Review of the Back

*Cervical (C2-C7) Motion* _____________ (amount of) mobility for vertebral column. Facets are generally ______, with superior facets facing _______ and _________ and inferior facets facing _____ and ________. Facets oriented midway between _________ and ___________. Lots of motion permitted in _____ planes.

Greatest Flat, posterior/ superior, anterior, inferior Horizontal, vertical all

*Atlanto-axial Joint Complex* Central AA joint is between _____ of C2 and "ring" formed by _________ arch and __________ligament of atlas, which holds _______ tightly against _________ arch of _______to prevent _________ of dens.

dens, anterior, transverse, dens, anterior, atlas, dislocation

*Intervertebral Foramina* The _________ root ________ is located within the IVF. Dorsal and ventral rami divide ________ existing IVF.

dorsal root ganglion after

Nuchal ligament runs from ___________ __________ protuberance to spine of C___

external occipital protuberance, C7

*Components of a Typical Vertebra* Processes for muscle and/or ligamentous attachment include a single ___________ process posteriorly or bilateral ___________ processes posterolaterally.

spinous, transverse

*Coccygeal Vertebrae* (1) ______(#) vertebra fuse into _______-shaped bone = the coccyx (2) Superior ________ (the _____) articulates with the _______ of the sacrum

(1) 4, triangular (2) coccyx, base, apex

*Sacral Vertebra* (1) _____(#) sacral vertebra fuse to form the ________ (2) Function of sacrum is to transmit weight of ___ body to lower______s. (3) Sacral promontory = sharpened ___ edge of S___ vertebra (4) Large _____________ surfaces on lateral sides articulate with the ______ of the os coxae (5) Sacral canal houses and protects ______ _______ of the spinal cord. (6) Failure of last sacral segment to fuse posteriorly results in normal gap at ______ sacrum called sacral __________.

(1) 5, sacrum (2) upper, limbs (3) anterior, S1 (4) auricular, ilia (5) cauda equina (6) inferior, hiatus

*Cervical Vertebrae* (1) Small _________, wider ______ than AP (2) Large, _______-shaped vertebral foramen (3) Short ________processes giving off anterior and posterior __________(for _____ attachment) (4) Bilateral transverse _________, for passage of _______ artery (important blood supply to the _______) (5) Relatively flat ________ facets oriented between _______ and horizontal planes (partially allows for large _____ that occurs in all planes, including sagittal ____/____, frontal/coronal horizontal ______ and lateral ________). (6) Short, ______ spinous processes (divided by notch into two parts)

(1) Body, mediolaterally (across) (2) Triangle (3) TVP, tubercles, muscle (4) foramina, vertebral, brain (5) articular, frontal, ROM, F/E, rotation, flexion (6) Bifid

*Thoracic Vertebrae* (1) _______-shaped body, equally wide and deep (2) Round vertebral _______ (3) Large _______ processes that project posterior-__________ (4) Costal facets on both __________ and ______ processes (for articulation with ______ and ______ of ribs, respectively) (5) Superior and inferior articular facets project ________ (oriented in ____plane, allowing mostly sagittal-plane _______ followed by horizontal__________, with less lateral _______. (6) Superior articular facets face ______ while inferior articular facets face ____________. (7) Spinous process are ________(length) and project ______ (thus overlap and limit hyper__________).

(1) Heart (2) foramina (3) Transverse, laterally (4) bodies, TVPs, heads, necks (5) vertically, coronal; F/E, rotation, flexion (6) posteriorly, anteriorly (7) long, inferiorly, hyperextension

ROM of vertebral column depends on: (1) __________ and shape of articular facets (2) _________ of other structures (e.g. ribs, sternum) (3) Elasticity and _________ of IV disc (4) ________ capsule (5) ____________ Primary determinants are __________ orientation and __________ joints.

