Gross Anatomy Lecture 2

The Back
Lecture by Dr. Julius Ceazar
Reyes________________________________________________________________________-
______
Overview - Posterior convexity of the spine
(anterior concavity)
Posterior of the trunk
Inferior to neck Lordosis
Superior to buttocks
Attachment of upper limbs, lower - Anterior convexity of the spine
limbs are actually attached to pelvic ( posterior concavity)
girdle

Axial Skeleton
Attached to skull by foramen
magnum
Attached to pelvis by the ileum
72-75 cm in length, of length is
intervertebral (IV) disc and is
vertebrae

Vertebral Column
Encase spinal cord and its nerves Primary Curvature
Locomotion
- Thoracic and Sacral Kyphosis
Posture
- 1st to develop
Support weight of head and body
- Shows up in utero
Curvature of the Spine
Secondary Curvature
- Can only be seen in a sagittal section
- Cervical and Lumbar Lordosis
Kyphosis
- Cervical lordosis develops when
baby can raise its head (3-4 months)
- Lumbar lodosis develops when baby
can sit up ( 8-10 months)
Abnormalities in Curvature
Hyper Kyphosis
- Exaggerated posterior convexity of
the spine
- Common in old age, people who are
too tall (kuba)
Hyper Lordosis
- Exaggerated anterior convexity of
the spine
- Caused by polio, leg length
discrepancies, pregnancy and obesity
- Weight of the abdomen pulls spine
anteriorly
Scoliosis
- Lateral curvature of the spine with
ROTATIOAL COMPONENT
- Dextro/levoscoliosis depending on
the direction of curvature based on
normal anatomical position
- Detected by rib hump when bent
over
- Can be fixed by braces in youth, but
older patients may need metal rods
for support (ZsaZsa Padilla)
- Can restrict pulmonary function
Kyphoscoliosis
- Both hyperkyphosis and scoliosis
- Looks like the hunch back of Notre
dame
Vertebral Column Characteristics
- Anterior element (vertebral body)
- Posterior element (vertebral arch)
- Vertebral foramen between A/P
elements
- Spinal cord, meninges and nerves
run through the vertebral foramen
- 3 Processes
o 1 spinous process
o 2 transverse processes
- 4 articular surfaces ( 2 superior, 2
inferior)
- 33 total (7 cervical, 12 thoracic, 5
lumbar, 5 sacral, 4 coccygeal)
Pedicles
- 2 processes that project from the
vertebral body
- Have 2 notches (superior/inferior)
that serve as the path for spinal
nerves
Laminae
- 2 processes that project from the
pedicles
Spinous process
- Union of laminae
Transverse process
- Union of lamina and pedicle
Vertebral Foramen
- Union of vertebral body, 2 lamellae
and 2 pedicles
Types of Vertebra
Cervical
- 7 total (1,2,7 atypical/ 3-6 typical)
- Foramen Transversarium
(distinguishing feature) serves as
pathway for vertebral artery and vein
(C7 only transmits the vein)
- Spinous process is short and bifid for
attachment of ligamentumnuchae
(except C7)
 - Large triangular vertebral foramen (
spinal cord is larger in this area,
swollen because of the brachial
plexus)
- Superior articular surface is
backward and upward
- Inferior articular surface in forward
and downward
Atypical Cervical Vertebrae
C1- Atlas
- No vertebral body and spinous
process
- Has Anterior/Posterior arch
- Superior lateral articular process is
kidney shaped, forms atlanto-
occipital joint (YES joint)
- Inferior lateral articular process is
oval and flat, forms atlanto-axial
joint (NO joint)
C2-Axis
Distinguishing feature- Dens Odontoid
Process, a tooth-like process projecting
superiorly
- Often considered the strongest
vertebra
C7- Vertebra Prominens
- Very long spinous process, not bifid
