DEPARTMENT OF

ANATOMY

Back

Dr. SREEKANTH THOTA

 Back
The back comprises the posterior aspect of the trunk,
inferior to the neck and superior to the buttocks.

The back includes the

1. Vertebral column: the vertebrae, intervertebral (IV)

discs, and associated ligaments
2. Muscles: superficial layer and deep layer
3. Spinal cord and meninges (membranes that cover
the spinal cord).
Vertebrae
Vertebrae: (33)
7 cervical
12 thoracic
5 lumbar
5 sacral
4 coccygeal
Abnormal
Curvatures:

Kyphosis
Lordosis
Scoliosis

Excess of
Thoracic
Curvature
Scoliosis

Excess of Lateral
Curvature
Ligaments of the vertebral column
Anterior longitudinal.
Posterior longitudinal
Ligamentum flava
Ligamentum nuchae
Supra spinous
Interspinous
Intertransverse
Anterior and posterior longitudinal
ligaments, Ligamenta flava
Supraspinous ligament and ligamentum
nuchae
Interspinous ligaments
Laminectomy
The surgical excision of
one or more spinous
processes and the adjacent
supporting vertebral
laminae in a particular
region of the vertebral
column is called a
laminectomy
Surgical laminectomy is
often performed to relieve
pressure on the spinal
cord or nerve roots caused
by a tumor, herniated IV
disc, or bony hypertrophy
(excess growth).
 Back Muscles
Muscles of the back are organized into superficial,
intermediate, and deep groups.

Muscles in the superficial and intermediate groups are

extrinsic muscles because they originate
embryologically from locations other than the back.
They are innervated by anterior rami of spinal nerves

Muscles of the deep group are intrinsic muscles

because they develop in the back. They are innervated
by posterior rami of spinal nerves.
Superficial Group: (attach upper
extremity to the vertebral column)
Trapezius
Latissimus dorsi
Levator scapulae
Rhomboid major & minor
Intermediate group of back
muscles

1.Serratus
posterior
superior
2.Serratus
posterior
inferior
Deep Layer: (postural in function)

Erector spinae iliocostalis, longissmus,

spinalis
Splenius capitis & splenius cervicis
Deepest Layer : Transverso spinalis
group

Semispinalis
Multifidus
Rotators
Spinal Cord & the Meninges
Spinal Cord
The spinal cord begins as a continuation of the
medulla oblongata the caudal part of the
brainstem.
In adults, the spinal cord is 42 to 45 cm long and
extends from the foramen magnum in the
occipital bone to the level of the L1 or L2
vertebra.
In newborns extends till lower border of
L3

Beyond this level a thin filament extends,

which is Filum Terminale
Spinal Cord

The spinal cord is enlarged in two regions in

relationship to innervation of the limbs.
The cervical enlargement extends from the C4
through T1 segments of the spinal cord.
The lumbosacral (lumbar) enlargement extends
from T11 through S1 segments of the spinal cord.
Spinal Meninges and Cerebrospinal
Fluid

Spinal Dura Mater: The spinal dura mater is

separated from the periosteum-covered bone
and the ligaments that form the walls of the
vertebral canal by the epidural space.
This space is occupied by the internal vertebral
venous plexus embedded in a fatty matrix
(epidural fat).
Arachnoid Mater
Delicate, fibroelastic layer
Separated from the dura by the subdural
space
Separated from the piamater by the
subarachnoid space
Connected to the pia by fibrous strands
called Arachnoid Trabeculae.
Spinal Pia Mater

The spinal pia mater, the

innermost covering
membrane of the spinal
cord.
The spinal cord is
suspended in the dural
sac by the terminal filum
and especially by the
right and left sawtooth
denticulate ligaments
which run longitudinally
along each side of the
spinal cord
Spinal Nerves
31 pairs of spinal nerves:
Cervical 8
Thoracic 12
Lumbar 5
Sacral 5
Coccygeal 1

Each spinal nerve has a dorsal & ventral

root.
C1 lacks a dorsal root in 50% of the cases.
Spinal roots unite at the intervertebral
foramen to form a spinal nerve
Blood Supply of the Spinal Cord
Arterial supply

Ant spinal artery Post spinal artery

Br of vertebral Br of vertebral or Post inf

cerebellar artery (PICA)

These vessels are reinforced by blood from segmental

arteries called Radicular arteries.
Lumbar puncture
Introduction of long needle into lumbar subarachnoid space to either draw
CSF out or put drugs into the CSF.
3rd and 4th lumbar spines are marked
4th lumbar spine usually lies on a line joining iliac crests
Lumbar Puncture Layers
1. Skin
2. Superficial fascia
3. Supraspinous ligament
4. Interspinous ligament
5. Ligamentum flavum
6. Epidural space containing the internal vertebral venous plexus
7. Dura mater
8. Arachnoid
9. Subarachnoid space containing cerebrospinal fluid.
And remember Pia is not Pierced
Lumbar Puncture Layers Mnemonic
Some Super Supra Long L E Ds Are Substitutes.
Epidural block
Anaesthetic injected into epidural space of
sacral canal either of the following 3 ways
Sacral hiatus (caudal epidural) using sacral
cornua as landmarks
Posterior sacral foramina (transsacral
epidural)
Lumbar region
Surgery below diaphragm, childbirth,
caesarian
Anesthetic solution spreads superiorly to act on
spinal nerves S2 to Co1
Epidural block
Sacral hiatus (caudal epidural)