(1) Orientation (2) Attachments (3) thickness (4) Joint (5) Ligaments Facet, zygapophysial

*C1 (Atlas)* (1) Lacks ______ and _______ process. (2) Consists of anterior and posterior ___________ and lateral ______. (3) Superior articular facets are _______ (shape) and elongated _______ for articulation with occipital _________ of skull (4) Inferior articular facets articulate with the _________. (5) Movements between occipital ____ and C1 = _____/_______

(1) body, spinous process (2) arches, mass (3) concave, AP, condyles (4) axis (5) condyles, F/E

*C2 (Dens)* (1) Has ______ or (odontoid process) = _____ of axis projecting superiorly to articulate with very small "body" of the ______ (2) Atlas _______ or tilts around dens during motion at __________-______joint, facilitating cervical ________.

(1) dens, body, atlas (2) pivots, atlanto-axial, rotation

*Components of a Typical Vertebra* Contains ______ anteriorly and _________(neural) arch lateral and posteriorly. The _______ is the weight-bearing part of the vertebra.

Body, vertebral, body

*Lumbar Vertebra* (1) Large, ________-shaped body, wider _____ than deep AP (2) Relatively small, _________-shaped vertebral foramen (3) Superior ______facets face __________ or postero-__________ while inferior facets face ___________or antero-_____________. (4) ___________ processes project from posterior surface of _________ articular process (sites of attachment for ______ back mm, e.g. ________) (5) Small __________ processes at postero-__________ aspect of root of ________ process (site of attachment for ______ back mm, e.g. _____________) (6) _________ and __________ spinous processes that project _________ in __________ plane

(1) kidney, mediolaterally (across) (2) triangular (3) articular, medially, posteromedially, laterally, anterolaterally (4) Mammillary, superior, deep, multifidi (5) Accessory, inferior, TVP, deep, intertransverse (6) Short, stout, posteriorly, horizontal

*Atlanto-axial Joint Complex* Tough, fibrous cords running from dens to sides of foramen magnum (medial aspect of occipital condyles) Limit extremes of _____ of head and ____ on axis, acting as "_____" ligaments.

*Alar ligaments* rotation, atlas, check

*Ligaments of the Vertebral Column* Attaches to bodies and intervertebral discs on anterior surface of vertebral column Very strong, broad, and __________. Only ligament that limits _________ of vertebral column.

*Anterior longitudinal ligament* continuous extension

Situated "above axis" (= above TVP) Are _____ back mm attaching to _______skeleton Innervated by ________(posterior) rami of spinal nn.

*Epaxial muscles* deep, axial dorsal

Situated "below axis" (= below TVP) Are body _________and _________ mm attaching to limb or ______ skeleton. Innervated by ______(anterior) rami of spinal nn.

*Hypaxial muscles* wall, limb, appendicular ventral

*Ligaments of the Vertebral Column* Runs between adjacent spinous processes Aids in limiting _______

*Interspinous ligaments* flexion

*Ligaments of the Vertebral Column* Runs between adjacent transverse processes Most well-defined in______ region (fibers are scattered in _________ region and membranous in _______ region) Limits ______-bending

*Intertransverse ligaments* thoracic, cervical, lumbar lateral

*Ligaments of the Vertebral Column* Runs between adjacent laminae but ___________ (non-continuous) from laminae to adjacent laminae Fibers are ________(description) and yellowish Helps form ________ wall of vertebral canal. Limits __________.

*Ligamentum flavum* segmental Elastic Posterior Flexion

*Ligaments of the Vertebral Column* Attaches to bodies, intervertebral discs on posterior surface of vertebral bodies Narrow over bodies, but _______-shaped at each disc. Runs along __________wall of vertebral canal. Limits ____________. Strengthens IV ______posteriorly.

*Posterior longitudinal ligament* diamond-shaped anterior flexion disc

*Ligaments of the Vertebral Column* Runs between tips of adjacent spinous processes Strong and ____-like Merge superiorly with ________ ligament of neck Limits ________

*Supraspinous ligament* cord nuchal ligament flexion

*Joints Between Vertebral Bodies* IV disc contains _____ (#) portions (1) ________ _______ = outer fibrous portion. Consists of interwoven ____________ and inserts into ___________surfaces of adjacent vertebral bodies. (2) _________ _______ = inner gelatinous mass. More cartilagenous with high ______content; functions to cushion ________loads and facilitates movements in _____ planes. Movement is ______ when discs are compromised. There is no disc between the _______ and ________.