- Only transmits the vertebral vein
- Small foramen transverasium
- Very prominent when neck is flexed
forward
Fractures of Cervical Vertebra
Jeffersons Fracture
- Fracture of the atlas
- Laterally displaced fracture
- Follows Newtons third law (action-
reaction) where both the external
element and the axis exert force on
the atlas due to impact
- Atlas divides into multiple pieces,
usually 4
- Needs 2 fracture lines to displace
Hangmans Fracture
- Fracture of the axis
- Noose or restrictive element needs to
be placed anteriorly, otherwise the
hyoid will be damaged
- Can occur in vehicular accidents
(seatbelt can replicate the nooses
effects)
Fracture of the Dens Odontoid Process
- Common in vehicular accidents and
sudden blows to the head
- Odontoid process breaks off, excess
displacement can disturb the spinal
cord
- Can also distress the phrenic nerve,
responsible for the action of the
diaphragm, as a result, breathing is
compromised
- Excess twisting of the head can also
break the Odontoid process ( action
movie stealth kill), compromising
the phrenic nerve and arteries
supplying the brain and spinal cord
Radiography
- To appreciate C1 and C2, the
patients mouth must be opened due
to the interference of the maxillary
and mandibular bones
Thorcacic Vertebra
- Heart shaped vertebral body
- Medium sized
- Small, circular vertebral foramen
- Long, downward inclined spines
- Superior anterior vertebral process is
oriented backwards and laterally
 - Inferior anterior vertebral process is
oriented forward and medially
- Have costal facets (distinguishing
feature) to articulate with ribs
- Costal facets found on the vertebral
body articulate with the head of the
ribs (T1-T12)
- Costal facets found on the transverse
process articulate with the tubercle
of the rib (T1-T10 only; T11 and
T12 are hanging ribs, no tubercle)
- T7 is on the same level as the tip of
the scapula
Lumbar Vertebra
- Kidney shaped vertebral body
- Strong, thick pedicles and laminae
- Weight bearing vertebra
- Large, triangular foramen( enlarged
spinal cord in this area)
- Spinous processes are short, flat
quadrangular, projecting backwards
- Superior articulating surface is
projected medially
- Inferior articulating surface is
projected laterally
- Spinal cord is only until L2
Sacrum
- Triangular
- 5 bones fused into 1
- Base attaches to L5
- Apex attaches to coccyx
- Lateral to the iliac bone
Articulations
- Sacral hiatus
o Failure of 4th and 5th sacral
bones to fuse at the midline
- Sacral canal
o Transmits coda equina (distal
portion of spinal cord)
- Anterior sacral foramen
o Transmits spinal nerves
- Sacral promontory
o Examined in obstetrics
o Basis for Caesarean sections
o If prominent, C-section
Coccyx
- 4 fused rudimentary bones
- Small and triangular
- No vertebral arches, vertebral canal
Anatomical Variants
Cervical Rib
- C7 with rib
Lumbar Rib
- L1 with rib
Sacrolization
- L5 fused with S1
Lumbarization
- S1 separated from S2
Joints
Atlanto-Occipital Joint
- Synovial joint
- Between occipital condyle and
superior articular facet of atlas
- Encapsulated
- Used to nod (yes joint)
Ligaments
- Anterior atlanto-occipital membrane
o Continuous with anterior
longitudinal ligament
o Connects the anterior arch of
atlas to the anterior margin of
the foramen magnum
- Posterior antlanto-occipital
membrane
o Connects posterior arch of
the atlas to the posterior
 margin of the foramen - Movement depends of the orientation
magnum of articular surfaces
o Pierced by the vertebral
artery

