Module 2: Back

How Many Cervical Vertebrae are there

7

Atlas

C1, is known as what

Axis

C2

Kyphotic

Primary curvature of the spine, occurs in the Thoracic and Sacral aspects of the spine

Lordotic

Secondary curvature of the spine, occurs in the Cervical and Lumbar aspects of the spine

How many total vertebrae are there, what is the distribution

33, 7 Cervical, 12 Thoracic, 5 Lumbar, 5 Sacral, 4 coccygeal (fuse)

Defining Feature of Cervical Vertebrae

Transverse Foramen

Defining Feature of Thoracic Vertebrae

No transverse foramen, and no mammillary process

Defining Feature of Lumbar Vertebrae

Mammillary Process (responsible for muscle attachments)

Features of Cervical Arthrokinematics

Ipsilateral coupled actions (Lateral flexion occurs with Cervical Rotation to the Same side)

Features of Lumbar Arthrokinematics

At L1-L3 the spine is mini extended, this causes Contralateral coupled action (left rotation+ right lateral flexion)

At L4-L5 the spine is “mini flexed”, this causes Ipsilateral couple action (right rotation+ right lateral flexion)

Where is the majority of weight bearing at in the vertebrae? Secondary WB?

The Functional Spinal Unit, consists of the intervertebral (IV) discs (70% of weight bearing) and the facet joints (30% of weight bearing).

Features of the intervertebral discs (IV discs)

They contain an annulus fibrosus

Contains a nucleus pulposus

Features of the Annulus Fibrosus

25 layers, of fibrous lamellae of fibrocartilage oriented concentrically in alternating 45* angles aids limiting rotation while forming a strong bond between adjacent vertebrae

Features of the Nucleus Propolsus

Watery, more cartilaginous than fibrous, and are responsible for mobility, resilience of IV discs and vertebral column

Features of the Sacrum

5 bones fused into 1, Has 4 sacral foramina, where nerves protrude from, sacral base articulates with L5, Apex of Sacrum is attached to the coccyx

Ligament Flavum

segmental ligament: mostly elastin; joins adjacent lamina. and reinforces anterior joint capsules of facet joints

Transverse Ligament of Atlas

The horizontal part of the cruciform ligament; Responsible for locking dens into anterior arch of C1, prevents dislocation of C2, and protects spinal cord from dens

Anterior and Posterior Longitudinal Ligaments

Anterior Longitudinal Ligament: C spine to sacrum, attaches firmly to Vertebral bodies, loosely to discs, and resists extension of spine, and prevents increased lordosis

Posterior Longitudinal Ligament: C spine to coccyx, serrated appearance, attaches to posterior aspect of vertebral bodies, resists flexion of the spine

The Spinotransversales Muscles

Splenius Cervicis

Splenius Capitis

Erector Spinae Muscles (I Love Spaghetti)

Iliocostalis (lateral)

Longissimus (intermediate)

Spinalis (Medial)

Thoracolumbar fascia

Blending of Aponeurotic and fascial planes, form retinaculum around paraspinal regions of lower back and sacral region

Important for fascia, load transfer and respiration and posture. Form thickened brace between latissimus dorsi muscles

Insertion and Action of Splenius Cervicis

Insertion: Tubercles of Transverse processes of C1-C3/4 vertebrae

Action: Acting Unilaterally: laterally flexes neck and rotates muscle to same side (left side flex and rotation; head goes left)

Acting Bilaterally: extends head and neck

Splenius Capitis

Origin: Nuchal Ligament of spinal Processes of C7-T6 vertebrae

Innervation: Posterior Rami of Spinal Nerves

Origin of Splenius Cervicis

Origin: Nuchal Ligament of spinal Processes of C7-T6 vertebrae

Innervation: Posterior Rami of Spinal Nerves

Iliocostalis (lumborum, thoracis, and cervicis)

Origin: Broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament

Innervation: Posterior Rami of Spinal Nerves

Longissimus (thoracis, cervicis, capitis)

Origin: Broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament

Unilateral Action: laterally flex vertebral column

Innervation: Posterior Rami of Spinal Nerves

Insertion and Action of Longissimus

Insertion: thoracis, cervicis, capitis: fibers run ribs between tubercles and angles to transverse processes in thoracic and cervical regions and to mastoid process of temporal bone.

