Posterior Column
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Transcript Posterior Column
Dr. S. Nishan Silva
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At Birth
The spine of a newborn is Cshaped, with one curve
At About Six Months
As the infant lifts his or her head during the first
few months, the neck (cervical) curve and its
muscles develop
At About Nine Months
As the infant learns to crawl and stand, the lower
back (lumbar) curve and its muscles develop.
Strong back muscles help give your child the
strength and balance to walk and run.
The spinal column
The spinal column consists of individual bones called
vertebrae, the building blocks, which provide support
for the spine. These vertebrae are connected in the
front of the spine by intervertebral discs.
The spinal column consists of:
•seven cervical vertebrae (C1–C7) i.e. neck
•twelve thoracic vertebrae (T1–T12) i.e. upper back
•five lumbar vertebrae (L1–L5) i.e. lower back
•five bones (that are joined, or "fused," together in
adults) to form the bony sacrum
• three to five bones fused together to form the
coccyx or tailbone
The Back
Posterior median furrow – vertical groove along the
midline
Spinous processes of vertebrae
Spine of the scapula
Medial end is opposite T3
Medial border of the scapula
The Back
Inferior angle of the scapula
Iliac crests
Supracristal line – intersects L4
Sacrum – superior to cleft in the buttocks
Coccyx – posterior to the anus
Surface Anatomy of the Back
Figure 11.31a
Surface Anatomy of the Trunk
Scapulae
Latissimus dorsi muscle
erector spinae muscle
infraspinatus muscle
trapezius muscle
teres major muscle
posterior axillary fold
triangle of auscutation
12-8
Muscles of the Back
Trapezius
Latissimus dorsi
Erector spinae
Surface Anatomy of the Back
Figure 11.31b
Anatomy
Spinal cord ends below lower border of L1
Cauda equina is below L1
Mid dorsal spinal cord & neural canal space are of same
diameter hence prone for complete lesion
Mechanical injury - early ischaemia, cord edema - cord
necrosis
Neurological recovery unpredictable in cauda equina ie.
peripheral nerves
General Anatomy Lecture
Anatomy
Five lumbar vertebrae
Five pairs (10 total) facet
joints
Intricate ligamentous
support
Anterior & posterior
longitudinal
Interspinous &
supraspinous
Anatomy
Intervertebral disks
Annulus fibrosus
Outer zone (Sharpey’s fibers)
Intermediate zone
Inner zone
20 concentric collar like rings crisscrossed for strength
Nucleus pulposus
Fluid gradually changes to
fibrocartilage
Spinal Curves
Posterior View
Sagittal View
Primary
Secondary
Bone Palpation
Palpate L4/L5 junction (level of iliac crests)
Palpate spinous processes superiorly and inferiorly
S2 spinous process at level of posterior superior iliac
spine
Absence of any sacral and/or lumbar processes
suggests spina bifida
Visible or palpable step-off indicative of
spondylolisthesis
ANTERIOR PALPATION
Soft Tissue Palpation
4 clinical zones
Midline raphe
Paraspinal muscles
Gluteal muscles
Sciatic area
Anterior abdominal wall and inguinal area
Vertebral arch
7 vertebral processes arise from vertebral arch
3 lever-like processes - provide attachments sites for
ligaments and muscles
Spinous process
2 Transverse processes
4 articular processes
Arise from junction of pedicle and laminae
Vertebral Arch
Space enclosed by body and vertebral arch is the
vertebral foramen
Successive vertebral foramen form the vertebral
canal
Facet Joint
Formed by articulation of inferior and superior
processes of subsequent vertebrae
Orientation in lumbar spine is toward sagittal
plane, allowing flexion and extension but
limiting rotation of the lumbar vertebrae
Helps to prevent anterior movement of superior
vertebra on inferior vertebra
Articular surfaces are made up of
noninnervated articular cartilage
Capsule and synovial membrane are innervated
with pain receptors
Cervical spine anatomy
Anterior column - Anterior longitudinal ligament+
Anterior annular ligament and anterior half of VB.
Middle column – Posterior long. Lig. + Posterior
annular ligament +Posterior half of VB.
Posterior Column – Lig flavum + superior &
Interspinous lig + intertransverse capsular lig + neural
arch + pedicle & spinous process.
