Overview

 

The spinal column is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. When the spine is injured and its function is impaired the consequences can be painful and even disabling. According to estimates, 80 percent of Americans will experience low back pain at least once in their lifetime. A small number of patients will develop chronic or degenerative spinal disorders that can be disabling.

Men and women are equally affected by lower back pain, and most back pain occurs between the ages of 25 and 60. However, no age is completely immune. Approximately 12% to 26% of children and adolescents suffer from low back pain. Fortunately most low back pain is acute, and will resolve itself in three days to six weeks with or without treatment. If pain and symptoms persist for longer than 3 months to a year, the condition is considered chronic.

The normal anatomy of the spine is usually described by dividing up the spine into 3 major sections: the cervical, the thoracic, and the lumbar spine. (Below the lumbar spine is a bone called the sacrum, which is part of the pelvis). Each section is made up of individual bones called vertebrae. There are 7 cervical vertebrae, 12 thoracic vertebrae, and 5 lumbar vertebrae. An individual vertebra is made up of several parts.

The body of the vertebra is the primary area of weight bearing and provides a resting place for the fibrous discs which separate each of the vertebrae. The lamina covers the spinal canal, the large hole in the center of the vertebra through which the spinal nerves pass. The spinous process is the bone you can feel when running your hands down your back. The paired transverse processes are oriented 90 degrees to the spinous process and provide attachment for back muscles.


The anatomy of the spinal column is extremely well designed to serve many functions. All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain, mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it. The back is also the powerhouse for the entire body, supporting our trunks and making all of the movements of our head, arms, and legs possible.


Cervical Spine

Millions of people suffer from pain in their necks or arms. A common cause of cervical pain is a rupture or herniation of one or more of the cervical discs. This happens when the annulus of the disc tears and the soft nucleus squeezes out. As a result, pressure is placed on the nerve root or the spinal cord and causes pain in the neck, shoulders, arms and sometimes the hands. Cervical disc herniations can occur as a result of aging, wear and tear, or sudden stress like from an accident.

Most cases of cervical pain do not require surgery and are treated using non-surgical methods such as medications, physical therapy and/or bracing. However, if patients experience significant pain and weakness that does not improve, surgery may be necessary.


Thoracic Spine

This part of your spine is your upper back. It is made up of 12 vertebrae. The rib cage of the chest is attached to the thoracic spine at each level. This gives a great deal of stability and support to the upper body. This in turn, limits the back's movement at the chest level.

Because the upper back isn't designed for movement, it is uncommon to have injuries of the thoracic spine. However, irritation of the large muscles of the back and shoulder or joint problems in the upper back can be very painful.


Lumbar Spine

Physicians use a code to number each of the 24 vertebrae in the spine. The low back officially begins with the lumbar region of the spine directly below the cervical and thoracic regions and directly above the sacrum. The lumbar vertebrae, L1-L5, are most frequently involved in back pain because these vertebrae carry the most amount of body weight and are subject to the largest forces and stresses along the spine

The true spinal cord ends at approximately the L1 level, where it divides into many different nerve roots that travel to the lower body and legs. This collection of nerve roots is called the "cauda equina," which means horse's tail and describes the continuation of the nerve roots at the end of the spinal cord.


Vertebrae

The vertebral body is a thin ring of dense cortical bone. The vertebral body is shaped like an hourglass, thinner in the center with thicker ends. Outer cortical bone extends above and below the superior and inferior ends of the vertebrae to form rims. The superior and inferior endplates are contained within these rims of bone.


Pedicles

The pedicles are two short rounded processes that extend posteriorly from the lateral margin of the dorsal surface of the vertebral body. They are made of thick cortical bone.


Laminae

The laminae are two flattened plates of bone extending medially from the pedicles to form the posterior wall of the vertebral foramen. The Pars Interarticularis is a special region of the lamina between the superior and inferior articular processes. A fracture or congenital anomaly of the pars may result in a spondylolisthesis.


Intervertebral Discs

Intervertebral discs are found between each vertebra. The discs are flat, round structures about a quarter to three quarters of an inch thick with tough outer rings of tissue called the annulus fibrosis that contain a soft, white, jelly-like center called the nucleus pulposus. Flat, circular plates of cartilage connect to the vertebrae above and below each disc. Intervertebral discs separate the vertebrae, but they act as shock absorbers for the spine. They compress when weight is put on them and spring back when the weight is removed.


Facet Joints

Joints between the bones in our spine are what allow us to bend backward and forward and twist and turn. The facet joints are a particular joint between each vertebral body that help with twisting motions and rotation of the spine. The face joints are part of the posterior elements of each vertebra.


Ligamentum Flavum

The ligamentum flavum is a strong ligament that connects the laminae of the vertebrae. The term "flavum" is used to describe the yellow appearance of this ligament in its natural state.


Spinal Cord

The spinal cord is part of the central nervous system of the human body. It is a vital pathway that conducts electrical signals from the brain to the rest of the body through individual nerve fibers. The spinal cord is a very delicate structure that is derived from the ectodermal neural groove, which eventually closes to form a tube during fetal development.

From this neural tube, the entire central nervous system, our brain and spinal cord, eventually develops. Up to the third month of fetal life, the spinal cord is about the same length as the canal. After the third month of development, the growth of the canal outpaces that of the cord. In an adult the lower end of the spinal cord usually ends at approximately the first lumbar vertebra, where it divides into many individual nerve roots

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