Deep Back
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Questions and Answers

What is the shape of the vertebral foramen in the lumbar region?

  • Circular
  • Triangular (correct)
  • Oval
  • Square

    • What facilitates movement in the lumbar region of the vertebral column?

  • Medial rotation
  • Transverse bending
  • Flexion (correct)
  • Rotation

    • Which anatomical feature supports the lumbar puncture procedure?

  • Presence of ribs
  • Short and sturdy spinous processes
  • Thicker spinal cord region (correct)
  • Flat articular processes

    • Where does the spinal cord typically end in adults?

    <p>L1 or L2 region</p> Signup and view all the answers

    What is the characteristic shape of the lumbar spinous processes?

    <p>Short and stout</p> Signup and view all the answers

    What ligaments support the atlantoaxial joint at the odontoid process?

    <p>Cruciate ligament and alar ligaments</p> Signup and view all the answers

    Which characteristic describes the transverse foramen in the cervical vertebrae?

    <p>Smaller or absent, transmitting only small accessory veins</p> Signup and view all the answers

    In which direction do the thoracic spinous processes typically slope?

    <p>Sloping or angled inferiorly</p> Signup and view all the answers

    What is the location of the cruciate ligament when viewed from a superior perspective?

    <p>Posteriorly positioned</p> Signup and view all the answers

    Which vertebrae are known for having a smaller or absent transverse foramen?

    <p>C7 vertebrae</p> Signup and view all the answers

    What type of joint is the atlantoaxial joint?

    <p>Pivot joint</p> Signup and view all the answers

    Which muscles are primarily considered the chief extensors of the vertebral column?

    <p>Erector Spinae muscles</p> Signup and view all the answers

    What structure primarily maintains the stability of the atlantoaxial joint?

    <p>Transverse ligament</p> Signup and view all the answers

    Which ligaments must be traversed to access the vertebral canal from the back for spinal anesthesia?

    <p>Supraspinous and interspinous ligaments</p> Signup and view all the answers

    Which of the following is considered a misnomer in the context of the content provided?

    <p>Obliquus capitis inferior</p> Signup and view all the answers

    What is the primary function of the erector spinae muscles?

    <p>Extension of the vertebral column</p> Signup and view all the answers

    Which muscle is NOT part of the erector spinae group?

    <p>Rotatores</p> Signup and view all the answers

    What does the term 'iliocostalis' refer to?

    <p>A muscle from the iliac crest to the ribs</p> Signup and view all the answers

    Which of the following actions is NOT primarily associated with the erector spinae muscles?

    <p>Rotation of the cervical spine</p> Signup and view all the answers

    The term 'transversospinalis' refers to what characteristic of these muscles?

    <p>They arise from transverse processes to spinous processes</p> Signup and view all the answers

    Which nerve supply is responsible for the main action of the erector spinae muscles?

    <p>Posterior rami of spinal nerves</p> Signup and view all the answers

    What is a notable characteristic of the rotatores muscles?

    <p>They facilitate some rotation of the vertebral column</p> Signup and view all the answers

    What occurs as the back is flexed regarding the erector spinae muscles?

    <p>They control movement via eccentric contraction</p> Signup and view all the answers

    What anatomical structure do the fibers of erector spinae muscles pass to connect to?

    <p>Spinous processes</p> Signup and view all the answers

    What is the collective term for the deep intrinsic layer of back muscles?

    <p>Transversospinalis</p> Signup and view all the answers

    What structure does the sacral canal contain?

    <p>Spinal nerve roots of the cauda equina</p> Signup and view all the answers

    Which ligament primarily prevents hyperextension of the spine?

    <p>Anterior Longitudinal Ligament</p> Signup and view all the answers

    Where does the spinal cord typically end?

    <p>At the L1-L2 intervertebral disc</p> Signup and view all the answers

    Which ligament is known to weakly resist hyperflexion of the spine?

    <p>Posterior Longitudinal Ligament</p> Signup and view all the answers

    What is the primary attachment site of the Anterior Longitudinal Ligament?

