What is the back defined as?
The posterior part of the trunk.
What structures are included in the study of the back?
Skin, muscles, vertebral column, proximal parts of ribs, spinal cord, and segmental nerves.
p.11
Clinical Correlations of Spinal Conditions
Which anatomical landmark helps locate the L4 spinous process for lumbar puncture?
The superiormost plane connecting the iliac crests.
p.6
Clinical Correlations of Spinal Conditions
What can osteophytes near the zygapophysial joints cause?
Compression of nerve roots leading to radiculopathy.
What is the role of the posterior axioappendicular muscles?
To attach the upper extremity to the axial skeleton.
p.1
Vertebral Column Characteristics
What are secondary curvatures of the vertebral column?
Cervical and lumbar curvatures, which develop later in life.
p.1
Intervertebral Discs and Articulations
What is the significance of intervertebral discs?
They support articulations and act as check-rein structures to excessive movement.
p.1
Meninges and Cerebrospinal Fluid
What is the relationship of the meninges to the spinal cord?
The meninges protect and encase the spinal cord.
Which nerves innervate the extrinsic muscles of the back?
Anterior rami of the cervical and thoracic nerves, and one cranial nerve.
p.9
Craniovertebral Joints
What are the contents of the suboccipital triangle?
The suboccipital nerve and vertebral artery.
Where do the superomedial fibers of the splenius attach?
To the mastoid process on the skull.
What is the orientation of the splenius muscle fibers compared to the trapezius fibers?
Nearly perpendicular to the ipsilateral descending trapezius fibers.
p.9
Spinal Cord Structure and Function
At what point does the medulla of the brainstem become the spinal cord?
At the foramen magnum, transitioning to the C1 level.
What are the three groups of muscles that compose the erector spinae?
Iliocostalis, Longissimus, and Spinalis.
p.9
Spinal Cord Structure and Function
What does the filum terminale anchor to?
One part anchors to the dural sac around the S2 vertebral level and the other to the coccyx as the coccygeal ligament.
p.3
Vertebral Column Characteristics
What are the special features of the atlas (C1) and axis (C2) vertebrae?
They have unique characteristics that differentiate them from other vertebrae.
p.6
Blood Supply to the Vertebral Column
What concept helps mitigate the effects of ischemia in the spinal cord?
Redundant blood supply through anastomoses.
p.11
Clinical Correlations of Spinal Conditions
Which spaces are typically utilized for needle placement during a lumbar puncture?
The space between L3-L4 or L4-L5.
What is the primary function of intrinsic muscles of the back?
To maintain posture and control vertebral column movements.
p.6
Clinical Correlations of Spinal Conditions
What happens to the intervertebral discs as they age?
Dehydration of the nuclei pulposi leads to stiffer discs that resist deformation.
Which muscle lies superomedial to the suboccipital triangle?
The rectus capitis posterior minor muscle.
p.10
Spinal Cord Structure and Function
What is the primary difference in white and gray matter in the spinal cord?
White matter has myelin stained darkly and is located at the periphery, while gray matter is found in the center.
What does the intermediate layer of the deep back muscles refer to?
The erector spinae muscles.
p.9
Spinal Cord Structure and Function
What is the conus medullaris?
It occurs caudal to the last rootlets attaching to the spinal cord and tapers to the filum terminale.
p.1
Clinical Correlations of Spinal Conditions
What is the anatomical relevance of common developmental and pathological conditions involving the back?
Understanding these conditions helps in diagnosing and treating back issues.
p.6
Clinical Correlations of Spinal Conditions
What is a consequence of ischemia of the spinal cord?
Necrosis of neurons leading to weakness or paralysis.
What does the supraspinous ligament connect?
It runs on the surface of spinous processes from C7 to the sacrum.
p.10
Meninges and Cerebrospinal Fluid
How is CSF resorbed?
Through arachnoid granulations, ultimately returning to the venous blood.
p.3
Vertebral Column Characteristics
What are the characteristics of lumbar vertebrae?
They have large vertebral bodies, stout processes, and articular facets transitioning from sagittal to coronal plane.
p.3
Clinical Correlations of Spinal Conditions
What is spondylolysis?
Separation of the posterior part of the vertebral arch by fracture, potentially leading to spondylolisthesis.
p.4
Support of Intervertebral Joints
What is the role of the anterior longitudinal ligament?
It connects the anterior surfaces of the vertebral bodies and prevents excessive extension.
p.2
Clinical Correlations of Spinal Conditions
What causes excessive kyphosis?
Usually due to osteoporosis.
What is the significance of bifid spinous processes in cervical vertebrae?
