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CHAPTER 5 The Head, Neck and Spine
131
• yroidectomy is carried out through a transverse incision in a skin crease two ngers’ breadth above the
supersternal notch.
• Structures encountered are:
• platysma
• investing fascia, which is opened longitudinally
between the strap muscles and between the anterior
jugular veins
• strap muscles, which may be divided in their upper
half to preserve their nerve supply from the ansa cervicalis, which is into their lower half.
• Pretracheal fascia is then divided, exposing the thyroid
gland.
• Care must be taken in dividing the superior thyroid
artery (close to the gland, to avoid the external branch
of the superior laryngeal nerve) and the inferior thyroid
artery (far away from the gland, to avoid the recurrent
laryngeal nerve).
PARATHYROID GLANDS
• Four in number, superior and inferior on each side.
• Superior glands are usually constant in position and
lie at the middle of the posterior border of the lobe of
the thyroid above the level at which the inferior thyroid
artery crosses the recurrent laryngeal nerve.
• Inferior glands are subject to variation, but are normally on the posterior part of the lower pole of the
thyroid.
• Variations of the inferior parathyroid glands are common, and may be found in the carotid sheath and in the
Rarely, they may be found behind the oesophagus or
even in the posterior mediastinum.
• ey are supplied by the posterior branches of the superior and inferior thyroid arteries.
Clinical Points
• Because of their aberrant sites, searching for them may
be dicult at surgery.
• Occasionally they may be removed or rendered ischaemic during thyroid surgery, resulting in tetany due to
hypocalcaemia.
Epiglottis
• Leaf-shaped elastic cartilage.
• Attached to body of hyoid and back of thyroid cartilage.
• Sides connected to arytenoids by aryepiglottic folds,
which form the margins of the aditus to the larynx.
Thyroid Cartilage
• Two lateral plates meeting in the midline at the laryngeal prominence.
• Cricoid cartilage.
• Signet ring–shaped; deepest posteriorly.
• Complete ring of cartilage.
• Attached to trachea by cricotracheal membrane.
Arytenoid cartilages
• Attached to each side of the ‘signet’ of cricoid cartilage.
Corniculate Cartilage
• Small nodule.
• Lies at apex of arytenoids.
Cuneiform Cartilage
• Lies at margin of aryepiglottic fold.
Cricothyroid Membrane (Cricovocal Membrane)
• Sheet of elastic yellow tissue.
• e anterior attachment of the upper edges is to the posterior surface of the thyroid cartilage and posteriorly to
the vocal process of the arytenoids.
• Upper edge forms the vocal ligament.
• Anteriorly, the membrane thickens to form the cricothyroid ligament.
Vestibular Fold
• Upper fold of mucosa passing forwards from arytenoids
to back of thyroid cartilage.
• Forms the false vocal cord.
Vocal Cord
• Lower fold of mucosa passing forwards from arytenoids
to the back of the thyroid cartilage.
• Contains the vocal ligaments.
• ere is no submucosa over the vocal ligament.
THE LARYNX (Fig. 5.24 and 5.25)
e larynx consists of:
• epiglottis
• thyroid cartilage
• cricoid cartilage
• arytenoid cartilages.
Rima Glottidis
• Space between the vocal cords.
Three Compartments of the Larynx
• Supraglottic (vestibule), above the false cords.
• Glottic, between false and true cords.
• Subglottic, between true cords and rst tracheal ring.
132
Epiglottis
Thyrohyoid ligament
Cricotracheal ligament
A
s
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SECTION I Anatomy
Thyrohyoid ligament
Cartilago triticea
Superior cornu
Lamina
Arytenoid cartilage
Inferior cornu
A
Cricothyroid
joint
Cricoid
cartilage
B
Thyroid notch
Thyroid cartilage
Fig. 5.24 The cartilages of the larynx and the hyoid bone. (A) Posterior view. (B) Lateral view.