Atlanto-Axial Joint o Supraspinous Ligament

Attaches tips of
- Between Odontoid process and arch vertebral spines
of atlas, superior articular surface of o Interspinous ligament
the axis, and the inferior articular Connects adjacent
surface of the atlas spines
- Synovial joint o LigamentumFlava
- Encapsulated Connects laminae of
- Used to rotate head about its axis adjacent vertebrae
(NO joint) o Intervertebral ligaments
Connects transverse
Ligaments processes of adjacent
vertebrae
- Superficial ligament
o LigamentumNuchae
o Tectorial membrane
Thickening of
o Continuous with the posterior
supraspinous ligament
longitudinal ligament
Attachment of neck
o Attached to occipital bone
muscles
o Covers posterior surface of
From C7 to occipital
Odontoid process, cruciate,
portruberance
alar, and apical ligaments
Maintains the
- Intermediate ligament
orientation of the
o Cruciate ligament
neck
o Transversely attached to the
Triangular and sheet-
lateral mass on the inner
like
aspect of the atlas
o Anterior longitudinal
- Deep ligament ligament
o Apical ligament Attached superiorly to
Attaches apex of
the base of the skull,
odontoid process and
extends to the anterior
the anterior margin of
surface of the sacrum
the foramen magnum
Connected to
o Alar ligament vertebral bodies and
Connects the odontoid
intervertebral discs
process to medial side
o Posterior longitudinal
of occipital condyle
ligament
Intervertebral Joints Located on posterior
surfaces of vertebral
- Between articulating surfaces of bodies to the sacrum
adjacent vertebra Lines anterior surface
- Synovial, encapsulated joints of vertebral canal
 Connected to
vertebral bodies and
intervertebral discs
Costovertebral Joint
- Between thoracic vertebra(normally)
and ribs
Intervertebral Discs
- Joint between vertebral bodies
- Fibrous joint
- of total length of the vertebral
column
- Thickest where the is the most stress
( cervical and lumbar regions)
- Covered with hyaline cartilage
- Shock absorbers
- Create a rocking motion between
adjacent vertebrae
Parts of Intervertebral Discs
- Annulus Fibrosus
o Fibrocartilage surrounded by
concentric layers of collages
o Attached to vertebral rim of
vertebral body
o Peripheral fibers are tightly
bound to the anterior
longitudinal ligament and
posterior longitudinal
ligaments
- Nucleus Pulposus
o Mostly water with some
collagen fibers
o Ovoid, gelatinious in
structure and form
o Flattens with increased
pressure
Scapula
- Flat, triangular bone
- Attached to clavicle and humerus
- Posterior of chest
- Shoulder blade
- 3 borders
- 3 angles
- 4 fossae
- 3 processes
3 Borders
- Vertebral
o Adjacent to vertebral column
- Axillary
o Adjacent to axilla
- Superior
o Uppermost part
3 Angles
- Superior
o Union of superior border and
vertebral border
- Inferior
o Union of axillary and
vertebral border
- Lateral
o Union of axillary border and
superior border
o Associated with glenoid fossa
3 Processes
- Spinous Process
o Posterior surface projecting
backwards
o Subscapular spine
- Acromion Process
o Lateral end of spine
o Articulates with clavicle
- Coracoid Process
o Projects upward and above
glenoidglenoid cavity
providing attachment for
muscles and ligaments
 o Near subscapular notch ( o Upper fibers
where subscapular nerve, Elevate scapula
artery and vein pass) o Middle fibers
Pull scapula medially
o Lower fibers
Pull medial border of
scapula

4 Fossae
LatissimusDorsi
- Supraspinous
o Posterior surface - Origin
o Process of T6-L5, iliac crest,
o Above spine of scapula
rib 10-12
- Infraspinous
o Posterior surface - Insertion
o Intertubercular sulcus of
o Below spine of scapula
humerus
- Subscapular
o Anterior surface - Innervation
o Thoracodorsal nerve
o Shallow, concave
- Action
- Glenoid
o Extends, abducts and
o Found on lateral angle
medially rotates the arm
o Articulates with humerus
o Pear shaped

Levator Scapulae
Muscles of the Back - Origin
o Transverse processes of C1-
Superficial
C4
- Connect the upper limb to the - Insertion
vertebral column o Medial border of Scapula
- Innervation
Trapezius o Dorsal scapular nerve
- Action
- Neutralizer o Raises medial border of
- Origin scapula
o Occipital bone,
ligamentumnuchae, spine of
cervical vertebra, all thoracic Rhomboid Major
vertebra
- Insertion - Origin
o Clavicle (lateral), acromion o Spines of T2-T5
process, spine of scapiula - Insertion
- Innervation o Medial border of scapula
o Cranial Nerve IX (accessory) - Innervation
- Action o Dorsal scapular nerve
 - Action - Insertion
o Raises medial border of o Greater tuberosity of
scapula upward and medially humerus
- Innervation
o Subscapular nerve
- Action
o Laterally rotates arm and
stabilize humerus

Teres Minor

Rhomboid Minor - Origin

o Upper 2/3 of lateral border of
- Origin scapula
o Ligamentumnuchae, C7 and - Insertion
T1 thoracic spine o Greater tuberosity of
- Insertion humerus
o Medial border of scapula - Innervation
- Innervation o Axillary nerve
o Dorsal scapular nerve - Action
- Action o Laterally rotates arm and
o Raises medial border of stabilize humerus
scapula upward and medially

