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Back & Spine


Sp column functions Support & move head; Transmit & protect sp cord; support thorax & abdomen; transmit weight to lower limbs; provide framework for lower extremity
Sp column 5 vert types Cervical (7); Thoracic (12); Lumbar (5); Sacral (5) (fused); Coccygeal (3-4) (fused)
Vert canal (foramen): produced by: Vertebrae stacked w/vert foramina lined up
Cervical vert: typical features Small vert body; short spinous & transverse processes (spinous processes increase in size inferiorly)
Thoracic Vert features Long spinous process; Articular facets for ribs; Intermediately sized vertebral body
Thoracic Vert transverse processes Long transverse processes: articulate w ribs; some of these create indentation in aorta??
Lumbar vert features Largest vert body; Intermediate spinous and transverse processes; Gaps btw laminae allow access to vert canal
Compare zygopaphyses of diff verts Cervical = horizontal (sloped ant to post); thoracic = vertical; lumbar = wrapped
Spinal Column Movements: Cervical vertebrae Flexion/ extension; Some lateral flexion; Limited rotation
Spinal Column Movements: Thoracic vertebrae Rotation; Some lateral flexion
Spinal Column Movements: Lumbar vertebrae Flexion/ extension; Lateral flexion
Sacral & Coccygeal vert: fusion Initially fuse along lateral processes (wings); then bodies also fuse (at later age)
Relevance of Sacral & Coccygeal vert fusion May have relevance to devt/anatomy of pelvic outlet
Hemivertebra Results from lack of blood flow to half the vert body; results in curvature of spine
Vert Trauma/ Pathology include: Vert fractures (Pars interarticularis fx; Compression fracture); Spinal stenosis
2 intervert joint types Synovial joints (articular processes); have capsule; Intervertebral discs
Spine ligaments Ligamentum nuchae; Supraspinous lig; Interspinous lig; Ant/Post longitudinal ligs; Ligamentum flavum
Trapezius attach To nuchal region of occ bone & spinous processes (cerv & thoracic); insertion all along scapular spine
Transversospinales mxs attach: multifidus vs semispinalis Multifidus crosses fewer vert levels than semispinalis; semispinalis capitis runs up to occ region
Suboccipital mxs attach: To spinous processes of C1 and C2, transverse process of C1, and occipital bone
Suboccipital mxs (list) Rectus capitis posterior minor; Rectus capitis posterior major; Obliquus capitis inferior; Obliquus capitis superior
These form occipital triangle Rectus capitis posterior major; Obliquus capitis inferior; Obliquus capitis superior
Rectus capitis posterior major attaches: To occ bone; forms medial border of subocc triangle; assist in Yes movements
Obliqu cap inf attaches: To inf process of C1; "No" movements (w/obliquus capitis superior); rotating C1 around C2 dens
Extent of sp cord Foramen magnum to L1/L2 in adults; occupies superior 2/3s of vert canal; cervical & lumbar enlargements
Conus medullaris Inf termination of sp cord; typically L1-L2 (but can be T12 or L3); lower in neonates (L3-L4)
Meninges: parts Epidural space; Dura mater; Arachnoid mater (Subarachnoid space); Pia mater
Epidural (=extradural) space Btw vert canal & dura mater; filled with fat, connective tissue, veins; epidural anesthesia
LP: path Skin -> intrinsic back muscles -> ligamentum flavum -> dural sac -> arachnoid mater -> CSF; Perform under conus medullaris; usu L3 or L4
Sp cord arteries Ant/post spinal a. (from vert arts.); Segmental spinal arteries (from intercostal a.)
Primary curvatures of spine Concave anteriorly; Develop in fetus; thoracic/sacral
Secondary curvatures of spine Convex anteriorly; develop in infancy; cervical/lumbar
Hunchback deformity Thoracic kyphosis
Thoracic kyphosis hunchback
Lumbar lordosis swayback
Sp column movements Flexion/ Extension; Lateral Flexion/ Bending; Rotation
Articular facets AKA zygapophyses
Vertebrae: Most of body wt transmitted: vert body
intervert foramen prod by: verts stacked on each other
vertebral arch = pedicle + lamina
Spina bifida Severe to benign; Spina bifida occulta= approx 10%
Scoliosis: congenital form = Often accompanied by other devt anomalies
Fused vertebrae Non-segmentation
Sacrum has facets for articulation with: pelvic bone
Pars interarticularis fracture Spondylolysis/ spondylolisthesis (slippage of vert body)
Compression fracture Osteoporosis; Tuberculosis
Spinal stenosis Narrowing of vertebral canal
Passes thru ver foramen vertebral a.