Midbrain
Sphenoidal sinus
Clivus
Nasopharynx
nterior arch of atlas
Odontoid peg
Occipital lobe
Pons
Cerebellum
Posterior arch of atla
Oropharynx
Epiglottis
Trachea
Fig. 5.25 Sagittal MRI scan of neck showing the pharynx, larynx and trachea. (From Jacob S: Atlas of Human
Anatomy. Churchill Livingstone 2002, with permission.)
Hypopharynx
Spinal cord
CHAPTER 5 The Head, Neck and Spine
Base of
Corniculate
Glossoepiglottic
133
Piriform Fossa
• A recess on either side of the larynx where foreign bodies may lodge.
Muscles of the Larynx
Functions of muscles of the larynx are to:
• open the glottis in inspiration
• close the glottis in swallowing
• alter the tension of the vocal cords in phonation.
Actions
ese include:
• cricothyroid tenses the vocal cord
• posterior cricoarytenoid abducts the cords
• all other muscles adduct the cords, i.e. sphincter action.
Blood Supply
• Superior and inferior laryngeal arteries.
• Accompany the superior laryngeal nerve and the recurrent laryngeal nerves, respectively.
Lymphatic Drainage
• Above the vocal cords to the upper deep cervical nodes.
• Below the vocal cords to the lower deep cervical
nodes.
• Vocal cords separate the two areas of drainage anteriorly
but posteriorly there is cross-communication.
Nerve Supply
Superior laryngeal nerve
• Branch of vagus.
• Internal branch pierces thyrohyoid membrane and supplies laryngeal mucosa down to the level of the vocal
cords.
• External laryngeal branch is motor to the cricothyroid
(extrinsic muscle).
Recurrent laryngeal nerve
• Branch of vagus.
• Supplies all the intrinsic muscles of the larynx.
• Supplies the mucosa below the vocal cords.
Clinical Points
• e laryngeal nerves are at risk during thyroidectomy.
e external branch of the superior laryngeal nerve is
close to the superior thyroid artery and may be damaged when ligating the vessel. e recurrent laryngeal
nerve is related to the inferior thyroid artery close to
the gland. To avoid injury it should be ligated well
laterally.
• Damage to the superior laryngeal nerve results in a
change of pitch of the voice owing to loss of innervation
of cricothyroid muscle, which is a tensor of the vocal
cord.
• Damage to recurrent laryngeal nerve results in the
cord on the aected side being paralysed in a position
between abduction and adduction. e voice may be
hoarse. Bilateral damage results in loss of voice with
diculty in breathing through the partially open
glottis.
• e larynx can be inspected either directly by means of
a laryngoscope, or indirectly through a laryngeal mirror. e following structures may be seen (Fig. 5.26):
• base of the tongue
• valleculae
• epiglottis
• aryepiglottic folds
• piriform fossa
• false cords, which are red and wide apart
• pearly white true cords.
PHARYNX (Fig. 5.25)
e pharynx is a muscular tube attached to the base of
the skull and extends below as far as the sixth cervical
vertebra, where it continues as the oesophagus. It has
three parts:
• nasopharynx, opening anteriorly into the nasal cavities
• oropharynx, opening into the oral cavity
• laryngopharynx, opening into the larynx and continuing downwards as the oesophagus.
tongue
Epiglottis
Vallecula
False cord
Trachea
cartilage
Fig. 5.26 View of the larynx as seen by laryngoscope.
fold
Vocal fold
Vestibular fold
Aryepiglottic
fold
Cuneiform
cartilage
134
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SECTION I Anatomy
Nasopharynx
• Lies above the so palate, which cuts it o from the
remainder of the pharynx during deglutition, therefore
preventing regurgitation of food into the nose.
• e nasopharynx contains:
• the nasopharyngeal tonsil (adenoids)
• the orice of the Eustachian tube (auditory tube),
which connects the pharynx to the middle ear.
Examination of the nasopharynx can be performed by
placing a small, angled mirror in the oropharynx. e
following structures can be visualized:
• opening of the Eustachian tube
• tubal elevation
• pharyngeal recess
• adenoids
• posterior choanae
• posterior end of the inferior concha.
