Podcast
Questions and Answers
What is the primary function of the ligaments in the vertebral column?
What is the primary function of the ligaments in the vertebral column?
Which muscles are primarily involved in the movement of the back?
Which muscles are primarily involved in the movement of the back?
What type of joint is primarily found between vertebrae?
What type of joint is primarily found between vertebrae?
During which phase of the gait cycle is the foot fully on the ground?
During which phase of the gait cycle is the foot fully on the ground?
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What is a common symptom of a herniated intervertebral disc?
What is a common symptom of a herniated intervertebral disc?
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What is the primary structure involved in a herniated disc?
What is the primary structure involved in a herniated disc?
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Where does the spinal cord extend to in adults?
Where does the spinal cord extend to in adults?
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What percentage of people are projected to experience low back pain by 2050?
What percentage of people are projected to experience low back pain by 2050?
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What is the most common type of herniation?
What is the most common type of herniation?
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Which nerve root is indicated by pain radiating down the back of the leg?
Which nerve root is indicated by pain radiating down the back of the leg?
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How long does it typically take for 98% of individuals to recover from low back pain?
How long does it typically take for 98% of individuals to recover from low back pain?
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What is the position of spinal nerves C1-C7 in relation to their respective vertebrae?
What is the position of spinal nerves C1-C7 in relation to their respective vertebrae?
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What occurs to the gelatinous nucleus pulposus with increasing age?
What occurs to the gelatinous nucleus pulposus with increasing age?
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What structure lies between the spinous processes?
What structure lies between the spinous processes?
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Which type of joint between vertebrae allows for some rotation?
Which type of joint between vertebrae allows for some rotation?
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Which component of the intervertebral disc absorbs compression?
Which component of the intervertebral disc absorbs compression?
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What percentage of low back pain is typically attributed to facet joints?
What percentage of low back pain is typically attributed to facet joints?
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What is the primary function of the annulus fibrosus?
What is the primary function of the annulus fibrosus?
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Which vertebral region primarily limits flexion and allows some rotation?
Which vertebral region primarily limits flexion and allows some rotation?
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Which ligament is located between the laminae of the vertebrae?
Which ligament is located between the laminae of the vertebrae?
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Approximately what percentage of twisting motion is sustained by intervertebral discs?
Approximately what percentage of twisting motion is sustained by intervertebral discs?
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What is a potential consequence of untreated Cauda Equina Syndrome?
What is a potential consequence of untreated Cauda Equina Syndrome?
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Which muscle is responsible for elevating the scapula?
Which muscle is responsible for elevating the scapula?
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What symptoms are associated with Cauda Equina Syndrome?
What symptoms are associated with Cauda Equina Syndrome?
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Which of the following muscles helps in extending and adducting the humerus?
Which of the following muscles helps in extending and adducting the humerus?
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What does the ligamentum flavum thicken in response to?
What does the ligamentum flavum thicken in response to?
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What is one of the causes of Cauda Equina Syndrome?
What is one of the causes of Cauda Equina Syndrome?
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Which intrinsic muscle group is primarily responsible for maintaining posture?
Which intrinsic muscle group is primarily responsible for maintaining posture?
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What structure covers the deep muscles of the back and trunk?
What structure covers the deep muscles of the back and trunk?
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What is the primary function of the vertebral column?
What is the primary function of the vertebral column?
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Which type of curvature is characterized by an abnormal increase in the lumbar region?
Which type of curvature is characterized by an abnormal increase in the lumbar region?
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How many cervical vertebrae are normally present in the vertebral column?
How many cervical vertebrae are normally present in the vertebral column?
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What is scoliosis?
What is scoliosis?
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Which ligament helps limit hyperflexion and posterior herniation in the vertebral column?
Which ligament helps limit hyperflexion and posterior herniation in the vertebral column?
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What is a common cause of abnormal curvature in the vertebral column?
What is a common cause of abnormal curvature in the vertebral column?
