Spinal
CHAPTER 11 Injuries
ANATOMY OF THE SPINE
 Five Divisions
 Cervical Division (7)
 Thoracic Division (12)
 Lumbar Division (5)
 Sacral Division (5)
 Coccygeal Division (4)
 Four Curvatures
 Cervical Curvature
 Thoracic Curvature
 Lumbar Curvature
 Sacral Curvature
CERVICAL VERTEBRAE (ATLAS – C1)
 Parts to know:
 Vertebral Foramen
 Transverse Foramen
 Transverse Process
 Anterior Arch
 Posterior Arch
 Lateral Mass
 Superior Articular
Facet
 Articular Surface for
the Dens
 Inferior Articular Facet
(not pictured)
CERVICAL VERTEBRAE (AXIS – C2)
Parts to know:
 Vertebral Foramen
 Transverse Foramen
 Transverse Process
 Dens (Odontoid
Process)
 Superior Articular
Facet
 Lamina
 Bifed Spinous Process
 Inferior Articular Facet
CERVICAL VERTEBRAE (C3 – C7)
 Parts to know:
 Vertebral Foramen
 Transverse Foramen
 Transverse Process
 Body (Centrum)
 Superior Articular
Facet
 Pedicle
 Lamina
 Spinous Process
 Inferior Articular Facet
THORACIC VERTEBRAE (T1 – T12)
 Parts to know:
 Body
 Spinous Process
 Superior Demifacet
 Inferior Demifacet
 Transverse Costal
Facet
 Transverse Process
 Superior Articular
Facet
 Inferior Articular
Facet
 Prominent Lamina
 Vertebral Foramen
LUMBAR VERTEBRAE (L1 – L5)
Parts to know:
 Body
 Vertebral Foramen
 Transverse Process
 Spinous Process
 Superior Articular
Facet
 Inferior Articular
Facet
 Superior Vertebral
Notch
 Inferior Vertebral
Notch
SACRUM AND COCCYX
 Parts to Know:
 Sacrum
Base of the Sacrum
 Sacral Canal
 Median Sacral Crest
 Sacral Cornua
 Sacral Hiatus
 Sacral Foramen
 Ala
 Lateral Sacral Crest
 Apex of the Sacrum
 Coccyx
 Coccygeal Vertebrae
 Coccygeal Cornu
 Transverse Processes
INTERVERTEBRAL DISCS
Made up of
fibrocartilage.
Lie in between each
vertebrae.
Parts to know:
 Annulus Fibrosus
 Nucleus Pulposus
RANGES OF MOTION FOR THE SPINE
Flexion
Extension
Rotation
Lateral Flexion
Lumbar ROM
DERMATOMES & MYOTOMES
Dermatome
 An area of the skin
supplied by nerves
from a single spinal
root.
Myotome
 A myotome is the
group of muscles that
a single spinal nerve
root innervates.
INTRINSIC MUSCLES OF THE SPINE
 A deep layer of muscles
 3 layers of the muscles
 Deepest (Transversospinalis Group) layer – Semispinalis,
multifdus and rotator muscles.
 Intermediate (Erector Spinae Group) layer – divided into 3
columns:
 Spinalis muscles - medial column closest to spine.
 Longissimus muscles – intermediate column; next closest
to the spine.
 Iliocostalis muscles – lateral column; furthest from the
spine.
 Superficial Layer – Splenius muscles.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
 Semispinalis Capitis
 Origin –C7 and T1 – T6
transverse processes and
C4 – C6 articular
processes.
 Insertion – Between the
superior and inferior nuchal
lines of the occipital bone.
 Action – Extension and lateral
flexion of the cervical neck
and head, and rotation to the
opposite side.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
Semispinalis Cervicis
 Origin – Transverse processes of
T1 – T6.
 Insertion – Spinous processes of
C2 – C5.
 Action – Acting bilaterally,
extension of the cervical spine.
Acting unilaterally, lateral
flexion of the neck and head
and rotation to the opposite
side.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
Semispinalis Thoracis
 Origin – The transverse
processes of T6 – T10.
 Insertion – The spinous
processes of T1 – T4 and C6 –
C7.
 Action – Extends the spine and
rotates it towards the opposite
side.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
 Multifidus Group
 Origin – Posterior surface of the
sacrum, the dorsal end of the
iliac crest, the transverse
processes of L1 – L5, T1 – T12
and the articular processes of
C4 – C7.
 Insertion – Spinous processes of
all of the vertebrae except for
C1.
 Action – Acting unilaterally, lateral
flexion and rotation to the
opposite side. Acting bilaterally,
extension of the spine.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
 Rotators Group
 Origin – Transverse
processes of the
vertebrae.