Oropharynx
e most important structure in the oropharynx is the palatine tonsil (tonsil).
• Lies in the tonsillar fossa bounded by the anterior and
posterior pillars of the fauces.
• Anterior pillar is the palatoglossal arch produced by
palatoglossus muscle.
• Posterior pillar is the palatopharyngeal arch formed by
the palatopharyngeus muscle.
• Floor is the superior constrictor.
• Pharyngobasilar fascia, lining the inner surface of the
constrictor, forms the capsule of the tonsil, and lies
between the tonsil and the muscle.
• Capsule is normally separated from muscle by loose
areolar tissue.
• Tonsil is accumulation of lymphoid tissue.
• Oral surfaces are lined by mucous membrane, having
stratied squamous epithelium.
• Tonsillar crypts are cles on inner surface.
Blood Supply
• Tonsillar branch of facial artery, which pierces superior
constrictor to enter lower pole of tonsil.
• Additional branches from lingual, ascending palatine
and ascending pharyngeal arteries.
• Venous drainage passes to the pharyngeal plexus of veins.
• A paratonsillar vein extends from the so palate to lie on
the lateral surface of the tonsil before piercing the superior constrictor. It may be a troublesome cause of bleeding during tonsillectomy.
Lymphatic Drainage
• To the jugular digastric lymph node situated behind the
angle of the mandible.
• is node is oen palpable in chronic tonsillitis.
Clinical Points
• Tonsillectomy involves removal of the tonsil and the fascial capsule separating it from the loose areolar tissue
clothing the superior constrictor.
• e tonsil is dissected clear until it remains attached
only by a pedicle of vessels near its lower pole, which is
divided.
• A quinsy is suppuration in the peritonsillar tissue.
Laryngopharynx (Hypopharynx)
• Extends from the level of the tip of the epiglottis to the
termination of the pharynx into the oesophagus at level
of the sixth cervical vertebra.
• Inlet of the larynx, which is vertical, is bounded by the
epiglottis, aryepiglottic fold and the arytenoids.
• Anterolateral to the inlet is a recess known as the piriform fossa.
• e piriform fossa is a common site for lodging of foreign bodies.
• e piriform fossa has a rich lymphatic drainage and is
a ‘silent’ area for tumours, which spread rapidly into the
deep cervical nodes.
Structure of the Pharynx
e pharyngeal wall consists of:
• mucosa
• submucosa
• pharyngobasilar fascia
• muscle
• buccopharyngeal fascia (areolar tissue).
Mucosa
• Pseudostratied columnar ciliated epithelium in the
nasopharynx.
• Stratified squamous epithelium in the rest of the
pharynx.
Muscles of the Pharynx
e main muscles of the pharynx are three fan-shaped constrictor muscles:
• superior constrictor
• middle constrictor
• inferior constrictor.
ese are reinforced by smaller longitudinal muscles:
• stylopharyngeus
• salpingopharyngeus
• palatopharyngeus.
The Constrictor Muscles
Each constrictor muscle starts from a limited origin anteriorly, and broadens out laterally and posteriorly to be
inserted into a posterior midline raphe.
• Each constrictor overlaps the one above posteriorly.
CHAPTER 5 The Head, Neck and Spine
135
• ere are gaps laterally:
• between upper border of superior constrictor and
base of skull, which is bridged by pharyngobasilar fascia. e Eustachian tube enters the pharynx
through this gap
• between the middle and superior constrictor, where
the stylopharyngeus muscle accompanied by the
glossopharyngeal nerve enters the pharynx
• between the inferior and middle constrictor, which is
occupied by the thyrohyoid ligament and associated
structures.
• e inferior constrictor has two parts:
• thyropharyngeus: fan-shaped and attached to the
lamina of the thyroid cartilage
• cricopharyngeus: circular and acts like a sphincter.
