ANATOMY 1 Neck, Back and Spine

8/13/2019 ANATOMY 1 Neck, Back and Spine

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ANATOMY 1

Neck, Back and Spine

College of Rehabilitation Science

De La Salle-Health science Institute


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OSTEOLOGY


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Vertebral Column

The spine or vertebral column

Protects the spinal cord

Supports the head and body 26 bones

24 vertebrae, the sacrum, and the coccyx


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Vertebra


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The Vertebral Column

Vertebrae

The neck

Seven cervical vertebrae

The upper back

12 thoracic vertebrae

Each articulates with one or more pair of ribs

The lower back

Five lumbar vertebrae


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The Sacrum and Coccyx

The fifth lumbar vertebra articulates with the

sacrum

The sacrum articulates with the coccyx


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Four Curvatures of the Vertebral Column

Cervical curve

Thoracic curve

Lumbar curve

Sacral curve


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SPINAL CURVES

Thoracicand sacral curves

Are called primary curves(present during fetal

development)

Or accommodation curves(accommodate internal organs)

Lumbarand cervical curves

Are called secondary curves(appear after birth)

Or compensation curves(shift body weight for upright

posture)


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The Vertebra

Structure of a Vertebra

The vertebral body(centrum)

Transfers weight along the spine

The vertebral arch

Posterior margin of vertebral foramen

The articular processes

Lateral projections between laminae and pedicles


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Typical Vertebra


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Typical Vertebra


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The vertebral arch

Pedicles:

walls of the vertebral arch

Laminae:

roof of the vertebral arch

Spinous process:

projection where vertebral laminae fuse

Transverse process:

projection where laminae join pedicles


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The articular processes

Superior articular process

Inferior articular process:

have articular facetson articular faces


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Vertebral Foramina

Intervertebral foramina

Gaps between pedicles of adjacent vertebrae

For nerve connections to spinal cord

Vertebral canal

Formed by vertebral foramina

Encloses the spinal cord

Intervertebral Discs

Are pads of fibrous cartilage

Separate the vertebral bodies

Absorb shocks


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The Cervical Vertebrae

Small body (support only head)

Large vertebral foramen (largest part of spinal

cord)

Concave superior surface

Slopes posterior to anterior

C1(atlas) has no spinous process

All others have short spinous processes

tip of each spinous process is notched (bifid)


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CERVICAL VERTEBRA


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Transverse processes Are fused to costal processes

Which encircle transverse foramina(protect arteries

and veins)

Atlas(C1)

Articulates with occipital condyles of skull

Has no body or spinous process

Has a large, round foramen within anteriorandposterior arches


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Axis(C2)

Supports the atlas

Has heavy spinous process To attach muscles of head and neck

Axis and atlas bodies fuse during development to form the dens

Vertebra prominens(C7)

Transitions to thoracic vertebrae

Has a long spinous process with a broad tubercle

Has large transverse processes

Ligamentum nuchae(elastic ligament) extends from C7to skull


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Thoracic vertebrae(T1T12)

Have heart-shaped bodies

Larger bodies than in C1C7

Smaller vertebral foramen than in C1C7

Long, slender spinous processes

Dorsolateral surfaces of body have costal facets:

Which articulate with heads of ribs


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Thoracic vertebrae(T1T12)

T1T10

Have transverse costal facets On thick transverse processes for rib articulation

Ribs at T1T10

Contact costaland transverse costal facets

T1T8articulate with two pairs of ribs At superiorand inferiorcostal facets

T9T11articulate with one pair of ribs

T10T12transition to lumbar vertebrae


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Thoracic Vertebra


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Lumbar vertebrae(L1L5)

Largest vertebrae

Oval-shaped bodies

Thicker bodies than T1T12

No costal or transverse costal facets

Triangular vertebral foramen Superior articular processes

Face up and in

Inferior articular processes

Face down and out


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Lumbar vertebrae(L1L5) Transverse processes

Slender

Project dorsolaterally Spinous process:

