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Thoracic and

Lumbar Spine
Anatomy
Orthopedic Assessment III
Head, Spine, and Trunk
with Lab
PET 5609C

Clinical Anatomy

Vertebral Column:

Cervical Spine:

Thoracic Spine:

Lordotic curvature
Greatest ROM
Most vulnerable to
injury
Greatest protection
Least ROM

Lumbar Spine:

Balance between
protection/ROM

Clinical Anatomy

Vertebral Column:

Extends from skull


to the pelvis
33 total vertebrae:

Superiorly: 24
individual vertebrae
(separated by
intervertebral discs)
Inferiorly: 9 fuse to
form 2 composite
bones

Sacrum (5)
Coccyx (4)

Clinical Anatomy

Vertebral
Column:

Functions:
Transmits weight
of the trunk to
the lower limbs
Surrounds/protec
ts spinal cord
Attachment point
for the ribs and
muscles of neck
and back

Clinical Anatomy

Vertebral Column:
Major Supporting
Ligaments

Anterior Longitudinal
Ligament runs
vertically along anterior
surface of vertebral
bodies

Neck - Sacrum
Attaches strongly to both
vertebrae and
intervertebral discs (very
wide)
Prevents back
hyperextension

Clinical Anatomy

Vertebral Column:
Major Supporting
Ligaments

Posterior
Longitudinal
Ligament - runs
vertically along
posterior surfaces of
vertebral bodies

Narrower, weaker
Attaches to
intervertebral discs
Prevents hyperflexion

Clinical Anatomy

Vertebral Column: Major


Supporting Ligaments

Ligamentum Flavum - strong


ligament that connects the
laminae of the vertebrae

Protects the neural elements


and the spinal cord
Stabilizes the spine to
prevent excessive vertebral
body motion
Strongest of the spinal
ligaments
Forms the posterior wall of
the spinal canal with the
laminae
Stretches with forward
bending / recoils in erect
position

Clinical Anatomy

Vertebral Column:
Supporting
Ligaments

Intertransverse
Ligament - located
between the
transverse processes

Cervical region: consist


of a few irregular,
scattered fibers
Thoracic region:
rounded cords
connected with deep
muscles of the back
Lumbar region: thin
and membranous

Clinical Anatomy

Vertebral Column:
Supporting
Ligaments

Interspinal
Ligament - connect
spinous processes
(spans the entire
process)

Meets the
ligamentum flavum
in front and the
supraspinal ligament
behind

Clinical Anatomy

Vertebral Column:
Supporting Ligaments

Supraspinal Ligament
-connects together the
apexes of the spinous
processes

Extends from 7th cervical


vertebra to sacrum
Strong fibrous cord
At points of attachment
(tips of the spinous
processes) fibrocartilage
is developed in the
ligament

Supraspinal
Ligament

Clinical Anatomy

Bony Anatomy:

Body : Centrum

Anterior part
Weight-bearing
segment

Vertebral Arch:
Neural Arch

Posterior part
Formed by pedicle
and lamina on each
side

Clinical Anatomy

Bony Anatomy:

Vertebral Foramen:

Pedicles: (2)

Opening
Sides of vertebral
arch
Little feet project
posteriorly from
body

Laminae: (2)

Flat roof plates


Complete arch
posteriorly
Thoracic
Vertebrae

Clinical Anatomy

Bony Anatomy:

Transverse Processes:

Project laterally from


each pedicle-lamina
junction
Attachment site for
intrinsic ligaments and
muscles

Spinous Processes:

Prominent posterior
projections
Attachment site for
intrinsic ligaments and
muscles

Cervical

Cervical

Thoracic

Thoracic

Lumbar
Vertebrae

Lumbar
Vertebrae

Clinical Anatomy

Facet Joints:

Articulations between
superior articular
facet (bottom
vertebrae) and inferior
articular facet (above
vertebrae)
Contribute to ROM
Weight-bearing
stress through
vertebral body and
disc
Synovial joints

Clinical Anatomy

Pars Interarticularis:

Area between the


superior and inferior
facets
Common site for
stress fractures
(lumbar spine)
Spondylolysis - refers
to the defect (black
arrows) present when
the pars
interarticularis (green
arrow) is fractured

