Bone, Muscles of vertebral columnBone, Muscles of vertebral column

ByBy

Prof. Pasuk Mahakkanukrauh, MDProf. Pasuk Mahakkanukrauh, MD

Vertebral ColumnVertebral Column

Vertebrae : cervical Vertebrae : cervical ((CC)) : thoracic : thoracic ((TT)) : lumbar : lumbar ((LL)) : sacrum : sacrum ((SS)) : coccyx : coccyx ((CoCo))

Function : ProtectionFunction : Protection : Weight bearing: Weight bearing : Movement: Movement

Normal Curvature of Vertebral ColumnNormal Curvature of Vertebral Column

Primary CurvaturePrimary CurvatureSecondary CurvatureSecondary CurvatureClinical correlation Clinical correlation

: kyphosis : thoracic kyphosis: kyphosis : thoracic kyphosis : lordosis : lumbar lordosis: lordosis : lumbar lordosis : scoliosis : myopathic, idiopathic: scoliosis : myopathic, idiopathic

VertebraeVertebraeVertebral Body : weight bearing Vertebral Body : weight bearing Vertebral ArchVertebral Arch : Protection: Protection

: pedicle: pedicle : lamina: lamina : spinous process: spinous process : articular process: articular process : transverse process: transverse process

* Vertebral foramen* Vertebral foramen * Vertebral * Vertebral ((spinalspinal)) canal canal

Component

Cervical vertebraeCervical vertebrae

Foramen transversarium : vertebral a.Foramen transversarium : vertebral a.C3-C6 : short spinous process+bifidC3-C6 : short spinous process+bifid

: Uncinate process : Uncinate process ((UncusUncus)) : : LuschkaLuschka JointJoint

C1 : AtlasC1 : AtlasC2 : AxisC2 : AxisC7 : prominens spinous processC7 : prominens spinous processFacet joint : horizontalFacet joint : horizontal

AtlasAtlasArticular facet : kidneyArticular facet : kidney

No spinous processNo spinous process

No bodyNo body

Anterior-posterior tubercleAnterior-posterior tubercle

Lateral massLateral mass

Anterior-posterior archAnterior-posterior arch

AxisAxisDens or Odontoid processDens or Odontoid process

Bifid big spinous processBifid big spinous process

Thoracic vertebraeThoracic vertebrae

Costal facetCostal facet

Long spinous processLong spinous process

Body : Heart shape : T5-8Body : Heart shape : T5-8

T1-4 : cervical likeT1-4 : cervical like

T9-12 : lumbar likeT9-12 : lumbar like

Facet joint : obliqueFacet joint : oblique

Lumbar vertebraeLumbar vertebrae

Big body : L5Big body : L5

No costal facetNo costal facet

Body : kidney shapeBody : kidney shape

Big transverse processBig transverse process

Lumbosacral angleLumbosacral angle

Facet joint : vertical Facet joint : vertical

SacrumSacrum : anterior: anterior

Fusion 5 sacrumFusion 5 sacrum

Triangular shapeTriangular shape

Lateral massLateral mass

Sacral foraminaSacral foramina

Sacral promontarySacral promontary

SacrumSacrum : posterior: posterior

Median crestMedian crest

Intermediate sacral crestIntermediate sacral crest

Lateral sacral crestLateral sacral crest

Sacral hiatusSacral hiatus

Sacral cornuaSacral cornua

Clinical ApplicationClinical Application

Epidural Epidural ((caudalcaudal) ) anesthesia or blockanesthesia or block

LumbarizationLumbarization

SacralizationSacralization

CoccyxCoccyx

4 Remnant…..14 Remnant…..1

Coccygeal cornuaCoccygeal cornua

No weight bearingNo weight bearing

** Coccygonia** Coccygonia

MovementMovement Joint of the vertebral columnJoint of the vertebral column

Back muscle and ligamentBack muscle and ligament

Craniovertebral jointCraniovertebral joint

atlanto-occipital jointatlanto-occipital joint - synovial type - synovial type ((condyloidcondyloid))

- Atlanto-occipital membrane- Atlanto-occipital membrane - transverse ligament, cruciform ligament- transverse ligament, cruciform ligament - alar ligament, apical ligament- alar ligament, apical ligament - tectorial membrane- tectorial membrane

atlanto-axial jointatlanto-axial joint - synovial type - synovial type ((pivot typepivot type)) - transverse ligament- transverse ligament

Uncovertebral Uncovertebral ((LuschkaLuschka) ) joint joint

Joint of the vertebral columnJoint of the vertebral column

Joint of vertebral bodyJoint of vertebral body

Joint of vertebral archJoint of vertebral arch

- - zygapophyseal zygapophyseal ((facetfacet) ) joint joint

Joint of vertebral bodyJoint of vertebral bodyMain ligament Main ligament

- ALL- ALL - PLL- PLL

Intervertebral disc Intervertebral disc - Connect vertebrae- Connect vertebrae - Shock absorber- Shock absorber - Weight bearing- Weight bearing - Component : nucleus pulposus - Component : nucleus pulposus ((H2OH2O))