Short, heavy

For attachment of lower back muscles


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Vertebra


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Vertebra


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Vertebra


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SACRUM

The sacrum Is curved, more in males than in females

Protects reproductive, urinary, and digestive organs

Attaches The axial skeleton to pelvic girdle of appendicular skeleton

Broad muscles that move the thigh

The adult sacrum

Consists of five fused sacral vertebrae

Fuses between puberty and ages 2530

Leaving transverse lines


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SACRUM

The sacrum Sacral canal

Replaces the vertebral canal

Sacral cornua

Horn shaped

Formed by laminae of the fifth sacral vertebra

Which do not meet at midline

Sacral hiatus

Opening at the inferior end of the sacral canal

Formed by ridges of sacral cornua

Covered by connective tissues


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SACRUM

Median sacral crest

Fused spinous processes

Four pairs of sacral foraminaopen to either side

Lateral sacral crest

Fused transverse processes

Attach to muscles of lower back and hip


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SACRUM

Auricular surface

Thick, flattened area

Articulates with pelvic girdle (forming sacroiliac joint)

Sacral tuberosity

Rough area

Attaches ligaments of the sacroiliac joint


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SACRUM

Four regions of the sacrum Base:

the broad superior surface

Ala:

wings at either side of the base to attach muscles

Sacral promontory:

at the center of the base

Apex:

the narrow inferior portion

articulates with the coccyx


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The coccyx Attaches ligaments and a constricting muscle of the anus

Mature coccyx Consists of three to five fused coccygeal vertebrae

First two coccygeal vertebrae: Have transverse processes Have unfused vertebral arches

Coccygeal cornua Formed by laminae of first coccygeal vertebra


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Vertebral Regions


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Thoracic Cage

The skeleton of the chest

Supports the thoracic cavity

Consists of:

thoracic vertebrae

ribs

sternum (breastbone)

The Rib Cage

Formed of ribs and sternum


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Thoracic Cage


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Thoracic Cage


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Thoracic Cage

Functions of the Thoracic Cage

Protects organs of the thoracic cavity

Heart, lungs, and thymus

Attaches muscles

For respiration

Of the vertebral column

Of the pectoral girdle

Of the upper limbs


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Thoracic Cage

Ribs

Are mobile

Can absorb shock

Functions of ribs

Rib movements (breathing):

affect width and depth of thoracic cage

changing its volume


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The Thoracic Cage


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The Thoracic Cage

Ribs(costae)

Are 12 pairs of long, curved, flat bones

Extending from the thoracic vertebrae

Ribs are divided into two types

True ribs

False ribs


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The Thoracic Cage

Ribs 1

7 (true ribs) Vertebrosternal ribs

Connected to the sternum by costal cartilages

Ribs 812 (false ribs)

Do not attach directly to the sternum

Vertebrochondral ribs(ribs 810)

Fuse together

Merge with cartilage before reaching the sternum

Floatingor vertebral ribs(ribs 1112)

Connect only to the vertebrae and back muscles

Have no connection with the sternum


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Thoracic Cage


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Thoracic Cage

Structures of the Ribs

The head(capitulum)

At the vertebral end of the rib

Has superior and inferior articular facets

The neck

The short area between the head and the tubercle


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Thoracic Cage

Structures of the Ribs

The tubercle(tuberculum)

A small dorsal elevation

Has an auricular facet that contacts the facet of its

thoracic vertebra (at T1T10only)

The tubercular body(shaft)

Attaches muscles of the pectoral girdle and trunk

Attaches to the intercostal muscles that move the ribs


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Thoracic Cage


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Thoracic Cage


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Thoracic Cage

The sternum

A flat bone

In the midline of the thoracic wall

Three parts of the sternum

The manubrium

The sternal body

The xiphoid process


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Thoracic Cage

Manubrium

The superior portion of sternum

Broad, triangular shape

Articulates with clavicles (collarbones)

Articulates with cartilages of first rib pair

Has ajugular notch, a shallow indentation

between clavicular articulations


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Thoracic Cage

The sternal body

Is tongue-shaped

Attaches to the manubrium

Attaches to costal cartilages of ribs 27

The xiphoid process

Is the smallest part of the sternum

Attaches to the sternal body

Attaches to diaphragmand rectus abdominismuscles


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Thoracic Cage


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The Thoracic Cage

Development of the Sternum

The developing sternal body

Consists of four unfused bones

Completes fusion about age 25

Leaving transverse lines

The xiphoid process

Is the last part of sternum to fuse

Can easily be broken away


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RADIOLOGIC CORRELATION


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AP Open

Mouth

OPEN MOUTH

Odontoid Process


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Occipital condyles

Lateral Masses C1

Transverse Process C1

Posterior Arch C1

C2 Spinous Process

C3 Spinous Process AP Open

Mouth

Odontoid Process


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Neutral

Lateral

Cervical

Lateral View


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C1 Anterior TubercleC1 Posterior Arch

