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7/05/2013

Anatomy of the Spine


Dr. Lakal Dissabandara
Presented on 13/04/2010

Griffith School of Medicine

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Griffith School of Medicine

7/05/2013

Functions of the Spine


Support upright position of the trunk and the
cranium
Transmission of weight of the trunk to the
inferior extremities/shock absorption
Provides articular surfaces for the attachment
of the ribs/muscles
Protection of the spinal cord
Haemopoisis

Parts of Vertebra

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Types of Vertebrae
Cervical transverse foramina
for the vertebral artery, bifid
spine
Thoracic Articular demi
facets for ribs on the body and
transverse processes
Lumbar large vertebral
bodies for wt bearing, straight
spine

Inter-vertebral Joints
Two types
Anterior IV joint (Between the vertebral bodies
Symphyses)
allow slight movement in all directions
Reinforced by the anterior and posterior longitudinal
ligaments
Weight bearing and shock absorption
Initially nucleus pulposus absorb the force and
then transmitted to annulus
Posterior IV joint - Facet joints (Zygapophyseal)
Synovial
Normal synovial joint structure
Allow gliding movements
Thoracic spine has joints with ribs

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Inter Vertebral Disc


Parts
Annulus fibrosus fibrocartilage
consisting of concentric lamellae of
Collagen (65% water)
Outer margin is tightly attached
to the vertebra
Nucleus Pulposus jeatinous
Proteoglycans and some Collagen
(80% water)
Secreted by cells in the annulus
Proteoglycans responsible for
the strength and pliability
End plates
A hyaline cartilage
Attached to the disc tightly, and
loosely to the vertebral body
Important for vertical growth of
IVD.

Annulus facilitate torsional movements


IVD s account for 25% of height of spine
IVD s are also supported by ALL and PLL of spine.

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Ligaments

Anterior longitudinal lig.


Supports
IVD as well
Posterior longitudinal lig.
Ligamentum flavum lig.
Supraspinous lig. Ligamentum Nuchae in Cervical
spine
Interspinous lig.
Intertransverse lig.
Facet capsular lig.

http://www.hkeducationcenter.com/courses/OEC_Previews/hf-ft101ue_preview/images/Fig_28.png

7/05/2013

Curves of the spine


Primary curvature At birth the spine is concave
forwards
Secondary curvatures
With lifting of head forward convexity of cervical
spine
With standing forward convexity of lumbar spine
2ry curvatures are primarily due to the shape of the
IVD s.
Curvatures increase the shock absorbing capacity and facilitate stability &
equilibrium of spine
(Resistance of a system of column = number of curvature2 + 1)

Normal Curvatures

Abnormal Curvatures
Scoliosis
Sideward deviation

2ry cervical
forward convexity

1ry forward
concavity

Kyphosis
Increased forward
concavity

2ry Lumbar
forward
convexity

Increased Lordosis
Increased forward
Convexity of L spine

http://www.emory.edu/back.html

7/05/2013

Movements

AIVJ restricts movements & the ligaments restrict movements


Cervical
Very mobile tall IVD s, smaller bodies, morphology of C1 &
C2
Flexion, extension, lateral flexion, rotation
Thoracic
Rotation
Other movements are restricted
Presence of ribs
IVD s are thin
Long spines
Orientation of facets
Lumbar
Flexion & extension
Direction of articular facets makes rotation difficult

Flexion/Extension Yes

Rotation No
Alar Lig

Transverse Lig

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Lumbar` vertebra
Articular facets more
in a sagittal plain
`
Limit Rotation

Thoracic vertebra
Articular facets more in
a coronal plain
Rotation possible

Muscles moving vertebral column


Back Muscles

Extrinsic Back
Muscles

Trapezius
Rhomboids major
Rhomboids minor
Levator scapulae
Latissimus dorsi

Intrinsic Back Muscles

Superficial

Intermediate

Deep

Erector spinae

(Transversospin
ales)

Interspinales

- Illiocostalis
- Longissimus
- Spinalis
Splenius

Intertransversales

Rotators
Multifidus
Semispinales

(Vertical)
Prevertebral muscles
Scalenes - Cervical region
Psoas/Quadratus lumborum
Anterior abdominal muscles

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Superficial Back Muscles

Rhomoboids major
Trapezius

Rhomoboids minor

Serratus
posterior
superior
/inferior
Latissimus dorsi
Thoracolumbar fascia

Intrinsic Back Muscles

How are these


muscles innervated?

