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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



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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



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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


-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


-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


-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

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