• e weakest area of the pharyngeal wall is the gap
between thyropharyngeus and cricopharyngeus in the
midline posteriorly. is is Killian's dehiscence, a com-
Innervation of the Pharynx
• Motor innervation: all the muscles of the pharynx except
stylopharyngeus are supplied by pharyngeal branches
of the vagus nerve. Stylopharyngeus is supplied by the
glossopharyngeal nerve.
• Sensory innervation:
• nasopharynx: maxillary division of trigeminal
nerve
• oropharynx: glossopharyngeal nerve
• laryngopharynx: internal laryngeal branch of the
vagus.
Posterior Triangle
e boundaries are:
• anterior: posterior border of sternocleidomastoid
• posterior: anterior border of trapezius
• apex: meeting points of the upper attachment of trapezius and sternocleidomastoid
• base: middle third of clavicle
• roof: investing layer of deep cervical fascia extending
between trapezius and sternocleidomastoid
• oor: from above downwards, splenius capitis, levator
scapulae, scalenus medius, scalenus anterior; all covered
by prevertebral fascia
• the skin over the anterior triangle has platysma only in
its anterior part.
Contents
• Subclavian artery (third part).
• Transverse cervical artery.
• Suprascapular artery.
• Occipital artery.
• External jugular vein courses in the supercial fascia
obliquely, pierces the deep fascia just above the clavicle
and drains into the subclavian vein.
• e most important structure in the posterior triangle is
the spinal accessory nerve:
• exits from jugular foramen
• passes deep to sternocleidomastoid and enters poste-
rior triangle
• lies supercially embedded in deep cervical fascia of
roof
• enters under surface of trapezius
• supplies sternocleidomastoid and trapezius.
Surface Marking of Accessory Nerve
• Draws a line connecting the junction between the upper
third and lower two-thirds of the posterior border of
sternocleidomastoid to a point joining the lower third
and upper two-thirds of trapezius.
• It lies on the levator scapulae.
Clinical Points
• e accessory nerve may be damaged during biopsy of a
lymph node in the posterior triangle of the neck or as a
result of a penetrating injury.
• is will result in paralysis of trapezius, causing inability
to shrug the shoulder on the aected side.
CERVICAL PLEXUS (Fig. 5.27)
e rst four anterior primary rami contribute to the cervical plexus. e ascending branch of the rst cervical nerve
joins the hypoglossal nerve and this arrangement gives rise
to two sets of branches:
• supercial, supplying the skin over the head and neck
• deep, supplying muscles.
Superficial Branches
e supercial branches of the cervical plexus are:
• lesser occipital nerve
• greater auricular nerve
• transverse cervical nerve
• supraclavicular nerve.
Deep Branches
e deep branches of the cervical plexus supply muscles
derived from the exor compartment of the neck:
• prevertebral muscles
• infrahyoid muscles
• diaphragm.
Infrahyoid Muscles
• Supplied by the ansa cervicalis.
136
Greater auricular
Phrenic nerve
Ansa cervicalis
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SECTION I Anatomy
nerve (C2, C3)
Fig. 5.27 The cervical plexus.
Lesser occipital nerve
Hypoglossal nerve
Transverse cervical nerve (C2, C3)
Supraclavicular nerve
• Ansa cervicalis is a loop formed anterior to the carotid
sheath by a branch of C1 aer it has joined the hypoglossal nerve, and a branch from the union of C2 and C3.
The Phrenic Nerve
• e most important branch of the cervical plexus.
• Each nerve supplies:
• all of the muscles in its own half of the diaphragm
• sensory bres to the mediastinal and diaphragmatic
pleura
• sensory bres to the parietal pericardium
• sensory bres to the diaphragmatic peritoneum
(sensation at the periphery of the diaphragm is supplied by the intercostal nerves).
• on lateral surface of superior vena cava and superior
mediastinum
• runs vertically down the right surface of the pericardium to pierce the diaphragm in company with the
inferior vena cava.
C1
• Le phrenic nerve:
• in the superior mediastinum it lies between the le
C2
subclavian artery posteriorly and the le common
carotid artery anteriorly
C3
• crosses le side of arch of aorta to pass anteriorly to
root of lung
• travels down on the le surface of the pericardium to
C4
C5
C6
pierce the diaphragm.
