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THE HUMAN SPINE

Slide Your Mouse Down The Spine

• 24 vertebrae

• the sacrum which is composed of five fused vertebrae, and

• the tailbone or coccyx which is composed of four fused vertebrae.

The spine has four regions which start at the neck and progress downward within the body toward the pelvis. The regions of the spine work together providing the majority of the strength, stability and flexibility of movement for the upper body and are weight bearing as well. These spinal regions are:

• the cervical spine

• the thoracic spine

• the lumbar spine and

• the sacral spine.

The spine may seem like a simple collection of bones, but it is integral to the proper functioning of the body's fluidity of movement in actions such as twisting, bending and rotation. While, the spine itself does not actually perform these motions, the spines flexibility is a combined effort of the spinal column and the facets joints and intevertebral disks which are structures between the bones of the spine. Without a correctly aligned spinal column each of these actions can bring on pain which can become chronic, and without a properly functioning spine your range of motion of the upper body will be severely limited if not completely incapacitated.

Below is a Glossary of Terms:
 

Ankylosis — This refers to the stiffening that can occur across a joint or a disc in the spine. Once a complete ankylosis has developed, there is no more motion across that spinal level. The most common cause of ankylosis in the spine is aging (seen across most levels of the spine in all elderly people), although ankylosis can also occur in younger people after trauma, infection or other destructive/degenerative problem.
 

Annulus Fibrosus— This is the outer portion of the intervertebral disc in the spine. In simplest terms imagine that the disc is similar to a radial tire and the outer portion of the disc, which has thick crossing fibers (annulus fibrosus) are like the fibers that bind and give strength to a tire.
 

Anterior Longitudinal Ligament — The spinal column is held together and stabilized by a number of structures including ligaments and the intervertbral disc. The Anterior longitudinal ligament (ALL) is a thick band of tissue that runs all the way along the spine from the skull down to the sacrum. It sits in the front of the spinal column and provides stability and limits motion between vertebrae. In conditions such as severe scoliosis this ligament is sometimes released (cut) in order to gain motion between vertebrae and permit correction of the deformed spine.
 

Arthritis — This refers to degeneration (wearing out) of a joint. Most healthy joints have a layer of cartilage overlying the bones that permits smooth motion. Arthropathy means that this cartilage has been destroyed and with that the joint may become stiff, swollen and misshapen. Pain and deformity can develop in the spine with advanced arthropathy. The most common cause for this condition is aging although trauma, infection and other problems can lead to arthropathy in younger people as well.
 

Arthrosis — This is a term similar to arthropathy and refers to inflammation in a joint. In the spine, joint inflammation is part of many conditions. Aging itself leads to gradual joint destruction, inflammation and sometimes pain.
 

Atlas — This is the upper most vertebra of the spinal column (also labeled C1). The atlas is located just beneath the skull at the top of the cervical spine. The bone has an unusual ring-like appearance, it has a set of joints with the skull and with the next vertebra beneath it, the axis (also labeled C2).
 

Axis — This is the second vertebra of the upper part of the spine, the cervical spine. The axis is located just beneath the atlas and has an unusual projection upwards which is called the dens. The axis can be injured in trauma, such as diving accidents or motor vehicle accidents. Rheumatoid arthritis and other conditions can lead to loss of stability between the axis and atlas that may require treatment.
 

Bone Graft — When surgical treatment involves a spinal fusion and an attempt at bone healing between levels of the spine is desired, then bone must often be delivered from other parts of the body. Bone which is harvested (collected) from one part of the body and placed into another part is called bone graft material. The most common areas to harvest bone include local bone structures (spinous process, lamina) and iliac bone (from the iliac crest of the pelvis).
 

Brachial Plexus — This refers to branches of nerves which originate from the spinal cord in the neck area and extend toward the arms. The brachial plexus is situated at the base of the neck toward the shoulder area and contains all the nerves that provide signals to and from the arms and hands. Accidents and birth related injury can cause nerve injury in the brachial plexus leading to weakness, paralysis and dysfunction in the arms/hands.
 

Cage Implant — This refers to an implantable device used for stabilizing and creating spinal fusion between levels of the spine. Some cages are metal (stainless steel, titanium) and some are made of synthetic materials such as carbon fiber. Many cages are designed such that they can be filled with bone to encourage spinal fusion.
 