 Insertion – Bases of the
spinous processes
(lamina) 1-2 vertebrae
above.
 Action – Acting unilaterally,
rotation of the spine to
the opposite side. Acting
bilaterally, extension of
the spine.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
 Interspinales
 Origin & Insertion – Pairs of
small muscles joining the
spinous processes of
adjacent vertebrae, one
on each side of the
interspinous ligament.
Continuous in the
cervical region extending
from the axis to the 2 nd
thoracic vertebra and in
the lumbar region from the
1 st lumbar to the sacrum.
 Action – Extension of the
spine.
DEEP LAYER - TRANSVERSOSPINALIS
GROUP
 Intertransversarii
 Origin & Insertion – Pairs
of small muscles,
anterior and posterior,
on each side of the spine
joining the transverse
processes of adjacent
vertebrae. They extend
from the Atlas (C1) to the
first thoracic vertebra (T1)
and from the 10 th thoracic
(T10) to the last lumbar
vertebra (L5).
 Action – Acting unilaterally,
lateral flexion of the spine.
INTERMEDIATE LAYER – ERECTOR
SPINAE GROUP – MEDIAL COLUMN
Spinalis Capitis
 Origin – C5 – C7 and T1 – T3
vertebrae (spinous
processes).
 Insertion – Occiput between
the superior and inferior
nuchal lines.
 Action - Extension, rotation,
and lateral bending of Cspine.
INTERMEDIATE LAYER – ERECTOR
SPINAE GROUP – MEDIAL COLUMN
 Spinalis Cervicis
 Origin – The lower portion of the
ligamentum nuchae, spinous
processes of C7 and
sometimes T1 - T2.
 Insertion – The spinous
process of the Axis (C2) and
sometimes the spinous
processes of C3 - C4.
 Action – Acting unilaterally,
lateral flexion of the C-spine.
Acting bilaterally, extension of
the spine.
INTERMEDIATE LAYER – ERECTOR
SPINAE GROUP – MEDIAL COLUMN
Spinalis Thoracis
 Origin – The spinous processes
of L2, L1, T12, T11.
 Insertion – The spinous
processes of the upper
thoracic vertebrae (T4 – T8).
 Action – Acting unilaterally,
lateral flexion or the
thoracic spine. Acting
bilaterally, extension of the
thoracic spine.
INTERMEDIATE LAYER – ERECTOR SPINAE
GROUP – INTERMEDIATE COLUMN
Longissimus Capitis
 Origin – Transverse processes
of T1 - T5 and the articular
processes of C4 – C7.
 Insertion – The posterior
margin of the mastoid
process.
 Action – Acting bilaterally,
extends the head; acting
unilaterally, laterally flexes
and rotates the head to the
same side.
INTERMEDIATE LAYER – ERECTOR SPINAE
GROUP – INTERMEDIATE COLUMN
Longissimus Cervicis
 Origin – Transverse processes of
T1 – T5.
 Insertion – Transverse processes
of C2 – C6 and sometimes the
Atlas (C1).
 Action – Acting unilaterally,
laterally flexes the neck.
Acting bilaterally, extension of
the neck.
INTERMEDIATE LAYER – ERECTOR SPINAE
GROUP – INTERMEDIATE COLUMN
 Longissimus Thoracis
 Origin – The common broad, thick
tendon with the iliocostalis
lumborum, fibers from the
transverse and accessory
processes of the lumbar
vertebrae and thoracolumbar fascia.
 Insertion – The tips of the transverse
processes of all thoracic vertebrae
and the lower 9-10 ribs between the
tubercles and the angles.
 Action – Acting unilaterally, laterally
flexes the vertebral column. Acting
bilaterally, extension of the vertebral
column; draws ribs down.
INTERMEDIATE LAYER – ERECTOR SPINAE
GROUP – LATERAL COLUMN
Iliocostalis Cervicis
 Origin – Superior borders of the
angles of rib 3 – 6.
 Insertion – The posterior
tubercles of the transverse
processes of the 4 th, 5 th, and
6 th cervical vertebrae (C4 –
C6).
 Action – Acting bilaterally,
extension of the spine.
Acting unilaterally, laterally
flexes the vertebral column.
INTERMEDIATE LAYER – ERECTOR
SPINAE GROUP – LATERAL COLUMN
 Iliocostalis Thoracis
 Origin – Superior borders of
the angles of the lower 6
ribs medial to the
tendons of insertion of
the iliocostalis lumborum.
 Insertion – Into the angles
of the upper 6 or 7 ribs
and into the transverse
process of the 7 th cervical
vertebra.
