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Back
Objectives
Describe the parts of
vertebrae and learn
distinguishing features for
each.
Analyze why flexion is
limited in the thoracic
region and extension is
maximum in the lumbar
region.
Objectives
Objectives
Describe the Meninges and the
clinical significance of where to
perform a spinal tap
Recognize why the superficial
muscles of the back have no
action on the vertebral column
Recognize the actions of intrinsic
muscles of the back on the
vertebral column and evaluate
possible causes of low back pain
Overview
Back
VERTEBRAE
Vertebrae
How many vertebrae?
How are they arranged?
What happens to the size of the
vertebrae?
I-V discs, what is their function??
How many IV discs are there?
Vertebral column
Curvatures of the vertebral
column
Cervical
Thoracic
Lumbar
sacral
Vertebrae
Typical features
Vertebral body
Vertebral arch
Pedicle
Lamina
Vertebral foramen
Epiphyseal rim
Seven processes:
2TP, 1SP, 2superior and 2 inferior
articular processes
VERTEBRAE
Cervical
DISTINCTIVE FEATURES
Small bodies, large vertebral foramina, foramina in transverse
processes, anterior and posterior tubercles, bifid spinous processes,
transverse foramina
Thoracic
Lumbar
Sacral
Fused as sacrum, four pairs of dorsal and ventral foramina for nerve
exit and triangular sacral canal
Coccygeal
Objectives
Spinal cord
Originates at the inferior end of the
medulla oblongata and terminates
as conus medullaris
Is approximately 42 to 45 cm long
from the foramen magnum to L2
Is connected from the conus
medullaris to the coccyx by the
filum terminale (a strand of
connective tissue that connects
exits from the dural sac and passes
through the sacral hiatus)
Spinal cord
Cervical enlargement - corresponds
roughly to the brachial plexus nerves,
which innervate the upper limb. It includes
spinal cord segments from about C4 to T1.
The vertebral levels of the enlargement are
roughly the same (C4 to T1).
Lumbosacral enlargement - corresponds to
the lumbosacral plexu nerves, which
innervate the lower limb. It comprises the
spinal cord segments from L2 to S3 and is
found about the vertebral levels of T9 to
T12.
Spinal cord
Has the following features in cross
section
Dorsal median sulcus and ventral
median fissure that divide cord into
symmetrical halves
Central canal carrying cerebrospinal
fluid (CSF)
White matter surrounding an Hshaped core of grey matter (ventral
and dorsal horns)
Spinal cord
Structure of Spinal Nerves 31 pairs
of spinal nerves
8 cervical, 12 thoracic, 5 lumbar, 5
sacral, 1 coccygeal
C1C7 exit superior to corresponding
vertebrae
C8 exits inferior to the C7 vertebra
T1Co exit inferior to corresponding
vertebrae
Spinal cord
Ventral roots
Dorsal roots
Spinal cord
Ventral and dorsal roots: combine
to form a (mixed) spinal nerve which
exits through the intervertebral
foramen and divides almost
immediately into (mixed) ventral
and dorsal rami
Caudal equina: spinal nerve roots
inferior to the conus medullaris,
travelling obliquely to exit vertebral
canal
Segmental
Level
Cervical
Number of
Nerves
8 (C1-C8)
Thoracic
12 (T1-T12)
Lumbar
5 (L1-L5)
Sacral
5 (S1-S5)
Nerves S1-S4 branch into anterior and posterior rami within the
sacrum, with the respective rami passing through the anterior and
posterior sacral foramina
Coccygeala
1 (Co1)
The 5th sacral and coccygeal nerves pass through the sacral hiatus
a The
first cervical nerves lack posterior roots in 50% of people, and the coccygeal nerves may be
Spinal segments
Because the vertebral column grows longer
than the spinal cord, spinal cord segments do
not correspond to vertebral segments in
adults, especially in the lower spinal cord.
In the fetus, vertebral segments do
correspond with spinal cord segments. In the
adult, however, the spinal cord ends around
the L1/L2 vertebral level, forming a structure
known as the conus medullaris. For example,
lumbar and sacral spinal cord segments are
found between vertebral levels T9 and L2.
Meninges
Dura mater:
Tough fibroelastic membrane
Meninges
Arachnoid mater:
Delicate, avascular, fibroelastic membrane
lining dural sac
Opposed to dura by CSF pressure
Is external to the subarachnoid space,
between arachnoid and pia, containing CSF,
traversed by strands of connective tissue
(arachnoid trabeculae)
Contains the lumbar cistern, an
enlargement of subarachnoid space
between L2 and S2
Meninges
Pia mater:
Highly vascular innermost layer
covering roots of spinal nerves
Continues as the filum terminale
Suspends the spinal cord within
the dural sac by lateral
extensions between the anterior
and posterior roots, called
denticulate ligaments
Dermatomes
A well-defined strip of skin extending from the
anterior to the posterior midline, supplied by a
single spinal nerve
Cervical supply neck and upper limb
Thoracic supply trunk (T1 also supplies upper
limb)
C5 abuts T1 on the superior anterior chest wall
Lumbar predominantly supply anterior lower
limb
Sacral predominantly supply posterior lower
limb
LEVEL
C5
T4
T10
L1
L3/4
S2S4
SOMATIC SUPPLY
Clavicles
Nipples
Level of umbilicus
Inguinal ligament
Over the knee
Perineum
SPINAL CORD
BLOOD SUPPLY TO THE SPINAL CORD
SEGMENTAL ARTERIES
Anterior and posterior segmental
medullary arteries are derived from the
spinal branches of the ascending cervical,
deep cervical, posterior intercostal, and
lumbar arteries.