Cervical Spine — This is the upper most part of the spinal column and includes all vertebrae of the neck. There are seven vertebrae in the cervical spine (labeled C1 to C7) and each has an important role in stabilization, motion and protection of the spinal cord which is located inside the spinal canal that runs down the spinal column. The cervical spine is straight when seen from the front and has a slight backward curvature when seen from the side (a lordosis). Due to the significant motion which occurs across levels of the cervical spine, this part of the spinal column is at risk of developing disc related problems (herniations, degeneration), arthritis and injuries with trauma.
 

Delayed Union — When a spinal fusion is performed during a surgical procedure, the goal is to establish a solid bone union. A delayed union refers to slower than expected healing between levels of the spine . If the spinal levels which were intended to be fused never actually develop solid bone healing this is called a pseudarthrosis or non-union.
 

Dens — This bone structure is part of the second spinal vertebra (C2), the axis. The dens is like a small bone peg that protrudes upward from C2 into the ring-like structure of C1. Due to the dens there is good stability and yet motion possible between the upper two cervical vertebrae. The dens is vulnerable to injury with trauma and is frequently involved in advanced rheumatoid arthritis.
 

Disc — The intervertebral disc is a soft tissue structure that sits between vertebrae of the spine. A disc is present at each level of the spine from the second cervical vertebra (the axis, or C2) down to the sacrum (just below L5, the last lumbar vertebra). The discconsists of a gelatinous center, called the nucleus pulpous, and a thick fibrous outer network, called the annulus fibrosus. The healthy disc provides a shock absorbing quality, permits motion between the vertebrae of the spine and ensures controlled motion so that no injury occurs. Most of the disc is quite spongy and contains over 80% water. With aging the discloses some of its water content and therefore some of its thickness. We therefore become shorter and somewhat more hunched as we get older. The disc can become injured or herniate (bulge out of its usual position) and rarely is a site of infection.
 

Dura — The brain, the spinal cord and a portion of the nerve roots that exit the spinal canal are covered by layers of tissue. The outermost layer is called the dura, it is quite thin and forms a sheath which is quite impermeable. The brain, spinal cord and nerve roots are bathed in a fluid called Cerebrospinal fluid (CSF) contained within the dura. The dura can be injured in number of ways (this can cause what is called a CSF leak) and rarely is involved in diseases.
 

Facet — The vertebrae in the spinal column are connected to one another in the front of the column by the discs and ligaments. In the back portion (posterior) of the column the vertebrae move in respect to one another through a set of small joints which are called the facet joints. The facet of a vertebra is the small bone structure which contains a cartilage surface in order to glide with the next vertebra through its facet. There is one up-going (called the superior facet) and one down-going (called the inferior ) facet on each side of the vertebra posteriorly.
 

Facet Joint — The small joint posteriorly between the upper and lower facets of two vertebrae is called the facet joint. There is one facet joint on each side of the spine (right and left) at each level. These small joints have a capsule encasing the facets, they contain a small amount of fluid (like a lubricant) and permit smooth and controlled motion between the vertebrae. Aging, injury or infection can lead to wear or destruction of the facet joints.
 

Failed Back — This refers to a condition of continued pain and/or deformity and disability following spinal surgery. Even the best surgeons and spine teams do not always get as good a result from surgery as hoped or planned. When the surgical result still leaves significant pain after healing and recovery from surgery then the term "failed back" has been used. There are numerous possible causes of poor outcome and a thorough evaluation is necessary to define the cause of persistent pain or disability.
 

Flatback —The Flatback Syndrome is a condition related to poor sagittal plane alignment. In the vast majority of cases this is due to previous spinal fusion, particularly for scoliosis. Common symptoms of Flatback include a feeling of leaning forwards, fatigue in the lower back, difficulty walking on uneven ground and progressive pain. In some cases permanent hip and knee flexion are necessary to maintain balance and level vision. Mild cases are often treated non-operatively, severe cases may require surgical re-alignment for effective relief. Read more about Flatback in the medical conditions section.
 

Foramen — This term means a tunnel or opening in a tissue or structure. In the spinal canal, the foramen refers to the tunnel leading out of the canal through which the nerves pass on their way to other organs or the arms/legs. The sides of the vertebral formen are mostly solid bone although the facet joint sits along a portion of the foramen. With facet arthritis the facet joints can thicken and slowly encroach upon the space of the vertebral foramen. The nerve which passes through the foramen can thus become irritated or compressed leading to symptoms such as numbness, tingling, pain or weakness. When a surgical freeing of the nerve in the foramen is performed this is called a foramenotomy.
 

