ANATOMY | PT
101
BACK & SPINE
THE BACK GENERAL CHARACTERISTICS OF A
VERTEBRA
• posterior surface of the trunk
• extends from the skull to the tip of the
coccyx
VERTEBRAL COLUMN
• central bony pillar of
the body
FUNCTIONS:
• supports the skull, CHARACTERISTICS
VERTEBRAL BODY - Anterior
pectoral girdle, upper
limbs, and thoracic cage VERTEBRAL FORAMEN - Encloses the spinal
cord
VERTEBRAL ARCH - Posterior
• transmits body cylindrical; sides
PEDICLES
weight to the lower of the arch
limbs LAMINAE flattened;
completes arch
• protects the spinal VERTEBRAL ARCH: 7 PROCESSES
cord, the roots of the
spinal nerves, and the
covering meninges, to
which the vertebral column gives great
protection.
VERTEBRAL COLUMN COMPONENTS
33 VERTEBRAE
ORIENTATION
1 SPINOUS PROCESS OR SPINE - ‘posteriorl
7- CERVICAL
y’
2 TRANSVERSE PROCESSES - ‘laterally’
12- THORAX
4 ARTICULAR PROCESSES - ‘vertically’
two superior
5- LUMBAR two inferior
5- SACRUM
4- COCCYX
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ANATOMY | PT
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CHARACTERISTICS OF ATYPICAL CERVICAL VERTEBRAE
A TYPICAL VERTEBRA FEATURES
CLINICAL NOTES
Jefferson Fracture
• Fracture of the Atlas (C1)
• MOI: vertical force --> lateral
displacement
Hangmans
: Neck Hyperextension
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ANATOMY | PT
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FRACTURE OF THE ODONTOID FOUR ANTERIOR SACRAL FORAMINA
PROCESS OF THE AXIS
• for the passage of the anterior and
•MOI: falls or blows on the head
posterior rami of the upper four sacral
nerves.
SACRAL PROMONTORY
SACRUM
• anterior and upper margin of the first
sacral vertebra
• Five rudimentary
vertebrae fused
• bulges forward as the posterior margin
together
of the pelvic inlet
• Wedge-shaped bone
• obstetric importance and is used when
concave anteriorly
measuring the size of the pelvis
SACRUM BORDERS
SACRAL CANAL
• vertebral foramina
of the sacrum
BORDERS ORIENTATION
UPPER BORDER - 5TH lumbar Passageway for:
OR BASE vertebra • anterior and
INFERIOR BORDER - coccyx posterior roots of the
- two iliac sacral and coccygeal
LATERAL BORDERS bones spinal nerves
(sacroiliac
joints) • filum terminale
• fibrofatty material
• lower part of the subarachnoid space
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ANATOMY | PT
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SACRAL HIATUS Atlanto-Occipital Joints: LIGAMENTS
• laminae of the
5th sacral
vertebra, and
sometimes those
of the 4th, fail to
meet in the
midline
COCCYX
Atlanto-Axial Joints: LIGAMENTS
• four vertebrae
fused together
to form a
single, small
triangular bone
• articulates at
its base with
the lower end
of the sacrum JOINTS BETWEEN TWO VERTEBRAL
BODIES
• first coccygeal vertebra:
• usually not fused or is incompletely • synovial joints between the superior
fused with the second vertebra and inferior articular processes of
adjacent vertebrae
JOINTS OF THE VERTEBRAL COLUMN
• facets are covered with hyaline cartilage
and surrounded by a capsular ligament
• superior and inferior surfaces of the
bodies are covered by thin plates of
hyaline cartilage and IV disc in between
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ANATOMY | PT
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INTERVERTEBRAL (IV) DISC •The outward thrust of the nucleus is
accommodated by the resilience of the
• semi-elastic discs surrounding anulus fibrosus.
• extend from C2 to the •Sometimes, the outward thrust is too
sacrum great for the anulus fibrosus and it
ruptures, allowing the nucleus pulposus
• responsible for one to herniate and protrude into the vertebral
quarter (1/4) of the length of the vertebral canal, where it may press on the spinal
column below the level of C2 nerve roots, the spinal nerve, or even the
spinal cord
• thickest in the cervical and lumbar
regions, where the movements of the CLINICAL NOTES
vertebral column are greatest
DISC PATHOLOGIES
Functions
• main structure that binds the vertebral
bodies
• serve as shock absorbers when the load
on the vertebral column is suddenly
increased
• allows the rigid vertebrae to move one DISC HERNIATION
on the other
INTERVERTEBRAL (IV) DISC PARTS
• A sudden increase in the compression
load on the vertebral column causes the
semifluid nucleus pulposus to become
flattened
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ANATOMY | PT
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Vertebral Column: LIGAMENTS SPONDYLOLISTHESIS
MOVEMENT OF THE VERTEBRAL
Curves of the Vertebral Column COLUMN
cervical and lumbar regions
• Flexion:
• Extension
• Lateral flexion
Least extensive in lumbar region
• Rotation
CERVICAL REGION
Flexion
1. longus cervicis,
2. scalenus anterior
3. sternocleidomastoid muscles
Extension
1. postvertebral muscles
Lateral flexion
1. scalenus anterior and medius
2. trapezius
CLINICAL NOTES 3. sternocleidomastoid muscles.