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Which region of the vertebral column has convex curves?
Which region of the vertebral column has convex curves?
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What is the role of the anterior longitudinal ligament?
What is the role of the anterior longitudinal ligament?
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Which of the following is NOT a typical abnormality of gait?
Which of the following is NOT a typical abnormality of gait?
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What connective tissue structure primarily supports the vertebral column?
What connective tissue structure primarily supports the vertebral column?
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What is a characteristic movement that occurs at the intervertebral joints?
What is a characteristic movement that occurs at the intervertebral joints?
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Which component of the intervertebral disc is primarily responsible for resisting tensile forces?
Which component of the intervertebral disc is primarily responsible for resisting tensile forces?
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What is the main effect of the lumbar region's curvature on body mechanics?
What is the main effect of the lumbar region's curvature on body mechanics?
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What complication can arise from untreated Cauda Equina Syndrome?
What complication can arise from untreated Cauda Equina Syndrome?
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Which muscle is primarily responsible for elevating the scapula?
Which muscle is primarily responsible for elevating the scapula?
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What is a potential pathophysiological consequence of the gradual loss of height in the intervertebral disk space?
What is a potential pathophysiological consequence of the gradual loss of height in the intervertebral disk space?
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Which nerve is involved in the function of the latissimus dorsi muscle?
Which nerve is involved in the function of the latissimus dorsi muscle?
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What structural change occurs to the ligamentum flavum as a compensatory mechanism?
What structural change occurs to the ligamentum flavum as a compensatory mechanism?
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Which of the following factors is NOT associated with Cauda Equina Syndrome?
Which of the following factors is NOT associated with Cauda Equina Syndrome?
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What function does the thoracolumbar fascia serve in the body?
What function does the thoracolumbar fascia serve in the body?
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What is the main role of the intrinsic muscles of the back?
What is the main role of the intrinsic muscles of the back?
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What type of cartilage is primarily associated with symphyses between the vertebral bodies?
What type of cartilage is primarily associated with symphyses between the vertebral bodies?
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What role does the nucleus pulposus play in the intervertebral disc?
What role does the nucleus pulposus play in the intervertebral disc?
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Which ligament runs along the tips of the spinous processes?
Which ligament runs along the tips of the spinous processes?
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Which vertebral region primarily allows for flexion and extension due to its sloping orientation?
Which vertebral region primarily allows for flexion and extension due to its sloping orientation?
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What percentage of axial compression is sustained by the vertebral body compared to other structures?
What percentage of axial compression is sustained by the vertebral body compared to other structures?
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What is the role of the annulus fibrosus in the intervertebral disc?
What is the role of the annulus fibrosus in the intervertebral disc?
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Which condition can occur as a result of degenerative changes in the annulus fibrosus?
Which condition can occur as a result of degenerative changes in the annulus fibrosus?
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What is the primary function of facet joints in the vertebral column?
What is the primary function of facet joints in the vertebral column?
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Which vertebrae region consists of fused vertebrae?
Which vertebrae region consists of fused vertebrae?
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What is the primary characteristic of scoliosis?
What is the primary characteristic of scoliosis?
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What is the function of the posterior longitudinal ligament?
What is the function of the posterior longitudinal ligament?
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Which curvature is associated with lordosis?
Which curvature is associated with lordosis?
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Which term describes the abnormal increase in thoracic curvature?
Which term describes the abnormal increase in thoracic curvature?
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In which region are large gaps present in the vertebral column anatomy?
In which region are large gaps present in the vertebral column anatomy?
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What typically contributes to abnormal curvature in the vertebral column?
What typically contributes to abnormal curvature in the vertebral column?
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Which ligament is primarily involved in supporting the intervertebral discs?
Which ligament is primarily involved in supporting the intervertebral discs?
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What commonly occurs with aging concerning the nucleus pulposus in intervertebral discs?
