BACK
Spinal cord and Nervous system
BACK UNIT OVERVIEW
Spinal cord & Nervous system review
Meninges and CSF
Vasculature
Skeletal structures / joint surfaces
Ligamentous support
Musculature
BACK OBJECTIVES
Describe the gross anatomy for each system (circulatory, muscular, nervous, and
skeletal) in the region of the back.
Integrate the systems to discuss the vertebral column functions.
Analyze common dysfunctions in the vertebral column.
For each muscle, describe how the attachment sites result in an action around a joint.
For each muscle, identify the innervation (peripheral nerve and nerve roots).
GENERAL SKELETAL STRUCTURE
Lordosis vs. Kyphosis
Joints – vertebral discs & zygapophysial joints
Movements
VERTEBRAL SPINE DEVELOPMENT
Size (height) of vertebrae
SPINAL CORD
DEVELOPMENT
Spinal cord level vs. vertebral level
LUMBAR CISTERN
Filled with CSF
Begins at L2
Contains cauda equina & internal filum
terminale
Site of epidural anesthetic
Subarachnoid Space
NERVOUS SYSTEM
OVERVIEW
Central nervous system
Peripheral nervous system
Dermatomes and myotomes
NERVOUS SYSTEM
OVERVIEW CONT’D
Dorsal (posterior) and ventral (anterior)
rami (ramus)
Spinal nerve roots vs peripheral nerves
Plexi (plexus)
AUTONOMIC VS SOMATIC
Functional divisions
Autonomic and somatic nerves throughout CNS and PNS
SPINAL CORD MENINGES
Dura Mater
Arachnoid Mater
Pia Mater
Epidural, Subdural,
Subarachnoid spaces
WHICH OF THE FOLLOWING IS INCORRECT
PERTAINING TO THE LUMBAR CISTERN?
95%
A. It contains CSF.
B. It contains the cauda equina.
C. It contains the internal filum
terminale.
It
co
co
nt
nt
ai
ai
ns
n
It
st
co
CS
h
nt
e
F.
ca
ai
ns
ud
th
ae
e
qu
in
It
in
te
ty
a.
rn
pi
al
ca
fil
lly
um
be
gi
t..
ns
.
in
ad
It
ul
ts
co
nt
at
ai
L2
ns
.
ep
id
ur
al
fa
t.
It
D. It typically begins in adults at
L2.
E. It contains epidural fat.
0% 3% 3% 0%
THE C1 SPINAL CORD SEGMENT IS LINED UP
WITH THE C1 VERTEBRA, EVEN THOUGH IT IS
NOT LINED UP IN THE LUMBAR REGION.
98%
A. True
B. False
se
Fa
l
Tr
ue
3%
THE SPINAL NERVES EXIT THE
INTERVERTEBRAL FORAMEN BELOW THE
CORRESPONDING NUMBERED VERTEBRA.
They all do
They all do not
They do above C8
They do below C8
100%
w
be
lo
Th
ey
Th
ey
do
al
ey
Th
do
ld
ab
o
o
ve
no
t
ld
al
ey
C8
0%
C8
0%
o
0%
Th
A.
B.
C.
D.
VASCULAR SUPPLY
Vertebrae
Back muscles
Spinal cord
BLOOD SUPPLY OF VERTEBRAE
WHICH OF THE FOLLOWING IS INCORRECT PERTAINING
TO THE NEUROVASCULAR SUPPLY OF THE VERTEBRAL
COLUMN?
97%
ve
rt
eb
ra
Ve
lb
no
od
us
ie
sa
dr
ai
re
na
su
ge
Zy
pp
ga
is
li.
to
po
.
ph
bo
ys
th
ea
in
Pa
lj
te
in
oi
r..
nt
fib
.
s
er
a
re
sf
ro
su
m
Pr
pp
op
th
li.
e
r io
.
lig
ce
a
pt
m
en
ive
tu
fib
m
er
...
sf
ro
m
th
e
...
3% 0% 0% 0%
Th
e
A. The vertebral bodies are supplied exclusively by
the anterior and posterior spinal arteries.
B. Venous drainage is to both internal (within the
vertebral canal) and external venous plexuses.
C. Zygapophyseal joints are supplied by medial
branches of posterior rami of spinal nerves.
D. Pain fibers from the ligamentum flavum are
conveyed by (recurrent) meningeal branches of
spinal nerves.
E. Proprioceptive fibers from the anterior
longitudinal ligament are conveyed by (recurrent)
meningeal branches of spinal nerves.
SKELETAL STRUCTURES – THE BACKBONE
Physiological properties
General vertebral shape
CERVICAL REGION
Intervertebral foramina
Uncus (uncinated processes)
Bifid spinous processes
Angles of zygapophysial joints
VERTEBRAL ARTERY
Travels up in transverse
foramina
Loops over C1 in groove
for vertebral artery
Merges ventral to Pons to
form Basilar artery
Supplies brainstem,
cerebellum, and posterior
cerebrum
ATLAS AND AXIS
Atlantoaxial joint
INTERPRETING LATERAL VIEW CERVICAL
RADIOGRAPHS
JEFFERSON (BURST) FRACTURE
HYPERFLEXION WITH
HERNIATION
Disc herniation – nucleus pulposis
squeezed posteriorly
OTHER VERTEBRAL INJURIES
Hyperextension (whiplash)
Hangman’s fracture
RUPTURE OF TRANSVERSE LIGAMENT OF ATLAS
WHICH OF THE FOLLOWING IS INCORRECT
PERTAINING TO THE VERTEBRAL ARTERY?
100%
It
on
ha
th
sb
ep
ra
os
nc
t..
he
.
st
ha
ts
up
pl
yt
..
on
ly
sa
gr
oo
ve
tc
an
tra
ve
rs
e
oc
c lu
de
d,
i
It
If
pa
rti
al
ly
st
he
tra
ns
ve
rs
ef
ca
us
e
or
a.
..
...
0% 0% 0%
It
tra
ve
rs
e
A. It traverses the transverse foramina of
the cervical vertebrae.
B. If partially occluded, it can cause
dizziness upon turning the head.
C. It traverses a groove on the posterior
arch of the atlas.
D. It only has branches that supply the
brain.
IN THE FOLLOWING IMAGE OF A LATERAL RADIOGRAPH
OF THE CERVICAL PART OF THE VERTEBRAL COLUMN,
THE ARROW POINTS TO A FRACTURE OF THE:
95%
in
te
ra
rt
icu
la
ris
of
po
th
e
st
ax
er
is
io
ra
(..
.
rc
h
of
th
e
la
at
m
la
in
s.
a
of
th
sp
e
in
at
ou
la
sp
s.
ro
ce
ss
of
oc
C3
c ip
.
ita
lc
on
dy
le
s.
0% 0% 5% 0%
pa
rs
A. pars interarticularis of the axis
(hangman's fracture).
B. posterior arch of the atlas.
C. lamina of the atlas.
D. spinous process of C3.
E. occipital condyles.
LIGAMENTOUS SUPPORT OF
ATLANTOAXIAL JOINT
Ligaments to hold atlantoaxial joint together:





Cruciate ligaments (superior band, transverse, inferior band)
Alar ligaments aka apical ligament (dens to occiput)
Zygapophyseal articular capsule
Atlanto-axial membranes
Tectorial membrane