ROOT OF NECK (Fig. 5.28)
Knowledge of the anatomy of the root of the neck is
essential to perform procedures such as subclavian vein
catheterization or brachial plexus block, and to understand the effect of a Pancoast tumour. The root of the
neck is the junctional area between the thorax and neck,
and contains all the structures going from thorax to neck
and vice versa. Important structures of the root of the
neck are:
• suprapleural membrane (Sibson’s fascia)
• subclavian artery
• subclavian vein
• brachial plexus
• thoracic duct
• stellate ganglion.
Suprapleural Membrane (Sibson’s Fascia)
• Attached to the inner border of the rst rib and to the
transverse process of the sixth cervical vertebra.
• Prevents the lung and pleura rising further into the neck
during inspiration.
• Subclavian artery, subclavian vein and brachial plexus
lie on suprapleural membrane.
Course of the Phrenic Nerve
• Formed at the lateral border of scalenus anterior, passing inferiorly on its anterior surface lateral to the internal jugular vein.
• Leaves the neck by passing between subclavian artery
posteriorly and subclavian vein anteriorly, traversing the thoracic inlet in contact with the mediastinal
pleura.
• As it descends through the thorax it lies anteriorly to
the root of the lung in contact with the mediastinal
pleura.
• Right phrenic nerve:
• anterior to right vagus nerve
Subclavian Artery
• Arches laterally over cervical pleura and Sibson's fascia
and apex of lung to reach surface of rst rib.
• Lies posterior to insertion of scalenus anterior on rst
rib.
• Root and trunks of brachial plexus lie behind subclavian
artery on the rst rib between scalenus anterior and scalenus medius.
• Continues beyond the rst rib into the axilla as axillary
ar tery.
• Pulse of subclavian artery can be felt at the medial third
of the clavicle near the lateral border of sternocleidomastoid on deep palpation against rst rib.
Stellate
Carotid sheath
carotid artery
jugular vein
Left recurrent
ganglion of
sympathetic
trunk
Oesophagus
Thoracic duct
Trachea
laryngeal nerve
CHAPTER 5 The Head, Neck and Spine
Phrenic nerve
Scalenus medius
Scalenus anterior
Brachial plexus
Upper trunk
Middle trunk
Lower trunk
Subclavian artery
Vagus nerve
Subclavian vein
137
Common
Internal
Fig. 5.28 The structures of the thoracic inlet. The carotid sheath and contents are cut and reflected to show the
deep structures in the neck.
• e branches of the subclavian artery are as follows:
• vertebral artery
• internal mammary (thoracic) artery
• thyrocervical trunk
Clinical Point
• Inadvertent puncture or laceration of the thoracic duct
will cause escape of lymph into the surrounding tissues
and occasionally into the chest (chylothorax).
• costocervical trunk.
Stellate Ganglion
Subclavian Vein
• Follows course of subclavian artery in neck but lies in
front of scalenus anterior on the rst rib.
• Veins accompanying branches of subclavian artery
drain into the external jugular, the subclavian or its continuation, the brachiocephalic vein.
Brachial Plexus
is is described in the section on the upper limb (see
Chapter 3).
Thoracic Duct
e thoracic duct carries lymph from the whole body,
except from the right side of the thorax, right upper limb,
and right side of head and neck, which drains into the right
lymph duct. e course of the thoracic duct is as follows:
• Commences at the cisterna chyli between the abdominal aorta and right crus of the diaphragm.
• Passes upwards through aortic opening to become thoracic duct.
• Ascends behind the oesophagus, inclining to the le at
the level of T5.
• At root of neck it arches laterally, lying between
carotid sheath and vertebral artery, and enters the
junction between the internal jugular and subclavian
veins.
• First thoracic ganglion frequently fuses with the inferior
cervical ganglion to form the stellate ganglion.
• e stellate ganglion lies at the root of the neck against
the neck of the rst rib.
