BACK AND SPINE

Description

Is the posterior surface of the trunk

Borders

Inferior to the trunk

Superior to the buttocks

Pectoral & shoulder girdle

VERTEBRAL COLUMN

-AXIAL skeleton

-From CRANIUM to the tip of the COCCYX

-Length: 72-75 cm

Functions

Bony composition (33 all)

-Protects the spinal cord and nerves

Cervical

7

Lordosis

Skeleton of the neck-Supports the weight

Thoracic

12

Kyphosis

Skeleton of the thorax-Locomotion

Lumbar

5

Lordosis

-Maintains the body weight

Sacral

5

Kyphosis

coccygeal

4

Kyphosis

Remnant; non-functional

KYPHOSIS kuba

LORDOSIS liyad

SCOLIOSIS

KYPHOSCOLIOSIS-Posterior convex-

Anterior convex-Sagittal displacement of

-Kyphosis + scoliosis-Anterior concave-

Posterior concave

the vertebral column

Primary curvature (since birth)

Secondary curvature

Levo- Scoliosis= rotation to the

-Over curvature with lateral

-Thoracic kyphosis-

-

Cervical lordosis- infant

LEFT; observerib hump

deviation with rotation

common in elderly

able to raise his head

Dextro-Scoliosis= lateral deviatory

-Sacral kyphosis-

Lumbar lordosis- child

(RIGHT) movement plus rotatory

able to sit

motion

In FETUS, all kyphotic position

Thoracic lordosis- common in

TREATMENT:

(thoracic, lumbar, sacral)

pregnant women-Below the level of

maturity: can correct

(braises)

-Above the level of

maturity: braces not

applicable anymore;

surgical

TYPICALVERTEBRA

ATYPICALVERTEBRA

Anterior Element

-

Vertebral body

Atlas

C1; no spinous process

Posterior Element

-

Pedicles

Axis

C2; with DENS/ ODONTOID process

-

Laminae

-STRONGEST among the 7

-

Spinous process

cervical vertebra

-

Transverse process

Vertebral foramen

Canal

Vertebral Prominens

C7; prominent spinous process; NO

VERTEBRAL ARTERY

Articular surface

2 superior; 2 inferior

Sacrum

Vertebral notch

Small superiorly; large inferiorly

Coccyx

Intervertebral foramen

Union of the inferior vertebral

notch (L2) plus the superior

vertebral notch (L3); transmit spinal

nerve

CERVICAL VERTEBRA

TYPICAL

ATYPICAL

ATLAS (C1)

AXIS (C2)

VERTEBRAL PROMINENS (C7)

Transverse process

Transverse Process

Transverse Process

Cervical Spine- long; NOT BIFID

Cervical spine

Arch

Cervical Spine

Transverse Process

Vertebral body

Vertebral Foramen

Vertebral Body DENS ODONTOID

Vertebral foramen

Lateral Articular Surface (sup/ inf)

Vertebral Foramen

Superior Articular Surface

Vertebral Body

Superior Articular Surface

Inferior Articular Surface

Cervical Spine

Inferior Articular Surface

JEFFERSONs FRACTURE/ BURST

HANGMANs FRACTURE common

FRACTURE when hit the head and

in suicidal patient; pedicle is

displaced

dearticulated to laminae;

associated with HYOID fracture

ODONTOID FRACTURE

RUSS BAUSTISTA

THORACIC VERTEBRA

-Body is medium size and HEART-shaped

Transverse process

Thoracic spine-inclined downward

Vertebral body

Vertebral foramen-circular

Superior articular surface-backward and lateral

Inferior articular surface-forward and medial

Costal Facets (Transverse-articulate with the TUBERCLE of-T11 and T12= no tubercle; floating

Process)

the ribs (T1-T10)ribs

Costal Fascets-articulation of HEAD of the ribs

LUMBAR VERTEBRA

-Vertebral body is KIDNEY/ BEAN shaped

-Pedicle and laminae are more strong and thick

Transverse process

Lumbar spine-short, flat, quadrangular; backward

Vertebral body

Vertebral foramen-triangular

Superior articular surface-medially

Inferior articular surface-laterally

SACRAL VERTEBRA

-WEDGE- shaped

-Concave anteriorly

-5 rudimentary bones fused into ONE!

Articulations-5th lumbar vertebra

-Base

-Apex-1st coccyx

-lateral-iliac

Sacral Hiatus-failure of the 4th / 5th laminae to

fuse in the midline

Sacral Canal-transmit spinal cord

Anterior Sacral Foramina-transmit the spinal nerves

Saacral promontory-obstetrical significance-measure to check if the

baby can deliver/

perform vaginal delivery

COCCYGEAL VERTEBRA

-consist of FOUR (4) vertebra fused into ONE!