Rotation
1. sternocleidomastoid
[Link]
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ANATOMY | PT
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SUPERFICIAL MUSCLES OF SHOULDER
THORACIC REGION
GIRDLE (TLLR)
Rotation:unilateral//contraction
[Link] • Trapezius
2. rotatores • Latissimus dorsi
Assisted: oblique muscles of the • Levator Scapulae
anterolateral abdominal wall. • Rhomboids (minor/major)
LUMBAR REGION
INTERMEDIATE MUSCLE
Fle x io n
• Serratus posterior
1. Rectus Abdominis
2. Psoas
DEEP MUSCLES OF THE BACK
Extension (POSTVERTEBRAL MUSCLES)
1. postvertebral muscles.
Superficial Vertically Running Muscles
Lateral flexion
1. postvertebral muscles • Erector spinae
2. quadratus lumborum, • Iliocostalis
3. oblique muscles ( ALAW) • Longissimus
4. psoas (to some extent)
• Spinalis
Rotation
1. rotatores muscles Intermediate Oblique Running Muscles
2 oblique muscles ( ALAW)
• Transversospinalis
• Semispinalis
MUSCLES OF THE BACK
• Multifidus
The muscles of the back may be divided • Rotatores
into three groups:
• Deepest Muscles
• The superficial muscles connected with • Interspinales
the shoulder girdle • Intertransversarii
SPLENIUS
• The intermediate muscles involved with
movements of the thoracic cage
•Bandage muscle
• The deep muscles or postvertebral •Cervicis (neck); Capitis (head)
muscles belonging to the vertebral •The splenius is a detached part of the
column deep muscles of the back.
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ANATOMY | PT
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It consists of two parts: OTHER CLINICAL CONDITIONS
• The splenius capitis arises from the WHIPLASH
lower part of the ligamentum nuchae and
the upper four thoracic spines and is • Rear end collision
inserted into the superior nuchal line of (hyperextend then flexion of neck)
the occipital bone and the mastoid
process of the temporal bone. • Head on collision
(flexion followed by extension)
• The splenius cervicis has a similar
origin but is inserted into the transverse • Side sweep (clash at side)
processes of the upper cervical
vertebrae. • Neck pain, tenderness, limitation of
motion, headache, lightheadedness,
ERECTUS SPINAE (CHIEF BACK positive neurologic findings
EXTENSOR)
SPONDYLOSIS
• Iliocostalis – lateral
• Longissimus – intermediate • Osteoarthritis of the spine
• Spinalis – medial
• >60 years old, degenerative
TRANSVERSOSPINALIS • C5-c6 vertebrae most common because
it is the most mobile
• Semispinalis – largest
(capitis, cervicis, thoracis) SPONDYLOLYSIS
• Multifidus • Defect of pars interarticularis or
– most active if Erector Spinae is weak isthmus (most common L4-L5)
- strongest extensor from a forward
flexed position • Scotty dog with collar
• Rotatores – deepest band smallest • Due to weightlifting, football, rugby
games
INTERTRANSVERSARII
SPONDYLOLISTHESIS
• Unilateral contraction if side bending
movement • Anterior slippage of the superior
vertebra
• Bilateral contraction if extension
movement • Most common L5-S1 because of the
oblique orientation of L5 – Sacrum
• Scotty dog with decapitated head
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ANATOMY | PT
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SPINAL STENOSIS SPINA BIFIDA
• Narrowing of spinal canal •Incomplete closure of neural tube
• CAUSES: (FoLDS)
• Facet hypertrophy Ligamentous DISK HERNIATION
hypertrophy
• Disc protrusions
• Spur formation
ANKYLOSING SPONDYLITIS
• MARIE STRUMPELL DISEASE
FORWARD HEAD
• VON BECHTEREV DISEASE
• Bamboo Spine (seen thru X-RAY) • Increase AO and upper cervical
extension
TIETZE’S SYNDROME
• Increase upper thoracic and lower
• Also known as costochondritis cervical flexion
• Painful inflammation in costochondral • With mandibular retrusion
cartilage
COCCYGODINIA
• Also known as COCCYALGIA
• Pain on lower part of sacrum, coccyx
• Managed by proper seating
TORTICOLLIS UPPER
CROSSED SYNDROME
• Tight trapezius and levator scapulae
• Wry-Neck plus pectoral muscles
• Muscle involved SCM
FLAT NECK
• Ipsilateral flexion and contralateral
rotation
• Increase AO and upper cervical flexion
• Decreased cervical lordosis
• With mandibular protrusion
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ANATOMY | PT
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SWAY BACK POSTURE
• APT (pelvic)
• Increase lumbar lordosis
• Increased thoracic kyphosis
• Increased hip extension
SCOLIOSIS
STRUCTURAL
• Irreversible
• Neuromuscular
• Idiopathic (unknown)
• Osteopathic
NON-STRUCTURAL
• Leg length discrepancy
• Habitual asymmetric posture
• Muscle guarding
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