Some causes of spinal pain include: Irritation of the large nerves as they exit the bony confines of the spine leading to the arms and legs Irritation of the smaller nerves of the spine that involve innervate or supply the discs between the vertebrae, facets and ligaments Strain of the large muscles of the back that hold the spine upright Injuries to the bones, ligaments or joints Damage or disease to the discs that separate the vertebrae Abnormal movement between segments Tumors, infection, trauma, deformity or other spinal disorders The spinal column is made up of many parts, all designed to help the back move flexibly, support body weight and protect the spinal cord and nerves.
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See Our Spine Program. Choose a doctor and schedule an appointment. The ventral and dorsal roots fuse together to form a spinal nerve, which travels down the spinal canal, alongside the cord, until it reaches its exit hole - the intervertebral foramen Fig.
Once the nerve passes through the intervertebral foramen, it branches; each branch has both motor and sensory fibers. The smaller branch called the posterior primary ramus turns posteriorly to supply the skin and muscles of the back of the body.
The larger branch called the anterior primary ramus turns anteriorly to supply the skin and muscles of the front of the body and forms most of the major nerves. The spinal nerves are numbered according to the vertebrae above which it exits the spinal canal. The 8 cervical spinal nerves are C1 through C8, the 12 thoracic spinal nerves are T1 through T12, the 5 lumbar spinal nerves are L1 through L5, and the 5 sacral spinal nerves are S1 through S5.
There is 1 coccygeal nerve. The spinal nerves innervate specific areas and form a striped pattern across the body called dermatomes Fig. Doctors use this pattern to diagnose the location of a spinal problem based on the area of pain or muscle weakness.
For example leg pain sciatica usually indicates a problem near the L4-S3 nerves. The spinal cord is covered with the same three membranes as the brain, called meninges. The inner membrane is the pia mater, which is intimately attached to the cord. The next membrane is the arachnoid mater. The outer membrane is the tough dura mater Fig. Between these membranes are spaces used in diagnostic and treatment procedures.
The space between the pia and arachnoid mater is the wide subarachnoid space, which surrounds the spinal cord and contains cerebrospinal fluid CSF. This space is most often accessed when performing a lumbar puncture to sample and test CSF or during a myelogram to inject contrast dye.
The space between the dura mater and the bone is the epidural space. This space is most often accessed to deliver anesthetic numbing agents, commonly called an epidural, and to inject steroid medication see Epidural Steroid Injections. We comply with the HONcode standard for trustworthy health information. This information is not intended to replace the medical advice of your health care provider. In recent decades medical scientists have made a quantum leap in their understanding of the human brain and spinal cord.
Their discoveries have been fueled by advances in imaging technology and neurobiology. Whether they are studying new surgical techniques, participating in clinical trials, or quantifying outcomes, Mayfield clinician researchers are working every day to discover what works best for our patients.
Learn more about our spine research at MayfieldFoundation. To make an appointment call Make an Appointment. Anatomy of the Spine Overview The spine is made of 33 individual bones stacked one on top of the other.
However, changes of spinal position can stress muscles and cause spinal deformity. If the spine is injured and unable to function properly, it can be very painful or even disabling. The spine is made of many parts that protect the spinal cord, facilitate movement and support the body. The spinal cord has nerve pathways that carry signals, such as pain, from the arms, legs, and the body to the brain.
Nerve roots are used to transmit information between the spinal cord and the other parts of the body, such as arms, legs and organs. The flat plates of the lamina create the outer wall of the vertebral canal and help protect the spinal cord. Discs separate the vertebrae. They are made of tough, elastic material that allows the spine to bend and twist naturally. The spinous process protrudes from the back of each vertebra. Muscles and ligaments that move and stabilize the vertebrae attach to the spinous processes.
Two transverse processes stick out of the sides of each vertebra. Muscles and ligaments that move and stabilize the vertebrae attach to the transverse processes. All of the above elements of the spinal column and vertebrae protect the spinal cord, which provides communication to the brain. The spinal cord also transmits sensation and mobility in the body through interaction of ligaments, bones and muscle structures of the back and its surrounding nerves.
