Dr. S. Nishan Silva
(MBBS)
At Birth
The spine of a newborn is Cshaped, with one curve
At About Six Months
As the infant lifts his or her head during the first
few months, the neck (cervical) curve and its
muscles develop
At About Nine Months
As the infant learns to crawl and stand, the lower
back (lumbar) curve and its muscles develop.
Strong back muscles help give your child the
strength and balance to walk and run.
The spinal column
The spinal column consists of individual bones called
vertebrae, the building blocks, which provide support
for the spine. These vertebrae are connected in the
front of the spine by intervertebral discs.
The spinal column consists of:
•seven cervical vertebrae (C1–C7) i.e. neck
•twelve thoracic vertebrae (T1–T12) i.e. upper back
•five lumbar vertebrae (L1–L5) i.e. lower back
•five bones (that are joined, or "fused," together in
adults) to form the bony sacrum
• three to five bones fused together to form the
coccyx or tailbone
The Back
 Posterior median furrow – vertical groove along the
midline
 Spinous processes of vertebrae
 Spine of the scapula
 Medial end is opposite T3
 Medial border of the scapula
The Back
 Inferior angle of the scapula
 Iliac crests
 Supracristal line – intersects L4
 Sacrum – superior to cleft in the buttocks
 Coccyx – posterior to the anus
Surface Anatomy of the Back
Figure 11.31a
Surface Anatomy of the Trunk
 Scapulae
 Latissimus dorsi muscle
 erector spinae muscle
 infraspinatus muscle
 trapezius muscle
 teres major muscle
 posterior axillary fold
 triangle of auscutation
12-8
Muscles of the Back
 Trapezius
 Latissimus dorsi
 Erector spinae
Surface Anatomy of the Back
Figure 11.31b
Anatomy
 Spinal cord ends below lower border of L1
 Cauda equina is below L1
 Mid dorsal spinal cord & neural canal space are of same
diameter hence prone for complete lesion
 Mechanical injury - early ischaemia, cord edema - cord
necrosis
 Neurological recovery unpredictable in cauda equina ie.
peripheral nerves
General Anatomy Lecture
Anatomy
 Five lumbar vertebrae
 Five pairs (10 total) facet
joints
 Intricate ligamentous
support
 Anterior & posterior
longitudinal
 Interspinous &
supraspinous
Anatomy
 Intervertebral disks
 Annulus fibrosus




Outer zone (Sharpey’s fibers)
Intermediate zone
Inner zone
20 concentric collar like rings crisscrossed for strength
 Nucleus pulposus

Fluid gradually changes to
fibrocartilage
Spinal Curves
 Posterior View
 Sagittal View
 Primary
 Secondary
Bone Palpation
 Palpate L4/L5 junction (level of iliac crests)
 Palpate spinous processes superiorly and inferiorly
 S2 spinous process at level of posterior superior iliac
spine
 Absence of any sacral and/or lumbar processes
suggests spina bifida
 Visible or palpable step-off indicative of
spondylolisthesis
ANTERIOR PALPATION
Soft Tissue Palpation
 4 clinical zones
 Midline raphe
 Paraspinal muscles
 Gluteal muscles
 Sciatic area
 Anterior abdominal wall and inguinal area
Vertebral arch
 7 vertebral processes arise from vertebral arch
 3 lever-like processes - provide attachments sites for
ligaments and muscles


Spinous process
2 Transverse processes
 4 articular processes

Arise from junction of pedicle and laminae
Vertebral Arch
 Space enclosed by body and vertebral arch is the
vertebral foramen
 Successive vertebral foramen form the vertebral
canal
Facet Joint
 Formed by articulation of inferior and superior
processes of subsequent vertebrae
 Orientation in lumbar spine is toward sagittal
plane, allowing flexion and extension but
limiting rotation of the lumbar vertebrae
 Helps to prevent anterior movement of superior
vertebra on inferior vertebra
 Articular surfaces are made up of
noninnervated articular cartilage
 Capsule and synovial membrane are innervated
with pain receptors
Cervical spine anatomy
 Anterior column - Anterior longitudinal ligament+
Anterior annular ligament and anterior half of VB.
 Middle column – Posterior long. Lig. + Posterior
annular ligament +Posterior half of VB.
 Posterior Column – Lig flavum + superior &
Interspinous lig + intertransverse capsular lig + neural
arch + pedicle & spinous process.
Cervical Alignment
 Anterior vertebral body
 Posterior vertebral body
 Spinolaminal line
 Spinous process tips
General Vertebral Anatomy
 Body
 Vertebral Arch
 Pedicles
 Laminae
 Vertebral Foramen
 Spinous Process
 Facets
 Superior Articulating Surface
 Inferior Articulating Surface
 Transverse Process
 Intervertebral Foramen
Distinguishing Features of Cervical
Vertebrae
 Transverse foramina
 C1 transverse process
 Spinous Processes
 C6 and C7
 C3-C6 = bifurcate
 None for C1
 Articulating Facets
Atlas
 1st Cervical Vertabrae
 Lack of Body
 Superior Articular
Foveae
 Inferior Articulating
Foveae
 Fovea Dentis
Axis
 C2
 Dens
 Rotation between skull
and atlas
C7
 Body
 Spinous process
 Transverse Foramina
 Anterior element
Articulations within cervical region
 Lateral Atlantoaxial Joints
 Superior facets and inferior
facets of atlas
 Flat and in transverse plane
 Rotation