and Tubercle

Odontoid Process

Vertebral Bodies


C2

C3

C4

C5

C6

C7

Spinous Processes

Neutral

Lateral

Cervical

Articular Processes


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Oblique

Cervical

OBLIQUE VIEW

C1 Posterior Arch

and Tubercle


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Oblique

Cervical

C1 Anterior Tubercle

Pedicles

Articular Processes

Intervertebral

Foramina

T1

C7

C6

C5

C4

C3

1stRibs

T1 Transverse

Process

ANTERO POSTERIOR VIEW


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AP

Lower

Cervical

ANTERO POSTERIOR VIEW


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AP

Lower

Cervical

T1 Transverse

Process

C7 Transverse

Process

C5

C6

C7

T1

C4

Articular Processes or

Pillars

Spinous Processes

Uncinate Processes

1stRib

THORACIC AP VIEW


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AP

Thoracic

THORACIC AP VIEW

T1


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AP

Thoracic

PediclesPosterior Ribs

Intervertebral Discs TransverseProcesses

T1

T12

T6

LATERAL VIEW


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Lateral

Thoracic

LATERAL VIEW


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Lateral

Thoracic


Vertebral BodiesIntervertebral

Foramina

Pedicles

T12

T6

Superior Articular

Processes

Spinous Processes


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AP

Lumbar

LUMBAR AP VIEW

Superior Articular

ProcessesLUMBAR AP VIEW


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AP

Lumbar

Inferior Articular

Processes

Pedicles

Spinous ProcessesTransverse

Processes

Sacroiliac

JointsMedian Sacral Crest


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Lateral

Lumbar

LATERAL VIEW


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Lateral

Lumbar

Intervertebral

Foramina

Inferior Articular

Processes

Superior Articular

Processes

L5

Pedicles

Spinous Processes

Vertebral Bodies


Sacrum

Sacral Canal

LATERAL VIEW


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Oblique

Lumbar

LUMBAR OBLIQUE VIEW

T


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Oblique

Lumbar

Scotty Dog

Appearance

Pedicles

Superior Articular

Processes

Inferior Articular

Processes

Partes Interarticulares

Sacroiliac Joint

Transverse

Processes

LUMBAR

OBLIQUE VIEW


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Arthrology


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Intervertebral Joints

I t t b l Di


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Intervertebral Disc

Intervertebral disk make up 20-30% of theheight of the column and thickness variesfrom 3mm in cervical region, 5mm inthoracic region to 9 mm in the lumbarregion.

Ratio between the vertebral body heightand the disk height will dictate the mobility

between the vertebra Highest ratio in cervical region allows for

motion

Lowest ratio in thoracic region limits motion

Disc Structure


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Disc Structure

Nucleus Pulposus (NP) is located in the centerexcept in lumbar lies slightly posterior.

Gelatinous mass rich in water binding PG

(proteoglycan) AKA (glycoaminoglycos) GAG-proteinmolecule.

Chondrotin-4 sulfate in PG molecule gives the disc a

fluid maintaining capacity (hydrophyllic) - decreases

with age.

Hydration of the disc will also decrease with

compressive loading - this loss of hydration

decreases its mechanical function.

Disc Structure


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Disc Structure

80-90% is H2Odecreases with age. Disc volume will reduce 20% daily (reversible)

which causes a loss of 15-25 mm of height in

the spinal column. Acts as a hydrostatic unit allowing for uniform

distribution of pressure throughout the disc.

Disc Structure


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Disc Structure

Compressive stresses on the disc translate intotensile stresses in the annulus fibrosis

This makes the disc stiffer which adds stability and

support to the spine. Bears weight and guides motion.

Avascular - nutrition diffusion through end-

plate.

A l Fib i


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Annulus Fibrosis

Collagen arranged in sheets called lamellae (outer layers).

These lamellae are arranged in concentric rings -10-12layers that lessen in number with age and thicken

(fibrose).