Dens of C2 attaches to: C1 above
C1 vert body C1: no vert body; actually fused to C2
Atlanto-occipital joint movement Neck flexion/ extension; “YES”
Atlanto-axial joint movement Neck rotation; “NO”
Sacral vertebrae 5 vert fuse in late adolescence
Coccygeal vertebrae 3-4 vert fuse to one another (and often to sacrum)
Intervertebral discs symphyses btw vert bodies (no capsule); Annulus fibrosis & Nucleus pulposis
IV disks names for: verts they are between: "disk T4/5"
First palpable vert C7
Level of inf angle of scapula T7
Level of iliac crest L4
Intermediate extrinsic back mx Serratus posterior superior; Serratus posterior inferior
Extrinsic back mx innervation ventral ramus
Intrinsic back mx innervation dorsal ramus
Trapezius innervated by: CN XI
Trapezius action Raise scapula
Lat dorsi attach: along sp processes (thoracic & lumbar); inserts on humerus
Lev scap attach: fr transverse processes (cervical) to sup border of scapula
Rhomboid attach: to medial border of scap to spinous processes
Vert devt: 1 ossificn ctr for vert body and 2 oss ctrs for vert arches
Extrinsic back mx’s fn Attach appendicular skeleton of upper extremity to axial skeleton
Extrinsic back mx’s (list) Trapezius; Lat dorsi; Levator scapulae; Rhomboid major/ minor
Triangle of auscultn Sup lat dorsi, medial scapula, & inferolateral trapezius
Extrinsix Intermediate mx’s fn In respn
Intrinsic mx covered by: Thoracolumbar fascia
Intrinsic mx: superficial groups Erector spinae mxs; Splenius mxs (AKA spinotransversales)
Suboccipital mx action shake head yes or no
Intrinsic back mx fibers Very long; as go longer/deeper, get shorter (nesting dolls)
Iliocostalis mx Ilium, TL fascia to ribs or transverse processes
Longissimus mx attach: to transverse processes & to ribs; from iliac crest/sacrum
Longissimus mx: cranial segment (to mastoid process); Longissimus capitis
Spinalis mx attach: to spinous processes
Primary extensors of head and back = Erector spinae mxs
Erector spinae mxs bilateral function = maintain posture
Erector spinae mxs unilateral function = lateral flexion/rotation of head (ipsilateral side)
Main mxs used to maintain posture iliocostalis (most lateral of erector spinae mxs)
Splenius mxs (list) Splenius capitis; Splenius cervicis
Splenius capitis attach: Spinous processes -> occipital
Splenius cervicis attach: Spinous processes -> cervical transverse processes
Splenius mxs fns Extend or rotate head
Splenius mxs bilateral action head/ neck extension
Splenius mxs unilateral action rotate head/ neck to ipsilateral side
Transversospinales mxs fn Extend back or rotate trunk
Transversospinales mxs bilateral action = extend vertebral column
Transversospinales mxs unilateral action = rotate trunk to contralateral side
Levatores costarum attach: Transverse process to ribs
Intertransversarius attach: Btw adjacent transverse processes
Interspinales attach: Btw adjacent spinous processes
Segmental muscles Fn to elevate ribs and stabilize adjoining vertebrae
Suboccipital mxs: location Deep to splenius and semispinalis capitis
Will see _____ inside subocc triangle vert art. (runs up, turns left, joins vert art from other side)
Greater occ nerve locn: just below subocc triangle
Sp cord parts Foramen magnum; Conus medullaris; Cauda equina; Filum terminale
Cauda equina AKA “horse’s tail”; Elongated lumbosacral nerves
Sp cord devt: sp cord grows slower than vert canal
Dura mater Dural Sac (ends at S2)
Subarachnoid space Lumbar cistern (inside dural sac): subarachnoid epidural
LP not indicated with: increased intracranial pressure (risk of brainstem herniation)
Sp cord veins Ant/post spinal veins; Internal vertebral plexus
Extrinsix Intermediate mx’s attach Along sp column & attach to ribs
Intrinsic back mxs enclosed by Thoracolumbar fascia: (some of the mx originate off TL fascia)
Intrinsic mx: deep groups Transversospinales mxs; Segmental mxs; Suboccipital mxs
Erector spinae mxs: 3 groups Iliocostalis; Longissimus; Spinalis
Transversospinales mxs attach: Transverse process superiorly to spinous process
Transversospinales mxs (list) Semispinalis; Semispinalis capitis; Multifidus; Rotatores
Segmental muscles (list) Levatores costarum; Intertransversarius; Interspinales
LP: usu perform @ L3-L4? filum terminale = projection of pia mater to anchor ? to coccyx
Interruption to segmental spinal arteries may cause: Necrosis of spcord & loss of fn
Created by: Abarnard
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