Teres Major
Rotator Cuff Muscles
- Origin
- Muscles that connect the humerus to o Lower 1/3 of lateral border of
the scapula scapula
- SITS - Insertion
o Deltoid tuberosity of
Supraspinatus humerus
- Orgin - Innervation
o Fossa of infraspinatus o Lower subscapular nerve
- Insertion - Action
o Greater tuberosity of o Medially rotates and adducts
humerus arm, stabilize shoulder joint
- Innervation Deltoid
o Suprascapular nerve
- Action - Origin
o Laterally rotates arm and o Lateral third of clavicle,
stabilizes shoulder joint acromion process, spine of
scapula
Infraspinatus - Insertion
- Origin o Deltoid tuberosity of
o Fossa of infraspinatus humerus
 - Innervation o Upper lumbar and lower
o Axillary nerve thoracic spines
- Action - Insertion
o Abducts arm, anterior fibers o Lower ribs
flex and rotate arm, posterior - Innervation
fibers extend and laterally o Intercostal nerves
rotate arms - Action
o Depresses ribs
o Expiration

Nerves Postvertebral Muscles

- Suprascapular nerve - Posture
o Supraspinatus - Always active
o Infrapsinatus
- Axillary nerve Erector Spinae
o Teres major
o Deltoid - Run vertically
- Subscapular nerve o Iliocostalis
o Teres major (lower branch o Longissimus
only) o Splinalis
o Subscapular (upper and lower
branch)
Intermediate Obliquely Running
Muscles
Intermediate Muscles
- Run obliquely
- For respiration o Semispinalis
- Attached to ribs o Multifidus
o Rotatores
Serratus Posterior Superior
Deep Muscles
- Origin
o Lower cervical and upper - Run between transverse processes of
thoracic spines adjacent vertebrae
- Insertion o Interspinales
o Upper ribs o Intertransversarii
- Innervation Triangle of Ascultation
o Intercostal nerves
- Action - Where heartbeat may be most clearly
o Raises ribs heard with a stethoscope
o Inspiration - Formed by:
o Lateral border of trapezius
Serratus Posterior Inferior o Superior border of
- Origin latissimusdorsi
o Medial border of scapula
 Lumbar Triangle - Internal Vertebral Venous Plexus
o Within spinal canal but
- Exit of most intraabdominal pus outside the dura matter of
- Formed by: spinal cord
o Inferior border of - Basivertebral Veins
latissimusdorsi - Intervertebral Veins
o Posterior border of external o Pass outward with spinal
oblique nerves through the
o Iliac crest intervertebral foramen
o Drain spinal cord and
meninges
Arterial Supply of The Back
Nerve Supply of the Back
Cervical Region
- Posterior rami of 31 pairs of spinal
- Occipital Artery nerves
o Brach or external carotid o Nerve C2-C5
artery Posterior Head
- Vertebral Artery o Nerve C6-C8
o Branch of subclavian artery Posterior shoulder
- Deep Cervical Artery o Nerve T1
o Branch of costocervical trunk Tip of Axilla
o Nerve T4
Inferior angle of
scapula
o Nerve 10
Thoracic Region Umbilicus

- Posterior Intercostal Arteries Shingles (Herpes Zoster)

o Branch of thoracic aorta
(above the diaphragm)
Lumbar Region
- Subcostal Arteries
- Lumbar Arteries
- Resurgence of chickenpox
- Extremely painful
- Follows the spinal nerves
- Predictable dermal pattern
Lymphatic Drainage of the Back

Sacral Region - Collects interstitial fluid

- Lymph drainage follow the veins
- Iliolumbar and Lateral Arteries o Deep cervical
o Branches of internal iliac Cervical area
artery o Posterior mediastinal
Thoracic area
Venous Drainage of the Back o Lateral Aortic
Lumbar and sacral
- External Vertebral Venous Plexus
region
o Drains outside and surrounds
o Sacral Nodes
the vertebral column
 Lumbar and Sacral
region

References

- Previous transcriptions from rejoice

- Doctor Julius Ceazar Reyes Lecture
- Grays Anatomy (2005)