3b. The Vertebral Column as a Whole

The vertebral column is situated in the median line, as the posterior part of the trunk; its average length in the male is about 71 cm. Of this length the cervical part measures 12.5 cm., the thoracic about 28 cm., the lumbar 18 cm., and the sacrum and coccyx 12.5 cm. The female column is about 61 cm. in length. 1 Curves.—Viewed laterally (Fig. 111), the vertebral column presents several curves, which correspond to the different regions of the column, and are called cervical, thoracic, lumbar, and pelvic. The cervical curve, convex forward, begins at the apex of the odontoid process, and ends at the middle of the second thoracic vertebra; it is the least marked of all the curves. The thoracic curve, concave forward, begins at the middle of the second and ends at the middle of the twelfth thoracic vertebra. Its most prominent point behind corresponds to the spinous process of the seventh thoracic vertebra. The lumbar curve is more marked in the female than in the male; it begins at the middle of the last thoracic vertebra, and ends at the sacrovertebral angle. It is convex anteriorly, the convexity of the lower three vertebræ being much greater than that of the upper two. The pelvic curve begins at the sacrovertebral articulation, and ends at the point of the coccyx; its concavity is directed downward and forward. The thoracic and pelvic curves are termed primary curves, because they alone are present during fetal life. The cervical and lumbar curves are compensatory or secondary, and are developed after birth, the former when the child is able to hold up its head (at three or four months), and to sit upright (at nine months), the latter at twelve or eighteen months, when the child begins to walk. 2 The vertebral column has also a slight lateral curvature, the convexity of which is directed toward the right side. This may be produced by muscular action, most persons using the right arm in preference to the left, especially in making long-continued efforts, when the body is curved to the right side. In support of this explanation it has been found that in one or two individuals who were left-handed, the convexity was to the left side. By others this curvature is regarded as being produced by the aortic arch and upper part of the descending thoracic aorta—a view which is supported by the fact that in cases where the viscera are transposed and the aorta is on the right side, the convexity of the curve is directed to the left side. 3 Surfaces.—Anterior Surface.—When viewed from in front, the width of the bodies of the vertebræ is seen to increase from the second cervical to the first thoracic; there is then a slight diminution in the next three vertebræ; below this there is again a gradual and progressive increase in width as low as the sacrovertebral angle. From this point there is a rapid diminution, to the apex of the coccyx. 4 Posterior Surface.—The posterior surface of the vertebral column presents in the median line the spinous processes. In the cervical region (with the exception of the second and seventh vertebræ) these are short and horizontal, with bifid extremities. In the upper part of the thoracic region they are directed obliquely downward; in the middle they are almost vertical, and in the lower part they are nearly horizontal. In the lumbar region they are nearly horizontal. The spinous processes are separated by considerable intervals in the lumbar region, by narrower intervals in the neck, and are closely approximated in the middle of the thoracic region. Occasionally one of these processes deviates a little from the median line—a fact to be remembered in practice, as irregularities of this sort are attendant also on fractures or displacements of the vertebral column. On either side of the spinous processes is the vertebral groove formed by the laminæ in the cervical and lumbar regions, where it is shallow, and by the laminæ and transverse processes in the thoracic region, where it is deep and broad; these grooves lodge the deep muscles of the back. Lateral to the vertebral grooves are the articular processes, and still more laterally the transverse processes. In the thoracic region, the transverse processes stand backward, on a plane considerably behind that of the same processes in the cervical and lumbar regions. In the cervical region, the transverse processes are placed in front of the articular processes, lateral to the pedicles and between the intervertebral foramina. In the thoracic region they are posterior to the pedicles, intervertebral foramina, and articular processes. In the lumbar region they are in front of the articular processes, but behind the intervertebral foramina. 5 Lateral Surfaces.—The lateral surfaces are separated from the posterior surface by the articular processes in the cervical and lumbar regions, and by the transverse processes in the thoracic region. They present, in front, the sides of the bodies of the vertebræ, marked in the thoracic region by the facets for articulation with the heads of the ribs. More posteriorly are the intervertebral foramina, formed by the juxtaposition of the vertebral notches, oval in shape, smallest in the cervical and upper part of the thoracic regions, and gradually increasing in size to the last lumbar. They transmit the spinal nerves and are situated between the transverse processes in the cervical region, and in front of them in the thoracic and lumbar regions. 6

FIG. 111– Lateral view of the vertebral column. (See enlarged image)

Vertebral Canal.—The vertebral canal follows the different curves of the column; it is large and triangular in those parts of the column which enjoy the greatest freedom of movement, viz., the cervical and lumbar regions; and is small and rounded in the thoracic region, where motion is more limited. 7 Abnormalities.—Occasionally the coalescence of the laminæ is not completed, and consequently a cleft is left in the arches of the vertebræ, through which a protrusion of the spinal membranes (dura mater and arachnoid), and generally of the medulla spinalis itself, takes place, constituting the malformation known as spina bifida. This condition is most common in the lumbosacral region, but it may occur in the thoracic or cervical region, or the arches throughout the whole length of the canal may remain incomplete. 8

FIG. 112– The thorax from in front. (Spalteholz.) (See enlarged image)

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