BACK & SPINE ANATOMY

FUNCTION “SIRENA” Supports the head Encloses & protects the Spinal Cord
Important attachment of muscles & ligaments provides mobility/flexibility of the trunk
Ribs attachments Ability to transmit wt. of head & body to the LE

VERTEBRAL COLUMN NORMAL CURVES of the VERTEBRAL COLUMN

Male: 72cm Female: 62cm
Adult Child Primary Curve Secondary curve
Cervical 7 7 st
1 curve to appear Developmental curve
Thoracic 12 12 Kyphotic curve Lordotic curve
Lumbar 5 5 Appears at birth Cervical lordosis: 2-3 mos.
Sacral 1 sacrum 5 Thoracic - raises head & sitting upright
Coccygeal 1 coccyx 4 Sacral Lumbar lordosis: 10-12 mos.
Total 26 33 Coccygeal - standing & walking

VERTEBRAL JOINT PARTS

Anterior Posterior
Vertebral body Transverse Process
IV discs Spinous process
Longitudinal ligaments Bilateral facet joints
Functions: Wt. bearing, Shock Joint capsules
absorption, Mobility in all directions Ligaments
Functions: ↑ leverage of ms attachments,
LOM, Protects the spinal cord/canal
*Lamina- connects spinous process to transverse process; located Posterior (LaPos)
*Pedicle- connects transverse process to vertebral body; located Anterior (PAnte)
*Pedicle: Transverse View- widest (L5), narrowest (T4); Sagittal View- widest (T11), narrowest (T1)
*Facet Jt/Z jt/Articular process- found between pedicle & laminae

PARTS of a TYPICAL VERTEBRA

Cervical (C3-C6) Thoracic (T5-T8) Lumbar (L1-L4)

Vertebral Body Small Medium, Heart-shaped Large, Kidney-shaped

Spinous Process Short & bifid Long & inclined downward Short, broad & quadrangular
(+) transverse foramen, vertebral (+) costal facets that attach at the Conical (long & slender)
Transverse Process
veins, arteries, sympathetic n. (VAN) ribs
Spinal Canal Large & triangular Smaller & circular Triangular
Sup: sup & post Sup: lat & post Sup: medial
Facet Joint
Inf: inf & ant Inf: med & ant Inf: lateral
Inclination 45° 60° 90°
Location Between transverse & frontal plane Along frontal & vertical plane Along frontal & sagittal plane

ATYPICAL
> C1 (Atlas)- no body & spinous process; (+) Anterior arch; Jefferson’s Fx; AO jt
> C2 (Axis/Epistropheus)- (+) des/odontoid process, large bifid spinous process & small transverse process
- Hangman Fx (C2), Teardrop Fx (dens); AA jt
> C7 (Vertebra Prominens)- long & non-bifid spinous process; Clay Shoveler’s Fx; Small transverse foramen- vertebral veins

INTERVERTEBRAL DISCS (C2-S1)- 25% of Vertebral column’s ht. (1:4)

1) Nucleus pulposus- gel-like material made up of Proteoglycans (80% water)
2) Annulus Fibrosus- fibrocartilaginous rings; 30° alternating pattern/crisscross of Lamellae
3) Vertebral End plates- connects the nucleus pulposus & inner AF to vertebral body; 2 hyaline cartilaginous plates
4) Sharpey’s fibers- connects outer AF to the VB; Protects & ↑strength of AF *Hoof’s stretch- generated stretch from AF
THREE JOINT COMPLEX- functional unit of the vertebral column
- 1 Adjacent vertebral body & 1 IV disc
- Paired superior & inferior facet joints
UNCOVERTEBRAL JOINTS- not a TRUE jt
- aka Uncinate jt/Joints of Von Luschka/Neurocentral jt
- vertebral body of sup vertebra & paired base of pedicles of inf vertebra
- Found in levels: C3-C7, 12 joints
- Can be seen: 6-9y/o & thru degeneration
- Fully developed at age of 18y/o
- LOM: Side bending/Lat. flexion
AO JOINT (Atlanto-Axial Joint)- “YES” joint, 50% flex & ext, Condyloid joint
AA JOINT (Atlanto-Axial Joint)- “NO” joint, 50% rotation, Trochoid/Pivot joint