They increase surface area for muscle attachments.
p.11
Clinical Correlations of Spinal Conditions
What is the purpose of a lumbar puncture?
To sample cerebrospinal fluid (CSF) for analysis.
Name the superficial muscles of the back.
Trapezius, latissimus dorsi, levator scapulae, rhomboid major, and rhomboid minor.
p.1
Vertebral Column Characteristics
What are primary curvatures of the vertebral column?
Thoracic and sacral curvatures, which are present at birth.
p.6
Clinical Correlations of Spinal Conditions
Where does herniation of the nucleus pulposus typically occur?
Usually posterolaterally through the annulus fibrosus.
p.6
Clinical Correlations of Spinal Conditions
What are common sources of back pain?
Soft tissues, muscles, nerve tissue, meninges, etc.
p.10
Spinal Nerves and Their Functions
What is the cauda equina?
A collection of nearly vertical nerve roots in the lumbar cistern where the spinal cord has ended.
p.10
Spinal Nerves and Their Functions
What are intercostal nerves?
Anterior rami of spinal nerves T1-T11 that course along the ribs and supply skin and intercostal musculature.
What is the significance of the semispinalis muscle?
It attaches to the occipital bone and can produce significant movement of the cervical vertebral column and head.
What are the boundaries of the suboccipital triangle?
Medially by the rectus capitis posterior major, laterally by the superior obliquus capitis, and inferiorly by the inferior obliquus capitis.
p.3
Vertebral Column Characteristics
How does the orientation of thoracic articular facets affect movement?
Frontal plane orientation allows side-bending and rotation, inhibiting flexion/extension.
p.4
Vertebral Column Characteristics
What is located at the base of the sacrum?
The most superior part of the sacrum.
p.4
Intervertebral Discs and Articulations
What is the function of intervertebral discs?
They allow movement between vertebrae and function as shock absorbers.
p.5
Craniovertebral Joints
What is the role of the posterior atlanto-occipital membrane?
It limits flexion/extension of the atlanto-occipital joints.
p.5
Craniovertebral Joints
What is the function of the transverse ligament of the atlas?
It holds the anterior arch of the atlas against the dens.
p.4
Support of Intervertebral Joints
What changes its name to the tectorial membrane at C2?
The posterior longitudinal ligament.
p.2
Clinical Correlations of Spinal Conditions
What is a compression fracture?
A collapsing of the vertebral body, as if crushed vertically.
p.11
Clinical Correlations of Spinal Conditions
What layers are punctured to access the subarachnoid space?
The dura and arachnoid layers.
p.1
Vertebral Column Characteristics
How many vertebrae are typically found in the human vertebral column?
33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 fused sacral, and 4 fused coccygeal.
What is the function of the serratus posterior superior and inferior muscles?
Traditionally described as acting on the ribs to elevate and depress, but their role is more in proprioception.
What is the focus of the study regarding extrinsic and intrinsic back muscles?
Their origin, insertion, innervation, and actions.
p.6
Blood Supply to the Vertebral Column
What arteries supply the thoracic region of the vertebral column?
Posterior intercostal arteries.
p.10
Meninges and Cerebrospinal Fluid
What are the three layers of the spinal meninges?
Dura mater (outermost), arachnoid mater (middle), and pia mater (innermost).
p.10
Meninges and Cerebrospinal Fluid
What is the role of cerebrospinal fluid (CSF)?
It cushions the brain and spinal cord, and is produced by the choroid plexus.
p.9
Spinal Cord Structure and Function
What makes up the peripheral white matter of the spinal cord?
Rostrally and caudally running axons.
What type of movement do the ligaments of the vertebral column limit?
Flexion (anterior/posterior or lateral).
p.5
Craniovertebral Joints
What movement is primarily allowed by the atlanto-occipital joints?
Flexion/extension of the head, as in nodding 'yes'.
p.3
Vertebral Column Characteristics
What role does the sacrum play in the body?
It bears body weight and transfers force to the hip girdle and femurs.
p.2
Vertebral Column Characteristics
What are the main structural elements of a vertebra?
Vertebral body, pedicle, lamina, vertebral arch, spinous process, superior/inferior articular process, articular facet, vertebral notch, vertebral foramen, intervertebral foramen, intervertebral disc.
p.2
Clinical Correlations of Spinal Conditions
What are the types of spina bifida?
Occulta, meningocele (cystica), and meningomyelocele.
p.2
Clinical Correlations of Spinal Conditions
What is osteoporosis?
A metabolic bone disease where calcium balance favors resorption rather than deposition, leading to weak and brittle bones.
What do uncinate processes provide in cervical vertebrae?