Cervical Alignment
Anterior vertebral body
Posterior vertebral body
Spinolaminal line
Spinous process tips
General Vertebral Anatomy
Body
Vertebral Arch
Pedicles
Laminae
Vertebral Foramen
Spinous Process
Facets
Superior Articulating Surface
Inferior Articulating Surface
Transverse Process
Intervertebral Foramen
Distinguishing Features of Cervical
Vertebrae
Transverse foramina
C1 transverse process
Spinous Processes
C6 and C7
C3-C6 = bifurcate
None for C1
Articulating Facets
Atlas
1st Cervical Vertabrae
Lack of Body
Superior Articular
Foveae
Inferior Articulating
Foveae
Fovea Dentis
Axis
C2
Dens
Rotation between skull
and atlas
C7
Body
Spinous process
Transverse Foramina
Anterior element
Articulations within cervical region
Lateral Atlantoaxial Joints
Superior facets and inferior
facets of atlas
Flat and in transverse plane
Rotation
Side toward rotation
Side away from rotation
Median Atlantoaxial
Joints
Dens of axis and anterior
arch of atlas
Tectorial membrane
Cruciform ligament
Articulation within cervical spine
Atlanto-occipital
Occipital condyles of
skull and superior
articulating surface of
atlas
Rotation
Articulations within cervical spine
Body-to-body
articulation
Fibrocartilogenous
Intervertebral Disk
Annulos fibrosis
Nucleus puplosis
Articulations within cervical spine
Cervical facet joints
Parallel to frontal plane
45 degrees to
transverse plane
Rotation
Ligaments within cervical spine
Ligamentum Nuchae
Interspinous
Ligament
Ligamentum Flava
Posterior Atlantooccipital membrane
Intertransverse
Ligament
Curvature of cervical spine
Lordotic Curve
Cervical spine movement
Flexion/Extension
Atlanto-occipital
Rotation
Atlanto-axial joint
Brachial Plexus
Nerve Roots
C5,6,7,8,T1
Trunks
Upper
Middle
Lower
Divisions
Anterior
Posterior
Cords
Lateral
Posterior
Medial
Throat Anatomy
1. Thyroid gland
2. Trachea
3. Brachiocephalic artery
4. Common carotid artery
5. Internal jugular vein
6. Superior vena cava
Thoracic Vertebrae
Bodies
Pedicles
Laminae
Spinous Processes
Transverse Processes
Inferior & Superior Facets
Distinguishing Feature
Costal Fovea
T1
T2-T8
T9-12
Thoracic Vertebrae and Rib Junction
Functions of Thoracic
Spine
Costovertebral Joint
Costotransverse Joint
Motions
All available
Flexion and extension
limited
T7-T12
Lumbar Spine
Bodies
Pedicles
Laminae
Transverse Process
Spinous Process
Articular Facets
Lumbar Spine
Thoracolumbar Fascia
Lumbar Spine
Iliolumbar Ligaments
Functions of Lumbar
Spine
Resistance of anterior
translation
Resisting Rotation
Weight Support
Motion
Spinal Ligaments
Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum
Interspinous
Ligaments
Supraspinous
Ligaments
Intertransverse
Ligaments
Intervertebral Disks
Ratio between disk
thickness and
vertebral body height
Disk Composition
Nucleus pulposis
Annulus Fibrosis
Vertebral venous plexus
Deep Muscles of
the Back (Erector
Spinae)
Iliocostalis
Iliocostalis lumborum
Iliocostalis Thoracis
IliocostalisCervicis
Iliocostalis Lumborum
O
Common tendon origin in
sacrum, iliac crest, lumber
vertebrae
I
Lower borders ribs 6-12
N
Dorsal rami of spinal nerves
F
Bilateral
Spinal extension
Maintenance of erect posture
Stabilization of spine during
flexion
Unilateral
Lateral flexion
Ipsilateral rotation
Iliocostalis Thoracis
O
Upper borders rib 6-12
I
Lower borders ribs 1-6
N
Dorsal rami of spinal
nerves
F
Bilateral
Same as above
Unilateral
Same as above
Iliocostalis Cervicis
O
Angles ribs 1-6
I
C4-6 transverse
processes
N
Dorsal rami of spinal
nerves
F
Same as above
Longissimus
Longissimus Thoracis
Longissimus Cervicis
Longissimus Capitus
Longissimus Thoracis
O
Common tendon origin
in sacrum, iliac crest,
lumber vertebrae
I
T1-12 transverse
processes
N
Dorsal rami of spinal
nerves
F
Same as above
Longissimus Cervicis
O
T1-5 transverse processes
I
C2-6 transverse
processes
N
Dorsal rami of spinal
nerves
F
Same as above
Longissimus
Capitus
O
T1-5 transverse processes
C5-7 articular processes
I
Posterior mastoid process
N
Dorsal rami of spinal nerves
F
Extends and rotates head
Spinalis
Spinalis Thoracis
Spinalis Cervicis
Spinalis Capitus
Spinalis Thoracis
O
Common tendon origin
in sacrum, iliac crest,
lumber vertebrae
I
T3-8 spinous processes
N
Dorsal rami pf spinal
nerves
F
Same as above
Spinalis Cervicis
O
C6-T12 spinous
processes
I
C2 spinous process
N
Dorsal rami of spinal
nerves
F
Same as above
Spinalis Capitis
O
Spinous processes of lower
cervical and upper thoracic
I
Between superiior and inferior
nuchal line on occiput
N
Dorsal rami of spinal nerves
F
Same as above
Transversospinal Muscles
Semispinalis thoracis
Semispinalis Cervicis
Semispinalis Capitus
Semispinalis Thoracis
O
T6-10 transverse
processes
I
C6 – T4 spinous
processes
N
Sorsal rami of spinal
nerves
F
Same as above
Semispinalis Cervicis
O
T1-T6 spinous processes
I
C2-5 spinous processes
N
Dorsal rami of spinal
nerves
F
Same as above
Semispinalis Capitis
O
C4-7 transverse processes
T1-7 vertebrae
I
Between superior and inferior
nuchal lines of occiput
N
Dorsal rami of spinal nerves
F
Same as above
Multifidus
O
Transverse processes C4-L5
Sacrum
PSIS
I
Spinous process of vert
above origin
N
Spinal nerve roots
F
Extend and lateral flexion of
vertebral column
Quadratus Lumborum
O
Iliolumbar Ligament
Iliac crest
I
Lower border 12th rib
L1-L4 transverse processes
N
ventral branches of T12 and L1
to L4.