    <p>Anterolateral aspect of vertebral bodies</p> Signup and view all the answers

    Which factor contributes to the weakness of the Posterior Longitudinal Ligament?

    <p>Its narrow structure compared to other ligaments</p> Signup and view all the answers

    Which ligament is the strongest and helps limit spinal extension?

    <p>Anterior Longitudinal Ligament</p> Signup and view all the answers

    The sacral cornua consists of what anatomical feature?

    <p>Inferior articulating processes of S5 vertebrae</p> Signup and view all the answers

    What primary function does the Posterior Longitudinal Ligament serve?

    <p>Helping prevent herniation of the nucleus pulposus</p> Signup and view all the answers

    What is one of the unique features of the Anterior Longitudinal Ligament?

    <p>It is only found from C1 to the sacrum</p> Signup and view all the answers

    What distinguishes the C2 vertebra (Axis) from the C1 vertebra (Atlas)?

    <p>C2 has a more prominent spinous process.</p> Signup and view all the answers

    Which of the following best describes the function of the dens in the C2 vertebra?

    <p>It allows for rotation and articulation of the atlas.</p> Signup and view all the answers

    Which characteristic is true for the atlantoaxial joint formed by the C1 and C2 vertebrae?

    <p>It is the only pivot joint in the vertebral column.</p> Signup and view all the answers

    How does the structure of the C1 vertebra contribute to its function?

    <p>Its ring shape facilitates greater flexibility and movement.</p> Signup and view all the answers

    What injury is associated with the C2 vertebra (Axis) due to its structure?

    <p>Fracture during hanging.</p> Signup and view all the answers

    What feature of the C2 vertebra contributes to it being regarded as the strongest among cervical vertebrae?

    <p>The presence of the dens providing structural integrity.</p> Signup and view all the answers

    Which anatomical structure serves as an attachment point for the C1 and C2 vertebrae at their inferior and superior facets?

    <p>The atlantoaxial joint.</p> Signup and view all the answers

    Which statement accurately describes the anatomical relationship of the facets in the C1 vertebra?

    <p>They connect with the occipital condyles of the skull.</p> Signup and view all the answers

    Which type of ligaments are responsible for connecting adjacent vertebrae?

    <p>Intersegmental ligaments</p> Signup and view all the answers

    What is a primary function of the deep back musculature?

    <p>Maintaining position of the axial skeleton</p> Signup and view all the answers

    What structure primarily connects adjacent vertebrae through zygapophysial joints?

    <p>Articular processes</p> Signup and view all the answers

    Which curvature is mostly associated with the vertebral column's structure?

    <p>Lordosis</p> Signup and view all the answers

    Which group of muscles is responsible for posture and axial skeleton stabilization?

    <p>Erector spinae</p> Signup and view all the answers

    Which abbreviation refers to the Anterior Longitudinal Ligaments?

    <p>ALL</p> Signup and view all the answers

    How are the 'true back muscles' categorized in terms of their location?

    <p>Deep layer of muscles</p> Signup and view all the answers

    Which blood supply contributes significantly to the deep back musculature?

    <p>Vertebral arteries</p> Signup and view all the answers

    What type of joint is the atlanto-axial joint?

    <p>Pivot joint</p> Signup and view all the answers

    Which ligament acts as a covering over the cruciate ligament?

    <p>Tectorial membrane</p> Signup and view all the answers

    Which group of back muscles is considered superficial?

    <p>Extrinsic back muscles</p> Signup and view all the answers

    What supports the atlanto-axial joint at the odontoid process?

    <p>Cruciate ligament and Alar ligament</p> Signup and view all the answers

    Which function is NOT associated with the muscles of the back?

    <p>Regulate blood pressure</p> Signup and view all the answers

    The atlas (C1 vertebra) lacks which key component found in most vertebrae?

    <p>Vertebral body</p> Signup and view all the answers

    Which ligaments are primarily responsible for the stability of the atlanto-axial joint?