-remnant

ANATOMICAL VARIANTS OF VERTEBRAE

Cervical Rib

-C1-C12 normally have no rib

-C7 have cervical rib

Lumbarization

-L1 have rib

-Lumbarized S1

-S1 fused to L5

Sacralization

-Sacrolized L5

-L5 fused to S1

RUSS BAUSTISTAJOINTS OF THE VERTEBRAL COLUMN

JOINTSBONETYPE OF JOINTS

LIGAMENTSMOVEMENTS

COMPARTMENTS

Atlanto-Ocipital Joint-between occipitalSynovial jointAnterior atlanto-occipital membrane-Flexion- Extention

condyles andenclosed by capsulecontinuation of the ALL, which runs as a bandYES joint

superior articularwith synovial fluiddown to anterior surface of the vertebral

facet of the atlas

column; connects the anterior arch of the

atlas to the anterior margin of the foramen

magnum

Posterior Atlanto- Occipital Membrane-

similar to Ligamentum flavum; connects the

posterior arch of the atlas to the posterior

margin of the foramen magnum

Atlanto-axial JointBetween dens/Synovial jointSuperficial Ligament (TECTORIAL LIGAMENT)Rotation

odontoid and theEnclose by capsule-Upward continuation of the PLLNO joint

arch of the atlas

-Attached to the occipital bone just

between superior

within the foramen magnum

articular surface of

-Covers the posterior surface of the

the axis and inferior

odontoid process and the apical,

articular surface

alar, & cruciate ligaments

Intermediate Ligament (CRUCIATE

LIGAMENT)

-Transverse part attached on each

side to the inner aspect of the

lateral mass of the atlas and binds

the odontoid process to the

anterior arch of the atlas

-Vertical part: from the posterior

surface of the body of the axis to

the inner margin of the foramen

Deep Ligament

APICAL- median-placed structure that

connects the apex of the odontoid process to

the anterior margin of the foramen magnum

ALAR- lie on each side of the apical ligament

and connects the odontoid process to the

medial side of the occipital condyle

Joints between 2Two adjacentSurface is covered byAnterior Longitudinal Ligament (ALL)Prevents excessive

vertebral bodiesvertebral bodieshyaline cartilage-Wide, stronger, and attached to theextension

IV disc- fibrocartilage

front and sides of the vertebral

bodies and IV discs

Bone-hyaline c.-IV-Continuous bands down the

disc- hyaline c.- bone

anterior surfaces of the vertebral

column from the skull to the sacrum

Posterior Longitudinal Ligament (PLL)Prevent excessive

-Weak, narrow, and attached to theflexion of vertebrae

posterior border of the IV discs and

vertebral bodies

-Continuous bands down to the

posterior surface of the vertebral

-column from the skull to the sacrum

Joints between 2Between articularSynovial jointSupraspinous LigamentDepends on the

vertebral archessurface of adjacentEnclosed by capsule-Between the tip of the spineorientation of the

vertebraArticular facets areInterspinous Ligamentarticular surface

Intervertebral JointBetween twocovered by hyaline-Connects adjacent spine

vertebral archescartilageIntertransverse Ligament

-Between adjacent transverse

process

RUSS BAUSTISTA

Ligamentum Flava

-Connects the laminae of adjacent

vertebrae

Ligamentum Nuchae

Prevents excessive

-Strong ligament formed byflexion of the neck;

thickened supraspinous andflexion stretches the

interspinous ligaments at theligament

cervical region

-From the spine of C7 to the external

occipital protuberance, with the

anterior border strongly attached to

the cervical spines

Costovertebral Joint

Synovial joint

Costotransverse radiate- head of rib and

vertebral body

Sacroiliac Joint

-to be discussed in PELVIC module

INTERVERTEBRAL DISC (IV Disc)

- length of the vertebral column

-Between two vertebral bodies

-Lined by fibrocartilage (symphysis)

Nucleus Pulposus

-ovoid and gelatinous

CLINICAL CORRELATION:

-Contains large amount of water; small

amount of collagen fibers; few cartilage

INTERVERTEBRAL DISC PROLAPSE

cells

-Rupture of the annulus

-old age: water decreases

fibrosus resulting in herniation

-compression: flattened

of the nucleus pulposus

Anulus Fibrosus

-fibrocartilage

-Can result in spinal cord or

-collagen fibers arranged in concentric

nerve impringement

layers

-Patient bear weight on the

-peripheral layer connected to ALL and

other side to prevent

PLL

aggravation of the herniation

-FUNCTION: shock absorption; creates

-MANAGEMENT: content

rocking motion

brought back to center or

LAMINECTOMY

SCAPULA

part of upper limb flat, triangular bone

lies posterior to the chest wall

attached to the clavicle by the ACROMION and humerus by the GLENOID FOSSA

BORDERS (3)ANGLES (3)FOSSAE (3)PROCESSES (4)SUPRASCAPULAR NOTCH

VertebralSuperiorSupraspinous FossaSpinous ProcessArtery

AxillaryInferiorInfraspinous FossaAcromion ProcessVein

SuperiorLateralSubscapular FossaCoracoid ProcessNerve

Glenoid Fossa

MUSCLES OF THE BACK and SPINE

Superficial Muscles connects upper limb to the vertebral column

NAMEORIGIN

INSERTIONACTION

NERVE SUPPLYTrapezius1.occiput bone1.upper fibers- lateral1.upper- elevates theSpinal Accessory Nerve

