ANATOMY ACADEMIC SESSION

Head and Neck

Kristine Magno PTRP MD | September 18, 2020
AS3a
OUTLINE • Boundaries: latissimus dorse, trapezius and medial border
I. Muscles of scapula
II. Bones and Ligaments
III. Spine
MUSCLES OF THE BACK
• Extend from the skull to the tip of the coccyx
• Blood supply is from the posterior branches of the posterior
intercostal arteries and lumbar
• It’s easy. Just compartmentalize (Magno, 2020).

Fig 1 a picture

Triangle of Petit
• AKA Lumbar triangle
• Where pus may emerge from the abdominal wall
• Borders: latissimus dorse, external oblique, iliac crest

EXTRINSIC: Movements of upper extremities and

respiration
1st Layer Trapezius
Latissimus dorse
2nd Layer Levator scapulae
Rhomboids (major and minor)
INTRINSIC: Act on vertebral column; “True” muscles of the
back
1st Layer Splenius capitis and cervicis
2nd Layer Erector spinae Iliocostalis
Longissimus
Spinalis
3rd Layer Transversospinal Semispinalis
Multifidus
Rotatores

Auscultatory Triangle
• Site on the back where breath sounds may be most easily
hears with a stethoscope
• Lies on the 6th intercostal space

Trans AS3b| Galima, Gardaya, Gregorio 1 of 9

 ANATOMY ACADEMIC SESSION
Back and Spine

ORIGIN INSERTION NERVE ACTION

SUPPLY
SUPERFICIAL EXTRINSIC MUSCLES OF THE BACK
Trapezius Occipital Lateral 1/3 of Accessory Elevate scapula
bone, clavicle, nerve (CN XI) (upper fibers),
ligament acromion pull scapula
nuchae, C7 process, medially (middle
to T12 spine of fibers), pull
spines scapula medial border of
scapula
downward (lower
fibers)
Latissimus dorsi Iliac crest, Floor of Thoracodorsa Extend, adduct,
lumbar bicipital l nerve and medially
fascia, T7- groove of rotate arm
T12 spines, humerus
lower 3 or 4
ribs, inferior
angle of
scapula
Levator Transverse Medial Dorsal Raise medial
scapulae process of border of scapular border of
C1-C4 scapula nerve scapula
Rhomboid Minor Ligamentu Raise medial
m nuchae, Medial Dorsal border of 1. Levator scapulae
spines of border of scapular scapula upward 2. Rhomboid minor
C7 and T1 scapula nerve and medially 3. Rhomboid major
Rhomboid Major T2-T5 4. Latissimus dorse
spines 5. Trapezius
INTERMEDIATE EXTRINSIC MUSCLES OF THE BACK
Serratus Lower Upper ribs Intercostal Elevates ribs
posterior cervical and nerves
superior upper
thoracic
spines
Serratus Latissimus Lower ribs Intercostal Depresses ribs
posterior inferior dorse nerves

SUPERFICIAL INTRINSIC MUSCLES OF THE BACK

Splenius capitis Lower half Mastoid Posterior rami Together: draw
of process, of middle hear backward,
ligamentum skull below cervical extending neck
nuchae, lateral 1/3 of nerves Individually:
spinous superior draw and rotate
processes nuchal line head to one side
of C7 to T4

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Back and Spine
Splenius Spinous Transverse Posterior rami Together: extend
cervicis processes processes of of lower neck
of T3 to T6 C1 to C3 cervical Individually:
nerves draw and rotate
head to one side

INTERMEDIATE INTRINSIC MUSCLES OF THE BACK (ERECTOR SPINAE)

Iliocostalis From the Angle of the Dorsal ramus • Extends the
iliac crest, ribs of the spinal heads and the
Longissimus sacrum, Transverse nerves vertebral
sacroiliac process of column
ligaments, the thoracic • Longissimus
inferior and cervical rotates the
lumbar vertebrae, head to the
spinous mastoid same side
processes process of • “Releases” –
the temporal to allow
lobe flexion to be
Spinalis Spinous slow and
process of controlled
the thoracic
vertebrae

1. Splenius capitis
2. Spinalis
3. Longissimus
4. Iliocostalis
MAJOR DEEP INTRINSIC MUSCLES OF THE BACK (Transversospinal group)
Semispinalis
Capitis Transverse Medial area Dorsal rami of • Extends the
process of between the the cervical cervical and
T1-T6/T7 superior and spinal nerves the thoracic
and C7 and inferior regions of the
articular nuchal lines vertebral
process of region
C4 to C6 • Rotates these
Cervicis Transverse Spinous regions
process of process of towards the
upper five C2-C5 opposite side
or six • Extends the
thoracic head
vertebra
Thoracis Transverse Spinous
process of process of
T6-10 upper fours
thoracis and
lower two