2 (1) Anulus fibrosus; fibrocartilage, articular (2) Nucleus pulposus; water, axial, all limited atlas, axis

*Joints of the Vertebral Column* There are ____ (#) types of joints between vertebra. (1) Joints between _________bodies --> _________ with IV disk, primarily for _______-bearing (2) Joints between ________ processes of vertebral _________ --> ________joints that guide _________of joints

2 vertebral, symphysis, weight-bearing articular, arches, synovial, movement

Vertebral column contains ___(#)___bones running superiorly from the ______ to the ______ inferiorly. All bones are linked to each _________and to ______ cage and ________ by series of ligaments. There are _______ cervical, _____thoracic, ______ lumbar, ______ sacral, and ______ coccygeal vertebrae.

33, skull, pelvis, other, rib, pelvis 7, 12, 5, 5, 4

C1 exits ______ C1 vertebra, between occipital __________ of the skull and the C1 vertebra. C2 exits _________ C1 vertebra, C7 exits ______ C7 vertebra. C8 exits __________ C7 vertebra. All other spinal roots exit ______ their respective vertebrae.

Above, condyles Above Above Below below

There are two secondary curvatures, one in the _______ and one if the _____ region. Both are ________ anteriorly. Cervical curve appears when infants _____________________. Serves to help balance ________ on the trunk. Lumbar curve appears when child begins to ____________. Serves to balance ___________ on pelvis.

Cervical, lumbar, convex Begin to support, hold up their head; head walk upright; trunk

The primary curvature of the vertebral column is _______ anteriorly. It develops in the _________ and is maintained in the __________ and ___________ regions as adults.

Concave anteriorly fetus, thoracic, sacrococcyeal regions

*Atlanto-occipital Joint* Between bilateral, _________occipital condyles and bilateral, ________ superior facets on lateral masses of the __________. A rolling/ sliding_________ joint providing for ________ plane motion (_______/_________) and _________motion in other planes. Joint capsule runs between _______ and edges of ____ __________.

Convex, concave, atlas synovial, sagittal, flexion/ extension, limiting atlas, foramen magnum

*Segmental Muscle Group* ______ layer of back mm that runs between adjacent ______ or vertebrae to ________. Function to stabilize ________ _______ and aid in ____ movements.

Deep, vertebrae, ribs Vertebral column, finer

*Atlanto-axial Joint Complex* Lateral ________ joints between______ articular facets on _______mass of _____(C1) and superior facets on _____ (C2). From gliding _______joints.

Facet, inferior, lateral, atlas, axis; synovial

*Thoracic Motion* Facets relatively ______ with superior facets facing __________, inferior facets __________. More ________ and ______/________, limited ____-________. Movements limited by joints tying thoracic vertebra to ______ and ________.

Flat, posterior, superior rotation, flexion/extension, side-bending ribs, sternum

*Deep Back Muscle Group* Are true or ________ (= ___paxial) muscles. Attached to _______skeleton and arranged ________ (generally, no segment of muscle goes entire __________). Innervated serially by______ rami of __________spinal nn. No ______ cord or n. innervates entire muscle. Five groups: (1) Spino______________ (2) Erector _______ (3) Transverso___________ (4) ________ group (5) Sub___________group

Intrinsic, epaxial Axial, segmentally, length Dorsal, mixed, single (1) Spinotransversales (2) Erector spinae (3) Transversospinales (4) Segmental (5) Suboccipital

*Superficial Back Muscle Group* Are upper _______ mm and NOT true _______ mm (= ____axial mm). Run from ______ skeleton to ______ (limb) skeleton. Vertebra, skull, ribs, iliac crest = _________skeleton Scapula, clavicle, humerus = _________skeleton

Limb, back, hypaxial Axial, appendicular axial appendicular

*Transversospinales Group* ________ layer of deep back mm. Runs ________ and ________. Semispinalis runs from ______ process to _____ processes and _____. Span ____-___(#) vertebral levels. Function to ______ head and spine and rotate __________ (except ________, which rotates ipsilaterally). Contains ____, ________, and ________(superior only) regions.