    <p>Alar and cruciate ligaments</p> Signup and view all the answers

    What describes the atlanto-axial joint's functional significance?

    <p>Permits rotation of the head</p> Signup and view all the answers

    Which muscle is primarily responsible for the elevation of the scapula?

    <p>Trapezius</p> Signup and view all the answers

    Which nerve innervates the latissimus dorsi muscle?

    <p>Thoracodorsal nerve</p> Signup and view all the answers

    What is the action of the rhomboid major muscle?

    <p>Retract and rotate the glenoid fossa</p> Signup and view all the answers

    Which of the following muscles is categorized as part of the superficial extrinsic back muscles?

    <p>Latissimus dorsi</p> Signup and view all the answers

    What distinct shape does the trapezius muscle have?

    <p>Large and triangular</p> Signup and view all the answers

    Which function is primarily associated with the serratus posterior muscles?

    <p>Proprioception and respiration</p> Signup and view all the answers

    Which muscle among the following is responsible for retracting the scapula?

    <p>Trapezius</p> Signup and view all the answers

    What anatomical feature do muscles like the trapezius and latissimus dorsi connect?

    <p>Superior appendicular skeleton</p> Signup and view all the answers

    What is the main action of the splenius muscles when acting together?

    <p>Extend the neck and head</p> Signup and view all the answers

    Which part of the splenius muscle specifically attaches to the mastoid process?

    <p>Splenius capitis</p> Signup and view all the answers

    What is the distal attachment of the splenius cervicis?

    <p>Tubercles of transverse processes of C1-C3 or C4</p> Signup and view all the answers

    What is the nerve supply for the splenius muscles?

    <p>Posterior rami of spinal nerves</p> Signup and view all the answers

    Which muscle fibers run superiorly to the angles of lower ribs?

    <p>Iliocostalis</p> Signup and view all the answers

    Which part of the erector spinae group is NOT correctly matched with its attachment?

    <p>Longissimus: spinous processes of thoracic region</p> Signup and view all the answers

    Which action is primarily associated with the unilateral contraction of the splenius muscles?

    <p>Laterally flex and rotate the head</p> Signup and view all the answers

    Which of the following is NOT a part of the erector spinae group?

    <p>Semispinalis</p> Signup and view all the answers

    Which region of the vertebral column does the splenius muscle primarily influence?

    <p>Cervical region</p> Signup and view all the answers

    The fibers of the longissimus muscle run superiorly to what structures?

    <p>Angles of lower ribs and transverse processes</p> Signup and view all the answers

    What type of joint is the atlantoaxial joint classified as?

    <p>Pivot joint</p> Signup and view all the answers

    Which muscles are considered the chief extensors of the vertebral column?

    <p>Erector Spinae muscles</p> Signup and view all the answers

    Which ligament primarily maintains stability in the atlantoaxial joint?

    <p>Transverse ligament</p> Signup and view all the answers

    To access the vertebral canal from the back, which ligaments must be traversed?

    <p>Supraspinous, interspinous, and ligamentum flavum</p> Signup and view all the answers

    Which structure is considered a misnomer related to the vertebral column?

    <p>Obliquus capitis inferior</p> Signup and view all the answers

    What is the primary characteristic of the C7 vertebra?

    <p>It transitions from cervical to thoracic.</p> Signup and view all the answers

    What movement is primarily allowed in thoracic vertebrae?

    <p>Rotation</p> Signup and view all the answers

    Which thoracic vertebrae have some features resembling cervical vertebrae?

    <p>T1 - T4</p> Signup and view all the answers

    Which statement about the spinous process of T1 vertebra is true?

    <p>It is long and almost horizontal.</p> Signup and view all the answers

    What anatomical feature contributes to the attachment of the second rib?

    <p>Demifacet on T1</p> Signup and view all the answers

    Which of the following movements is limited in the thoracic vertebrae?

    <p>Flexion</p> Signup and view all the answers

    Which vertebra is commonly referred to as the 'vertebra prominens'?