Side toward rotation
Side away from rotation
 Median Atlantoaxial
Joints
 Dens of axis and anterior
arch of atlas
 Tectorial membrane
 Cruciform ligament
Articulation within cervical spine
 Atlanto-occipital
 Occipital condyles of
skull and superior
articulating surface of
atlas
 Rotation
Articulations within cervical spine
 Body-to-body
articulation
 Fibrocartilogenous
Intervertebral Disk


Annulos fibrosis
Nucleus puplosis
Articulations within cervical spine
 Cervical facet joints
 Parallel to frontal plane
 45 degrees to
transverse plane
 Rotation
Ligaments within cervical spine
 Ligamentum Nuchae
 Interspinous
Ligament
 Ligamentum Flava
 Posterior Atlantooccipital membrane
 Intertransverse
Ligament
Curvature of cervical spine
 Lordotic Curve
Cervical spine movement
 Flexion/Extension
 Atlanto-occipital
 Rotation
 Atlanto-axial joint
Brachial Plexus
 Nerve Roots
 C5,6,7,8,T1
 Trunks
 Upper
 Middle
 Lower
 Divisions
 Anterior
 Posterior
 Cords
 Lateral
 Posterior
 Medial
Throat Anatomy
 1. Thyroid gland
 2. Trachea
 3. Brachiocephalic artery
 4. Common carotid artery
 5. Internal jugular vein
 6. Superior vena cava
Thoracic Vertebrae







Bodies
Pedicles
Laminae
Spinous Processes
Transverse Processes
Inferior & Superior Facets
Distinguishing Feature
 Costal Fovea



T1
T2-T8
T9-12
Thoracic Vertebrae and Rib Junction
 Functions of Thoracic
Spine
 Costovertebral Joint
 Costotransverse Joint
 Motions
 All available
 Flexion and extension
limited
 T7-T12
Lumbar Spine
 Bodies
 Pedicles
 Laminae
 Transverse Process
 Spinous Process
 Articular Facets
Lumbar Spine
 Thoracolumbar Fascia
Lumbar Spine
 Iliolumbar Ligaments
 Functions of Lumbar
Spine
 Resistance of anterior
translation
 Resisting Rotation
 Weight Support
 Motion
Spinal Ligaments
 Anterior Longitudinal
 Posterior Longitudinal
 Ligamentum Flavum
 Interspinous
Ligaments
 Supraspinous
Ligaments
 Intertransverse
Ligaments
Intervertebral Disks
 Ratio between disk
thickness and
vertebral body height
 Disk Composition
 Nucleus pulposis
 Annulus Fibrosis
Vertebral venous plexus
Deep Muscles of
the Back (Erector
Spinae)
Iliocostalis
 Iliocostalis lumborum
 Iliocostalis Thoracis
 IliocostalisCervicis
Iliocostalis Lumborum
 O
 Common tendon origin in
sacrum, iliac crest, lumber
vertebrae
 I
 Lower borders ribs 6-12
 N
 Dorsal rami of spinal nerves
 F
 Bilateral
 Spinal extension
 Maintenance of erect posture
 Stabilization of spine during
flexion
 Unilateral
 Lateral flexion
 Ipsilateral rotation
Iliocostalis Thoracis
O
 Upper borders rib 6-12
I
 Lower borders ribs 1-6
N
 Dorsal rami of spinal
nerves
F
 Bilateral
 Same as above
 Unilateral
 Same as above
Iliocostalis Cervicis
O
 Angles ribs 1-6
I
 C4-6 transverse
processes
N
 Dorsal rami of spinal
nerves
F
 Same as above
Longissimus
 Longissimus Thoracis
 Longissimus Cervicis
 Longissimus Capitus
Longissimus Thoracis
O
 Common tendon origin
in sacrum, iliac crest,
lumber vertebrae
I
 T1-12 transverse
processes
N
 Dorsal rami of spinal
nerves
F
 Same as above
Longissimus Cervicis
O
 T1-5 transverse processes
I
 C2-6 transverse
processes
N
 Dorsal rami of spinal
nerves
F
 Same as above
Longissimus
Capitus
O
 T1-5 transverse processes
 C5-7 articular processes
I
 Posterior mastoid process
N
 Dorsal rami of spinal nerves
F
 Extends and rotates head
Spinalis
 Spinalis Thoracis
 Spinalis Cervicis
 Spinalis Capitus
Spinalis Thoracis
O
 Common tendon origin
in sacrum, iliac crest,
lumber vertebrae
I
 T3-8 spinous processes
N
 Dorsal rami pf spinal
nerves
F
 Same as above
Spinalis Cervicis
O
 C6-T12 spinous
processes
I
 C2 spinous process
N
 Dorsal rami of spinal
nerves
F
 Same as above
Spinalis Capitis
 O
 Spinous processes of lower
cervical and upper thoracic
 I
 Between superiior and inferior
nuchal line on occiput
 N
 Dorsal rami of spinal nerves
 F
 Same as above
Transversospinal Muscles
 Semispinalis thoracis
 Semispinalis Cervicis
 Semispinalis Capitus
Semispinalis Thoracis
O
 T6-10 transverse
processes
I
 C6 – T4 spinous
processes
N
 Sorsal rami of spinal
nerves
F
 Same as above
Semispinalis Cervicis
O
 T1-T6 spinous processes
I
 C2-5 spinous processes
N
 Dorsal rami of spinal
nerves
F
 Same as above
Semispinalis Capitis
O
 C4-7 transverse processes
 T1-7 vertebrae
I
 Between superior and inferior
nuchal lines of occiput
N
 Dorsal rami of spinal nerves
F
 Same as above
Multifidus
O
 Transverse processes C4-L5
 Sacrum
 PSIS
I
 Spinous process of vert
above origin
N
 Spinal nerve roots
F
 Extend and lateral flexion of
vertebral column
Quadratus Lumborum
 O
 Iliolumbar Ligament
 Iliac crest
 I
 Lower border 12th rib
 L1-L4 transverse processes
 N
 ventral branches of T12 and L1
to L4.
 F