Frontal Plane — A standing person when seen from the front is seen in the frontal plane. If you look at someone from the side you are observing the sagittal plane. The term frontal plane therefore refers to the aspect from which one notices changes in position, displacement or deformity. For example, if a patient has a scoliosis with a curve swayed to the side then one could say that the spine is curved when seen from the frontal plane.
 

Hook — In spinal surgery there is sometimes the need to attach a metal rod to the spine in order to provide stability or correction of a deformity. Numerous devices and techniques have been developed to connect something directly to the spinal column (hooks, wires, cables, screws?. Special metal hooks are one of several types of connections to the spine commonly used in scoliosis correction.
 

Iliolumbar Ligaments — The ilium is the large bone which forms part of the pelvis. The lumbar spine is the lowest portion of the spinal column in the area of the lower back. Between the lumbar spine and the ilium there are a number of thick ligaments, the iliolumbar ligaments (fibrous bands) that provide stability. In spinal conditions such as pelvic obliquity (commonly seen in neuromuscular scoliosis and cerebral palsy) these iliolumbar ligaments must be released to permit correction of the pelvic position. In the healthy spine the ligaments provide excellent stability to the last lumbar vertebra (L5) and explains why many degenerative conditions tend to cause more problems at the L4-L5 than at the L5-S1 level.
 

Ilium — The ilium is the large bone which forms part of the pelvis and the edge of bone one can feel around the waist line on the side and back of the body. This large bone provides muscular attachments to the pelvis, supports the trunk through a connection with the sacrum and is linked to the hips and legs. Due to the size and location of the ilium, it is a common source of taking bone graft, either in the front or the back. The area that bone is harvested from is most commonly the iliac crest.
 

Interspinous Ligament — Between the spinous processes in the posterior (back part) spinal column there are a number of ligaments (fibrous bands) that provide support and controlled motion between the vertebrae. The interspinous ligaments run between the spinous processes from level to level, they are rarely injured.
 

Intervertebral Disc — The intervertebral disc is a soft tissue structure that sits between vertebrae of the spine. A disc is present at each level of the spine from the second cervical vertebra (the axis, or C2) down to the sacrum (just below L5, the last lumbar vertebra). The disc consists of a gelatinous center, called the nucleus pulposus, and a thick fibrous outer network, called the annulus fibrosus. The healthy disc provides a shock absorbing quality, permits motion between the vertebrae of the spine and ensures controlled motion so that no injury occurs. Most of the disc is quite spongy and contains over 80% water. With aging the disc loses some of its water content and therefore some of its thickness. We therefore become shorter and somewhat more hunched as we get older. The disc can become injured or herniate (bulge out of its usual position).
 

Kyphoplasty&174; — This is a new surgical technique that involves reinforcing a vertebra of the spinal column with bone cement. It can be applied in the setting of bone collapse (fracture) due to osteoporosis or other bone destructive process (tumor, necrosis). Through a small incision in the back a special balloon is passed into the collapsed vertebra. This balloon is then inflated, by filling it with liquid solution, in order to open up a small cavity in the collapsed bone. Once this has been achieved, the balloon is deflated and withdrawn. Bone cement is then slowly and carefully introduced into the prepared area of the vertebra. In this manner, as the bone cement hardens, a solid support of the vertebra is created.
 

Kyphosis — When seen from the side, the spinal column has a number of gentle curves due to the shape and alignment (the way they are stacked upon another) of the vertebrae. Kyphosis refers to a hunching, or forward curvature in the spine. In a healthy spine the thoracic levels have some degree of kyphosis (ranging from around 25 to 55 degrees). When the degree of kyphosis is above normal then some form of treatment may be required. With aging there is a gradual, and natural, increase in the thoracic kyphosis that gives an appearance of hunching forward more with advancing age. A kyphosis in the cervical spine or lumbar spine is not normal and many conditions can cause such a problem.
 

Lateral Recess — This refers to the edges of the spinal canal which is housed inside the spinal column. Although the spinal cord and nerve roots run inside the spinal canal, the lateral recess is that portion where the nerves run as they begin to exit the spinal canal (through the foramen). This lateral recess can become narrowed or obstructed by a herniated disc and lead to nerve irritation or compression.
 