    <p>C7</p> Signup and view all the answers

    Which thoracic vertebra provides attachment for the ribs associated with it?

    <p>T1</p> Signup and view all the answers

    What type of joint is responsible for the rotation of the head while using the atlanto-axial joint?

    <p>Pivot joint</p> Signup and view all the answers

    Which of the following best describes the movement facilitated by the lateral atlanto-axial joints?

    <p>Gliding movement</p> Signup and view all the answers

    Which layer of extrinsic back muscles is primarily involved in respiration?

    <p>Intermediate layer</p> Signup and view all the answers

    What is the primary functional role of the extrinsic back muscles?

    <p>Controlling limb movements</p> Signup and view all the answers

    Which atlanto-axial joints are classified as gliding-type synovial joints?

    <p>Lateral atlanto-axial joints</p> Signup and view all the answers

    What anatomical components form the lateral atlanto-axial joints?

    <p>Inferior facets of C1 and C2</p> Signup and view all the answers

    Which articulation allows for the head to move from side to side?

    <p>Lateral atlanto-axial joint</p> Signup and view all the answers

    What characterizes the movements produced by the superficial extrinsic back muscles?

    <p>Control of limb movements</p> Signup and view all the answers

    What is the primary function of intervertebral discs?

    <p>To absorb shock and support movement</p> Signup and view all the answers

    Which anatomical feature is a major obstetrical landmark?

    <p>Sacral Promontory</p> Signup and view all the answers

    What characteristic describes the movement capabilities of the coccyx?

    <p>It permits slight anterior flexion when sitting</p> Signup and view all the answers

    What is the composition of intervertebral discs?

    <p>Annulus fibrosus and nucleus pulposus</p> Signup and view all the answers

    Which of the following statements is true regarding the sacrum?

    <p>Its posterior surface features rudimentary articular processes.</p> Signup and view all the answers

    Which of the following best describes the structure of the coccyx?

    <p>4-5 segments of fused rudimentary vertebrae</p> Signup and view all the answers

    What type of motion is primarily prohibited by the coccyx?

    <p>Rotation</p> Signup and view all the answers

    What role do cervical and lumbar regions play in the vertebral column?

    <p>They allow for greater flexibility and movement.</p> Signup and view all the answers

    What is a distinctive feature of the C2 vertebra (Axis) that contributes to its strength?

    <p>Presence of the dens (odontoid process)</p> Signup and view all the answers

    Which joint is formed between the C1 and C2 vertebrae, enabling a specific type of movement?

    <p>Atlantoaxial joint</p> Signup and view all the answers

    What aspect of the C1 vertebra (Atlas) contributes to its role in the skull's articulation?

    <p>Ring-shaped structure with paired lateral masses</p> Signup and view all the answers

    Which characteristic of the C2 vertebra reflects its vulnerability to certain injuries?

    <p>Weakest cervical vertebra</p> Signup and view all the answers

    Which feature of the C1 vertebra aids in forming the joint with the occipital condyles of the skull?

    <p>Superior articular surfaces</p> Signup and view all the answers

    What anatomical relationship exists between the C1 and C2 vertebrae concerning their facets?

    <p>C1's inferior facets attach to C2</p> Signup and view all the answers

    Which of the following statements regarding the C2 vertebra's structure is true?

    <p>It has the dens that protrudes upwards</p> Signup and view all the answers

    How is the C1 vertebra influenced by its ring-shaped design?