Enclose the nucleus and oriented in opposite directions atan angle of 120 degrees (or 45-65 degrees).

Controls the tensile loading from shear, accessory motions

in the anterior compartment and disc forces which can beup to 5x the external compression force.

A l Fib i


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Annulus Fibrosis

Mostly avascular and lacking innervation butthe outermost layers are probably innervated

(sinovertebral nerve).

Thickest anteriorly.

Outermost 1/3 connects to vertebral body via

Sharpies fibers.

Outer 2/3 connect to the end plate.

L it di l Li t


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Longitudinal Ligaments

Anterior longitudinalSupraspinous

Posterior longitudinal

Ligamentum flavum (elastic)

PLL diverts herniation posteriolaterally

Posterior Structures (Elements) of Motion


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Posterior Structures (Elements) of Motion

Segment

Pedicles and lamina form the neural arch.

Facet joints between the superior and inferior

articulating surfaces.

Transverse and spinous processes.

Interspinous and supraspinous ligaments.

Ligamentum lavum.

Intervertebral foramina.


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Facet Joint

Articulation between

the superior (concave)

and inferior (convex)

facets.

Guide intervertebral

motion through their

orientation in thetransverse and frontal

planes.

Facet Joint Capsule


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Facet Joint Capsule

Limit motions.

Strongest in thoracolumbar and

cervicothoracic regions where the curvatures

change.

Resist flexion and undertake tensile loading

in the superior portion with axial loading or

extension. Resists rotation in lumbar region.


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Intervebral Foramina

Exit for nerve root.

The size is dictated by thedisc heights and thepedicle shape.

Will lose space withosteophytic formation,hypertrophy of ligamentsand loss of disc heightwith aginglateral

stenosis. Decreases by 20% with

extension and increases24% with flexion


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UNCOVERTEBRAL (LUSCHKAS) JOINTS

Uncinate process -Elevations at the lateralmargins of the upper surface

Articulation with thebody of the vertebra

above commonly between unci of

the bodies of C3 or 4-C6 or 7vertebrae

the lateral & posterolateralmargins of the intervertebraldiscs

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Joints between vertebrae

reinforced & supported by numerous ligaments

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Ligaments of the Vertebral Column


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Ligaments of the Vertebral Column


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TRUNKMUSCLES

NECK

MUSCLES


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TRUNK

MUSCLES

Back Muscles

Abdominal

Muscles


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TRUNK MUSCLES: Back

Superficial Layer

Intermediate Layer Deep Layer


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ERECTOR


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ERECTOR

SPINAE

Spinalis

Longissimus

Iliocostalis


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iliocostalis


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longissimus


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Spinalis


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Longissimus Iliocostalis

TRANSVERSO


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TRANSVERSO-

SPINAL

Semispinalis

Multifidus

Rotatores


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semispinalis


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mulitifidus


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rotatores


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MultifidusSemispinalis


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Rotatores

SHORT


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SHORT

SEGMENTAL

Interspinalis

Intertransver-sarius

TRUNK MUSCLES Abd i l


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TRUNK MUSCLES: Abdominal

Rectus Abdominis Internal Oblique External Oblique Transversus Abdominis


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NECK


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NECK

MUSCLES

Antero-LateralMuscles

Posterior

Muscles


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NECK MUSCLES: Antero-Lateral


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Sternocleidomastoid Scalenes (anterior,

medius, posterior) Longus colli & capitis

Rectus capitis (anterior,lateralis)


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NECK MUSCLES: Posterior


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Superficial

Splenius cervicisSplenius capitis


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NECK MUSCLES: Posterior


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DeepRectus capitis posterior

(minor/major)Obliquus capitis

superior & inferior


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LAND MARKS

C3 level of the hyoid


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C3level of the hyoid

bone

C4-C5thyroid cartilage

C6cricoid cartilage (only

complete ring)

T2 superior angle of


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T2 superior angle of

scapula T3spine of scapula

T4-T5sternal angle ofLouise (where the trachea

terminates)


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T7inferior angle of

scapula

T10xiphoid process L1-L2Spinal cord ends

at adult

L4 Ili t/ l l f


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L4Iliac crest/ level of

spinal tap

S2ASIS anteriorly; PSISposteriorly, SI joint,

Dimples of Venous

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ANATOMY 1 Neck, Back and Spine

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