F
Pelvis elevation
Trunk extension
Trunk lateral flexion
Pulls down rib 12 to fix origin of
diaphragm
Rotatores
O
Transverse processes from
axis to sacrum
I
Laminae of vert above
N
Direct branches over spinal
nerve roots
F
Spine extension
Rotation to opposite side
Range of Motion
Flexion
Extension
Lateral Bending
Rotation
Flexion - 80º
Extension - 35º
Side bending - 40º each side
Twisting - 3-18º
Neurologic Exam:
Sensory
Sensory dermatomes
C2-C3: Occipital area and angle of jaw
C4: Supraclavicular area
Axillary Nerve Patch: Lateral aspect of
shoulder
C5: Lateral upper arm
C6: Lateral forearm, thumb, and index
finger
C7: Middle finger and palmar aspect of
hand
C8: Small finger, ring finger, and
medial portion of palmar surface
Neurologic Exam:
Sensory
Sensory dermatomes
T1: Medial side of forearm and elbow
T2: Medial aspect of upper arm
T3: Medial aspect of upper arm
T10: Umbilicus
L2: Medial mid-thigh
L3: Superior aspect of medial knee (vastus
medialis)
L4: Knee and medial arch
L5: Dorsum of the foot
S1: Lateral border and lateral aspect of foot
S2: Popliteal fossa
Neurologic Exam: Motor
C1-C2: Neck flexion
C1-C2: Neck extension
C3: Neck lateral flexion
C4: Shoulder elevation
C5: Shoulder abduction and external rotation
C6: Elbow flexion and wrist extension
C7: Elbow extension and wrist flexion
C8: Thumb abduction and ulnar deviation
Neurologic Exam: Motor
T1: Finger approximation
L2: Hip flexion
L3: Knee extension
L4: Dorsiflexion
L5: Great toe extension, ankle dorsiflexion, ankle
eversion
S1: Plantarflexion
S2: Knee flexion
Neurologic Exam: Reflexes
Biceps (C5-C6)
Supinator (C5-C6)
Triceps (C7-C8)
Upper abdominal (T8-T10)
Lower abdominal (T11-T12)
Patella (L3-L4)
Achilles tendon (S1-S2)
Babinski
Myotomes
Map of Dermatomes – Anterior
View
Figure 14.17a
Map of Dermatomes –
Posterior View
Figure 14.17b
Cervical
Read
Back Pain
Common Sources of LBP
Somatic dysfunction
Muscle in “spasm”
Nerve root
In somatic dysfunction, some muscles become overactive (“spasm”)
and other muscles become inactive.
Muscles
Joint Receptors
Joint receptors
vasculature
Blood vessels
Muscle Spindles
viscera
Nocioceptors
Pressure, temperature
chemical
Internal organs
Connective
tissues
Humoral Factors
circulating hormones
(gender-specific response)
Bones and ligaments
immune proteins
cortisol
Disc Diseases
Radicular Signs
Pain radiation to
buttocks – Sciatica
Posterior thigh pain
Parasthesia – nerve root
impringement
Lower Spinal conditions
Spondylolysthesis
Spondylolysthesis
Spondylolysis
Facet joint
pain
Spinal injuries
Watch video
Atlas Fractures
Type Odontoid
Treated with external orthrosis
Spinal Column Injury
Subaxial (C3-C7) #
Whiplash injury:
Traumatic injury to the
soft tissue in the cervical
region
Hyperflexion,
hyperextention
No fractures or
dislocations
Most common automobile
injury
Recover 3-6 months
Hangman’s Fracture