Pelvis elevation
Trunk extension
Trunk lateral flexion
Pulls down rib 12 to fix origin of
diaphragm
Rotatores
O
 Transverse processes from
axis to sacrum
I
 Laminae of vert above
N
 Direct branches over spinal
nerve roots
F
 Spine extension
 Rotation to opposite side
Range of Motion
 Flexion
 Extension
 Lateral Bending
 Rotation
Flexion - 80º
Extension - 35º
Side bending - 40º each side
Twisting - 3-18º
Neurologic Exam:
Sensory
 Sensory dermatomes
 C2-C3: Occipital area and angle of jaw
 C4: Supraclavicular area
 Axillary Nerve Patch: Lateral aspect of




shoulder
C5: Lateral upper arm
C6: Lateral forearm, thumb, and index
finger
C7: Middle finger and palmar aspect of
hand
C8: Small finger, ring finger, and
medial portion of palmar surface
Neurologic Exam:
Sensory
 Sensory dermatomes
 T1: Medial side of forearm and elbow
 T2: Medial aspect of upper arm
 T3: Medial aspect of upper arm
 T10: Umbilicus
 L2: Medial mid-thigh
 L3: Superior aspect of medial knee (vastus




medialis)
L4: Knee and medial arch
L5: Dorsum of the foot
S1: Lateral border and lateral aspect of foot
S2: Popliteal fossa
Neurologic Exam: Motor
 C1-C2: Neck flexion
 C1-C2: Neck extension
 C3: Neck lateral flexion
 C4: Shoulder elevation
 C5: Shoulder abduction and external rotation
 C6: Elbow flexion and wrist extension
 C7: Elbow extension and wrist flexion
 C8: Thumb abduction and ulnar deviation
Neurologic Exam: Motor
 T1: Finger approximation
 L2: Hip flexion
 L3: Knee extension
 L4: Dorsiflexion
 L5: Great toe extension, ankle dorsiflexion, ankle
eversion
 S1: Plantarflexion
 S2: Knee flexion
Neurologic Exam: Reflexes
 Biceps (C5-C6)
 Supinator (C5-C6)
 Triceps (C7-C8)
 Upper abdominal (T8-T10)
 Lower abdominal (T11-T12)
 Patella (L3-L4)
 Achilles tendon (S1-S2)
 Babinski
Myotomes
Map of Dermatomes – Anterior
View
Figure 14.17a
Map of Dermatomes –
Posterior View
Figure 14.17b
Cervical
Read
Back Pain
Common Sources of LBP
Somatic dysfunction
Muscle in “spasm”
Nerve root
In somatic dysfunction, some muscles become overactive (“spasm”)
and other muscles become inactive.
Muscles
Joint Receptors
Joint receptors
vasculature
Blood vessels
Muscle Spindles
viscera
Nocioceptors
Pressure, temperature
chemical
Internal organs
Connective
tissues
Humoral Factors
circulating hormones
(gender-specific response)
Bones and ligaments
immune proteins
cortisol
Disc Diseases
Radicular Signs
 Pain radiation to
buttocks – Sciatica
 Posterior thigh pain
 Parasthesia – nerve root
impringement
Lower Spinal conditions
Spondylolysthesis
Spondylolysthesis
Spondylolysis
Facet joint
pain
Spinal injuries
 Watch video
Atlas Fractures
Type  Odontoid

Treated with external orthrosis
Spinal Column Injury
Subaxial (C3-C7) #
Whiplash injury:
 Traumatic injury to the
soft tissue in the cervical
region
 Hyperflexion,
hyperextention
 No fractures or
dislocations
 Most common automobile
injury
 Recover 3-6 months
Hangman’s Fracture