Developmental anomalies, pathological changes, or obesity can enhance the normal vertebral column curves, resulting in the development of abnormal or excessive curvatures Figure 2. Kyphosis, also referred to as humpback or hunchback, is an excessive posterior curvature of the thoracic region. This can develop when osteoporosis causes weakening and erosion of the anterior portions of the upper thoracic vertebrae, resulting in their gradual collapse Figure 3.
Lordosis, or swayback, is an excessive anterior curvature of the lumbar region and is most commonly associated with obesity or late pregnancy. The accumulation of body weight in the abdominal region results an anterior shift in the line of gravity that carries the weight of the body. This causes in an anterior tilt of the pelvis and a pronounced enhancement of the lumbar curve.
Figure 2. Abnormal Curvatures of the Vertebral Column. Figure 3. Osteoporosis is an age-related disorder that causes the gradual loss of bone density and strength.
When the thoracic vertebrae are affected, there can be a gradual collapse of the vertebrae. This results in kyphosis, an excessive curvature of the thoracic region. Scoliosis is an abnormal, lateral curvature, accompanied by twisting of the vertebral column. Compensatory curves may also develop in other areas of the vertebral column to help maintain the head positioned over the feet. Scoliosis is the most common vertebral abnormality among girls.
The cause is usually unknown, but it may result from weakness of the back muscles, defects such as differential growth rates in the right and left sides of the vertebral column, or differences in the length of the lower limbs. When present, scoliosis tends to get worse during adolescent growth spurts. Although most individuals do not require treatment, a back brace may be recommended for growing children. In extreme cases, surgery may be required. Excessive vertebral curves can be identified while an individual stands in the anatomical position.
Observe the vertebral profile from the side and then from behind to check for kyphosis or lordosis. Then have the person bend forward. If scoliosis is present, an individual will have difficulty in bending directly forward, and the right and left sides of the back will not be level with each other in the bent position. Within the different regions of the vertebral column, vertebrae vary in size and shape, but they all follow a similar structural pattern.
A typical vertebra will consist of a body, a vertebral arch, and seven processes Figure 4. The body is the anterior portion of each vertebra and is the part that supports the body weight. Because of this, the vertebral bodies progressively increase in size and thickness going down the vertebral column.
The bodies of adjacent vertebrae are separated and strongly united by an intervertebral disc. Figure 4. Parts of a Typical Vertebra. A typical vertebra consists of a body and a vertebral arch. The arch is formed by the paired pedicles and paired laminae. Arising from the vertebral arch are the transverse, spinous, superior articular, and inferior articular processes. The vertebral foramen provides for passage of the spinal cord.
Each spinal nerve exits through an intervertebral foramen, located between adjacent vertebrae. Intervertebral discs unite the bodies of adjacent vertebrae. The vertebral arch forms the posterior portion of each vertebra. It consists of four parts, the right and left pedicles and the right and left laminae. Each pedicle forms one of the lateral sides of the vertebral arch.
The pedicles are anchored to the posterior side of the vertebral body. Each lamina forms part of the posterior roof of the vertebral arch. The large opening between the vertebral arch and body is the vertebral foramen , which contains the spinal cord. In the intact vertebral column, the vertebral foramina of all of the vertebrae align to form the vertebral spinal canal , which serves as the bony protection and passageway for the spinal cord down the back.
When the vertebrae are aligned together in the vertebral column, notches in the margins of the pedicles of adjacent vertebrae together form an intervertebral foramen , the opening through which a spinal nerve exits from the vertebral column Figure 5. Seven processes arise from the vertebral arch.
Each paired transverse process projects laterally and arises from the junction point between the pedicle and lamina. The single spinous process vertebral spine projects posteriorly at the midline of the back.
The vertebral spines can easily be felt as a series of bumps just under the skin down the middle of the back. The transverse and spinous processes serve as important muscle attachment sites. A superior articular process extends or faces upward, and an inferior articular process faces or projects downward on each side of a vertebrae. The paired superior articular processes of one vertebra join with the corresponding paired inferior articular processes from the next higher vertebra.
These junctions form slightly moveable joints between the adjacent vertebrae. The shape and orientation of the articular processes vary in different regions of the vertebral column and play a major role in determining the type and range of motion available in each region.
Figure 5.
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