The medullary segmental arteries are
located chiefly where the need for a good
blood supply to the spinal cord is
greatestthe cervical and lumbar
enlargements
SEGMENTAL ARTERIES
SEGMENTAL ARTERIES
Great anterior segmental artery (of
Adamkiewicz)
Occurs on the left side in 65% of
individuals
Contributes to two thirds of the circulation
to the inferior spinal cord
It typically arises from a left posterior
intercostal artery, which branches from
the aorta, and supplies the lower two
thirds of the spinal cord via the anterior
spinal artery
RADICULAR ARTERIES
The dorsal and ventral radicular
arteries are also derived from the
spinal branches of the ascending
cervical, deep cervical, posterior
intercostal, and lumbar arteries.
These arteries course along most
nerve roots (all except those
supplied by a segmental medullary
artery) and supply blood to the
dorsal and ventral roots of the
spinal nerves and their coverings.
RADICULAR ARTERIES
The dorsal and ventral radicular
arteries typically do not reach
the anterior or posterior spinal
arteries.
Most radicular arteries are small
and supply only the nerve roots;
Clinical relevance
Clinical points
Epidural hematomas
Subdural hematomas
Meningitis
Muscles of back
Superficial back,
MUSCLE
ORIGIN
INSERTION
Trapezius
Ligamentum
nuchae; spines
of C7T12
Lateral clavicle,
acromion,
spine of
scapula,
Intertubercular
groove of
humerus
Latissimus Spines of T6
dorsi
T12,
thoracolumbar
fascia, iliac
crest
Levator
Transverse
scapulae processes C1
C4
Superior
medial border
of scapula
ACTION
Elevates,
retracts, and
rotates
scapula
Extends,
adducts,
medially
rotates
humerus
Elevates
scapula
INNERVATION
CN XI, spinal
root, spinal
nerves C3C4
Thoracodorsal
Dorsal
scapular
C3and 4
MUSCLE
ORIGIN INSERTI
ON
Rhomboi Spines Inferior
d minor of C7 medial
T1
border
of
scapula
Rhomboi Spines Inferior
d major of T2 medial
border
T5
of
scapula
ACTION
Retracts and
rotates
scapula
Retracts and
rotates
scapula
INNERVATIO
N
Dorsal
scapular
Dorsal
scapular
MUSCLE
ORIGIN
Serratus
posterior
superior
Spines of
C7T3
Superior
border of
ribs 25
Elevate Intercostal
s ribs nerves T2
T5
Serratus
posterior
inferior
Spines of
T11L2
Inferior
border of
ribs 812
Depres Intercostal
ses
nerves T9
ribs
T12
Triangle of auscultation
It has the following boundaries:
Superiorly and medially, by the
inferior portion of the Trapezius
Inferiorly, by the Latissimus Dorsi
Laterally, by the medial border of
the scapula
BACK
DEEP BACK
MUSCLE
ORIGIN
INSERTION
ACTION
Ligamentum nuchae
Spinous processes of
C7T3/4
Capitis: Mastoid,
nuchal line
Cervicis: Transverse
processes C1C4
Unilaterally: Laterally
flex and rotate head
Together: extend
head and neck
Angles of ribs
Unilaterally: laterally
flex column,
Together: extend
vertebral column and
head
Spinalis
Thoracic and C
ervical transverse
processes, and to
mastoid process
Thoracic spinous
processes, skull
Transverse
processes
Spinous processes
12 segments
above
Extend and
rotate column
contralaterally
Stabilize
vertebrae
during small
movements
Locally extend
and rotate
vertebral
column
C and L spinous
processes
Aid in
extension of
rotation of
column
Transverse processes
above
Levatores
costarum
Aid in
lateral
flexion of
column
Elevate ribs,
aid in lateral
flexion
Tips of transverse
processes C7T11
Intermediate layer
Flexion
Extension
Lateral Bending
Suboccipital Muscles
Muscle
Origin
Rectus capitis
Spinous process of
posterior major
vertebra C2
Insertion
Lateral part of inferior nuchal line
of occipital bone
Rectus capitis
posterior minor
Posterior tubercle of
posterior arch of
vertebra C1
Obliquus capitis
inferior
Posterior tubercle of
posterior arch of
vertebra C2
Obliquus capitis
superior
Transverse process of
vertebra C1
Suboccipital Triangle
Aspect of Triangle
Superomedial boundary
Structures
Rectus capitis posterior major
Superolateral boundary
Inferolateral boundary
Floor
Roof
Semispinalis capitis
Contents