Ligamentum Flavum — The spinal canal which houses the spinal cord and nerve roots is protected by bone from the vertebrae and covered posteriorly (in the back portion) by a ligament that runs between the laminae of the vertebrae. With aging, arthritis or some other conditions the ligament may become thickened or buckled. When this occurs the space available in the spinal canal for the nerve roots and spinal cord may become narrowed leading to a condition called spinal stenosis. During a surgical decompression of nerve structures, this ligamentum flavum is often removed.
 

Lordosis — When seen from the side, the spinal column has a number of gentle curves due to the shape and alignment (the way they are stacked upon another) of the vertebrae. Lordosis refers to a backward curvature of a portion of the spine. In a healthy spine the neck (cervical spine) and the lower back (lumbar spine) have some degree of lordosis. A loss of the normal degree of lordosis in the spine is occasionally noted when muscle spasm is present and in the setting of spinal deformity. With aging there is also some loss of the normal lumbar lordosis.
 

Lumbar — This refers to the lowest portion of the spinal column (in the area of the lower back). There are 5 lumbar vertebrae in the normal spine, numbered L1 to L5. The lowest vertebra is L5 and it sits just above the sacrum that is part of the pelvis.
 

Nerve — This structure refers to the "wiring" of the nervous system, through which signals are sent to and from the brain. In the spine the nerves which branch off from the spinal cord, pass out of the spinal column through the foramena. From there the nerves lead to the muscles, tendons, ligaments, joints, skin and other organs. Signals of input such as pain, sensation, temperature, position are transmitted to the brain through the nerves. In the other direction, the brain sends signals such as those regarding muscle contraction down the nerve to the destined group of muscles. Injury to the nerves can lead to disruption of these important signals and can thus lead to symptoms of numbness, tingling, pain, weakness and in severe cases, paralysis.
 

Nerve Root — The portion of a nerve as it forms just off the spinal cord is called the nerve root. In cases of spinal stenosis or disc herniation, it is most commonly the nerve root which is irritated or compressed.
 

Non-Union — A spinal fusion procedure has as a goal to obtain a solid bone bridge between two or more levels of the spine. It may take months and sometimes over a year to obtain a solid fusion. When this does not occur, and bone never completely grows across an area of intended spinal fusion, then one calls this a "non-union" or pseudarthrosis. This condition can be painful and sometimes requires revision surgery in order to obtain a solid fusion.
 

Nucleus Pulposus — The intervertebral disc consists of a thick outer fibrous layer (annulus fibrosus) and a soft, sticky, spongy inner portion that is called the nucleus pulposus (NP). Most of the NP is water, and with aging the NP loses some of its water content (becomes dessicated). When a disc herniates, then in many cases this means that a portion of the NP is pushing beyond the fibers of the annulus fibrosus. This can be very irritating to the nerve roots, which lay next to the disc causing numbness, tingling, pain and dysfunction (such as weakness, paralysis).
 

Odontoid — This is a bone structure in the upper cervical spine, also called the dens. The odontoid is part of the C2 vertebra.
 

Osteotomy — When a bone needs to surgically cut or broken, this is called an osteotomy. In the spine, an osteotomy is sometimes performed to create motion between segments of the spine in order to correct a deformity. Another reason for an osteotomy may be to remove a block of bone that obstructs the spinal canal or requires removal for clearer visualization of nerves or other structures around the spine.
 

Pedicle — The vertebrae of the spinal column are complex bone structures. The pedicles are part of the vertebra that bridges the front and the back of each of vertebra. It is a bone extension from the vertebral body (front portion) to the laminae, facets, and spinous processes which are posterior (in the back portion). There is one pedicle one each side of a vertebra (right and left). When spinal instrumentation is placed in the spine, pedicle screws are occasionally used. These screws are positioned inside the pedicles and can offer excellent anchorage.
 

Pedicle Screw — This refers to a special type of instrumentation that is used in spinal surgery in order to solidly hold on to a vertebra. Screws are used in combination with rods to offer stability in the spine, they can be used in spinal fusions.
 

Pelvis — The connection between the legs (hips) and the lower spine is through the large bone structures that grouped together are called the pelvis. The bones that make up the pelvis include the ilium, pubis, ischium and through the ilium they are attached to the sacrum. The hip joints are part of the pelvis and the lumbosacral junction refers to the connection between L5 (last lumbar vertebra) and S1 (upper most part of the sacrum).
 

