BACK AND SPINE

Is the posterior surface of the

Description
trunk
Border
s
Inferior to the trunk
Superior to the buttocks
VERTEBRAL COLUMN
- AXIAL skeleton
- From CRANIUM to the tip of the COCCYX
- Length: 72-75 cm
Functio
ns
Bony composition (33 all)
Protects the spinal cord and
- nerves
Cervical
7
Lordosis
Supports the
- weight
Thoracic
12
Kyphosis
- Locomotion
Lumbar
5
Lordosis
- Maintains the body weight
Sacral
5
Kyphosis
coccygeal
4
Kyphosis
KYPHOSIS kuba
-

LORDOSIS liyad

Posterior convex

- Anterior concave
Primary curvature (since
birth)
Thoracic
- kyphosiscommon in elderly
-

Sacral kyphosis

In FETUS, all kyphotic

position
(thoracic, lumbar, sacral)

Anterior Element

Anterior convex

- Posterior concave
Secondary
curvature
Cervical lordosis- infant
able to raise his head
Lumbar lordosis- child
able to sit
Thoracic lordosis- common
in
pregnant women

TYPICA VERTEB
L
RA
- Vertebral body

Posterior Element

Pedicles

Laminae
Spinous process
Transverse process

SCOLIOSIS
Sagittal
- displacement of
the vertebral
column
LevoScoliosis
= rotation to the
LEFT;
observe
rib hump
Dextro= lateral
Scoliosis
deviatory
(RIGHT) movement plus
rotatory
motion

Atlas
Axis

Canal

Vertebral Prominens

Articular surface

2 superior; 2 inferior
Small superiorly; large
inferiorly
Union of the inferior vertebral
notch (L2) plus the superior
vertebral notch (L3); transmit
spinal
nerve

Sacrum

CERVICAL VERTEBRA

Skeleton of the neck

Skeleton of the thorax

Remnant; non-functional
KYPHOSCOLIOSIS
-

Kyphosis + scoliosis

Over curvature with

lateral
deviation with rotation

TREATMENT:
- Below the level of
maturity: can
correct
(braises)
- Above the level of
maturity: braces not
applicable anymore;
surgical

Vertebral foramen

Vertebral notch
Intervertebral foramen

Pectoral & shoulder girdle

Coccyx

ATYPICA
L
VERTEBRA
C1; no spinous process
C2; with DENS/ ODONTOID
process
STRONGEST among
the 7
cervical vertebra
C7; prominent spinous process;
NO
VERTEBRAL ARTERY

TYPIC
AL

ATYPIC
AL

ATLAS (C1)

AXIS (C2)

Transverse process
Cervical spine

Transverse Process
Arch

Vertebral body

Transverse Process
Cervical Spine
Vertebral Body DENS
ODONTOID

Vertebral Foramen
Lateral Articular Surface (sup/
inf)
Vertebral Foramen
Vertebral Body
Superior Articular Surface
Cervical Spine
Inferior Articular Surface

Vertebral foramen
Superior Articular Surface
Inferior Articular Surface

JEFFERSONs FRACTURE/
BURST
FRACTURE when hit the
head and
displac
ed

RUSS BAUSTISTA

HANGMANs FRACTURE
common
in suicidal patient; pedicle is
dearticulated to laminae;
associated with HYOID
fracture
ODONTOID FRACTURE

VERTEBRAL PROMINENS
(C7)
Cervical Spine- long; NOT
BIFID
Transverse Process

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
-articulate with the
Costal Facets (Transverse
TUBERCLE of
Proces
s)
the ribs (T1-T10)
-articulation of HEAD of the
Costal Fascets
ribs
LUMBAR VERTEBRA
Vertebral body is KIDNEY/ BEAN
- shaped
- Pedicle and laminae are more strong and thick
Transverse process
-short, flat, quadrangular;
Lumbar spine
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
th
-5 lumbar vertebra
- Base
st
-1 coccyx
- Apex
- lateral
-iliac
th
th
Sacral Hiatus
-failure of the 4 / 5 laminae to
fuse in the midline
Sacral Canal
-transmit spinal cord
Anterior Sacral Foramina
-transmit the spinal nerves
Saacral promontory

-obstetrical significance

-T11 and T12= no tubercle;

floating
ribs

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
C1-C12 normally have
Cervical Rib
- no rib
C7 have cervical
- rib
Lumbarization
- L1 have rib
- Lumbarized S1
- S1 fused to L5
Sacralization
- Sacrolized L5
- L5 fused to S1

RUSS
BAUSTISTA

JOINTS OF THE VERTEBRAL COLUMN

JOINTS

Atlanto-Ocipital
Joint

Atlanto-axial
Joint

TYPE OF
BONE
JOINTS
COMPARTMENT
S
-between
occipital
Synovial joint
enclosed by
condyles and
capsule
superior
articular
with synovial fluid

