Axial Skeleton

Development of the Skull

The skull is divided into two main parts:

  • Neurocranium - or the cranial vault which covers the brain and lined by dura mater.
  • Viscerocranium - bones that make up the facial part of the skull and the hyoid bone.

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The viscerocranium consists of bones that form the face, lower jaw and hyoid.
They are
derived from neural crest mesenchyme of the first three pharyngeal arches.
The
maxillary process of the first pharyngeal arch gives rise to the maxilla, zygomatic and the squamous part of the temporal bone.
The
mandibular process forms the malleus and incus and parts of the middle ear cavity.
The
mandible forms via intramembranous ossification.
The
second and third pharyngeal arches form the stapes and styloid process along with the hyoid bone.

The neurocranium surrounds and protects the brain.
The bones that form the neurocranium develop by both intramembranous and endochondral ossification and are derived from
mesenchyme of both neural crest and somitic mesoderm origin.

The
part of the neurocranium that develops by endochondral ossification, the base, is the chondrocranium.

The
part formed by intramembranous ossification, the dome, is the dermatocranium. So called because of its relemblence to dermal plates seen in the heads of lower vertebrates.

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The chondrocranium, which is the base of the skull, develops by endochondral ossification from mesenchyme of both neural crest and somitic mesoderm origin.

The arrow marks the cranial end of the notochord.
The
bones of neural crest origin (blue) include:

  • ethmoid bones
  • greater and lesser wings of the sphenoid bone
  • anterior part of the sella turcica

The
bones of somitic mesoderm origin (pink) include:

  • posterior part of the sella turcica
  • body of the sphenoid
  • base of the occipital bone
  • petrous part of the temporal bone.

The membranous neurocranium (dermatocranium) consists of the flat bones of the roof of the skull that form by intramembranous ossification.

The bones of
neural crest origin (blue) include:

  • frontal bone
The bones of somitic mesoderm origin (pink) include:
  • parietal bones
  • upper part of the occipital bone

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At birth the flat bones of the skull are separated by connective tissue, which will eventually form the sutures of the skull. The fontanelles, located where more than two bones meet, are generally wide. This allows the bones of the skull to overlap during birth. After birth, the bones move back to their original position. The fontanelles also allow the brain to continue to grow at the same rapid pace as it had prenatally during the first few years of life (through ~age 5). The emphasis on growth of the neurocranium is reflected in its disproportionate size in the neonate (~4/5ths of skull volume) relative to the smaller size of the face (~1/5th). At around 5 to 7 years old, the child has nearly all of the cranial volume and subsequent growth of the skull is due to increase in the size of the facial skeleton. In adults, the facial skeleton and the cranial vault are each about 50% of the skull volume.

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Palpation of the anterior fontanelle can provide information about the normal progress of ossification of the skull and whether intracranial pressure is normal.
 
The posterior fontanelle generally closes around the second month after birth while the larger anterior fontanelle closes around the 18th month post partum.

Paraxial Mesoderm

By the end of the fourth week, mesoderm occupies a position between the ectoderm and endoderm of the trilaminar embryonic disk.

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The notochord forms the midline axis of the embryo.  
Paraxial mesoderm, on either side of the neural tube, forms vertebrae and deep muscles of the back.  
Intermediate mesoderm, more lateral, forms genitourinary structures
Lateral plate mesoderm splits to a somatic layer to form the muscles, skeleton and lining of the body cavities and a splanchnic layer to form the muscle wall of the hollow viscera and serosal covering.

Paraxial mesoderm, forms blocks of tissue, called somites, along both sides of the notochord and neural tube. Somites become subdivided into specific clusters of cells committed to considerably different fates.

Somites

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Somites first appear in the cranial region around day 20.

In this
day 22 embryo, pairs of somites lie along the neural tube.

Recall that the
neural tube forms by fusion of neural folds, beginning in the middle of the embryo and proceeding simultaneously in cranial and caudal directions as indicated by the double red arrow.

The
anterior and posterior neuropores usually close by day 25 and day 28 respectively. Failure to do so may result in cranial or vertebral defects.

This cranial to caudal, progression of somite formation is regulated by HOX genes which also determine where along the craniocaudal axis of the body the upper and lower limb buds will appear.

At 5 weeks, roughly 44 pairs of somites can be seen through the surface ectoderm of the embryo. Viewed from the right side, they are grouped into:

  • 4 occipital pairs (orange)
  • 8 cervical pairs (green)
  • 12 thoracic pairs (blue)
  • 5 lumbar pairs (yellow)
  • 5 sacral pairs (purple)
  • 3-5 coccygeal pairs (pink)

The occipital somites contribute to head structures and will be discussed later. The remaining somites form the vertebral column and back muscles.

Note that
somites correspond to the number of vertebrae in each region of the vertebral column, except for the cervical region.