Middle, superior, medial TVP, SP, occiput; 4-6 Extend, contralaterally, capitis thoracic, cervicis, capitis

*Intermediate Back Muscle Group* Includes serratus __________ superior and inferior (serves to _______/_______ ribs) (= _______axial mm). Innervated by ______rami of ______ spinal nn. Runs from _________ process to ribs. Superior ________ ribs while inferior _____ ribs. Minimally aids _________, esp. in pts w/ chronic labored breathing.

Posterior, elevate/depress, hypaxial ventral, mixed spinous process elevates, depresses; respiration

Primary functions of the vertebral column are to provide: (1) ____________ for the spinal cord (2) Support for and movement of the ________ (3) Sites for __________ attachments and lever arms for muscle________ advantage.

Protection Trunk Muscle, mechanical

*Transversospinales Group* Multifidus runs from ______, _________ and _______ processes to ______ process. Spans _____-___(#) vertebral levels. Found in ______, ______, and _________ regions but best seen in ________and _______ thoracic regions. Function to ________ and _____-laterally rotate spine.

Sacrum, ilium, transverse, spinous; 2-4 lumbar, thoracic, cervical; lumbar, lower thoracic Extend, contralaterally

*Segmental Muscle Group* Interspinales run between adjacent _____ processes. Function to _________ vertebral column.

Spinous Extend

*Erector Spinae Group* Spinalis runs from ______ process to spinous processes and ______. Functions to _______ spine and ______. Contains ________ region that blends with semi_________, ________ and ________regions.

Spinous, occiput extend, head capitus, semispinalis, cervicis, thoracis

*Spinotransversales Group* Superficial layer that runs ______ and ________. Splenius capitus runs from ____ ligament and SP C___-T___ to superior ________ line and _________ process. Bilaterally, _______ head and unilaterally laterally _____ and _______ _____laterally.

Superior, *lateral* Nuchal, C7-T4, nuchal, mastoid extends, bends, rotates, ipsilaterally

*Components of a Typical Vertebra* Bilaterally, there are two __________and two _________ vertebral _________. Inferior vertebral notches of a _______vertebra with superior vertebral notch of_______ vertebra form the _______________(IV) foramina, which provide the passage for ____________nerves to and from the vertebral _________.

Superior, inferior, notches Superior, inferior, intervertebral, spinal, canal

*Joints Between Articular Processes* Are ____________joints. Found between ________facets on superior and inferior processes of adjacent vertebrae. Articular surfaces are covered with _________ cartilage. May be called __________facet joints or ____________ joints. ________ligaments attach between articular facets of adjacent vertebra. Relatively thin _________ _______ attaches to margins of articular __________. Joints allow for _______(translatory) movements.

Synovial; articular, articular; articular, zygapophysial joints capsular, joint capsule, processes gliding

*Spinotransversales Group* Splenius cervicis runs from SP T____-T____ to TVP of C___-C___. Bilaterally, ________neck and unilaterally ____-_______and _____ _____laterally.

T3-T6, C1-C3 extends, side-bends, rotates ipsilaterally

*Transversospinales Group* Rotatores run from ______ and ________ processes to ________ process or laminae. Span ___-___(#) vertebral levels. Best developed in ______ region. Function to _____ and ______laterally rotate spine.

TVP, articular, spinous; 1-2 thoracic extend, contralaterally

*Atlanto-occipital Joint* The _________ membrane is a continuation of the posterior longitudinal ligament. It is strong and lines ____ surface of vertebral canal, protecting the spinal _________. The __________longitudinal ligament attaches to the _______ portion of the occipital bone.

Tectorial, anterior, cord anterior, basilar

Muscles of the back can be organized into ____(#) groups: (1) Superficial back mm group = ________limb mm (2) ___________ mm group (serve to _____/_____ ribs and are accessory ___________ mm) (3) Deep mm group = _______ or "true" back mm

Three (1) upper (2) Intermediate, elevate/depress, respiratory (3) epaxial

*Segmental Muscle Group* Intertransversarii run between adjacent ____________ processes. Function in ______-________ of vertebral column.