LIGAMENTS

Anterior atlanto-occipital
membranecontinuation of the ALL, which runs as
a band
down to anterior surface of the
vertebral
column; connects the anterior arch
facet of the atlas
of the
atlas to the anterior margin of the
foramen
magn
um
Posterior Atlanto- Occipital
Membranesimilar to Ligamentum flavum;
connects the
posterior arch of the atlas to the
posterior
margin of the foramen magnum
Superficial Ligament (TECTORIAL
Between dens/
Synovial joint
LIGAMENT)
Upward continuation of the
odontoid and the Enclose by capsule
PLL
Attached to the occipital bone
arch of the atlas
just
between
superior
within the foramen magnum
articular surface
Covers the posterior surface of
of
the
the axis and
odontoid process and the
inferior
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

MOVEMENTS

Flexion- Extention
YES joint

Rotation
NO joint

Surface is covered
by

Joints between 2

Two adjacent

vertebral bodies

vertebral bodies hyaline cartilage

IV discfibrocartilage
Bone-hyaline c.-IV
disc- hyaline c.bone

Joints between 2
vertebral arches
Intervertebral
Joint

Anterior Longitudinal Ligament

(ALL)
Wide, stronger, and attached
to the
front and sides of the
vertebral
bodies and IV discs
Continuous bands down the
anterior surfaces of the
vertebral
column from the skull to the
sacrum
Posterior Longitudinal Ligament
(PLL)
Weak, narrow, and attached to
the
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
Supraspinous Ligament

Between articular
surface of
adjacent
vertebra

Synovial joint
Enclosed by
capsule
Between the tip of the spine
Articular facets are Interspinous Ligament

Between two
vertebral arches

covered by hyaline
Connects adjacent spine
cartilage
Intertransverse Ligament
Between adjacent transverse
process

Prevents
excessive
extension

Prevent excessive
flexion of
vertebrae

Depends on the
orientation of the
articular surface

RUSS BAUSTISTA
Ligamentum
Flava
Connects the laminae of
adjacent
vertebrae
Ligamentum Nuchae
-

Costovertebral
Joint
Sacroiliac
Joint

Synovial joint
-to be discussed in PELVIC module

INTERVERTEBRAL DISC (IV

Strong ligament formed by

thickened supraspinous and

interspinous ligaments at the
cervical region
From the spine of C7 to the
external
occipital protuberance, with
the
anterior border strongly
attached to
the cervical
spines
Costotransverse radiate- head of rib
and
vertebral body

Prevents excessive
flexion of the
neck;
flexion stretches
the
ligament

Disc)
-

length of the vertebral column

Between two vertebral
- bodies
- Lined by fibrocartilage (symphysis)
-ovoid and
gelatinous
Nucleus Pulposus
-Contains large amount of water;
small
amount of collagen fibers; few
cartilage
cells

CLINICAL
CORRELATION:
INTERVERTEBRAL DISC
PROLAPSE
- Rupture of the annulus
fibrosus resulting in
herniation

-old age: water decreases

-compression:
flattened

Anulus Fibrosus

-fibrocartilage
-collagen fibers arranged in
concentric

of the nucleus pulposus

Can result in spinal cord
or

layers
-peripheral layer connected to ALL
and

nerve impringement
Patient bear weight on
the

PLL
-FUNCTION: shock absorption;
creates
rocking motion

other side to prevent

aggravation of the
herniation
-

MANAGEMENT: content
brought back to center or
LAMINECTOMY

SCAPULA
1234-

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)

Vertebral

Superior

Axillary

Inferior

Superior

Lateral

FOSSAE (3)
Supraspinous
Fossa

PROCESSES (4)

SUPRASCAPULAR
NOTCH

Spinous Process Artery

Acromion
Infraspinous Fossa Process
Vein
Coracoid
Subscapular Fossa Process
Nerve
Glenoid Fossa

MUSCLES OF THE BACK and SPINE

Superficial Muscles
NAME
Trapezius

connects upper limb to the vertebral column

ORIGI
N
1. occiput bone
2. ligamentum
nuchae
(except
C7-T12)
3. thoracic
vertebrae

Latissimus

1. iliac crest

INSERTION
upper fibers1. lateral
thirds of clavicle
2.
3.

middle fibersacromion
lower fibers
spine
od the scapula

Floor of the bicipital

ACTIO
N
1.

upper- elevates the

scapula

2.

middle- pull scapula

medially

lower pull medial

border of scapula
downward
Medially rotate the arms

NERVE SUPPLY
Spinal Accessory
Nerve
(CN XI)

3.