Action: Bilateral action: extend vertebral column and head; as back is flexed, control movement via eccentric contraction

Unilaterally: lateral flexion of vertebral column

Origin of Spinales

Origin: Broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament

Innervation: Posterior Rami of Spinal Nerves

Origin of Multifidus

Origin: arises from posterior sacrum, posterior superior iliac spine of the ilium. aponeurosis of erector spinae, sacro-iliac ligaments, mammillary processes of lumbar vertebrae, transverse of T1-T3, articular processes of C4-C7

Innervation: Posterior Rami of Spinal Nerves

Origin of Semispinales (thoracis, cervicis, and capitis)

Origin: Arises from transverse process of C4-T12 vertebrae

Innervation: Posterior Rami of Spinal Nerves

Origin of Rotatores (brevis and longus)

Origin: arises from transverse processes of vertebrae; best developed in thoracic region

Innervation: Posterior Rami of Spinal Nerves

Origin of Interspinales

Origin: superior surfaces of spinous processes of cervical and lumbar vertebrae

Innervation: Posterior Rami of Spinal Nerves

Origin of Intertransversarii

Origin: Transverse processes of cervical and lumbar vertebrae

Innervation: Anterior and Posterior Rami of Spinal Nerves

Origin of Levatores Costarum

Origin: Tips of transverse process of C7 and T1-T11 Vertebrae.

Innervation: Posterior Rami of Spinal Nerves (C8-T11)

Suboccipital Muscle group

Rectus capitis posterior major

Rectus capitis posterior minor

Obliquus capitis inferior

Obliquus capitis superior

Where and what borders the suboccipital triangle? What is inside the anatomical space

Location: Inferior to the occiput, superior to the C2

Bordered by: Rectus Capitis Posterior Major, Obliquus Capitis inferior and Obliquus Capitis Superior

Contains the Suboccipital Nerve (C1) and vertebral artery

Rectus Capitis Posterior Major

Origin: Spinous process of vertebra C2

Insertion: Lateral part of inferior nuchal line of Occipital

Rectus Capitis Posterior Minor

Origin: Posterior tubercle of posterior arch of vertebra C1

Insertion: Medial part of inferior nuchal line of Occipital Bone

Obliquus Capitis Superior

Origin: Transverse process of vertebra C1

Insertion: Occipital bone between superior and inferior nuchal lines

Obliquus Capitis Inferior

Origin: Posterior Tubercle of Posterior Arch of Vertebra C2

Insertion: Transverse process of vertebra C1 *only capitis muscle that has NO attachment to skull*

Insertion and Action of Splenius Capitis

Insertion: mastoid process of temporal bone, Lateral 1/3rd of Superior nuchal line of Occipital bone

Action: Acting Unilaterally: laterally flexes neck and rotates muscle to same side (left side flex and rotation; head goes left)

Acting Bilaterally: extends head and neck

Insertion and Action of Levatores Costarum

Insertion: insert on rib between tubercle and angle

Action: Elevate ribs, assist in respiration; assist with lateral flexion of vertebral column.

Insertion and Action of intertransversarii

Insertion: transverse process of adjacent vertebrae

Action: aid in lateral flexion of vertebral column;

Acting bilaterally, stabilize vertebral column

Insertion and Action of interspinales

Insertion: inferior surfaces of spinous processes of vertebra superior to vertebra of proximal attachment

Action: aid in extension and rotation of vertebral column

Insertion and Action of Rotatores (brevis and longus)

Insertion: fibers pass junction of lamina and transverse process or spinous process of vertebra immediately (brevis)

2 segments superior to vertebra for longus

Action: stabilize vertebrae and assist with local extension and rotary movements of vertebral column; maybe organ of proprioception

Insertion and Action of Semispinales

Insertion: fiber attach to occipital bone and spinous process in thoracic and cervical regions, spanning 4-6 segments

Action: extends head and thoracic and cervical regions of vertebral column and rotates contralaterally

Insertion and Action of Multifidus

Insertion: located 2-4 segments superior to proximal attachment

Action: stabilizes vertebrae during local movements of vertebral column

Insertion and Action of Spinales

Insertion: Thoracis cervicis and capitis; Fibers run superiorly to spinous processes in the upper thoracic region and cranium

Action: Bilateral action: extend vertebral column and head; as back is flexed, controls movement via eccentric contraction

Unilateral: laterally flexes vertebral column

Insertion and Action of Iliocostalis

Insertion: lumborum, thoracis, cervicis: fibers run to angles of lower ribs and cervical transverse processes

Action: Extend vertebral column and head, aid in controlling movement during flexed position via eccentric contraction

Acting Unilaterally: lateral flexion of vertebral column