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Back and Spine
cervical
vertebrae
Multifidus Sacrum, Base of Dorsal rami of Unilaterally:
origin of spinous the cervical flexes the trunk
erector processes of spinal nerves laterally and
spinae, all vertebra rotates it to the
posterior from L5 to opposite side
superior C2 Bilaterally:
iliac spine, extends the
mamillary trunk and
processes stabilizes the
of lumbar vertebral column
vertebrae,
transverse
processes
of thoracic
vertebra
and
articular
processes
of lower
four cervical
vertebrae
Rotatores
Lumborum Mamillary Spinous Dorsal rami of • Rotate the
process of process of the cervical superior
lumbar lumbar spinal nerves vertebrae to
vertebrae vertebrae the opposite
Thoracis Transverse Spinous side
processes process of • Stabilize
of thoracic thoracic vertebrae and
vertebrae vertebrae assist with
Cervicis Articular Spinous local
processes process of extension and
of cervical cervical rotatory
vertebrae vertebrae movements of
vertebral
column
• Proprioceptio
n
MINOR DEEP INTRINSIC MUSCLES OF THE BACK
Interspinales Superior Inferior Posterior rami Aid in extension
surfaces of surfaces of of spinal and rotation of
spinous spinous nerves vertebral column
processes processes of
of cervical vertebra
and lumbar superior to
vertebrae vertebra of
proximal
attachment
Intertransversari Transverse Transverse Posterior and Aid in lateral
i processes processes of anterior rami flexion of
of cervical adjacent of spinal vertebral
and lumbar vertebrae nerves column; acting
vertebrae bilaterally,
stabilize
vertebral column
Levator Tip of Pass Posterior rami Elevates ribs,
costarum transverse inferolaterall of T8-T11 of assisting
process of y and insert thoracic respiration,
C7 and T1- on rib spinal nerves assists with
T11 between lateral flexion of
vertebrae vertebral column

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Back and Spine
tubercle and
angle

Differences Cervical Thoracic Lumbar

BONES AND LIGAMENTS Vertebral Small, Oval Med, Heart Large,
SEGMENTS OF THE SPINE Body Kidney
• Cervical (7) Vertebral Wide, Oval Med, Round Wide,
o Typical vertebrae – C3 to C6 Canal Triangular
o Atypical vertebra – C1 or atlas Transverse Short Costal facets Long
o Atypical vertebra – C2 or axis Process tubercles,
o Vertebra prominens – C7 foramina
Spinal Bifid Long, Thick, stout,
Process Angled down horizontal
Others Uncinate
processes

• Thoracic (12)
o Primary characteristic features: costal facets
o For articulation with the ribs
o Found in transverse process – for articulation
with tubercle of rib
o Found in vertebral body – on the sides, for
articulation with head of rib
• Lumbar (5)
o Body: massive for weight support
o Pedicles: strong and directed backward
o Laminae: short in a vertical dimension
(important when performing a spinal tap)
• Sacrum
o 5 bones fused together as one
o Concave anteriorly
• Coccyx
o 4 bones, but the lower three are fused
together GENERAL CHARACTERISTICS OF A TYPICAL VERTEBRA
Consists of:
1. Vertebral body
2. Vertebral arch
3. Seven Processes

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Vertebral Body LIGAMENTS OF THE VERTEBRAL COLUMN
• Anterior part
• More massive, roughly cylindrical
• Increases as the column descends, most markedly
from T4 inferiorly (support of body weight)