    <p>It facilitates the connection to the brainstem</p> Signup and view all the answers

    Study Notes

    Atlantoaxial Joint

    • The cruciate and alar ligaments support this joint at the odontoid process
    • The transverse ligament supports the atlantoaxial joint

    Vertebrae

    • C2 vertebrae
      • Sloping or angled inferiorly like the thoracic spinous processes
      • Smaller or absent transverse foramen
      • Transmit only small accessory veins
    • C7 vertebrae
      • Has a long spinous process
      • Has a large, prominent, non-bifid spinous process that is easily palpable
    • Lumbar vertebrae
      • Vertebral foramen: triangular, bigger, accommodates the lumbar section of the spinal cord, houses the cauda equina
      • Spinous process: short, sturdy
      • Articular processes tend to face inward and outwards
      • Movements: Facilitates flexion, extension, lateral flexion; Prohibits rotation
    • Sacral vertebrae
      • Sacral Canal: continuation of the vertebral canal, contains the bundle of spinal nerve roots arising inferior to the L1 vertebra called cauda equina
      • Sacral Cornua: Inferior articulating processes of S5 vertebrae

    Ligaments

    • Anterior Longitudinal Ligament (ALL)
      • Largest, widest, and weakest of the longitudinal ligaments
      • Function: prevents hyperextension, strongest, only ligament that limits extension
      • Attachment: anterolateral aspect of vertebral bodies
      • Location: C1- sacrum
    • Posterior Longitudinal Ligament (PLL)
      • Narrower and stronger than the ALL
      • Function: weakly resists hyperflexion, helps prevent herniation of the nucleus pulposus, prevents hyperflexion
      • Attachment: posterior to vertebral bodies, IV discs
      • Location: Within vertebral canal
    • Supraspinous, Interspinous, and Ligamentum Flavum - Posterior Ligaments
      • They are located in the back and must be traversed to perform spinal anesthesia or take a sample from the spinal fluid from a posterior approach

    Erector Spinae Muscles

    • Chief extensors of the vertebral column
    • Often referred to as “long muscles” of the back
    • Located in the “muscular hump” at the “small of the back”
    • Combination of three muscles: iliocostalis, longissimus, spinalis
    • Forms the lateral column
    • Dynamic muscles
    • Acting unilaterally: laterally flex
    • Acting bilaterally: extend the vertebral column

    Transversospinalis Muscles

    • Called “transversospinalis” because it transverses from the transverse processes to the spinous processes
    • Fibers pass obliquely superomedially to entire length of spinous processes
    • Located 2-4 segments superior to proximal attachment
    • Main action: extension
    • Stabilizes the vertebrae during local movements of the vertebral column
    • Rotatores
      • Smallest of the 3 muscles in the deep intrinsic major layer
      • From the transverse process below to the spinous process above
      • Allow for a little bit of rotation of the vertebral column

    Lymph Drainage

    • Everything below the inguinal lymph nodes drain into the inguinal lymph nodes (drains anteriorly)
    • The skin and neck lymph drain into cervical nodes

    Review Questions

    • The chief extensors of the vertebral column are the: Erector Spinae muscles
    • Which of the following muscles is considered as a misnomer: Obliquus capitis inferior
    • In order to access the vertebral canal from the back, you need to go through the: Supraspinous, interspinous, and ligamentum flavum
    • The transverse ligament primarily maintains the stability of the: Atlantoaxial joint

    Vertebral Column

    • Composed of vertebrae, each connected to adjacent vertebrae via zygapophysial (facet) joints
    • Vertebral column has 5 regions: Cervical, Thoracic, Lumbar, Sacral, and Coccygeal
    • Curvatures of the vertebral column: Cervical (concave posteriorly), Thoracic (convex posteriorly), Lumbar (concave posteriorly), and Sacral (convex posteriorly)

    Cervical Vertebrae

    • Typical cervical vertebrae (C3-C7) are ring-shaped with paired lateral masses and transverse processes
    • Superior facets form joints with the occipital condyles of the skull
    • Inferior facets join with the C2 vertebrae
    • Weakest of all cervical vertebrae, susceptible to fractures during hanging, compressing the brainstem
    • Widest of the cervical vertebrae, from tip to tip of the transverse processes
    • Superior articular surface articulates with the occipital condyles, connecting to the base of the cranium

    Atlas (C1)

    • Ring-shaped with paired lateral masses and transverse processes
    • Has no vertebral body
    • Superior facets articulate with the occipital condyles of the skull
    • Posterior to each superior facet are grooves for the vertebral artery
    • Inferior facets articulate with the axis (C2)
    • Weakest of all cervical vertebrae