Thoracodorsal nerve

Dorsi
2. lumbar fascia
spine of C6 up
3. to
thorax
inferior angle
4. of
the scapula

RUSS BAUSTISTA

groove of
humer
us

Adduct the arm

Extensor of the shoulder
joint

Levator
Scapulae

Transverse process

Scapula: (Medial Border)

C1-C4
Rhomboids
Minor

Spine:

Spine:
T2-T6

Scapula: (Medial Border)

- adjacent to
infraspinous fossa

TRIANGLE OF AUSCULTATION

LUMBAR TRIANGLE

Borde
rs:

Borde
rs:

Lateral border of
Trapezius

NAME

muscle
Superior border of
Latissimus
dorsi
Medial border of scapula

Intermediate Muscles
ORIGI
N

Splenius capitis Spine:

Splenius
Cervicis
C7-T4

Serratus
Posterior
Superior

Serratus
Posterior
Inferior

Deep Muscles

Dorsal scapula nerve

Scapula: (Medial Border)

adjacent to
- scapular
spine

C7-T1
Rhomboids
Major

adjacent to
supraspinous
fossa

Raises the medial border of

the
scapul
a

MUSCLES CONNECTING THE

SCAPULA
TO THE HUMERUS

Inferior border of
Latissimus

dorsi
Posterior border of
external
oblique
Iliac crest

Rotator Cuff Muscles

(fixators)
(SITS
muscles)

Deltoid (posterior)

Teres Major

chest wall muscle involved in RESPIRATION

INSERTION
Capitis: Temporal bone
and
Occipital Bone
Cervicis: Transverse
Process of
C1-C4

ACTION

NERVE SUPPLY
Posterior Rami of
Spinal

Acting alone:

Nerve
Acting together:

1. Lower cervical Upper Ribs

spine
2. Upper thoracic
spine

Raises ribs:
Muscle of INSPIRATION

1. Lower thoracic Lower Ribs

spine
2. Upper Lumbar
Spines

Depresses the ribs:

Muscle of EXPIRATION

Intercostal Nerves

muscles that moves the vertebra

SUPERFICIAL VERTICALLY
RUNNING
MUSCLES (ERECTOR SPINAE)
- Iliocostalis
- Longissimus
- Spinalis
I LOVE SHAWARMA
(LateralMedial)

INTERMEDIATE OBLIQUE RUNNING

MUSCLE
(TRANSVERSOSPINALIS)
- Semispinalis
- Multifidus
- Rotatores

DEEPEST MUSCLE
-

Interspinales
Intertransversarii

ARTERIAL SUPPLY OF THE BACK

Occipital Artery

Cervical Region

Vertebral Artery
Deep Cervical Artery

Thoracic Region
Lumbar Region
Sacral Region

Posterior Intercostal Arteries

Subcostal artery
Lumbar artery
Iliolumbar Artery -only muscle
not
supply the perineal________

Branch of External carotid

artery (face
and posterior area)
Branch of subclavian artery
(arises from
the aorta)
Branch of costocervical trunk
Branch of Thoracic Aorta (part
of
descending aorta)
Branch of abdominal aorta
Branch of internal iliac artery
(pelvis and
perineum)

Lateral Sacral Artery

RUSS
BAUSTISTA

VENOUS DRAINAGE OF THE BACK

Venous Drainage of the
vertebral
column

External Vertebral Venous

Plexus
- Drains the external
vertebral
plexus
Internal Vertebral Venous
Plexus
- Lies within the vertebral
canal,
outside the dura mater

Basilar Veins

Intervertebral Veins
- Drains the spinal cord
and
meninges
Main Venous Drainage of the
Back

LYMPHATIC DRAINAGE
Cervical Region
Thoracic Region
Lumbar Region
Sacral Region

Venae Commitantes
- Counterpart of the arterial
supply of the back

follows the veins of the back

Deep Cervical group of Lymph nodes

Intercostal Lymph
Nodes
Posterior Mediastinal Lymph Nodes
Lateral Aortic
Sacral Nodes

NERVOUS SUPPLY

12-

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 SUPPLY
MYOTOMAL SUPPLY
- Innervation of the
- Innervation of the SKIN
MUSCLE
1- Area of the skin supplied by the
somatosensory fibers from a single spinal
nerve ; useful in localizing the levels
of lesions
C2-C5
Neck
C1
Supplies the deep muscle of
- the
C6-C8
Posterior shoulder
C6
T1
Tip of axilla
C7
back and DO NOT supply the
T4
Inferior angle of the scapula
C8
SKIN.
T10
umbilicus
L4
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
S1
S5

Big toe
Small toe
perineum

ANIMO LA
SALLE!

RUSS
BAUSTISTA