: anulus fibrosus : anulus fibrosus ((CollagenCollagen))Accessory ligamentAccessory ligament

-Ligament flavum-Ligament flavum -Interspinous ligament-Interspinous ligament -Intertransverse ligament-Intertransverse ligament -Supraspinous ligament-Supraspinous ligament

Zygapophyseal JointZygapophyseal Joint

Articular processArticular processAccessory ligamentAccessory ligament

-Ligament flavum-Ligament flavum

-Interspinous ligament-Interspinous ligament

-Intertransverse ligament-Intertransverse ligament

-Supraspinous ligament-Supraspinous ligament

Biomechanic : C-spineBiomechanic : C-spine

Most Movement Most Movement

Occipitoatlantoaxial complexOccipitoatlantoaxial complex

- O-C1 : main F/E, no rotation- O-C1 : main F/E, no rotation

- C1-C2 : main rotation, no lateral rotation- C1-C2 : main rotation, no lateral rotation

Lower cervical spineLower cervical spine

- - C3-C7 : F/E, lateral flexion, rotationC3-C7 : F/E, lateral flexion, rotation

Biomechanic : T-spineBiomechanic : T-spine

main rotation, lateral flexionmain rotation, lateral flexion

mild F/E : facet joint, costal cartilage, mild F/E : facet joint, costal cartilage, spinous processspinous process

Biomechanic : L-spineBiomechanic : L-spine

Weight bearingWeight bearing

main F/E, lateral flexion, no rotationmain F/E, lateral flexion, no rotation

Clinical correlationClinical correlation

SpondylolysisSpondylolysisSpondylolisthesisSpondylolisthesisSpondylosisSpondylosisSpondylitisSpondylitisWhiplash injuryWhiplash injuryCounting vertebraeCounting vertebrae

Back MusclesBack Muscles

Extrinsic back musclesExtrinsic back muscles

- superficial layer : trapezius,latissimus dorsi- superficial layer : trapezius,latissimus dorsi

- middle layer : serratus posterior, levator - middle layer : serratus posterior, levator costarumcostarum

Intrinsic back muscles : deep layerIntrinsic back muscles : deep layer

- superficial back muscles- superficial back muscles

- middle back muscles- middle back muscles

- deep back muscles- deep back muscles

Superficial back musclesSuperficial back muscles

Splenius muscleSplenius muscle

- splenius capitis- splenius capitis

- splenius cervicis- splenius cervicis

** ** Cervical flexionCervical flexion: levator scapulae, : levator scapulae, sternocleidomastoid,scalenus ant.-mediussternocleidomastoid,scalenus ant.-medius

Cervical extension

Middle back musclesMiddle back muscles

Ertector spinae Ertector spinae ((sacrospinalissacrospinalis)) m.m. - Iliocostalis- Iliocostalis - Longissimus- Longissimus - spinalis- spinalis *** Function: back extension*** Function: back extension *** Back strain*** Back strain

Deep back musclesDeep back muscles((transversospinalistransversospinalis))

SemispinalisSemispinalisMultifidusMultifidusRotatorRotatorInterspinalisInterspinalisIntertransversariusIntertransversariuslevator costarumlevator costarum

Middle-deep layer : back extensionMiddle-deep layer : back extension

**** back flexion : abdominal m.**** back flexion : abdominal m.

Abdominal MusclesAbdominal Muscles

External ObliqueExternal Oblique

Internal ObliqueInternal Oblique

Transversus AbdominisTransversus Abdominis

Rectus abdominisRectus abdominis

Stability of spineStability of spineLigaments : ALL, PLL, LF, Interspinous lig.Ligaments : ALL, PLL, LF, Interspinous lig.

Back musclesBack muscles

Reference

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Neck FlexionNeck Flexion

- SternocleidomastoidSternocleidomastoid- Scalenus muscleScalenus muscle- Levator scapulaeLevator scapulae

Neck ExtensionNeck Extension

- Splenius muscleSplenius muscle

Trunk FlexionTrunk Flexion

- Abdominal muscleAbdominal muscle

EO,IO,TA,RAEO,IO,TA,RA

Trunk ExtensionTrunk Extension

- Erector spinaeErector spinae- Deep layer of back muscleDeep layer of back muscle

((multifidus, rotator, multifidus, rotator, interspinalis,interspinalis,

intertransversalisintertransversalis))

Trunk lateral Trunk lateral bendingbending

Anterior-posterior Anterior-posterior Abdominal muscleAbdominal muscle

Ipsilateral contractionIpsilateral contraction

Trunk rotationTrunk rotation

- Ipsilateral contraction IOIpsilateral contraction IO- Contralateral EOContralateral EO- MultifidusMultifidus