Pinched Nerve — This refers to common term used to describe nerve irritation and consequent pain, numbness or weakness (most frequently felt in the arm/hand or legs) due to compression of a nerve along its passage from the spinal cord to the arms or legs. The most common causes include: disc herniation, spinal stenosis, foramenal stenosis.
 

Plumb Line — This is a term which refers to the balance, in a standing person, of the head being centered above the pelvis when seen from the front (frontal plane) and from the side (sagittal plane). In a simple way the plumb line is a string which has a weight on the end. When one holds the upper part of the string against an x-ray of a standing person in the middle of the cervical spine then the free end of the string (with the weight attached) should be hanging straight down and pass directly through the center of the pelvis and sacrum on the x-ray. When the plumbline does not fall well centered on an x-ray then one can measure the degree of offset, which is then called the "plumbline offset".
 

Posterior Longitudinal Ligament — The spinal column is held together and stabilized by a number of structures including ligaments and the intervertbral discs. The Posterior longitudinal ligament (PLL) is a thick band of tissue that runs all the way along the spine from the skull down to the sacrum. It sits just behind the vertebral bodies (and discs) of the spinal column and provides stability and limits motion between vertebrae.
 

Pseudarthrosis — A spinal fusion procedure has as a goal to obtain a solid bone bridge between two or more levels of the spine. It may take months and sometimes over a year to obtain a solid fusion. When this does not occur, and bone never completely grows across an area of intended spinal fusion, then one calls this a "non-union" or pseudarthrosis. This condition can be painful and sometimes requires revision surgery in order to obtain a solid fusion.
 

Radiculopathy — This term refers to dysfunction of a nerve root. In mild cases of nerve irritation the term radiculitis is often used. In a true radiculopathy, nerve dysfunction can range from mild weakness and abnormal reflexes to severe weakness or paralysis. Radiculopathy can develop due to many diseases, conditions, or injury. Common causes include: herniated discs, fractures of the spine, severe trauma, tumors, infections.
 

Revision Surgery — When surgery has not lead to the desired results or many years after an operation a new problem develops that requires another surgery in the same area, one calls this revision surgery. This does not necessarily mean that the first surgery was wrong or badly done, it simply means that another surgery in the same area is required to fix a problem. Revision surgery is often a complex undertaking though, and should only be considered after a thorough review of all treatment options. An experienced surgical team is important since added risks and difficulties are faced when operating in an area of the spine which already has been surgically treated.
 

Sacrum — The lowest portion of the spine (L5, lumbar vertebra) attaches to the pelvis through the sacrum. The sacrum is a bone which houses some of the lowest spinal nerves, it is rarely injured and rarely is a cause of nerve related troubles. Instrumentation is sometimes placed into the sacrum to offer solid anchorage/fixation to the spine in the setting of spinal fusion.
 

Spinal Alignment — The healthy, normal spine has when seen from the side has a number of gentle curves, and when seen from the front is pretty much straight. This shape is created by the individual vertebrae and the discs and ligaments that link the vertebrae together. The way that the individual vertebrae are stacked upon each other is called alignment. One says that a spine is well aligned when the spinal column has a shape and balance that is normal, or close to normal.
 

Spinal Canal — The central part of the spinal column contains a space shaped much like a tunnel that runs from the skull down to the pelvis. This central tunnel is called the spinal canal and it contains the spinal cord and nerve roots. The spinal canal can become narrowed for many different reasons (injury, abnormal formation, infection, disc herniation, facet joint degeneration?. When the spinal canal becomes narrowed due to degenerative causes (disc and facet joint wearing out) then this is commonly called spinal stenosis.
 

Spinal Cord — The brain which controls, directs or modifies most of the body's functions sends most of its signals through a systems of nerves. From the brain, most of the signals first pass through the spinal cord before branching off into nerves that travel to various parts of the body. The spinal cord sits inside the spinal canal and extends from the brain down the the lumbar spine, usually ending around the L1 vertebral level. The spinal cord is a delicate structure, and is protected inside the spinal canal by the vertebrae and other supportive structures.
 

Spinal Cord Monitoring — This involves a technique of measuring the conduction of signals across the spinal cord and nerves. It is frequently applied during complex spinal surgery and particularly spinal deformity surgery. Although they are not failsafe, the monitoring techniques permit a constant assessment of nerve conduction during surgery. If the spinal cord or nerves are stretched, compressed or becoming dysfunctional during an operation, this is usually rapidly detected by the monitoring team. The surgical team is immediately notified and can thus modify or change the work being done to avoid or minimize injury to neurologic structures. Common monitoring techniques include SSEP (Somatosensory evoked potentials) MEP (motor evoked potentials) and EMG (electromyogram).
 