2.ligamentum

thirds of clavicle

scapula(CN XI)

nuchae (except2.middle fibers-2.middle- pull scapula

C7-T12)

acromion

medially

3.thoracic3.lower fibers spine3.lower pull medial

vertebrae

od the scapula

border of scapula

downward

Latissimus Dorsi1.iliac crestFloor of the bicipital groove ofMedially rotate the armsThoracodorsal nerve

2.lumbar fasciahumerus

Adduct the arm

3.spine of C6 up to

Extensor of the shoulder joint

thorax

4.inferior angle of

the scapula

RUSS BAUSTISTALevator Scapulae

Transverse processScapula: (Medial Border)Raises the medial border of theDorsal scapula nerve

C1-C4-adjacent toscapula

supraspinous fossa

Rhomboids Minor

Spine:Scapula: (Medial Border)

C7-T1-adjacent to scapular

spine

Rhomboids Major

Spine:Scapula: (Medial Border)

T2-T6-adjacent to

infraspinous fossa

TRIANGLE OF AUSCULTATIONLUMBAR TRIANGLE

MUSCLES CONNECTING THE SCAPULA

TO THE HUMERUS

Borders:

Borders:

-Lateral border of Trapezius-Inferior border of Latissimus-Rotator Cuff Muscles (fixators)

muscle

dorsi

(SITS muscles)

-Superior border of Latissimus-Posterior border of external-Deltoid (posterior)

dorsi

oblique

-Medial border of scapula-Iliac crest

-Teres Major

Intermediate Muscles chest wall muscle involved in RESPIRATION

NAMEORIGIN

INSERTIONACTIONNERVE SUPPLYSplenius capitisSpine:

Capitis: Temporal bone andActing alone:Posterior Rami of SpinalSplenius CervicisC7-T4

Occipital Bone

Nerve

Cervicis: Transverse Process ofActing together:

C1-C4

Serratus Posterior1.Lower cervicalUpper RibsRaises ribs:

Superior

spine

Muscle of INSPIRATIONIntercostal Nerves

2.Upper thoracic

spine

Serratus Posterior1.Lower thoracicLower RibsDepresses the ribs:

Inferior

spine

Muscle of EXPIRATION

2.Upper Lumbar

Spines

Deep Muscles muscles that moves the vertebra

SUPERFICIAL VERTICALLY RUNNINGINTERMEDIATE OBLIQUE RUNNING MUSCLEDEEPEST MUSCLE

MUSCLES (ERECTOR SPINAE)(TRANSVERSOSPINALIS)

-Iliocostalis-Semispinalis-Interspinales

-Longissimus-Multifidus-Intertransversarii

-Spinalis-Rotatores

I LOVE SHAWARMA (LateralMedial)

ARTERIAL SUPPLY OF THE BACK

Occipital ArteryBranch of External carotid artery (face

Cervical Region

and posterior area)

Vertebral ArteryBranch of subclavian artery (arises from

the aorta)

Deep Cervical ArteryBranch of costocervical trunk

Thoracic RegionPosterior Intercostal ArteriesBranch of Thoracic Aorta (part of

descending aorta)

Lumbar Region

Subcostal arteryBranch of abdominal aorta

Lumbar artery

Iliolumbar Artery -only muscle notBranch of internal iliac artery (pelvis and

Sacral Regionsupply the perineal________perineum)

Lateral Sacral Artery

RUSS BAUSTISTAVENOUS DRAINAGE OF THE BACK

Venous Drainage of the vertebralExternal Vertebral Venous Plexus

column- Drains the external vertebral

plexus

Internal Vertebral Venous PlexusBasilar Veins

- Lies within the vertebral canal,

outside the dura mater

Intervertebral Veins

- Drains the spinal cord and

meninges

Main Venous Drainage of the BackVenae Commitantes

- Counterpart of the arterial

supply of the back

LYMPHATIC DRAINAGE follows the veins of the back

Cervical Region

Deep Cervical group of Lymph nodes

Thoracic Region

Intercostal Lymph Nodes

Posterior Mediastinal Lymph Nodes

Lumbar Region

Lateral Aortic

Sacral Region

Sacral Nodes

NERVOUS SUPPLY

POSTERIOR RAMI of the 31 pairs od spinal nerves supplies the muscles of the back and skin

ANTERIOR RAMI- follows the course of the limb, thoracic wall & thoracic chest (intercostal nerve)

DERMATOMAL SUPPLYMYOTOMAL SUPPLY- Innervation of the SKIN- Innervation of the MUSCLEArea of the skin supplied by the somatosensory fibers from a single spinal nerve ; useful in localizing the levels of lesions

C2-C5NeckC1-Supplies the deep muscle of the

C6-C8Posterior shoulderC6

T1Tip of axillaC7

back and DO NOT supply the

SKIN.

T4Inferior angle of the scapulaC8

T10umbilicusL4

L5

NEUROANATOMY BOOK:

C2

Back of head

C5

Tip of shoulder

C6

Thumb

C7

Middle finger

C8

Small finger

T4-T5

Nipple

T10

Umbilicus

L1

Inguinal

L4-L5

Big toe

S1

Small toe

S5

perineum

ANIMO LA SALLE!

RUSS BAUSTISTA