What commonly occurs with aging concerning the nucleus pulposus in intervertebral discs?
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What is the approximate percentage of low back pain cases projected to rise by 2050?
What is the approximate percentage of low back pain cases projected to rise by 2050?
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In which region is posterolateral herniation most commonly found?
In which region is posterolateral herniation most commonly found?
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What does pain radiating from the back down the front of the leg indicate?
What does pain radiating from the back down the front of the leg indicate?
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Where does the spinal cord typically extend to in adults?
Where does the spinal cord typically extend to in adults?
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Which factor increases the likelihood of nerve roots being compressed in older patients?
Which factor increases the likelihood of nerve roots being compressed in older patients?
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Which test is used to assess L4/L5/S1 nerve root tension?
Which test is used to assess L4/L5/S1 nerve root tension?
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Study Notes
Weight-bearing, the Back & Locomotion
- The presentation covers the anatomy and function of the back and how it relates to human locomotion.
- Learning outcomes for the lecture included: understanding the vertebral column's anatomy and curvature, describing a typical vertebra and its types and numbers, identifying the ligaments supporting the spine, describing intervertebral joints, outlining the back muscles and thoracolumbar fascia, understanding different types of movement in the spine, describing gait cycles (walking and running), identifying typical gait abnormalities, and describing the anatomy and symptoms of a herniated intervertebral disc.
- Recommended reading includes several anatomy textbooks: McMinn & Abrahams' Clinical Atlas of Human Anatomy, Gray's Anatomy for Students, Essential Clinical Anatomy, Netter Atlas of Human Anatomy, Gray's Surface Anatomy and Ultrasound, Weir & Abrahams' Imaging Atlas of Human Anatomy.
Back
- The back is the posterior aspect of the body.
- Vertebrae are the primary contributors to the back, but other regions (skull base, pelvis, and ribs) also contribute.
- Function: supporting the body's weight, positioning the head, aiding upper limb movement, protecting the nervous system, and facilitating movement.
Vertebrae
- There are 33 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral (fused), and 3-4 coccygeal (often fused).
- Vertebrae have distinguishing features such as vertebral bodies, vertebral arches, and processes (superior articular process, transverse process, spinous process).
Anatomy of the vertebral column
- The vertebral column exhibits curves (kyphosis in the thoracic and sacral regions; lordosis in the cervical and lumbar regions).
- Laminas and spinous processes overlap, and large gaps are present in the lumbar region.
- Abnormalities include excess lordosis or kyphosis, and scoliosis.
Abnormal Curvature
- Abnormal curvatures result from developmental or pathological processes (e.g., osteoporosis).
- Lordosis is an increased lumbar curvature due to anterior pelvic rotation.
- Kyphosis is an increased thoracic curvature.
- Scoliosis is a three-dimensional spine deformity affecting the coronal, sagittal, and axial planes. In most cases, it is idiopathic and represents 80% of all cases.
Ligaments of the Vertebral Column
- Anterior longitudinal ligaments support intervertebral discs and limit extension.
- Posterior longitudinal ligaments limit hyperflexion and posterior herniation.
- Ligamenta flava are between laminae.
- Supraspinous ligaments extend between the skull and C7 spinous processes.
- Interspinous ligaments are between spinous processes.
Joints between Vertebrae
- Symphyses are between vertebral bodies with a layer of hyaline cartilage and an intervertebral disc. An intervertebral disc consists of an outer annulus fibrosus (ring of collagen) and an inner nucleus pulposus (gelatinous center absorbing compression).
- Synovial (zygapophysial) joints permit flexion, extension, limited rotation in cervical region, and more restricted motion in thoracic and lumbar regions.
The Motion Segment
- The functional unit of the spine is composed of two adjacent vertebrae, the intervertebral disc (with nucleus pulposus and annulus fibrosus), ligaments, two facets, and capsule.
- Nucleus pulposus acts like a ball bearing allowing 'rolling' during flexion and extension.
