BACK AND SPINE

o CURVES OF THE SPINE

1o curve = Kyphosis
o FUNCTIONS 2o curve = Lordosis
S – supports the head Cervical: 2-3 months upon lifting head in prone
I – important attachment of muscles and ligaments Lumbar: 10-12 months upon standing and walking
R – Ribs attachment
E – encloses and protects the spinal cord o PARTS OF A VERTEBRA
N – nag provide ng mobility and flexibility of the trunk a) Body
A – ability to transfer weight the head and body to the lower b) Transverse process
extremities c) Spinous process
d) Vertebral foramen
o VERTEBRAL SPINE e) Pedicle, anterior
LENGTH OF THE SPINAL CORD: - Connects transverse process to body
Male: 72cm Female: 62cm f) Lamina, posterior
- Connects the spinous process to transverse
o VERTEBRAE process
INFANT ADULT g) Vertebral arch, zygapophyseal joint, facet joint
CERVICAL 7 7 - Area between pedicle and lamina
THORACIC 12 12 o TYPICAL VERTEBRA
LUMBAR 5 5 a) Cervical, C3-C6 Typical (2x)
SACRAL 5 1 b) Thoracic (+2) T5-T8 Typical
COCCYX 4 1 c) Lumbar (+4) L1-L4 Typical
TOTAL 33 26
 Cervical Thoracic Lumbar o ATYPICAL VERTEBRA
Moderate Large/ a. Cervical
Vertebral sized, heart massive,  C1, ATLAS
Small
body shaped kidney - No vertebral body
shaped - No spinous process
Long and  C2, AXIS
inclined Short, Thick, - Dens/ Odontoid process
Spinous Bifid spinous
downward/ Flat, - Short transverse process
process process, short
almost quadrilateral - Large, bifid spinous process
vertical
 C7, VERTEBRAL PROMINENS
Transverse Transverse foramen Costal Conical
- Long non-bifid spinous process
process Facets/ pits shape
b. Thoracic
Spinal
 T1
canal/ Largest and Smallest
Triangular - Horizontal spinous process
Vertebral triangular and circular
 T2-T4
foramen
- Almost horizontal spinous process
SAF: SAF: SAF:
- Costal facets at the superior edge of the vertebral
Posterior/Superior Posterior/ Medial
body
Facets IAF: Anterior/ Lateral IAF: IAF:
 T9: (+) Tubercles
Inferior Anterior/ Lateral
Medial  T10
Angle 45o 60o 90o - (+) Tubercles
- Costal facets at the outer/lateral part of the vertebral
STUCTURES PASSING THROUGH THE TRANSVERSE body
FORAMEN?  T11-T12
Vertebral artery and vein. Sympathetic Nerves. - (+) Tubercles
- Costal facets at the outer part of the pedicles
 c. Lumbar 6. Suprasternal notch iv. Back of neck – suboccipital region
 L5: Stout Transverse process
 3 Joint complex b. Thoracic
a. Adjacent vertebral bodies and IV discs (1)  T2 spine = superior angle
b. Paired Superior facets and paired inferior facets (between  T3 spine = scapular spine
pedicle and lamina) (2)  T7 spine = inferior angle
 T10 = Xiphoid process (Not dermatomal level, w/c is T6)
 5 Joint complex (Cervical uncovertebral joints aka Joints of c. Lumbar
von Luschka)  L4 – iliac crest
a. Vertebral body of superior vertebra and paired base of pedicles  L5 – tubercle of iliac crest
of inferior vertebra  S2 – SI and PSIS

