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Bone, Muscles of vertebral column

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Bone, Muscles of vertebral column

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  1. Bone, Muscles of vertebral column By Prof. Pasuk Mahakkanukrauh, MD

  2. Vertebral Column • Vertebrae : cervical (C) : thoracic (T) : lumbar (L) : sacrum (S) : coccyx (Co) • Function : Protection : Weight bearing : Movement

  3. Normal Curvature of Vertebral Column • Primary Curvature • Secondary Curvature • Clinical correlation : kyphosis : thoracic kyphosis : lordosis : lumbar lordosis : scoliosis : myopathic, idiopathic

  4. Vertebrae • Vertebral Body : weight bearing • Vertebral Arch: Protection : pedicle : lamina : spinous process : articular process : transverse process * Vertebral foramen * Vertebral (spinal) canal Component

  5. Cervical vertebrae • Foramen transversarium : vertebral a. • C3-C6 : short spinous process+bifid : Uncinate process (Uncus) : LuschkaJoint • C1 : Atlas • C2 : Axis • C7 : prominens spinous process • Facet joint : horizontal

  6. Atlas • Articular facet : kidney • No spinous process • No body • Anterior-posterior tubercle • Lateral mass • Anterior-posterior arch

  7. Axis • Dens or Odontoid process • Bifid big spinous process

  8. Thoracic vertebrae • Costal facet • Long spinous process • Body : Heart shape : T5-8 • T1-4 : cervical like • T9-12 : lumbar like • Facet joint : oblique

  9. Lumbar vertebrae • Big body : L5 • No costal facet • Body : kidney shape • Big transverse process • Lumbosacral angle • Facet joint : vertical

  10. Sacrum: anterior • Fusion 5 sacrum • Triangular shape • Lateral mass • Sacral foramina • Sacral promontary

  11. Sacrum: posterior • Median crest • Intermediate sacral crest • Lateral sacral crest • Sacral hiatus • Sacral cornua

  12. Clinical Application • Epidural (caudal) anesthesia or block • Lumbarization • Sacralization

  13. Coccyx • 4 Remnant…..1 • Coccygeal cornua • No weight bearing ** Coccygonia

  14. Movement • Joint of the vertebral column • Back muscle and ligament

  15. Craniovertebral joint • atlanto-occipital joint - synovial type (condyloid) - Atlanto-occipital membrane - transverse ligament, cruciform ligament - alar ligament, apical ligament - tectorial membrane • atlanto-axial joint - synovial type (pivot type) - transverse ligament • Uncovertebral (Luschka) joint

  16. Joint of the vertebral column • Joint of vertebral body • Joint of vertebral arch - zygapophyseal (facet) joint

  17. Joint of vertebral body • Main ligament - ALL - PLL • Intervertebral disc - Connect vertebrae - Shock absorber - Weight bearing - Component : nucleus pulposus (H2O) : anulus fibrosus (Collagen) • Accessory ligament -Ligament flavum -Interspinous ligament -Intertransverse ligament -Supraspinous ligament

  18. Zygapophyseal Joint • Articular process • Accessory ligament -Ligament flavum -Interspinous ligament -Intertransverse ligament -Supraspinous ligament

  19. Biomechanic : C-spine • Most Movement • Occipitoatlantoaxial complex - O-C1 : main F/E, no rotation - C1-C2 : main rotation, no lateral rotation • Lower cervical spine - C3-C7 : F/E, lateral flexion, rotation

  20. Biomechanic : T-spine • main rotation, lateral flexion • mild F/E : facet joint, costal cartilage, spinous process

  21. Biomechanic : L-spine • Weight bearing • main F/E, lateral flexion, no rotation

  22. Clinical correlation • Spondylolysis • Spondylolisthesis • Spondylosis • Spondylitis • Whiplash injury • Counting vertebrae

  23. Back Muscles • Extrinsic back muscles - superficial layer : trapezius,latissimus dorsi - middle layer : serratus posterior, levator costarum • Intrinsic back muscles : deep layer - superficial back muscles - middle back muscles - deep back muscles

  24. Superficial back muscles • Splenius muscle - splenius capitis - splenius cervicis ** Cervical flexion: levator scapulae, sternocleidomastoid,scalenus ant.-medius Cervical extension

  25. Middle back muscles • Ertector spinae (sacrospinalis)m. - Iliocostalis - Longissimus - spinalis *** Function: back extension *** Back strain

  26. Deep back muscles(transversospinalis) • Semispinalis • Multifidus • Rotator • Interspinalis • Intertransversarius • levator costarum

  27. Middle-deep layer : back extension **** back flexion : abdominal m.

  28. Abdominal Muscles • External Oblique • Internal Oblique • Transversus Abdominis • Rectus abdominis

  29. Stability of spine • Ligaments : ALL, PLL, LF, Interspinous lig. • Back muscles

  30. Reference ผาสุก มหรรฆานุเคราะห์. มหกายวิภาคศาสตร์การเคลื่อนไหว. กรุงเทพฯ : พีบีฟอเรนบุคส์ เซนเตอร์; 2547. 294 หน้า

  31. Good Luck

  32. Neck Flexion Sternocleidomastoid Scalenus muscle Levator scapulae Neck Extension Splenius muscle

  33. Trunk Flexion Abdominal muscle EO,IO,TA,RA Trunk Extension Erector spinae Deep layer of back muscle (multifidus, rotator, interspinalis, intertransversalis)

  34. Trunk lateral bending Anterior-posterior Abdominal muscle Ipsilateral contraction Trunk rotation Ipsilateral contraction IO Contralateral EO Multifidus