Added stability at the superolateral edges of the vertebral bodies.
p.1
Vertebral Column Characteristics
What are the two types of curvatures in the vertebral column?
Kyphoses (thoracic and sacral) and lordoses (cervical and lumbar).
p.6
Clinical Correlations of Spinal Conditions
What is a pathological sign of intervertebral disc aging?
Overt, localized disc thinning.
What is unique about the inferior obliquus capitis muscle?
It is the only 'capitis' muscle that doesn’t attach to the head.
p.10
Spinal Nerves and Their Functions
How are spinal nerves formed?
By the joining of anterior (efferent fibers) and posterior (afferent fibers) nerve roots.
p.10
Spinal Nerves and Their Functions
What is the significance of the intervertebral foramen?
It is where spinal nerves exit the vertebral column, covered by the dura mater.
What is the function of the deep 'transversospinal' muscles?
To stabilize the vertebral column and contribute to small, local movements.
How are the transversospinal muscles named?
Based on the number of vertebral segments crossed: 1 or 2 = rotatores, 3 or 4 = multifidus, greater than 4 = semispinalis.
p.3
Vertebral Column Characteristics
What is a notable characteristic of thoracic vertebrae spinous processes?
They are sharply sloped inferiorly, especially at mid-thoracic levels (T4-T8).
p.3
Vertebral Column Characteristics
What do all thoracic vertebrae possess for rib attachment?
Costal facets with smooth surfaces.
p.4
Vertebral Column Characteristics
What do the articular processes give rise to on either side of the median crest?
Left and right intermediate (or 'medial') crests.
p.5
Craniovertebral Joints
What are the two types of atlantoaxial joints?
Lateral atlantoaxial joints (planar) and the median atlantoaxial joint (pivot).
p.3
Vertebral Column Characteristics
What is the composition of the sacrum?
It is composed of five fused vertebrae.
p.3
Vertebral Column Characteristics
What structures are housed within the sacrum?
The sacral canal and four pairs of foramina for transmitting sacral ventral and dorsal primary rami.
p.2
Clinical Correlations of Spinal Conditions
What is spina bifida?
A general term for incomplete closure of the posterior neural arch during embryonic development, resulting in a gap in the lamina.
p.2
Clinical Correlations of Spinal Conditions
How can spina bifida be prevented?
By taking folic acid preconception and during prenatal care.
What are the characteristics of cervical vertebrae?
Small vertebral body, bifid spinous processes, transverse foramina, and uncinate processes.
p.6
Blood Supply to the Vertebral Column
What is the primary source of blood supply to the vertebral column?
Mainly from the aorta and vertebral arteries.
p.9
Spinal Cord Structure and Function
What do the cervical and lumbosacral enlargements represent?
Extensive innervation to the upper and lower extremities, respectively.
p.9
Spinal Nerves and Their Functions
What is the cauda equina comprised of?
Roots of lower lumbar, sacral, and coccygeal nerves.
p.9
Spinal Cord Structure and Function
Where are the cell bodies of neurons found in the spinal cord?
In the central gray matter.
What is the function of the interspinous and intertransverse ligaments?
They connect successive spinous processes and transverse processes, respectively.
p.3
Clinical Correlations of Spinal Conditions
What is lumbar spinal stenosis?
A condition characterized by narrowed vertebral foramina in the lumbar region, often inherited.
p.2
Clinical Correlations of Spinal Conditions
What are common neurologic symptoms associated with severe spina bifida?
Paralysis of lower extremities and urinary bladder incontinence.
p.2
Clinical Correlations of Spinal Conditions
What is a laminectomy?
The surgical removal of the spinous process and adjacent lamina to access the spinal canal and relieve pressure.
p.10
Spinal Nerves and Their Functions
What is the difference between 'vertebral level' and 'spinal level'?
Vertebral level refers to the location of the bone, while spinal level refers to the range of rootlets in the spinal cord.
p.4
Intervertebral Discs and Articulations
What type of joint exists between vertebral bodies?
A symphysis, which is a secondary cartilaginous joint.
What ligaments blend with the anterior longitudinal ligament between C1 and C2?
The anterior atlanto-axial membrane.
p.5
Craniovertebral Joints
What ligament supports the median atlantoaxial joint?
The cruciate (cruciform) ligament.
p.5
Craniovertebral Joints
Where do the alar ligaments run from and to?
From the dens to the occipital bone, off the midline.
p.2
Clinical Correlations of Spinal Conditions
What is scoliosis?
A lateral curvature of the spine.
What is the function of transverse foramina in cervical vertebrae?
For the passage of vertebral arteries and veins.