 Action – Acting bilaterally,
extension of the spine.
Acting unilaterally,
laterally flexes the spine.
INTERMEDIATE LAYER – ERECTOR
SPINAE GROUP – LATERAL COLUMN
 Iliocostalis Lumborum
 Origin – Anterior surface of a
broad and thick tendon
which originates from the
sacrum, spinous processes
of the lumbar and 11 th and
12 th thoracic vertebrae, and
from the medial lip of the
iliac crest.
 Insertion – Inferior borders of
the angles of the lower 6 or
7 ribs.
 Action – Acting bilaterally,
extension of the spine,
acting unilaterally, laterally
flexes the spine.
SUPERFICIAL LAYER
 Splenius Capitis
 Origin – Inferior one-half of
ligamentum nuchae and
spinous processes of C7 –
T4.
 Insertion – Mastoid process
and lateral portion of the
superior nuchal line.
 Action – Unilaterally, rotate the
head and neck to same
side, laterally flex the head
and neck to the same side;
bilaterally, extend the head
and neck.
SUPERFICIAL LAYER
Splenius Cervicis
 Origin – Spinous processes
of T3 – T6.
 Insertion – Transverse
processes of C1 – C3.
 Action – Unilaterally, rotate
the head and neck to
same side, laterally flex
the head and neck to the
same side; bilaterally,
extend the head and neck.
POSTURAL CONCERNS
Kyphosis
Lordosis
Scoliosis
Forward head
Flatback
Swayback
COMMON INJURIES
 Brachial Plexus Neurapraxia
(Burner/Stinger)
 Low Back Strains
 Sciatica
 Herniated Lumbar Disk
 Spondylosis and
Spondylolisthesis
 Scheuermann’s Disease
(Dorsolumbar Kyphosis)
 Lumbar Vertebrae Fracture
and Dislocation
 Myofascial Pain Syndrome
 Lumbar Sprains
 Back Contusions
 Cervical Fracture
 Cervical Dislocation
 Acute Strains of the Neck and
Upper Back
 Cervical Sprain (Whiplash)
 Acute Torticollis (Wryneck)
 Cervical Cord and Nerve Root
Injuries
 Cervical Spine Stenosis
 Cervical Disk Injuries
BRACHIAL PLEXUS NEURAPRAXIA
(BURNER/STINGER)
Etiology
Signs & Symptoms
 Stinger
Management
LOW BACK STRAINS
Etiology
Signs & Symptoms
Management
SCIATICA
Etiology
Signs & Symptoms
Management
HERNIATED LUMBAR DISK
Etiology
Signs & Symptoms
Management
SPONDYLOLYSIS AND
SPONDYLOLISTHESIS
Etiology
 “Scotty Dog” Fracture
Signs & Symptoms
Management
SCHEUERMANN’S DISEASE
(DORSOLUMBAR KYPHOSIS)
Etiology
Signs & Symptoms
Management
LUMBAR VERTEBRAE FRACTURE AND
DISLOCATION
Etiology
 Compression Fracture
 Fracture Dislocation
Signs & Symptoms
Management
MYOFASCIAL PAIN SYNDROME
Etiology
Signs & Symptoms
Management
LUMBAR SPRAINS
Etiology
Signs & Symptoms
Management
BACK CONTUSIONS
Etiology
Signs & Symptoms
Management
CERVICAL FRACTURE
Etiology
 Louisville Injury
Signs & Symptoms
Management
 Rutgers Injury
 Fear the Spear
CERVICAL DISLOCATION
Etiology
Signs & Symptoms
Management
ACUTE STRAINS OF THE NECK AND
UPPER BACK
Etiology
Signs & Symptoms
Management
CERVICAL SPRAIN (WHIPLASH)
Etiology
Signs & Symptoms
Management
ACUTE TORTICOLLIS (WRYNECK)
Etiology
Signs & Symptoms
Management
CERVICAL CORD AND NERVE ROOT
INJURIES
Etiology
Signs & Symptoms
 Spinal Cord
Hemorrhage (C2-C7)
 Spinal Cord
Contusion
Management
CERVICAL SPINE STENOSIS
Etiology
Signs & Symptoms
 Similar to cervical
fracture – like football
videos we watched
Management
CERVICAL DISK INJURIES
Etiology
Signs & Symptoms
Management
FOR YOUR QUIZZES
 You should be able to:
 Label the type of vertebrae and their different parts.
 Label the different muscles of the spinal column.
 Identify the different types of vertebrae and their parts by using the
vertebral models.
 Identify the different types of injuries discussed for the cervical,
thoracic, and lumbar regions of the spinal column/back.