Clinical Anatomy

Intervertebral
Foramen:

Space where spinal


nerve roots exit the
vertebral column
Size variable due to
placement, pathology,
spinal loading, and
posture

Can be occluded by
arthritic degenerative
changes and spaceoccupying lesions
(tumors, spinal disc
herniations)

Vertebral Anatomy
Level

Vertebral
Body

Transverse
Process

Spinous Process

Cervical

Small;
Vertebral
body
absent in
C1;
remaining
bodies
progressive
ly in size

Short;
Processes
contain the
transverse
foramen for
passage of
vertebral
artery

Small and short,


except for C7
(characteristics of
thoracic vertebrae)

Thoracic

Diameter
and
thickness
as spine
continues
inferiorly

Attachment of
muscles and
costovertebral
ligaments;
Processes of
T1-T12 have
articular
surfaces for
the ribs

Long and slender;


downward
projections
overlap of spinous
processes of
inferior vertebrae;
gradually thicken
in size as you move

Clinical Anatomy

Thoracic Segment:

Wider/thicker help
support torso weight
Spinous Processes:

Downward projection

Limit extension
Attachment for thoracic
muscles/ligaments

Transverse Processes:

Costotransverse Joints:

Articulation with ribs

Ribs 1 10
Ribs 11 and 12

No articulation with
transverse processes

Clinical Anatomy
Costoverte
bral
Joint

Costotransve
rse
Joint

Clinical Anatomy

Thoracic Segment:

Costovertebral Joint:

Articulation between vertebral bodies and ribs


Superior and Inferior Costal Facets

Superior Costal
Facet
Inferior Costal
Facet

Clinical Anatomy

Sacrum:

Curved,
triangular
shaped
5 fused vertebrae
Fixes the spinal
column to the
pelvis
Stabilizes the
pelvic girdle

Clinical Anatomy

Sacroiliac Joint (SI):

Between the sacrum (base of the spine) and the ilium


of the pelvis
Strong, weight bearing synovial joints (2)

Covered by 2 different kinds of cartilage

Functions:

Sacral surface (hyaline cartilage)


Iliac surface (fibrocartilage)

Shock absorption (spine)


Allows the transverse rotations (lower extremity) to be
transmitted up the spine.

Motions:

Anterior innominate tilt


Posterior innominate tilt
Sacral flexion (or nutation)
Sacral extension (or counter-nutation)

Clinical Anatomy

Clinical Anatomy

SI Ligaments:

Anterior
Sacroiliac
Ligament:

Connects the
anterior surface
of the lateral part
of the sacrum to
the ilium

Note: Black

Clinical Anatomy

SI Ligaments:

Posterior Sacroiliac
Ligament:

Forms the chief bond of


union between the bones
Upper part: (short PSL)

Nearly horizontal in
direction
Ilium to upper sacrum

Lower part: (long PSL)

Oblique in direction
Lower sacrum to PSIS

Short

Long PSL

Clinical Anatomy

SI Ligaments:

Sacrotuberous
Ligament:

Arises from ischial


tuberosity to blend
in with inferior
fibers of posterior
SI ligaments

Sacrotuberous
Ligament

Ischial

Clinical Anatomy

SI Ligaments:

Sacrospinous
Ligament:

Originates from
the ischial spine
and attaches to
the coccyx

Sacrospinous
Ligament

Clinical Anatomy

Coccyx: Tailbone

Consists of 4 (in
some cases 3 or
5) vertebrae
fused together

Attachment site
for muscles of
pelvic floor and
sometimes
portions of
gluteus maximus

Clinical Anatomy

Intervertebral Discs:

23 intervertebral discs
No disc between skull and
C1 or between C1-C2
Discs are thickest in the
lumbar vertebrae and
cervical regions (enhances
flexibility)

Functions:

Shock absorbers

walking, jumping, running

Allow spine to bend


At points of compression,
the discs flatten out and
bulge out a bit between the
vertebrae

