Spinal Column

Anatomy

  • 33 bones - 24 moveable, 9 immovable

  • 7 cervical vertebrae

  • 12 thoracic vertebrae

  • 5 lumbar vertebrae

  • Cervical spine

    • Convex

    • C1 atlas, C2 axis

  • Thoracic spine

    • Concave

    • T1-T10

  • Lumbar spine

    • Convex

  • Sacrum

  • Coccyx

  • Intervertebral discs

    • Annulus fibrosus

    • Nucleus pulposus

  • Intervertebral articulations

    • Cartilaginous joints

    • Gliding, lateral gliding, compression, distraction

    • Movement at fact joints

      • Synovial joints

  • Ligaments

    • Anterior longitudinal

    • Posterior longitudinal

    • Supraspinous

    • Interspinous
       

  • Muscles

    • Superficial

      • Erector spinae - longissimus, iliocostalis, spinal

    • Deep

      • Interspinal, multifidus, rotators, intertransversarii, semispinalis
         

  • Spinal cord

    • Part of the CNS that is within the vertebral canal

    • Foramen magnum --> filum terminale

  • Spinal nerves and peripheral branches

    • 31 pairs of spinal nerves

      • 8 cervical

      • 12 thoracic

      • 5 lumbar

      • 5 sacral

      • 1 coccygeal

    • Each nerve has the ventral (motor) root and dorsal (sensory) root --> join together to form a single spinal nerve

    • Dermatome

    • Five nerve plexuses

      • Cervical - C1-C4

      • Brachial - C5-T1 - axillary, radial, musculocutaneous, ulnar, median

      • Lumbar - L1-L4 - obturator, femoral, tibial

      • Sacral - L4-S4 - medial/lateral plantar, sural, common/deep/superficial peroneal

      • Coccygeal - S4-S5 and coccygeal nerve

Injury Prevention and Evaluation

  • Cervical spine

    • Muscle strengthening

    • ROM

      • 45 degrees of lateral flexion and adequate rotation for chin to be even with tip of the shoulder

    • Correct technique

  • Lumbar spine

    • Avoid stress

    • Correct biomechanical abnormalities

    • Correct lifting techniques

    • Core stabilization
       

  • Posture

    • Kyphosis - increased thoracic curve

    • Forward head posture - cervical spine extension

    • Flatback posture - decreased lumbar curve

    • Swayback posture - the anterior shifting of the pelvis

    • Lordosis - the increased curve of the lumbar spine and anterior pelvic tilt

    • Scoliosis - lateral curvature of the spine

  • Cervical spine

    • Shoulder level and symmetrical

  • Thoracic spine

    • Neck motion, trunk motion

  • Lumbar spine and sacroiliac

    • Pelvis and shoulders - level

Injuries

  • Cervical

    • Cervical fracture

    • Cervical dislocation

    • Acute strain

    • Cervical sprain (Whiplash)

    • Acute torticollis (Wryneck)

    • Cervical cord and nerve root injuries

      • Laceration

      • Hemorrhage

      • Contusion

      • Cervical cord neuropraxia

      • Spinal cord shock

    • Cervical spine stenosis

    • Brachial plexus neuropraxia (burner)

    • Cervical disc injury

  • Thoracic

    • Scheuermann's disease (Dorsolumbar kyphosis)

  • Lumbar

    • Lumbar vertebral fractures and dislocations

    • Low back muscle strain

    • Myofascial pain syndrome

    • Lumbar sprain

    • Back contusions

    • Sciatica

    • Herniated lumbar disc

    • Spondylolysis

    • Spondylolisthesis

    • Sacroiliac joint dysfunction

      • Sacroiliac sprain

        • Congenital abnormalities

        • Mechanical defects of the spine

        • Back trauma

        • Recurrent and chronic low back pain