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Back Pain
Mechanical due to injury of constituents of spine
(bones, ligaments or muscles)
Usually localized
SLRT Negative**** ????
Inflammatory
IVD prolapse/narrowing of IV foramen
Can cause nerve root compression
Radiating pain
+ ve SLRT/femoral stretch test
Neurological signs

Sensory Innervation of Vertebral column


All the ligaments,
facet joints, IVD
are richly
innervated.
Sympathetic
visceral sensory
fibres also
important for the
innervation Annulus

Back pain may occur due to pathology of any of these structures or due to
referred pain from viscera pancreas, kidneys

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Straight Leg Raising Test


No further deformation
of roots beyond this
point
Roots become
increasingly tensed
Start applying tension
on Roots

No tension on roots

Facet joints
SI joint
Muscle tightness

Hip joint pain

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Pain may be exacerbated by movements that transmit pressure to the nerve root
through the subarachnoid space (eg, moving the spine, coughing, sneezing, doing the
Valsalva maneuver). Lesions of the cauda equina, which affect multiple lumbar and
sacral roots, cause radicular symptoms in both legs and may impair sphincter and
sexual function.

Griffith School of Medicine

Femoral stretch test


Tests irritation of L2,3,4
roots
Patient feels pain on
anterior thigh

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IV Disc Prolapse
If the pressure on nucleus pulposus cannot be resisted
by the anulus, it will give away, releasing the nucleus
free impinge on nerve roots
3 stages BulgingProtrusionSequestration
Common at regional junctions where more movable
spine and relatively less mobile spine meets
Cervico thoracic
Lumbosacral
Sensory, Motor, Reflex testing would help to localize
the lesion
Compressed nerve root can be made to stretch by
doing SLRT/FST which elicit pain

Anatomy of IV Disc L4-5


Exiting root L4
Traversing root L5
Nerve roots of thecal sac
PLL
Lamina
Think about the
dermatomes, myotomes
and other important
structures (eg.sphinctors)
innervated by these roots.

Chirogeek.com

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7/05/2013

Bulging of the disc

Chirogeek.com

For disc herniation to occur, the disc must degenerate first. Drying of the
annulus makes it brittle and unable to retain the bulging nucleus.
Note the PLL (Blue), redened nerve roots supplying annulus (one cause
of back pain).

Protrusion

Extrusion

The nuclear material is pressing on PLL and its bulging out now
(Still connected to main mass of NP). Note the resultant Pressure
on L4, L5, S1 (become inflamed).

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Sequestration

Chirogeek.com

A portion of nuclear material (blue star) detached from the main mass.
Now more compression on traversing root (white star) and exiting root
(green star).
Also note compression of thecal sac by sequestered nuclear material.
Which nerve roots can be compressed by this? (refer to the fig 1)
What would be the effect?

Distribution of radicular pain


S1

Note the red areas


L5

L4

Chirogeek.com

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Thoracolumbar fascia
Functions
Stabilization of
spine
Help transfer of
load through
different muscle
groups
Attachment of
muscles
Limit flexion

Surface Anatomy
Surface Anatomy

C7
T3
T8

L4-5
Pos sup iliac
spine S2
Sacral Hiatus
Posterior Sup Iliac spine and sacral hiatus form and equilateral triangle

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Anatomy of LP

Highest position of
iliac crest L4-5

Anatomy of Caudal Epidural block

Blocks lowest nerve roots S1-5


Widely used in obstetric practice

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