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The Back To describe vertebral column in various regions To describe lumbar fascia To list back muscles The vertebral column: -Average length in the male is about 71 cm& in female about 61 cm -The column constitutes the five known regions: Cervical; 7 Thoracic; 12 Lumbar; 5 Sacral; 5 Coccyx; 1 Measurements (male values): -Cervical part: 12.5 cm. (17.5%) -Thoracic: 28 cm. (40%) -Lumbar: 18 cm. (25%) -Sacrum and coccyx: 12.5 cm. (17.5%) Curvatures: Primary curvatures (Flexion): 1- Thoracic; T2-T12 2- Pelvic; LS joint-coccyx Secondary curvatures (Extension): 1- Cervical; C2-T2 2- Lumbar; T12-LS joint Articulations of the vertebral column: 1- A series of synovial joints between the vertebral arches (between articular facets) 2- A series of secondary cartilagenous joints between vertebral bodies (intervertebral discs) Articulations between vertebral bodies: -Bodies of adjacent vertebrae are held to each other by fibrous discs which strongly adhere these vertebrae to each other -Movements at these joints is slight though summative movements permits considerable range -Ligaments supporting these joints are the anterior & posterior longitudinal ligaments The intervertebral discs: -These discs constitute about 1/4 the length of the articulated vertebral column -They vary in shape, size, and thickness, in different parts of the vertebral column, correspond with the surfaces of the adhering bodies -Each disc is composed of: 1- External annular fibrous part called annulus fibrosus. 2- Central bulbous cartilage called nucleus pulposus. Prolapsed IVD: -Herniation of nucleus pulposus into the vertebral canal compressing on spinal nerve roots Other ligaments in the vertebral column: 1 1- Ligamenta flava: -Elastic ligaments -Between adjacent laminae 2- Interspinous ligaments: 2 3 Connects adjacent spines 3- Supraspinous ligaments: Connects spines tips 4- Ligamentum nuchae: -Triangular fibrous sheet 4 -Attached to cervical spines & skull -Divides the back of neck into two halves Region Main characters Cervical -Additional joints of Luschka -Vertebral vessels passing through foramina transversaria -Seven vertebrae, eight spinal nerves -Spinal nerve passes superior to the pedicle of its numerically corresponding vertebra Thoracic -Articulation by their bodies & transverse processes with the ribs -Spinal nerve passes inferior to the pedicle of its numerically corresponding vertebra -Mainly permit trunk rotation Lumbar -Giant, kidney shaped bodies -Spinal nerve passes inferior to the pedicle of its numerically corresponding vertebra -Mainly permit trunk flexion-extensio & lateral flexion 4 Sacral -5 sacral segments fuse with each other -Articulates with lower limb bone (the hip) -Nerves leave through anterior & posterior sacral foramina 5 Coccyx Single triangular bone with no special feature 1 2 3 Kyphosis Scoliosis Overcurvature of thoracic vertebrae Abnormal lateral curvature of VC Surface localization of vertebrae: Principles: C2 C7 -The first palpable spine below the skull is C2 T3 -The next most prominent is C7 -T3 lies level with scapular spine T7 -T7 lies level with inferior scapular angle T12 -L4 lies level with iliac tubercle -T12 midway between T7 & L4 -Coccyx is the lower end L4 Surface localization of lower end of spinal cord: Principles: -Localize T12 & L4 as previously mentioned -Spinal cord terminates midway between them (L1-2) -Lumbar puncture is done at L3-4 level The thoracolumbar fascia: -This strong fascial structure lies in the posterior abdominal wall enclosing muscular compartments & gives attachment to many other muscles. -It is formed of 3 layers; anterior, middle & posterior -Anterior & middle layers are confined to the abdomen -The posterior one extends up in the thoracic & cervical regions -Quadratus lumborum is enclosed between the anterior & middle layers -Erector spinae is enclosed between the middle & posterior layers Back muscles: 1- Extrinsic: -Form superficial & intermediate layers -Involved with movements of the upper limbs and thoracic wall -Innervated by anterior rami of spinal nerves 2- Intrinsic: -They lie deep in position -They support and move the vertebral column and participate in moving the head -Innervated by the posterior rami of spinal nerves Layer 1 Superficial 2 Intermediate 3 Deep Muscles -Trapezius -Latissimus dorsi -Levator scapulae -The rhomboids -Serratus posterior superior & inferior 1- Splenius group: -Capitis -Cervicis 2- Erector spinae group: -Iliocostais (external) -Longissimus (intermediate) -Spinalis (deep) 3- Semispinalis group: -Semispinalis -Multifidus -Rotators The splenius muscles: -The two muscles run from the spinous processes upward and laterally -Splenius capitis is a broad muscle attached to the occipital bone and mastoid process of the temporal bone -Splenius cervicis is a narrow muscle attached to the transverse processes of the upper cervical vertebrae -Together they draw the head backward, extending the neck. -Individually, each muscle rotates the head to the same side of the contracting muscle The semispinalis muscles: -These muscles begin in the lower thoracic region and end by attaching to the skull -Crossing between four and six vertebrae from their point of origin to point of attachment. -Semispinalis muscles are found in the thoracic region (S. thoracis), cervical region (S. cervicis) & attach to the occipital bone (S. capitis). -They are prime extensors of the vertebral column The suboccipital muscles : 1- Rectus capitis posterior minor 2- Rectus capitis posterior major 3 3- Superior oblique 1 4- Inferior oblique -These muscles 2 are skull extensors -All are supplied by C1, posterior ramus 4 Suboccipital triangle: -2, 3 & 4 form the boundaries of this triangle -The triangle is roofed by splenius capitis -Floor is the back of atlas 3 -Contents: 1- In the triangle: -Vertebral artery -C1 posterior ramus 2- Passing in the roof: 1- Occipital artery 2- Great occipital nerve (C2) 2 4 Plain Cervical MRI Suboccipital C5 C3 MRI Cervical C7 MRI Thoracic SAP L1 IAP SAP IAP L5 Plain Lumbar L1 L5 CT Lumbar CT Upper sacrum