- Annulus fibrosus acts as a coiled spring holding vertebrae together. The normal range of movement in the spine changes with age; degeneration in annulus fibrosus can lead to herniation of the nucleus pulposus.
Distribution of Weight in the Spine
- The spine supports approximately 30% of body weight. L5/S1 sustains the highest contact force; 15-30% of low-back pain originates in this area.
- Intervertebral discs account for about 40% of twisting motion; herniated discs account for a relatively small percentage of back pain.
Back Pain
- Back pain is a significant health problem and can be caused by fibroskeletal structures (periosteum, ligaments, and annulus fibrosus of IV discs), meninges, synovial joints (zygapophysial), intrinsic back muscles, and nervous tissue (spinal nerves or nerve roots exiting IV foramina).
Spinal Nerves
- The spinal cord extends from the foramen magnum to L1-L2 in adults and L3 in neonates.
- Spinal nerves extend beyond the spinal cord end as cauda equina.
- C1-C7 emerge above their vertebrae, while C8 emerges above T1, with other spinal nerves emerging below their respective vertebrae.
Herniated Disc
- Herniation or protrusion of the nucleus pulposus into or through the annulus fibrosus can compress the spinal cord or nerves.
- Posterolateral herniation is most common in the lumbar region (L4-L5 or L5-S1).
- In older individuals, compression is more likely due to nerve root compression by increased ossification (osteophytes) of IV foramina.
Stretch Tests
- Sciatic stretch tests involve supine leg raises and ankle dorsiflexion; positive results suggest L4/L5/S1 nerve root tension.
- Femoral stretch tests involve prone positioning, knee flexion, and hip extension; positive results indicate L2/L3/L4 nerve root tension.
Aging and the Spine
- With age, the nucleus pulposus dehydrates and degenerates.
- This leads to a progressive loss of intervertebral disc height, abnormal facet joint loading, and development of facet arthritis.
Cauda Equina Syndrome
- Causes include midline, large herniations, trauma, tumors, and hematomas.
- Symptoms include bilateral lower limb weakness, perianal numbness, and incontinence (bladder, bowel, or sexual).
Superficial Muscles of the Back (Extrinsic)
- Includes the Trapezius, Levator Scapulae, Rhomboid Minor, Rhomboid Major, and Latissimus Dorsi. Detailed descriptions of origin, insertion, and actions are often provided in anatomy textbooks.
Deep Muscles of the Back (Intrinsic)
- Includes the Transversospinalis muscles and Splenius (capitis and cervicis). These muscles are vital for posture and controlling spine/column movement.
Movements of the Back
- Movements include extension, flexion, lateral bending, and rotation of the head and neck; and upper trunk, neck and head. Detailed anatomical descriptions of these movements are provided in textbooks.
Thoracolumbar Fascia
- Covers the deep back and trunk muscles. It consists of several layers (anterior, middle, posterior). It stabilizes the back muscles and plays a role in trunk movements.
Gait-Walking
- Locomotion consists of swing phase (40%) and stance phase (60%). The gait cycle involves one swing and one stance phase for one limb, consisting of heel strike, loading response, midstance, terminal stance, preswing, initial midswing, terminal swing, and push-off.
Gait-Running
- Running does not have a double support phase.
- It involves alternating single support periods separated by a double float phase (when both feet are airborne).
Gait Analysis
- Gait analysis is useful for initial diagnosis. Examples of gait abnormalities include hemiplegic, antalgic, Trendelenburg, high-stepping, and Parkinson's-related festination.
Additional Information
- Acknowledgement: The presentation was acknowledged as being prepared by Dr Sara Sulaiman.
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Description
This quiz explores the anatomy and function of the back, focusing on its role in human locomotion. Participants will learn about the vertebral column's structure, intervertebral joints, the muscles of the back, and gait cycles in both walking and running. Understanding the anatomy of a herniated disc and gait abnormalities is also included.
