and-u'osaral 1egions
Ve'te+'a&a'te'*
Ao'tic a'ch
Asce,i.ao'ta
Desce,i.ao'ta
Tho'acic
se.#eta&a'te'iesA+,o#ia&ao'ta
(ifu'catioof the ao'ta Lu#+a'
se.#eta&a'te'iesE2te'a& i&iac
a'te'* 0&eft 'i.ht1 Ite'a&
i&iac a'te'*0&eft 'i.ht1Fe#o'a& a'te'*
0&eft 'i.ht1
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The #ost i#"o'tat veous st'uctu'es i the
ce'vica& s"ie a'e the ite'a& a, e2te'a&/%G%LAR VEINS The ite'a& ?u.u&a' veis fo&&o>
a "ath si#i&a' to the ca'oti, a'te'ies The* shou&,
a&>a*s +e cosi,e'e, ,u'i. a* ate'io' ce'vica&
s"ie "'oce,u'e
?eins o$ t%e .ervial and T%orai1egion
E2te'a&?u.u&a'
Ate'io'?u.u&a'
Ite'a&
?u.u&a'
?eins o$ t%e T%orai and -u'ar
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?eins o$ t%e T%orai and -u'ar1egion
Ite'a&?u.u&a'
Su"e'io'vea cavaA*.osvei
Tho'acicse.#eta&
veis
)e#ia*.os
vei
Lu#+a'se.#eta&veis
Ife'io'vea cava
Co##oi&iac veis
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BatsonJs Ple+us
TheA-BGOS SBSTEMis a &a'.e
et>o'3 of veis ,'aii. +&oo, f'o#
the itesties a, othe' a+,o#ia&o'.as +ac3 to the hea't The
se.#eta& veis ,'ai ito the a*.os
vei &ocate, o the 'i.ht si,e of the
a+,o#e! o' ito the he#ia*.os vei
&ocate, o the &eft si,eThe a*.os s*ste# a&so
co##uicates >ith a va&ve&ess
veous et>o'3 3o> as (ATSONHS
PLEX%S he the vea cava is
"a'tia&&* o' tota&&* occ&u,e,! (atsoHs
"&e2us "'ovi,es a a&te'ate 'oute fo'+&oo, 'etu' to the hea't
The vesse&s of (atsoHs "&e2us
#a* +e 'efe''e, to as e"i,u'a& veis
(atsoHs"&e2us
S i l N St t
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Spinal Nerve StruturesS"ia& Co', .ontained in epidural spae
Net(ork o$ sensor# and otornerves
Fir, ord!like struture
Fo'a#e#a.u#
E2te,s f'o# fo'a#e #a.u#to
L:
Te'#iates at the
cous #e,u&a'is
Thecau,a euia +e.is
+e&o> L:
Fi&u# te'#ia&ee2te,s f'o#
cous #e,u&a'is to the cocc*2
Cous#e,u&a'is
Cau,aeuia
Meninges
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Meninges
Du'a #ate'
Su+,u'a& s"ace
A'achoi,&a*e'
Su+a'achoi,s"ace$ fi&&e,>ith CSF
Pia #ate'
ithi the s"ia& caa&! the s"ia& co', is su''ou,e, +* the
EPID%RAL SPACE! fi&&e, >ith fatt* tissue! veis! a, a'te'ies The fatt*
tissue acts as a shoc3 a+so'+e'
The s"ia& co', is cove'e, +* MENINGES>hich has th'ee &a*e's
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S i l N
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Spinal NervesS"ia&
co',
E"i,u'a&s"ace
Du'a #ate' a,A'achoi, &a*e's
Su+a'achoi,s"ace
Do'sa& 'oot
Vet'a&
'oot
Do'sa& 'oot.a.&io
Pe'i"he'a&
e've
A t i N S t
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Autonoi Nervous S#steI,e"e,et of vo&uta'* cot'o&
Cot'o&s .&a,u&a' a, ca',iac
fuctio a, s#ooth #usc&e such as
that fou, i the ,i.estive t'act
The'e a'e t>o co#"oets$ s*#"athetic
"a'as*#"athetic
The cot'o& cete's of +oth
s*ste#s a'e &ocate, outsi,e the
s"ia& co', i st'uctu'es ca&&e,
GANGLIA
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T%ank YouT%ank You