Clinical Anatomy

Nucleus Pulposus: Core

Gelatinous, acts like a


rubber ball (enables
spine to absorb
compressive forces)
60-70% water

Annulus Fibrosus:
Outer rings

Multilayered fibers (cross


from opposite directions)
Rings absorb compressive
forces themselves

Clinical Anatomy

Intervertebral Discs: Dehydration


Process
Collectively, the discs make up about 25%
of the height of the vertebral column
Nucleus pulposus becomes dehydrated
during course of day

Flattens out (height is 1-2 centimeters less at


night than when we awake in morning)
Aging Process = Permanent dehydration (ages
40 60)

Decreased ROM
Narrowing intervertebral foramen

Clinical Anatomy

Lumbar and Sacral


Plexus:

Lumbar:

Formed by 12th thoracic


nerve and L1-L5 nerve
roots
Innervation:

Anterior and medial


muscles of thigh
Dermatomes of medial
leg and foot

Femoral Nerve formed


by branches of L2, L3, L4
nerve roots
Obturator Nerve anterior
branches of L2, L3, L4

Clinical Anatomy

Lumbar and Sacral


Plexus:

Sacral:

Formed by L4, L5
and lumbosacral
trunk
Innervation:

Muscles of buttocks,
posterior femur, and
lower leg

Sciatic Nerve 3
sections

Tibial nerve
Common peroneal
nerve
Tibial nerve

Clinical Anatomy

Clinical Anatomy

Lumbarization:

1st sacral vertebrae


does not unite
with sacrum
Becomes a 6th
lumbar vertebrae

Sacralization:

5th lumbar
vertebrae becomes
fused to sacrum

Clinical Anatomy

Extrinsic Muscles primarily


function to provide respiration and
movement associated with the
upper extremity and scapula

Indirectly influence the spinal


column

Intrinsic Muscles lie close to


spinal column

Directly influence the spinal column

Clinical Anatomy

Middle Trapezius:

O: Lower portion of
ligamentun nuchae
and spinous
processes of C7 and
T1 T5
I: Acromion process,
scapular spine
A: Scapular
retraction and
fixation of thoracic
spine

Clinical Anatomy

Lower Trapezius:

O: Spinous
processes of T8
T12
I: Scapular spine
(medial portion)
A: Scapular
depression and
retraction;
fixation of
thoracic spine

Clinical Anatomy

Rhomboid Muscles:

Rhomboid Major and


Minor
O: Spinous processes
of C7 through T5
I: Vertebral border of
scapula between the
spine and inferior
angle
A: Scapular retraction,
elevation, and
downward rotation;
Fixation of thoracic
spine

Clinical Anatomy

Latissimus Dorsi:

O: Spinous processes
of T6 through T12
and the lumbar
vertebrae via the
thoracodorsal fascia,
posterior iliac crest
I: Intertubercular
groove of humerus
A: Extension of spine,
anterior rotation of
pelvis, stabilization of
lumbar spine
(depression of
shoulder girdle,
humeral extension)

Clinical Anatomy

Rectus
Abdominis:

O: Pubic crest
and symphysis
I: Xiphoid process
and costal
cartilages of 5th,
6th, and 7th ribs
A: Trunk flexion;
compression of
abdomen

Clinical Anatomy

External Oblique:

O: 5th through 12th


ribs
I: Iliac crest and
linea alba
A: Bilaterally:
trunk flexion;
compression of
abdomen;
Unilaterally: lateral
bending; rotation
to opposite side

Clinical Anatomy

Internal Oblique:

O: Inguinal ligament,
iliac crest,
thoracolumbar fascia
I: Tenth, eleventh,
and twelfth ribs; linea
alba, crest of pubis
A: Bilaterally: Trunk
flexion, compression
of abdomen;
Unilaterally: lateral
bending and rotation
to same side

Clinical Anatomy

Erector Spinae: 3
muscle pairs

Iliocostalis:

Longissimus:

Iliocostalis
Lumborum
Iliocostalis Thoracis
Iliocostalis Cervicis
Longissimus Thoracis
Longissimus Cervicis
Longissimus Capitis

Spinalis:

Spinalis Thoracis
Spinalis Cervicis
Spinalis Capitis

Clinical Anatomy

Transversospinal
Muscles:

Deep intrinsic layer


Fibers run from 1
transverse process
to the spinous
process superior to
them

Group formed by:

Semispinalis
Multifidus
Rotators