Vertebral Arch
• Posterior to the vertebral body
• Encloses the vertebral foramen
• gives rise to 7 processes*
• Consists of:
o pedicles (2)
▪ cylindrical
▪ attached to the vertebral body
▪ forming the sides of the arch
o laminae (2)
▪ flattened
▪ attached to the pedicle Anterior Longitudinal Ligament
▪ completing the arch posteriorly • Dense and powerful
• Attached to anterior disc and body
Vertebral foramen • Limits hyperextension and forward movement
• Walls: vertebral arch + posterior surface of the
vertebral body Posterior Longitudinal Ligament
• Contains the spinal cord and the roots of the spinal • Inside the spinal canal
nerves, along with the meninges, fat, and vessels that • Posterior disc and body
surround and serve them • Posterolateral aspect of segment not covered – site of
disc protrusion
Vertebral notch • Limits flexion
• Notch on the upper and lower border of the pedicles
• Formed by the projection of the body (anteriorly) and Ligamentum Flavum
the articulating processes (posteriorly) • Spans laminae
• The superior notch of one vertebra + inferior notch of • Under constant tension to maintain tension on disc
an adjacent vertebra = intervertebral foramina
Supraspinous Ligament
Interverterbal foramina • Cord-like band
• Superior notch of one vertebra + inferior notch of • Connects the tips of the spinous processeses from C7
adjacent vertebra to the sacrum
• Serve to transmit spinal nerves and blood vessels
• Where anterior and posterior nerve roots of a spinal Interspinous Ligament
nerve unite to form the segmental spinal nerves • Connects adjoining spinous processes (attaching from
the root to the apex of each process)
Seven Processes
• Spinous Process (1) Ligamentum Nuchae
o Median • Strong and broad; thickened fibroelastic tissue
o Projects posteriorly from the vertebral arch at • Extends from the spine of C7 to the external occipital
the junction of the laminae protuberance of the skull, with its anterior border
being strongly attached to the cervical spines in
• Transverse Processes (2) between
o Directed laterally from the junction of the
pedicles and laminae Intratransverse Ligament
• Connects one transverse process to another
• Articular Processes (4)
o Vertically arranged
o Consist of 2 superior and 2 inferior
processes
o 2 superior articular processes of one
vertebral arch articulates with 2 inferior
articular processes of the arch above = 2
synovial joints

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Back and Spine
DENIS THREE COLUMNS OF STABILITY

Anterior Column
• Anterior 2/3 of body + disc
• Anterior longitudinal ligament

Middle Column
• Posterior 1/3 of body + disc
• Posterior longitudinal ligament

Posterior Column
• Pedicle and posterior to it
• Lamina, Ligamentum flavum
• Facets
• Spinous process SPINAL MENINGES
• Interspinous ligament • Specialized membranes for protection, stability, and
shock absorption
ANATOMY OF THE SPINE • Continuous with cranial meninges
• Three layers
• Localized enlargements provide innervation to limbs
o Dura mater: outermost, thick, and fibrous
• 31 segments, with each segment having a pair of
o Arachnoid mater: middle layer
dorsal and ventral roots
o Pia mater: innermost layer
• Spinal nerves extend off cord
o Mixed nerves

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Back and Spine
• Spinal cord ends at L1 Laminae of Rexed
• Filum terminale: Continuation of pia mater

Lumbar Puncture
• L4-L5
• Layers traversed:
o Skin
o Supraspinous Ligament
o Interspinous Ligament
o Ligamentum flavum
o Epidural space
o Dura mater
o Arachnoid mater
o Subarachnoid space

Posterior horn contains Laminae 1-6

• Lamina 1:
o Origin to pathway relaying information about
pain to the thalamus
• Lamina 2 and 3:
o Regulates afferent input to spinal cord
• Lamina 4, 5, 6
o receives proprioceptive and sensory input

Intermediolateral gray horn

• Lamina 7
CROSS SECTION OF THE SPINAL CORD
• White matter Anterior horn
• Gray matter • Lamina 8 and 9:
• Central canal o Motor neurons supplying the limbs
• Dorsal root and Ventral root → Spinal nerve
Nuclear Cell Columns
Nuclear Posterior Marginalis
• Marginal Nucleus/Substantia Marginalis/Rexed
Lamina 1
• Most dorsal aspect of dorsal horn
• Receive input from Lissauer’s tract:
o pain and temperature
o Fast Pain

Substantia Gelatinosa
• Gelatinous substance of posterior horn
• Rexed Lamina II
• Low content of myelin
White Matter • Slow pain
• Ascending fibers: sensory
• Descending fibers: motor Nucleus Propius
o Contraction of muscles • Rexed Lamina III and IV
o Secretion of glands • Proprioceptive and Light touch input
• Commissural fibers: fibers crossing from other side
• Most pathways decussate at some point Lamina VI
• Most synapse 2 or 3 times along the way • Involved in muscle stretch reflex
• Muscle protection

Zona Intermedia/Lamina VII

• Dorsal nucleus of Clarke (C8-L2)
o Unconscious proprioception
o Input to (Dorsal) Spinocerebellar tract
• Intermediolateral cell column (T1-L2)

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Back and Spine
o Autonomic o Lateral: Limb muscles
• Dorsal-Ventral Axis
Motor Region/Lamina IX o Dorsal: Flexors
• Alpha and Gamma motor neurons o Ventral: Extensors
• Medial-Lateral Axis
o Medial: Axial muscles
Spinal Pathways

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