Clinical Points
• Damage to the stellate ganglion or invasion of it in a
Pancoast tumour will result in Horner’s syndrome:
• constriction of the pupil
• slight ptosis
• anhidrosis on the side of the lesion.
LYMPH NODES OF THE HEAD AND NECK
ese are divided into supercial and deep groups.
Superficial Nodes
• Anterior cervical nodes along the anterior jugular vein.
• Supercial cervical nodes along the external jugular vein.
• ese nodes drain from the supercial tissues of the
regions drained by the veins along which they lie.
Eerents drain to the deep cervical nodes.
Deep Lymph Nodes
ese are arranged in a vertical chain along the internal
jugular vein, and a circular chain.
138
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SECTION I Anatomy
Vertical Chain
• Constitutes the terminal group for all lymph nodes in
the head and neck.
• Lies within the fascia of the carotid sheath closely related
to the internal jugular vein.
• Divided into:
• superior deep cervical nodes
• inferior deep cervical nodes.
• Superior group lies in region where posterior belly of
digastric crosses internal jugular vein, and here they are
also known as the jugulodigastric nodes. ey drain:
• tonsils
• tongue (posterior third).
• e lower group lies where the omohyoid crosses the
internal jugular vein, and hence is sometimes referred
to as the jugulo-omohyoid group. ese nodes drain:
• tongue (anterior two-thirds)
• oral cavity
• trachea
• oesophagus
• thyroid gland.
• A few nodes in the deep cervical group extend into the
posterior triangle of the neck. ey may be palpated in
the supraclavicular region.
• An example is Virchow’s node associated with intraabdominal malignancy (Troisier’s sign).
In addition, there are other groups.
• Retropharyngeal nodes, which lie between pharynx and
prevertebral fascia and drain:
• back of nasal cavity, nasopharynx and Eustachian
tube.
• Pretracheal and prelaryngeal nodes, which drain:
• adjacent viscera.
Clinical Points
In block dissection of the neck all the lymph nodes in the
anterior and posterior triangles of the neck, along with the
associated structures, are removed en bloc.
• Block dissection of the neck extends from the mandible
above to the clavicle below and the midline anteriorly to
the anterior border of trapezius posteriorly.
• All structures from platysma to pretracheal fascia are
removed, leaving only the carotid arteries, the vagus
nerve, the sympathetic trunks, and the lingual and
hypoglossal nerves.
• Sternocleidomastoid, posterior belly of digastric and
omohyoid are all removed, along with the internal jugular and external jugular veins, submandibular gland and
lower part of the parotid gland.
• e accessory nerve, to which lymph nodes are related
in the posterior triangle, is also sacriced.
Circular Chain
e circular chain of lymph nodes consists of the following.
• Submental nodes, which drain:
• tip of tongue
• oor of mouth
• central part of lower lip.
• Submandibular nodes, which drain:
• side of nose
• upper lip
• lateral part of lower lip
• cheeks
• gums
• anterior two-thirds of margin of the tongue.
• Parotid nodes, which drain:
• eyelids
• front of scalp
• external and middle ear
• pinna of ear
• parotid gland.
• Posterior auricular nodes, which drain:
• back of scalp
• back of auricle
• external auditory meatus.
• Occipital nodes, which drain:
• back of scalp.
SPINE
Vertebral Column
e vertebral column is made up of 32–34 vertebrae:
• seven cervical vertebrae
• twelve thoracic vertebrae
• ve lumbar vertebrae
• sacrum (ve fused vertebrae)
• coccyx (three to ve fused vertebrae).
Basic vertebral pattern (Fig. 5.29)
e basic vertebral pattern consists of a body and a neural
arch surrounding a vertebral canal.
Neural Arch
• Composed of a pedicle on either side, supporting a lamina which meets its opposite posteriorly in the midline.
• Pedicle bears a notch above and below, with which its
neighbour forms the intervertebral foramen.
• Each arch bears:
• posterior spine
• lateral transverse processes
• upper and lower articular facets.