Spinal Fusion — Fusion is a surgically created solid bone bridge between two or more adjacent, usually freely mobile bones. In the spine this is used to create a stability between levels of the spine (vertebrae) that usually have some motion across a discand the facet joints. In order to achieve a fusion, bone must grow across the desired area in a gradual and solid fashion. A number of techniques can increase the chance of this to occur. The basic principle is to place bone tissue (bone graft) into the area of desired fusion, ensure sufficient immobility across that area (brace, cast, spinal instrumentation? and then wait for the fusion to take place (6-9months or more).
 

Spinal Instrumentation — When a surgical procedure is performed to create a spinal fusion or a correction of a deformity (such as scoliosis or kyphosis), there is often a need to firmly bind or link vertebrae together while a fusion is developing in the healing process after surgery. Numerous devices have been developed to attach and firmly hold the spine in a fixed position, these devices are generally called spinal instrumentation (rarely the term hardware is used). Common instrumentation systems that have been used in the past include the Harrington rods, Zielke instrumentation, Wisconsin system, Luque rods? Some of the common newer systems include the CD instrumentation, Isola, AO-Synthes system? There are many different actual devices which can be applied in spinal surgery as instrumentation, some of the common devices include: rods, hooks, wires, cables, screws.
 

Spinous Process — Each vertebra of the spine (below C1) has an anterior vertebral body and posterior elements. The posterior (toward the back portion) elements consist of laminae, facet joints and a central spinous process. The spinous process is a flattened protrusion of the vertebra that juts out toward the back and can be felt in most people (especially in thin individuals) as the firm bumps under the skin in the middle of the back.
 

Stinger — This is a term commonly used by athletes and trainers to describe pain experience with vigorous sports activity. A stinger describes a burning and sudden pain, most commonly in the neck area related to a muscle strain.  
 

Sublaminar Wires — These are special metal wires that have been developed to permit attachment to the spine for surgical procedures involving instrumentation (ex. Scoliosis correction). The wires are passed under the laminae of the spine and then attached to a rod. In that manner the spine is firmly linked to the instrumentation and can be shifted during tightening of the wire.
 

Thoracic Spine — The spinal column is divided into different regions: the neck contains the cervical spine, the upper back contains the thoracic spine, and the lower back contains the lumbar spine. The thoracic spine consists of 12 vertebrae and is attached to the ribcage.
 

Transverse Process — All thoracic and lumbar vertebrae have a small lateral (to the side) bone extension at the junction of the pedicle and facet joint on each side (right and left). The transverse process in the thoracic spine has an attachment to the rib at that level. In the lumbar spine the transverse processes have attachments to muscles and ligaments that aid in stabilization of the spinal column.
 

Uncinate Process — This refers to the lateral (on the side) bone lip of the cervical vertebral bodies. The upper and lower surfaces (called endplates) of the C3,C4,C5,C6 and C7 bodies are slightly dish-shaped, and the upward slope leading to the bone lip of the upper endplate is called the uncus, or uncinate process. Between the cervical vertebrae, the discs separate the endplates of vertebrae from one another, however when these discs collapse or wear down, the uncinate process of one vertebra will site directly upon the endplate of the next level. This becomes important in the treatment of cervical foraminal stenosis where the uncus contributes to compression of the nerve root exiting the spinal canal at that level.
 

Vertebra — The individual bones that make up the spinal column are called vertebrae. There are 7 cervical vertebrae (in the neck area), 12 thoracic vertebrae (upper back, rib cage area), and 5 lumbar vertebrae (lower back). Additionally, the sacrum, at the lowest part of the spine in the pelvic area consists of several vertebrae that are fused together into one large bone.
 

Vertebral Artery — In the cervical spine, there are a set of arteries (blood vessels) that run inside the lateral (to the side) portion of the spinal column, called the vertebral arteries. They are part of the network of blood vessels that supply blood directly to the brain.
 

Vertebrectomy — This refers to a surgical procedure of removal of all or part of a vertebra in the spinal column. Special surgical instruments and very careful surgical technique are required to safely remove a segment of bone from the spine. The nerves and spinal cord which lie inside the spinal canal are at risk from injury in such a procedure. A vertebrectomy is sometimes performed in rigid deformities of the spinal column that can only be corrected once some bone has been removed.