    Axis (C2)

    • Has a large bifid spinous process
    • Strongest of the cervical vertebrae due to the dens (odontoid process)
    • Dens protrudes upwards, allowing the atlas to articulate with the axis
    • Dens articulates with the atlas at the posterior articular facet

    Atlanto-Axial Joint

    • Formed between the atlas (C1) and axis (C2 vertebrae)
    • Synovial joint with no intervertebral disc
    • Supported by the alar ligament and cruciate ligament at the odontoid process
    • Posterior longitudinal ligament extends to the tectorial membrane
    • Acts as a covering for the cruciate ligament
    • Allows rotation, enabling the head to shake "no"

    Muscles of the Back

    • Most body weight lies anterior to the vertebral column, thus strong muscles are needed to support and move the column
    • Divided into two major groups: Extrinsic and Intrinsic back muscles

    Extrinsic Back Muscles

    • Superficial layer: Muscles of the posterior axioappendicular muscle group. Responsible for upper limb movement and positioning.
    • Deeper layer: “True back muscles”, responsible for movement and maintaining position of the axial skeleton (posture)

    Extrinsic Back Muscles: Superficial Layer

    • Trapezius: Large, triangular muscle. Innervated by the spinal accessory nerve (CN XI). Elevates, retracts, and depresses the scapula.
    • Latissimus Dorsi: Large, fan-shaped muscle. Innervated by the thoracodorsal nerve. Elevates and rotates the scapula.
    • Rhomboid Major: Thin, flat, and wider than the rhomboid minor.
    • Rhomboid Minor: Innervated by the dorsal scapular nerve. Retracts the scapula and rotates the glenoid fossa.

    Extrinsic Back Muscles: Intermediate Layer

    • Functions in respiration and proprioception
    • Serratus Posterior: Wing-like, long, and thin muscles. Found in different parts of the thoracic wall. Functions in proprioception and respiration.

    Intrinsic Back Muscles

    • "True back muscles", responsible for movement and maintaining position of the axial skeleton
    • Splenius: Muscles located in the cervical region. Inserts into the lateral aspect of the inferior nuchal line. It is one whole muscle with splenius cervicis and splenius capitis parts on each side.
      • Splenius Capitis: Fibers run superolaterally to the mastoid process of the temporal bone and the lateral third of the superior nuchal line of the occipital bone.
      • Splenius Cervicis: Fibers run superolaterally to the tubercles of the transverse processes of C1-C3 or C4 vertebrae.

    Erector Spinae Muscles

    • Iliocostalis: Arises from the posterior part of the iliac crest, posterior surface of the sacrum, sacroiliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament. Fibers run superiorly to angles of lower ribs and cervical transverse processes.
      • Iliocostalis Lumborum
      • Iliocostalis Thoracis
      • Iliocostalis Cervicis
    • Longissimus: Fibers run superiorly to ribs between tubercles and angles to transverse processes in the thoracic and cervical regions and to the mastoid process of the temporal bone.
      • Longissimus Thoracis
      • Longissimus Cervicis
      • Longissimus Capitis
    • Spinalis: Fibers run superiorly to the spinous processes in the upper thoracic region and to the cranium.
      • Spinalis Thoracis
      • Spinalis Cervicis
      • Spinalis Capitis
    • All Erector Spinae Muscles are innervated by the posterior rami of the spinal nerves.
    • Bilaterally, they extend the vertebral column.
    • Note:* This summary focuses on key facts and figures from the provided text. It's important to consult additional resources for a comprehensive understanding of the subject matter.

    C1 Vertebrae (Atlas)

    • Ring-shaped with paired lateral masses and transverse processes on either side
    • Superior facets form the articulation with the occipital condyles of the skull
    • Grooves for the vertebral artery are posterior to each superior facet
    • Facets in the inferior view are for articulating with C2 vertebrae
    • The weakest of all cervical vertebrae, it is the bone that fractures during hanging
    • Fracturing this bone compresses the brainstem, which can lead to death.
    • Widest of the cervical vertebrae (from tip to tip of its transverse processes)
    • The superior articular surface articulates with the occipital condyles, articulating to the base of the cranium.

