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Anatomy of the Spine and Back

Anatomy of the Spine and Back. Dr. S. Nishan Silva (MBBS). At Birth The spine of a newborn is C-shaped, with one curve. At About Six Months As the infant lifts his or her head during the first few months, the neck (cervical) curve and its muscles develop. At About Nine Months

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Anatomy of the Spine and Back

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  1. Anatomy of the Spine and Back Dr. S. Nishan Silva (MBBS)

  2. At Birth The spine of a newborn is C-shaped, with one curve At About Six Months As the infant lifts his or her head during the first few months, the neck (cervical) curve and its muscles develop At About Nine Months As the infant learns to crawl and stand, the lower back (lumbar) curve and its muscles develop. Strong back muscles help give your child the strength and balance to walk and run.

  3. The spinal column • The spinal column consists of individual bones called vertebrae, the building blocks, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs. • The spinal column consists of: • seven cervicalvertebrae (C1–C7) i.e. neck • twelvethoracic vertebrae (T1–T12) i.e. upper back • five lumbar vertebrae (L1–L5) i.e. lower back • five bones (that are joined, or "fused," together in adults) to form the bony sacrum • three to five bones fused together to form the coccyx or tailbone

  4. Surface Anatomy of the Back

  5. The Back • Posterior median furrow – vertical groove along the midline • Spinous processes of vertebrae • Spine of the scapula • Medial end is opposite T3 • Medial border of the scapula

  6. The Back • Inferior angle of the scapula • Iliac crests • Supracristal line – intersects L4 • Sacrum – superior to cleft in the buttocks • Coccyx – posterior to the anus

  7. Surface Anatomy of the Back Figure 11.31a

  8. Surface Anatomy of the Trunk • Scapulae • Latissimus dorsi muscle • erector spinae muscle • infraspinatus muscle • trapezius muscle • teres major muscle • posterior axillary fold • triangle of auscutation

  9. Muscles of the Back • Trapezius • Latissimus dorsi • Erector spinae

  10. Surface Anatomy of the Back Figure 11.31b

  11. Anatomy • Spinal cord ends below lower border of L1 • Cauda equina is below L1 • Mid dorsal spinal cord & neural canal space are of same diameter hence prone for complete lesion • Mechanical injury - early ischaemia, cord edema - cord necrosis • Neurological recovery unpredictable in cauda equina ie. peripheral nerves

  12. Vertebra General Anatomy Lecture

  13. Anatomy • Five lumbar vertebrae • Five pairs (10 total) facet joints • Intricate ligamentous support • Anterior & posterior longitudinal • Interspinous & supraspinous

  14. Anatomy • Intervertebral disks • Annulus fibrosus • Outer zone (Sharpey’s fibers) • Intermediate zone • Inner zone • 20 concentric collar like rings criss-crossed for strength • Nucleus pulposus • Fluid gradually changes to fibrocartilage

  15. Spinal Curves • Posterior View • Sagittal View • Primary • Secondary

  16. Bone Palpation • Palpate L4/L5 junction (level of iliac crests) • Palpate spinous processes superiorly and inferiorly • S2 spinous process at level of posterior superior iliac spine • Absence of any sacral and/or lumbar processes suggests spina bifida • Visible or palpable step-off indicative of spondylolisthesis

  17. ANTERIOR PALPATION

  18. Soft Tissue Palpation • 4 clinical zones • Midline raphe • Paraspinal muscles • Gluteal muscles • Sciatic area • Anterior abdominal wall and inguinal area

  19. Vertebral arch • 7 vertebral processes arise from vertebral arch • 3 lever-like processes - provide attachments sites for ligaments and muscles • Spinous process • 2 Transverse processes • 4 articular processes • Arise from junction of pedicle and laminae

  20. Vertebral Arch • Space enclosed by body and vertebral arch is the vertebral foramen • Successive vertebral foramen form the vertebral canal

  21. Facet Joint • Formed by articulation of inferior and superior processes of subsequent vertebrae • Orientation in lumbar spine is toward sagittal plane, allowing flexion and extension but limiting rotation of the lumbar vertebrae • Helps to prevent anterior movement of superior vertebra on inferior vertebra • Articular surfaces are made up of noninnervated articular cartilage • Capsule and synovial membrane are innervated with pain receptors

  22. Cervical spine anatomy • Anterior column - Anterior longitudinal ligament+ Anterior annular ligament and anterior half of VB. • Middle column – Posterior long. Lig. + Posterior annular ligament +Posterior half of VB. • Posterior Column – Lig flavum + superior & Interspinous lig + intertransverse capsular lig + neural arch + pedicle & spinous process.

  23. Cervical Alignment • Anterior vertebral body • Posterior vertebral body • Spinolaminal line • Spinous process tips

  24. General Vertebral Anatomy • Body • Vertebral Arch • Pedicles • Laminae • Vertebral Foramen • Spinous Process • Facets • Superior Articulating Surface • Inferior Articulating Surface • Transverse Process • Intervertebral Foramen

  25. Distinguishing Features of Cervical Vertebrae • Transverse foramina • C1 transverse process • Spinous Processes • C6 and C7 • C3-C6 = bifurcate • None for C1 • Articulating Facets

  26. Atlas • 1st Cervical Vertabrae • Lack of Body • Superior Articular Foveae • Inferior Articulating Foveae • Fovea Dentis

  27. Axis • C2 • Dens • Rotation between skull and atlas

  28. C7 • Body • Spinous process • Transverse Foramina • Anterior element

  29. Articulations within cervical region • Lateral Atlantoaxial Joints • Superior facets and inferior facets of atlas • Flat and in transverse plane • Rotation • Side toward rotation • Side away from rotation • Median Atlantoaxial Joints • Dens of axis and anterior arch of atlas • Tectorial membrane • Cruciform ligament

  30. Articulation within cervical spine • Atlanto-occipital • Occipital condyles of skull and superior articulating surface of atlas • Rotation

  31. Articulations within cervical spine • Body-to-body articulation • Fibrocartilogenous Intervertebral Disk • Annulos fibrosis • Nucleus puplosis

  32. Articulations within cervical spine • Cervical facet joints • Parallel to frontal plane • 45 degrees to transverse plane • Rotation

  33. Ligaments within cervical spine • Ligamentum Nuchae • Interspinous Ligament • Ligamentum Flava • Posterior Atlanto-occipital membrane • Intertransverse Ligament

  34. Curvature of cervical spine • Lordotic Curve

  35. Cervical spine movement • Flexion/Extension • Atlanto-occipital • Rotation • Atlanto-axial joint

  36. Brachial Plexus • Nerve Roots • C5,6,7,8,T1 • Trunks • Upper • Middle • Lower • Divisions • Anterior • Posterior • Cords • Lateral • Posterior • Medial

  37. Throat Anatomy • 1. Thyroid gland • 2. Trachea • 3. Brachiocephalic artery • 4. Common carotid artery • 5. Internal jugular vein • 6. Superior vena cava

  38. Thoracic Vertebrae • Bodies • Pedicles • Laminae • Spinous Processes • Transverse Processes • Inferior & Superior Facets • Distinguishing Feature • Costal Fovea • T1 • T2-T8 • T9-12

  39. Thoracic Vertebrae and Rib Junction • Functions of Thoracic Spine • Costovertebral Joint • Costotransverse Joint • Motions • All available • Flexion and extension limited • T7-T12

  40. Lumbar Spine • Bodies • Pedicles • Laminae • Transverse Process • Spinous Process • Articular Facets

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