Transverse processes Side-bending

*Segmental Muscle Group* Levator costarum run downward between _______process to _______. Function ______ ribs and assist with _____-________ of vertebral column.

Transverse processes, ribs Elevate, side-bending

*Lumbar Vertebra* Superior and inferior articular facets project ___________ and are oriented in _________ plane. Orientation facilitates lots of sagittal plane ______/______ but severely limits __________ _________. After only few degrees of this, inferior articular facet of ______ vertebra abuts superior articular facet of __________ vertebra.

Vertically, sagittal F/E, horizontal rotation superior, inferior

*Components of a Typical Vertebra* Typical vertebra includes bilateral __________ processes: two ________ and two ____________. These contain articular _______________, which articulate with adjacent vertebra to form ___________________ (or apophyseal/ facet) joints. EX: The superior articular facets of one vertebra articulate with the _____________ articular facets of the vertebra above.

articular, superior, inferior facets, zygapophyseal inferior

*Atlanto-occipital Joint* Cruciform ligament attaches the ______ and _____ to occipital bone ________(A/P?).Contains _____________band (ligament) and _________ band (ligament).

atlas, axis, anteriorly longitudinal, transverse

*Lumbar Motion* Superior facets are slightly _______(shape) and face _________ to postero-________. Inferior facets are slightly __________(shape) and face ____________ to antero-__________. This facilitates _____/_______, ___-__________ and only very limited __________.

concave, medially to postero-medial convex, laterally to antero-lateral flexion/extension, side-bending, rotation

*Thoracic Vertebrae* Some vertebral bodies have full__________ facets while others have partial ("_____") facets because the heads of some ribs share the _____ facets of two vertebral ________.

costal, demi, demi, bodies

*Components of a Typical Vertebra* Each vertebra contains a vertebral ________, which is surrounded by the _____ anteriorly and the ________ arch posteriorly. In vertical series, these form the vertebral _______, which houses and protects the spinal ________.

foramen, body, vertebral canal, cord

*Atlanto-axial Joint Complex* Consists of a central (__________) joint and bilateral _______ joints. Movements include rotation of the _____ and atlas about the _________. (Remember: rotation is *not* permitted at the _________-_________ joint.

median, facet head, axis, atlanto-occipital

*Components of a Typical Vertebra* The vertebral arch contains _________ and __________. Pedicles attach to the vertebral ____________ and vertebral _________. The laminae run from each __________ and meet in the ___________to form the ________ of the vertebral arch.

pedicles, laminae body, arch other, midline, roof

*Muscles of the Body Wall* Voluntary, ___________ mm innervated by ________NS. Divided into two groups based on original ________ relative to ________ processes of vertebrae.

striated, somatic position, transverse process

*Erector Spinae Group* Superficial layer that runs _________ and ________. Iliocostalis runs from common ______, _______, and angle of _______ to _______ and ________ processes of _____-spine. Functions to _______ and ____-bend spine. Contains _____ , _______, and_________regions.

superior, *lateral* tendon, ilium, ribs; ribs, transverse processes, C-spine extend, side-bend Cervicis, thoracic, lumborum

*Joints Between Vertebral Bodies* Are not synovial joints but _____________ characterized by two bones lined with _________ cartilage united with intervening _______________ disc. (The two adjacent vertebral ________ are separated and bound together by ___________ disc, called the _________ or IV disc.

symphyses, articular, fibrocartilagenous bodies, fibrocartilagenous, intervertebral

*Erector Spinae Group* Longissimus runs from common __________ and ______ process to _________ processes, rib _________ and _______ process. Functions to ___________ and _____-______ spine or ________. Contains ____, _______, and _______ regions.

tendon, transverse; TVPs, angles, mastoid Extend, side-bend, head Capitis, cervicis, thoracic

*Intervertebral Foramina* Located between adjacent ________; formed by superior and inferior vertebral _________. Allow passage of spinal _______. Segmental (between two __________ vertebrae) blood _________ follow spinal nerves and __________.

vertebrae; notches; nerves adjacent, vessels