    C2 Vertebra (Axis)

    • Known as the axis of the atlas
    • Has a large bifid spinous process that is palpable deep in the nuchal groove.
    • Strongest of all cervical vertebrae due to the dens (odontoid process).
    • The dens inserts into the ring of the atlas and forms the atlantoaxial joint (which is the only synovial pivot joint in the vertebral column).
    • The atlantoaxial joint is also formed by the articulating facets on either side.
    • The dens is the superiorly protruding part of the vertebral body.
    • It articulates with the atlas at the posterior articular facet.
    • It protrudes upwards, allowing the atlas to articulate with it.

    C7 Vertebra (Vertebra Prominens)

    • Transitions from cervical to thoracic
    • The spinous process is the longest of all cervical spinous processes.
    • It is called the vertebra prominens because it is palpable on the nape.
    • Its spinous process is almost as long as a thoracic spinous process.

    Thoracic Vertebrae

    • Located in the upper back and provides attachment for the ribs.

    T1-T4 Vertebrae

    • Have features of cervical vertebrae.
    • The spinous process is long, almost horizontal and may be as prominent as the vertebra prominens.
    • The superior edge has a demifacet that contributes to the articular surface of the second rib.

    T9-T12 Vertebrae

    • Have some features of lumbar vertebrae.

    Coccyx

    • Consists of 4-5 segments of small triangular bone
    • Fused rudimentary coccygeal vertebrae
    • Skeletal remnant of the embryonic tail-like caudal eminence
    • Very limited movement
    • When sitting, it may flex anteriorly, as it receives some weight.
    • Attachment for pelvic muscles and levator ani muscles
    • The pelvic surface is concave and relatively smooth.
    • The posterior surface contains rudimentary articular processes.
    • The transverse processes are short and connected to the sacrum.

    Sacrum

    • S1-S5 bones, including the transverse and spinous processes, are fused together to form one huge bony plate
    • The sacral promontory is an important obstetrical landmark.

    Intervertebral Discs

    • Provide strong attachment between vertebral bodies
    • 20-25% of the length (height) of the vertebral column
    • Absorb shock, support movement and allow for some flexibility of the vertebral column
    • Composed of 2 layers:
      • Annulus Fibrosus (ring of concentric lamellae) ▪ Superficial ▪ Intermediate ▪ Deep
    • The nucleus pulposus is located in the center of the disc
    • The nucleus pulposus is a gelatinous substance that allows diffusion of nutrients and waste.

    Movements of Atlanto-axial Joints

    • Three atlanto-axial articulations
    • The atlanto-axial joint allows for the head to move from side to side
    • There are two lateral atlanto-axial joints:
      • Left and right atlanto-axial joints
      • Gliding-type synovial joints
      • Between the inferior facets and lateral masses of C1 and the superior facets of C2
      • Two facet joints at the articulating processes of the vertebral arch
    • There is one median atlanto-axial joint:
      • Pivot joint
      • Between the dens of C2 and the anterior arch of the atlas
    • Everything below this point drains into the Inguinal lymph nodes (drains anteriorly)

    Extrinsic Back Muscles

    • Produce and control limb and respiratory movements.

    Superficial Extrinsic Back Muscles (Posterior axio-appendicular)

    • Produce and control movement of limbs

    Intermediate Extrinsic Back Muscles (Serratus Posterior)

    • For respiration and proprioception

    Transverse Ligament

    • Primarily maintains the stability of the atlantoaxial joint.
    • It allows for controlled head movement while preventing excessive movement.

    Spinal Anesthesia

    • To access the vertebral canal from the back (posterior approach), the posterior ligaments, including the supraspinous, interspinous, and ligamentum flavum must be traversed
    • This is done to perform spinal anesthesia or to take a sample from the spinal fluid.

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