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TABLE OF CONTENTS Back 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Divisions of the Vertebral Column Regional Characteristics of Vertebrae Joints of the Vertebral Column Ligaments of the Vertebral Column Sacrum and Coccyx Superficial Back Muscles and Serratus Muscles Rhomboids, Muscles of the Neck and Erector Spinae Arteries and Nerves Muscle Functions Blood Supply and Innervations Radiology - Spine Clinical - Lumbar Puncture, Epidural Anesthesia Clinical - Abnormal Curvatures of the Spine O TLINE Divisions and Curvatures of the Vertebral Column Characteristics of a Typical Vertebrae Regional Characteristics of Cervical Vertebrae Characteristics of the Sacrum Coccyx Divisions and Curvatures of the Vertebral Column Divisions and Curvatures of the Vertebral Column Divisions and Curvatures of the Vertebral Column REVIEW Back OUTLINE 1. Muscles Trapezius Latissimus Dorsi Rhomboid Major Rhomboid Minor Levator Scapulae Serratus Anterior Serratus Posterior Superior Serratus Posterior Inferior Erector Spinae Spinalis Longissimus Iliocostalis Splenius Capitis Splenius Cervicis Semispinalis Longissimus Capitis Suboccipital Muscles 2. Arteries Thyrocervical Trunk Transverse Cervical A. Dorsal Scapular A. Spinal Accessory N. XI Dorsal Scapular N. Triangle of Auscultation Thoracolumbar Fascia 3. Nerves 4. Miscellaneous https://commons.wikimedia.org/wiki/File:1119_Muscles_that_Move_the_Humerus_b.png LAT DORSI TRAPEZIUS SUPERIOR P TRANSVERSE TRUNK ARM ASCENDING A r U Boffin aoi AUSCULTATION LATDORS r https://commons.wikimedia.org/wiki/File:Gray409.png THORACOLUMBAR FASCIA yyyopn.co LUMBAR pyqz.qy.ec 0 LUMBAR VERT I 5 µ SERRATUS POSTERIOR INFERIOR WHAT ABOUT SUPERIOR https://commons.wikimedia.org/wiki/File:Serratus_anterior_mus cles_lateral.png https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png P SERRATUS LOOK ALWAYS me v A sina.EE O RIBS T https://commons.wikimedia.org/wiki/File:1117_Muscles_of_the_Neck_Upper_Back.png MAJOR LARGER INFERIOR MINOR SMALLER SUPERIOR MUSCLES OF NECK PLANE 1 SPLEN CAP 2 SPLEN CER https://commons.wikimedia.org/wiki/File:1111_Posterior_and_Side_Views_of_the_Neck_Deep_Posterior.png MUSCLESOENECK PLANE 2 MUSCLESOF NECK I SEMISPINALIS CA 2 LONGISSIMUS CA PLANE 3 TUBOCCIPITALS PLANE 1 OB CAPSUP OB CAP INF Iii Efta https://commons.wikimedia.org/wiki/File:Female_flight_attendant_performing_a_pre-flight_safety_demonstration.jpg 1 SPLENIUS SPLENIUS 2 CAPITIS CERVICIS SEMISPINALIS CAP LONGISSIMUS CAP 3 SUBOCCIPITALS https://commons.wikimedia.org/wiki/File:Gray389_-_Erector_spinae.png CAPITIS CERVICES THORACIS LUMBORUM Maia TE ERECTOR SPINAE I LIKE SPINES ILIOCOSTALIS LONGISSIMUS SPINALIS MULTIFID US https://commons.wikimedia.org/wiki/File:Thyrocervical_trunk.png E f T https://commons.wikimedia.org/wiki/File:Brachial_plexus_2.svg o n.sn re SCAPULA RHOMBOID MAJOR https://commons.wikimedia.org/wiki/File:Diagram_showing_the_muscle,_nerve_and_blood_vessel_sometimes_removed _with_a_lymph_node_dissection_of_the_neck_CRUK_314.svg WHAT'S YOUR FAVORITE ACCESSORY REVIEW OUTLINE Can You… 1. - Match the mm to the aa and nn - Differentiate between major and minor? Muscles Trapezius Latissimus Dorsi Rhomboid Major Rhomboid Minor Levator Scapulae Serratus Anterior Serratus Posterior Superior Serratus Posterior Inferior Erector Spinae Spinalis Longissimus Iliocostalis Splenius Capitis Splenius Cervicis Semispinalis Longissimus Capitis Suboccipital Muscles 2. Arteries Thyrocervical Trunk Transverse Cervical A. Dorsal Scapular A. Spinal Accessory N. XI Dorsal Scapular N. Triangle of Auscultation Thoracolumbar Fascia 3. Nerves 4. Miscellaneous REVIEW Back OUTLINE 1. Function 2. Muscles Trapezius Latissimus dorsi Rhomboid major Rhomboid minor Levator scapulae Serratus anterior Serratus posterior superior Serratus posterior inferior Spinalis Longissimus Iliocostalis Multifidus Back Bootcamp.com https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png TRAPEZIUS LATISSIMUS DORSI https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png Back Bootcamp.com RHOMBOID MAJOR LEVATOR SCAPULAE https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png E RHOMBOID MINOR Back Bootcamp.com SERRATUS ANTERIOR