SEM401: Back and Spine

• Spine


  Part of the axial skeleton (at the axis or midline of the body)
• Functions of the Spine

  • Supports the head
  • Important attachment of muscles and ligaments
  • Rib attachment (thoracic area)
  • Encloses and protects the spinal cord
  • Provides stability and flexibility of the entire body
  • Transmits weight to the lower extremity
• Major Segments of the Spine

  • Cervical – 7 vertebra (infant/adult)
  • Thoracic – 12 vertebra (infant/adult)
  • Lumbar – 5 vertebra (infant/adult)
  • Sacral – 5 vertebra (infant) / Sacrum – 1 (adult)
  • Coccygeal – 4 vertebra (infant) / Coccyx – 1 (adult)

  
• 33 bones in Infant Spine
• 26 bones in Adult Spine
• Average 72 cm and varies per gender
• Female spine length


  +/- 10 cm
• Primary curve


  Kyphotic curve (Flexed position during infancy)
• Secondary curve


  Lordotic curve (Cervical (2-3 months) and Lumbar (9-10 months), Develops during 2-3 months, Infant lifting of head = Develops the lumbar lordosis, 9-10 months - Infant is able to stand up)
• Parts of the Vertebra

  • Vertebral body
  • Spinal Canal
  • Transverse process
  • Spinous process
  • Pedicle
  • Lamina
  • Articular Facets / Articular Process / Z joints

  
• Intervertebral disc in the vertebral body is an intervertebral gel like structure that passes through the Spinal Canal
• Spinal cord passes through the Spinal Canal
• Transverse Foramen contains Vertebral Arteries, Vertebral Veins, Sympathetic Nerves
• Costal pits are located at the thoracic area and hang the rib posteriorly
• Compare the verterbral body of each Typical Vertebra

  • Cervical - small
  • Thoracic - medium heart shaped
  • Lumbar - large kidney shaped

  
• Atypical Vertebra: C1 (Atlas)


  No vertebral body, No spinous process, Fracture – Jefferson's fracture (Burst fracture at the ring of the atlas, Compression fracture, Force is directed outwards = No SCI)

  
• Atypical Vertebra: C2 (Axis)

  Dens / Odontoid process, Spinous process: Large and bifid, Fractures: Hangman's Fracture – Neural arc, Teardrop fracture – Dens

  
• Atypical Vertebra: C7 (Vertebra prominens)


  Spinous process: Long and non bifid, Fracture – Clay shovelers fracture (For the construction workers)
• Atlantooccipital


  Condyloid joint, Lateral flexion, Cervical flexion and extension, Yes joint
• Atlantoaxial


  Atlanto and axis, Pivot joint / trochoid joint, Rotation, No joint
• Joints of Luschka


  Uncovertebral joints, Can be seen in the lower cervical vertebra (C3 to C7), Total of 12 joints, Synovial joints and rudimentary (at birth di kita)
• Hyoid Bone

  Only bone in the anterior portion of the neck, U shaped or horse shoe shaped, In line with the C3 vertebra, No articulations or bony connections, Stylohyoid ligament attaches the hyoid bone to the skull, No bones but has muscular attachments
• Suprahyoid muscles

  "DMSG"

  • Digastric (dually innervated)
  • Mylohyoid
  • Stylohyoid
  • Geniohyoid
• Infrahyoid muscles

  "TOSS"

  • Thyrohyoid – Innervated C1
  • Omohyoid – Innervated by Ansa cervicale
  • Sternohyoid - Ansa cervicale
  • Sternothyroid - Ansa cervicale
• When combined, the suprahyoid and infrahyoid muscles serve as secondary muscles for mastication
• Ansa cervicale


  Loop of nerves from C1 - C4 cervical plexus
• SCM (Sternocleidomastoid)

  Bilateral: Cervical flexion

  Unilateral: Ipsilateral Lateral Flexion, Contralateral Rotation

  SCM Condition: Torticollis or Wryneck
• Scalene


  Bilateral: Cervical flexion

  Unilateral: Ipsilateral lateral flexion, Ipsilateral Lateral Rotation

  TOS – Thoracic Outlet Syndrome (When you palpate the radial pulse, you cannot feel it)
• Triangles of the Neck

  • Anterior Triangle (SAP, MAA)
  • Posterior Triangle (API, PTC)
  • Submental triangle (ALI, AAH)
  • Submandibular triangle (SAP, MAP)
  • Carotid triangle (SIP, PSA)
  • Muscular triangle (SAP, SAA)
  • Occipital triangle (API, PTI)
  • Supraclavicular Triangle (ASI, PIC)
• Biomechanics of the Spine

  • Flexion
  • Extension
  • Lateral Flexion
  • Rotation
• Muscles of the Back/Spine


  • Superficial: Trapezius, Rhomboids, Levator Scapulae, Latissimus dorsi
  • Intermediate: Serratus Posterior Superior, Serratus Posterior Inferior
  • Deep (superficial)
  • – Splenius Capitis
  • – Splenius Cervicis,
  • Deep (intermediate)
  • – Erector spinae "ILS" (Iliocostalis, Longissimus, Spinalis)
  • Deep (deep "SAMURAI")
  • – Semispinalis
  • – Multifidus
  • – Rotatores
• Ligaments of the Back

  • Intersegmental ligaments (Anterior Longitudinal Ligaments, Posterior Longitudinal Ligaments, Supraspinous ligaments)
  • Intrasegmental ligament (Ligamentum flavum, Ligamentum nuchae, Interspinous ligament, Intertransverse ligament)
• Intervertebral Discs


  25% of the height or sometimes 33% of the height of the vertebral column, ¼ of the height of the vertebral column, In 2 vertebral bodies, there is an IV disc, 23 IV discs, For shock absorption, Through development, nababawasan ang water, Greatest fluid: At 1 year old, Limited to no blood supply, With nerve

  
• Parts of the Intervertebral Discs

  • Nucleus pulposus
  • Anulus Fibrosis

  
• 3 Joint Complex


  IV joints (2 joints between 2 vertebral bodies), Superior and Inferior facet (2 paired facets of the superior and inferior)
• Anatomical Levels


  • Cervical (C3 – Hyoid bone, C4 – Thyroid bone, C6 – Cricoid bone, Junction of the larynx : Trachea, Junction of the pharynx : Esophagus)
  • Thoracic (T2 – Superior angle of Spine, T3 – Scapular spine, T7 – Inferior angle of Spine, T10 – Xiphoid process)
  • Lumbar (L4 – Iliac crest, L5 – Tubercle of Iliac crest, S2 – SI Joint / PSIS)

  
• Compare the vertebral body of each Typical Vertebra

  Cervical - small

  Thoracic - medium heart shape

  Lumbar - large kidney shape
• Compare the spinous process of each Typical Vertebra Cervical

  • Cervical - short and bifid
  • Thoracic - long and directed (inclined downward)
  • Lumbar - short, broad, flat, quadrangular
• Compare the spinal canal of each Typical Vertebra Cervical

  • Cervical - largest and triangular shape
  • Thoracic - smallest and circular shape
  • Lumbar - triangular shape
• Compare the transverse process of each Typical Vertebra Cervical

  • Cervical - (+) transverse foramen
  • Thoracic - (+) costal pits
  • Lumbar - conical shape, long and slender