BACK AND SPINE

• Vertebral Column


  • Supports the skull
  • Important attachment for muscles and ligaments
  • Rib attachment (Thoracic Vertebrae)
  • Encloses & protects the spinal cord
  • Provides mobility
  • Ability to transmit forces/weight

  
• Adult Vertebrae


  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacral (1)
  • Coccyx (1)

  
• Baby/Newborn Vertebrae


  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacral (5)
  • Coccyx (4)
• Typical Vertebrae


  • C3 - C6
  • T5 - T8
  • L1 - L4

  
• Atypical Vertebrae


  • Atlas (C01)
  • Axis (C02)
  • T1 - T4
  • T9 - T12
  • C7

  
• Atlas (C01) has a depression on the side, carries the skull, has no body, no spinous process, and is very flat
• Axis (C02) has a dens
• T1 - T4 and T9 - T12 are atypical due to the location of the costal facets
• T9 - T10 usually have tubercles on the ribs
• C7 is not bifid as it is transitioning to the thoracic vertebrae

  
• C7 can be identified by the foramen in the transverse process
• L5 is larger than most lumbar vertebrae
• Landmarks/Levels


  • Cervical Area - Mandible
  • C3 - Hyoid bone
  • C4 - Thyroid bone/Adam's apple
  • C6 - Cricoid
  • C7 - Vertebral prominence
  • T2 - Superior angle of scapula and Sternal notch
  • T3 - Spine of scapula
  • T4 - Sternal angle/angle of louis
  • T7 - Inferior angle of scapula
  • T10 - Bottom of xiphoid process
  • L4 - Iliac crest
  • S2 - PSIS

  
• T2 - T10 are board sensitive
• The spinal cord ends at L1 and L2, below which there are only spinal nerves

  
• Conus Medullaris Syndrome


  Injury to the conus medullaris nerve roots
• Spinal nerve roots continue until S4

  
• Cauda Equina Syndrome


  Injury to the nerve roots in the cauda equina
• The nerve roots that descend below the spinal cord resemble a horse's tail

  
• Uncus


  • Tooth-like projections on the side of the cervical vertebral bodies
  • Limited to cervical vertebrae
  • Starts at C3

  
• Zygapophyseal Joint


  Also called "Z joint" or "Facet joint", connects two facets, a 3 joint complex (intervertebral, right z joint, left z joint), a sliding joint that allows flexion, extension, and rotation
• The sacrum connects the lumbar spine to the pelvis through the sacroiliac joint
• Ligaments of the Vertebral Column

  • Anterior Longitudinal Ligament (ALL)
  • Posterior Longitudinal Ligament (PLL)
  • Ligamentum Flavum
  • Supraspinous Ligament
  • Interspinous Ligament
  • Intertransverse Ligament
  • Costotransverse Ligaments
  • Transverse Ligament of the Atlas
  • Apical Ligament
  • Alar Ligament
  • Accessory Ligament
• The ALL prevents hyperextension, the PLL prevents hyperflexion
• The Ligamentum Flavum is yellow in color due to the fatty tissues
• The Supraspinous Ligament prevents hyperflexion, its continuation to the occiput is the Ligamentum Nuchae
• The Intertransverse Ligament prevents rotation and lateral flexion
• The Costotransverse Ligaments prevent displacement of the ribs during trunk movement
• The Transverse Ligament of the Atlas keeps the dens process in place and prevents anterior dislocation
• The Alar Ligament connects the dens process to the occiput and prevents excessive rotation
• The Accessory Ligament helps the Alar Ligament
• Vertebral Fractures


  • C1 Fracture (Jefferson's Fx)
  • C2 Fracture (Hangman's Fx, Teardrop Fx)
  • C7 Fracture (Clay-Shoveler's Fx)
• Down Syndrome


  • Hypotonic, decreased muscle tone/weak
  • Ligaments are lax/loose, don't limit as they normally should
• Herniated Disc


  Tear in the annulus fibrosus allowing the nucleus pulposus to protrude, commonly posterolaterally
• Spondylolysis


  Fracture in the pars interarticularis
• Spondylolisthesis


  Anterior displacement of a vertebral body

  
• Retrolisthesis


  Posterior displacement of a vertebral body

  
• Cervical hyperextension can tear the Anterior Longitudinal Ligament
• Superficial Back Muscles


  • Trapezius
  • Levator Scapulae
  • Latissimus Dorsi
  • Rhomboids major and minor
  • Splenius Muscles (Capitis and Cervicis)
  • Serratus Posterior (Superior and Inferior)

  
• Intermediate Back Muscles


  • Erector Spinae (Iliocostalis, Longissimus, Spinalis)