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Back & Spine
Anatomy
| Question | Answer |
|---|---|
| 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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