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Bone, Muscles of vertebral column. By Prof. Pasuk Mahakkanukrauh, MD. Vertebral Column. Vertebrae : cervical ( C ) : thoracic ( T ) : lumbar ( L ) : sacrum ( S ) : coccyx ( Co ) Function : Protection
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Bone, Muscles of vertebral column By Prof. Pasuk Mahakkanukrauh, MD
Vertebral Column • Vertebrae : cervical (C) : thoracic (T) : lumbar (L) : sacrum (S) : coccyx (Co) • Function : Protection : Weight bearing : Movement
Normal Curvature of Vertebral Column • Primary Curvature • Secondary Curvature • Clinical correlation : kyphosis : thoracic kyphosis : lordosis : lumbar lordosis : scoliosis : myopathic, idiopathic
Vertebrae • Vertebral Body : weight bearing • Vertebral Arch: Protection : pedicle : lamina : spinous process : articular process : transverse process * Vertebral foramen * Vertebral (spinal) canal Component
Cervical vertebrae • Foramen transversarium : vertebral a. • C3-C6 : short spinous process+bifid : Uncinate process (Uncus) : LuschkaJoint • C1 : Atlas • C2 : Axis • C7 : prominens spinous process • Facet joint : horizontal
Atlas • Articular facet : kidney • No spinous process • No body • Anterior-posterior tubercle • Lateral mass • Anterior-posterior arch
Axis • Dens or Odontoid process • Bifid big spinous process
Thoracic vertebrae • Costal facet • Long spinous process • Body : Heart shape : T5-8 • T1-4 : cervical like • T9-12 : lumbar like • Facet joint : oblique
Lumbar vertebrae • Big body : L5 • No costal facet • Body : kidney shape • Big transverse process • Lumbosacral angle • Facet joint : vertical
Sacrum: anterior • Fusion 5 sacrum • Triangular shape • Lateral mass • Sacral foramina • Sacral promontary
Sacrum: posterior • Median crest • Intermediate sacral crest • Lateral sacral crest • Sacral hiatus • Sacral cornua
Clinical Application • Epidural (caudal) anesthesia or block • Lumbarization • Sacralization
Coccyx • 4 Remnant…..1 • Coccygeal cornua • No weight bearing ** Coccygonia
Movement • Joint of the vertebral column • Back muscle and ligament
Craniovertebral joint • atlanto-occipital joint - synovial type (condyloid) - Atlanto-occipital membrane - transverse ligament, cruciform ligament - alar ligament, apical ligament - tectorial membrane • atlanto-axial joint - synovial type (pivot type) - transverse ligament • Uncovertebral (Luschka) joint
Joint of the vertebral column • Joint of vertebral body • Joint of vertebral arch - zygapophyseal (facet) joint
Joint of vertebral body • Main ligament - ALL - PLL • Intervertebral disc - Connect vertebrae - Shock absorber - Weight bearing - Component : nucleus pulposus (H2O) : anulus fibrosus (Collagen) • Accessory ligament -Ligament flavum -Interspinous ligament -Intertransverse ligament -Supraspinous ligament
Zygapophyseal Joint • Articular process • Accessory ligament -Ligament flavum -Interspinous ligament -Intertransverse ligament -Supraspinous ligament
Biomechanic : C-spine • Most Movement • Occipitoatlantoaxial complex - O-C1 : main F/E, no rotation - C1-C2 : main rotation, no lateral rotation • Lower cervical spine - C3-C7 : F/E, lateral flexion, rotation
Biomechanic : T-spine • main rotation, lateral flexion • mild F/E : facet joint, costal cartilage, spinous process
Biomechanic : L-spine • Weight bearing • main F/E, lateral flexion, no rotation
Clinical correlation • Spondylolysis • Spondylolisthesis • Spondylosis • Spondylitis • Whiplash injury • Counting vertebrae
Back Muscles • Extrinsic back muscles - superficial layer : trapezius,latissimus dorsi - middle layer : serratus posterior, levator costarum • Intrinsic back muscles : deep layer - superficial back muscles - middle back muscles - deep back muscles
Superficial back muscles • Splenius muscle - splenius capitis - splenius cervicis ** Cervical flexion: levator scapulae, sternocleidomastoid,scalenus ant.-medius Cervical extension
Middle back muscles • Ertector spinae (sacrospinalis)m. - Iliocostalis - Longissimus - spinalis *** Function: back extension *** Back strain
Deep back muscles(transversospinalis) • Semispinalis • Multifidus • Rotator • Interspinalis • Intertransversarius • levator costarum
Middle-deep layer : back extension **** back flexion : abdominal m.
Abdominal Muscles • External Oblique • Internal Oblique • Transversus Abdominis • Rectus abdominis
Stability of spine • Ligaments : ALL, PLL, LF, Interspinous lig. • Back muscles
Reference ผาสุก มหรรฆานุเคราะห์. มหกายวิภาคศาสตร์การเคลื่อนไหว. กรุงเทพฯ : พีบีฟอเรนบุคส์ เซนเตอร์; 2547. 294 หน้า
Neck Flexion Sternocleidomastoid Scalenus muscle Levator scapulae Neck Extension Splenius muscle
Trunk Flexion Abdominal muscle EO,IO,TA,RA Trunk Extension Erector spinae Deep layer of back muscle (multifidus, rotator, interspinalis, intertransversalis)
Trunk lateral bending Anterior-posterior Abdominal muscle Ipsilateral contraction Trunk rotation Ipsilateral contraction IO Contralateral EO Multifidus