o JOINTS o IV DISCS
a. Atlanto-occipital joints (A-O joint): Yes joint - % of vertebral height: 25% of the vertebral height, 1:4
b. Atlanto-Axial joints (A – A joint): No Joint  Annulus Fibrosus (Outer)
1. Contains collagen (elasticity) and protein (lamellae,
o IMPORTANT LANDMARKS angled at 30o)
a. Cervical 2. Sharpey’s fibers – attached to outside part of A.F.
 Hyoid 3. Hoop’s stretch (Stretching of annulus fibrosus)
 C3 Thryoid  Nucleus Pulposus (Inner)
 C4 Cricoid 1. Contains collagen, water, and protein (Proteoglycans,
 C6 strong affinity with water)
1. Junction of the larynx and trachea 2. % of H2O 80-90%, through aging this amount decreases.
2. Junction of the pharynx and esophagus o PRESSURE
3. Middle cervical sympathetic ganglion  Supine 25% Sidelying 75%
4. Laryngeal Prominens (aka Adams Apple)  Standing upright 100%
5. First ring of trachea
 Sitting upright 140%
  Standing + bending forward 160% Shearing
Sliding ant, post,
- - - -
lat
 Sitting + bending forward 185%
 Standing + bending forward +weights 220%
Coupling motions: Lateral flexion is always coupled with rotation,
 Sitting + bending forward + weights 275%
vice versa.
Common direction of herniation
o ROM OF SPINE
Lumbar – posterolateral Motion AO joint AA joint C3-C7 Thoracic Lumbar
Flexion 10o 5o 45 o 15 o 40o
o BIOMECHANICS Extension 25 o 10 o 45 o 15 o 25
Biomechanic Vertebral body Spinous IV Foramin Facets Lateral L & R 5o L & R 10o L&R L & R 15o L & R 20o
s process Discs a flexion 30o
Flattens Opens, Rotation L & R 0o L & R 45o L&R L & R 40o L & R 5o
(Ant) anterosuperio 30o
Flexion Approximates Separates Opens
Pushed r movement 50% flex/ ext 50% rot
(Post)
Flattens Closes,
Approximate (Post) Posteroinferio o LIGAMENTS
Extension Separates Closes
s Pushed r A. INTERSEGMENTAL LIG
(Ant) - Connects many vertebrae
Approximates(Ips Flatten Closes Closes (Ipsi)
i) s (Ipsi) (Ipsi) Opens
1. ALL,
Lateral - Connects that anterior aspect of vertebral body of many
Separates(Contr - Pushed Opens (Contra)
Flexion
a) (Contra (Contra) vertebrae
)
- Taut: extension
Closes Closes (Ipsi)
At its - Lax: flexion
Rotates (Ipsi) Opens
Rotation Rotates (ipsi) weakes
(Contra) Opens (Contra)
t
(Contra)
Distraction Separates - - - -
Compressio Approximates - - - -
n
2. PLL 3. Intertransverse lig – connects the adjacent transverse
- connects the posterior aspect of the vertebral body of the processes
many vertebrae - Taut: lateral flexion contralateral
- Taut: flexion - Lax: lateral flexion ipsilateral
- Lax: extension
3. Supraspinous ligament – connects the tip of spinous process C. OTHER LIGAMENTS
of many vertebrae i. Alar ligaments
(C7 to sacrum) - “wing” controls the skull and atlas rotation over the axis
- Taut: flexion ii. Transverse ligament
- Lax: extension - holds the dens against the atlas
B. INTRASEGMENTAL LIG  Jefferson’s fracture – fracture of C1
- Connects individual vertebra  Hangmans fracture – fracture of C2
1. Ligamentum flavum/flava – connects the laminae of adjacent iii. Cruciform Lig
vertebrae - vertical ligament over the transverse ligament, limits rotation
- Taut: flexion of skull and atlas.
- Lax: Extension iv. Accessory Atlanto-Axial ligament
2. Ligamentum nuchae – connects the tip of spinous process of - (AAA lig) Functions similar to alar ligaments.
adjacent vertebrae
(Occiput to C7) o MUSCLES OF THE BACK AND SPINE
- Continuation of supraspinous ligament, in the neck region a. Superficial muscles (TRaLaLA)
- Taut: flexion i. Trapezius (Upper, middle, lower), shawl muscle
- Lax: Extension ii. Rhomboids – (Minor, Major)
2. Interspinous lig – connects the adjacent spinous processes iii. Levator Scapulae
- Taut: flexion iv. Latissimus Dorsi – broadest muscle “crutch walking muscle
- Lax: Extension
-
b. Intermediate
 Serratus Posterior
- Superior – forced inspiration
- Inferior – forced expiration
c. Deep
 Splenius cervicis, capitis (Bondage muscle)
 Erector spinae
1. I - Iliocostalis
2. L - longissimus
3. S – spinalis
 Transversospinalis (oblique muscles of the back)
1. S - Semispinalis
2. M - Multifidus
3. R – Rotatores
 Interspinalis muscle/ adjacent c interspinous process
 Intertransversarii / adjacent c transverse process
 Levatores Costarum
 Suboccipital region

d. Muscles of anterior trunk

i. Pectoralis Major and minor
ii. Rectus abdominis
iii. Transversus abdominis
iv. Obliques
 External oblique
 Internal oblique