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Each somite can be subdivided into four pieces:

  • sclerotome
  • epimere
  • hypomere
  • dermatome
 
The sclerotome of each somite, under the influence of Sonic hedgehog (Shh) from ventral neural tube and notochord, forms vertebrae and intervertebral discs.

The
epimere, gives rise to the epaxial (above the axis) musculature, ie. deep muscles of the back (erector spinae) under the influence of Wnt proteins secreted by the dorsal neural tube.

The
hypomere, forms muscles of the body wall and limbs under the influence of BMP4 secreted by the surface ectoderm and lateral plate mesoderm.

The
dermatome is induced to form the dermis of the skin by neurotropin - 3 (NT-3) from the dorsal neural tube.

Vertebra Formation

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Vertebrae develop from sclerotomes through the inductive influence of Sonic hedgehog (Shh) secreted by the notochord and ventral neural tube.

Shh
, induces cells of the sclerotome to express PAX 1, a gene controling cartilage formation (chondrogenesis) and subsequent bone formation (osteogenesis).

Sclerotome cells
migrate around the neural tube to form the vertebral arch and around the notochord to form the vertebral bodies and intervertebral discs.

In the image of a typical lumbar vertebra the original relationships between neural tube and notochord and the parts of the vertebra that are formed from the sclerotome are shown.
The
vertebral arch is formed by two pedicles and laminae and one spinous process.

The
notochord disappears within the bodies of the vertebrae, but persists in the intervertebral discs as the nucleus pulposus.

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The emerging spinal nerves course in the rostral (cranial ) part of the sclerotome.  
Each
sclerotome splits to cranial and caudal segments at the point where the spinal nerve passes.
Subsequently, the
cranial part of one sclerotome fuses with the caudal part of the sclerotome in front of it to form the vertebral bodies.  By default, the intervertebral foramina are then located between the contiguous (adjacent) vertebrae.

Caudal segment of the 4th occipital sclerotome (O4) (yellow) fuses with the cranial part of the first cervical sclerotome (C1) (yellow) to form the base of the occipital bone in the skull.
C1 spinal nerve emerges through the space between the (base of the skull) occipital bone and C1 (atlas) (top red circle).
All cervical spinal nerves emerge from the intervertebral foramen superior to their correspondingly numbered vertebra ending with the C7 nerve.

C8 spinal nerve passes between the C7 and T1 vertebrae.

Beginning with the T1 spinal nerve (bottom red circle), all spinal nerves emerge from the intervertebral foramen inferior to their correspondingly numbered vertebra.
 
This information is useful in evaluating patients who present with sensory or motor deficits that suggest involvement of a specific spinal nerve or nerves.

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Cauda Equina

Cauda equina (horse's tail) is formed by the dorsal and ventral roots of lower lumbar and sacral spinal nerves.

Initially, the spinal cord and vertebral column are equal in length and the origins of all the spinal nerves are adjacent to their intervertebral foramina.

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As the fetus grows, the vertebral column increases in length, while the spinal cord lengthens by a lesser degree.
As a result, the
caudal (inferior) end of the spinal cord, conus medullaris, shifts upward in the vertebral canal causing elongation of the lower lumbar and sacral nerve roots creating cauda equina.

At
birth, the conus medullaris is opposite the L3 vertebral level and by adulthood it has shifted upward to the level of L1 and L2.

Clinical Correlates

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Craniosynostosis

Craniosynostosis, premature closure of one or more sutures, is an important category of cranial anomalies. They occur in roughly 1/2500 births and are associated with over 100 genetic syndromes.
Though regulation of suture closure is not well understood, it is thought that 
craniosynostoses may be related to aberrant signaling at the boundary between neural crest and somitic mesoderm parts of the skull.
The intersection of the coronal and sagittal sutures is at one such junction. The frontal bone is of neural crest origin and the two parietal bones are from somitic mesoderm. Cells from these two sources mingle and interact for precise timing of suture closure.

Spina Bifida

Failure of the anterior neuropore to close results in cranioschisis, failure of the cranial vault to form and anencephaly, loss of brain tissue from exposure to amniotic fluid, a condition incompatible with life. These deficits will be addressed again in development of the head and neck.

Failure of the posterior neuropore to close results in spina bifida, a category of neural tube defects (NTDs). The least innocuous is spina bifida occulta, in which the posterior vertebral arches, usually S1 & S2 fail to develop but the spinal meninges and spinal cord are intact. It is often detected by the presence of a tuft of hair growing over the area of defect.

Meningocele describes herniation of the meningeal sac through the vertebral arch defect and meningomyelocele indicates herniation of both the meningeal sac and spinal cord through the vertebral arch defect.

Failure of the neural folds to elevate and form a neural tube, produces
rachischisis, the most severe form of the defect.

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Spinal bifida, marked by the 'X' on the image, is detectable through ultrasound examination during pregnancy. It is known to be prevented by folic acid in the maternal diet prior to conception and during pregnancy.

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