• e intravertebral foramina transmit the segmental spinal nerves as follows:
CHAPTER 5 The Head, Neck and Spine
Costal
transversarium
process
Foramen
Foramen
139
Pedicle
Superior articular
facet
Vertebral
canal
Spinous
process
transversarium
Body
Costal
process
Transverse
B
process
A
process
Body
Foramen
Transverse
Fig. 5.29 A typical cervical vertebra, C5. (A) Superior view. (B) Lateral view.
• C1–7 pass over the superior aspects of their corresponding cervical vertebrae
• C8 passes through the foramen between C7 and T1
• all subsequent nerves pass between the vertebra of
their own number and the one below.
• Pedicles and lamina serve to protect neural and vascular
tissue.
• bears a kidney-shaped superior articular facet on a
thick, lateral mass, which articulates with the occipital condyles of the skull
• posterior to this facet the upper part of the posterior
arch is grooved by the vertebral artery.
• e axis (C2):
• bears the dens (odontoid process) on the superior
aspect of its body (represents the detached centrum
Body
• Bears the major part of the weight transmitted by the
vertebra.
• Adapted to resist compressive forces, being composed
of interlocking plates of cancellous bone, the trabeculae being arranged mainly at right angles to one
another.
• Contain red marrow; erythropoiesis continues throughout life in the axial skeleton.
• Articulate with one another via strong intervertebral
of C1)
• nodding (agreement) and lateral exion occur at the
atlanto-occipital joint
• rotation of the skull (disagreement) occurs at the
atlantoaxial joint.
• Vertebra prominens (C7)—so called because it is the
rst clearly palpable spine of the vertebral column (T1
below it is in fact the most prominent one).
• Occasionally foramen transversarium is absent on C7
(does not transmit the vertebral artery).
discs.
Vertebrae from individual regions have distinguishing
features.
Thoracic Vertebrae (Fig. 5.31)
• Characterized by demifacets on sides of body for articulation with heads of ribs.
Cervical Vertebrae (Fig. 5.30)
• Contain foramen transversarium perforating the transverse processes.
• Foramen transversarium transmits vertebral artery, vertebral vein and sympathetic bres (artery does not pass
through the foramen of the seventh cervical vertebra).
• Spines small and bid, except C1 and C7, which are
single.
• Articular facets horizontal.
• e atlas (C1):
• has no body
• Characterized by facets on their transverse processes for
the rib tubercles (apart from lower two thoracic vertebrae).
• Characterized by long and downward-sloping spines.
• Articular facets relatively vertical.
Lumbar Vertebrae (Fig. 5.32)
• Large with strong, square, horizontal spines.
• Articular facets lie in the sagittal plain.
• L5 has a massive transverse process, which connects
with the whole of the lateral aspect of its pedicle and
encroaches on the body.
transversarium
Spinous
process
Inferior articular
facet
140
Spinous
facet
transversarium
Foramen
Anterior arch
process
Spinous
process
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SECTION I Anatomy
Anterior
arch
Transverse
process
Synovial joint
for anterior
arch of C1
Superior
articular facet
Foramen
A
transversarium
Body
Posterior
arch
Dens
process
Inferior articular
Posterior arch
Superior articular facet
Synovial joint
for dens
Foramen
transversarium
Transverse process
B
Superior articular facet
Dens
Foramen
transversarium
Transverse
Fig. 5.30 The atlas and the axis, C1 and C2. (A) Lateral views. (B) Superior views.
• Transverse processes of the lumbar vertebrae attach
solely to the junction of pedicle with lamina.
• Vertebral spines linked by the tough supraspinous and
weak interspinous ligaments.
• Articular facets linked by articular ligaments around
Sacrum and Coccyx
Described with pelvic girdle (see Chapter 4).
Intervertebral Joints (Fig. 5.33)
• Vertebral laminae linked by the ligamentum avum of
elastic tissue.
synovial joints.
• Tough anterior and posterior longitudinal ligaments
run the whole length of the vertebral bodies along anterior and posterior aspects, respectively.
• Vertebral bodies joined by strong, intervertebral
discs.
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