ANATOMIC LANDMARKS
Vertebral level Landmarks Cricoid (C6)- Junction:
C3 Hyoid bone (floating bone) Larynx- Trachea
C4-C5 Thyroid cartilage (Adam’s apple, the largest cartilage in the Pharynx- Esophagus
trachea) Middle Cervical sympathetic ganglion
C6 Cricoid cartilage (1st tracheal ring) Laryngeal prominence (Adam’s apple)
Back of Neck Suboccipital region Trachea (1st ring)
T2 Jugular/ Sternal notch/ Superior angle of the scapula Suprasternal notch
T3 Spine of scapula
T4 The junction between manubrium & sternum (nipple)
T7 The inferior angle of the scapula
T9 Xiphisternal joint
T10 Tip of Xiphoid process
L4 Iliac crest
L5 Tubercle of Iliac crest
S2 SI jt; PSIS

BIOMECHANICS of SPINE *Lat. flexion & Rotation- coupling motion

Biomechanics Vertebral Body Spinous Process IV Disc Facets Foramina Loads of the spine
A: flattens Open 1) Compression
Flexion Approximates Separates Open
P: pushed (antero-sup) 2) Distraction
A: pushed Close 3) Shearing forces
Extension Separates Approximates Close
P: flattens (postero-inf) Biomechanics:
I/L: approximates I/L: flattens Close Close
Lateral Flexion 1) Approximates
C/L: separates C/L: pushed Open Open
2) Separates
I/L: close Close
Rotation Same side rotation Opposite side rotation Weakest 3) Opposite forces
C/L: open Open

LIGAMENTS
INTERSEGMENTAL LIGAMENTS
1. Anterior Longitudinal Ligament (ALL)- connects ant of VB from C2-sacrum
- limits extension
2. Posterior Longitudinal Ligament (PLL)- connects post of VB from C2-sacrum
- INSIDE spinal canal; Limits flexion
*L4-L5- MC posterolateral disc herniation
- tectorial membrane: superior continuation of PLL
- Below L2: considered tapered/narrow
3. Supraspinous Ligament- connects tip of spinous process from C7-sacrum
- limits flexion
INTRASEGMENTAL LIGAMENTS
1. Ligamentum flavum- connects the adjacent lamina
- “Yellow ligament” (fatty content & elastic content)
2. Interspinous ligament- connects adjacent spinous process
3. Intertransverse ligament- connects adjacent transverse process; limits c/l flexion
4. Ligamentum nuchae- connects tip of spinous process from occiput-C7
 - superior continuation of Supraspinous ligament

OTHER LIGAMENTS “AATAC”

1. Alar ligament- connects the lat. aspects of the dens to occipital condyles
- limits rotation of skull & C1 rotation on C2
2. AAA (Accessory Atlantoaxial ligament)- supports the alar ligament
3. Transverse ligament- holds the dens against the atlas
- prevents atlantoaxial/post. subluxation of dens when fixed
4. Apical ligament- connects the apex of the dens to the ant. foramen magnum
5. Cruciform ligament- a combination of the transverse sup. & inf. crus

BACK MUSCLES
SUPERFICIAL MUSCLES “TLLR” INTERMEDIATE MUSCLES
1) Trapezius (Upper, Middle, Lower)- “Shawl muscle 1) Serratus Posterior: Superior- inhalation
2) Levator Scapulae Inferior- exhalation
3) Rhomboids Minor & Major
4) Latissimus Dorsi- broadest ms, “Crutch walking ms” Sh ExAdIR
DEEP MUSCLES “SETIILS
1) Splenius- “Bandage ms”, Fibers: Cervicis & Capitis
2) Erector Spinae- “Chief back extensors”, “Longitudinal ms”, “ILS” Iliocostalis, Longissimus, Spinalis
3) Transversospinalis- Oblique ms, “SMR” Semispinalis, Multifidus, Rotatores
4) Interspinalis
5) Intertransversalis
6) Levatore costarum- elevates lower ribs
7) Suboccipital ms- “Capital extensors”

THORACOLUMBAR MUSCLES
ANTERIOR (PeSeReTRO) LATERAL
1) Pecs Major & Minor 1) Quadratus Lumborum
2) Serratus Ant.- “Boxers ms” 2) Psoas Major
3) Rectus Abdominis (Upper & Lower)- “Abs”
4) Transversus Abdominis- “Corset ms”
5) Oblique ms (trunk rotation), External (inferomedial fiber) & Internal (inferolateral fiber)

DEEP MUSCLES (ETIILS)

- Erector Spinae, Transversospinalis, Interspinalis, Intertransversarii, Levatores costarum, Semispinalis

RANGE of MOTION
AO Joint AA Joint C3-C7 Thoracic Lumbar
Flexion 10° 5° 45° 15° 40°
Extension 25° 10° 45° 15° 25°
(L) Lateral Flexion 30° 15° 20°
5° 10°
(R) Lateral Flexion 30° 15° 20°
(L) Rotation 5°
0° 45° 30° 40°
(R) Rotation 5°
*Lumbar Rotation- most limited motion in spine