https://commons.wikimedia.org/wiki/File:Serratus_anterior_muscles_lateral.png Back Bootcamp.com https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png SERRATUS SERRATUS POSTERIOR INFERIOR https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png POSTERIOR SUPERIOR Back Bootcamp.com SPINALIS LONGISSIMUS AND ILIOCOSTALIS BILATERAL UNILATERAL NOTE THESE MUSCLES ARE KNOWN AS THE ERECTOR SPINAE https://upload.wikimedia.org/wikipedia/commons/1/1a/Gray389_-_Erector_spinae.png Back Bootcamp.com MULTIFID US BILATERAL UNILATERAL https://upload.wikimedia.org/wikipedia/commons/1/1a/Gray389_-_Erector_spinae.png Back Bootcamp.com https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png TRAPEZIUS ADDUCT 8 https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png OR LATISSIMUS DORSI EXTENDTHE SHOULDER Back Bootcamp.com RHOMBOID MAJOR MINOR OR LEVATOR SCAPULAE SCAPULAR RETRACTION E ROTATION 8 https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png Back Bootcamp.com ERECTOR SPINAE UNILATERAL y https://upload.wikimedia.org/wikipedia/commons/1/1a/Gray389_-_Erector_spinae.png OR MULTIFID US knoten.EE EIEE.fr zh.itrnfEIEfn REVIEW Back Review Questions Can you name the function for all of the muscles listed? OUTLINE 1. Function 2. Muscles Trapezius Latissimus dorsi Rhomboid major Rhomboid minor Levator scapulae Serratus anterior Serratus posterior superior Serratus posterior inferior Spinalis Longissimus Iliocostalis Multifidus REVIEW Back OUTLINE 1. Blood Supply 2. Innervation 3. Muscles Trapezius Latissimus dorsi Rhomboid major Rhomboid minor Levator scapulae Serratus anterior Serratus posterior superior Serratus posterior inferior Spinalis Longissimus Iliocostalis Multifidus Back Bootcamp.com https://upload.wikimedia.org/wikipedia/commons/2/28/Thyrocervical_trunk.png Back Bootcamp.com LATISSIMUS DORSI RHOMBOID RIOMBOID gi p st MAJOR y Yara t.IEYIcA y y THORACODORSALA MINOR LEVATOR SCAPULAE 6 SERRATUS ANTERIOR Back Bootcamp.com https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png AORTA I https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png Back Bootcamp.com SERRATUS POSTERIOR SUPERIOR DESCENDING AORTA SERRATUS POSTERIOR INFERIOR INTERCOSTAL A Back Bootcamp.com SACRUM https://upload.wikimedia.org/wikipedia/commons/1/1a/Gray389_-_Erector_spinae.png Back Bootcamp.com LUMBARAT SPINALIS LONGISSIMUS SACRUM ILIOCOSTALIS MULTIFIDUS j LATERAL SACRAL A Back Bootcamp.com DORSALROOTGANGLION DORSALROOTLET SPIKED i AMF VENTRALRAMI ROOTLET ventrally https://upload.wikimedia.org/wikipedia/commons/b/b1/Gray819.png Back Bootcamp.com SPINAL IS LONGISSIMUS ILIOCOSTALIS MULTIFIDUS https://upload.wikimedia.org/wikipedia/commons/1/1a/Gray389_-_Erector_spinae.png Back Bootcamp.com https://commons.wikimedia.org/wiki/File:Serratus_posterior_superior_muscle_back2.png TRAPEZIUS Ijerratus posterior superior SERRATUS POSTERIOR https://upload.wikimedia.org/wikipedia/commons/9/95/Gray409.png INFERIOR I Back Bootcamp.com Fatma D 3 https://commons.wikimedia.org/wiki/File:Brachial_plexus_2.svg TM xÉ Back Bootcamp.com LATISSIMUS DORSI ÉE 3 RHOMBOID MAJOR RHOMBOID MINOR E LEVATOR SCAPULAE ggg yyxNI THORACODORSAL N https://commons.wikimedia.org/wiki/File:Brachial_plexus_2.svg S AT ANTERIOR REVIEW Back Review Questions Can you name the blood supply and innervation for all of the muscles listed? OUTLINE 1. Blood Supply 2. Innervation 3. Muscles Trapezius Latissimus dorsi Rhomboid major Rhomboid minor Levator scapulae Serratus anterior Serratus posterior superior Serratus posterior inferior Spinalis Longissimus Iliocostalis Multifidus REVIEW Spine RadiologyBasics Spine Radiology-Basics Features of a vertebrae Body Pedicles Laminae Spinal Canal Transverse Processes Spinous Process Bootcamp.com Spine Radiology-Basics Articulations Bootcamp.com Spine Radiology-Basics Features of vertebrae at different heights Bootcamp.com Spine Radiology-Basics Features of vertebrae at different heights Bootcamp.com Spine Radiology-Basics Features of vertebrae at different heights Bootcamp.com Spine Radiology-Basics Features of vertebrae at different heights Bootcamp.com Spine Radiology-Basics Counting Vertebrae Candy Tastes Like Sugar Cane 7-12-5-5-4 Tried and true landmarks: C1/C2 L5/S1 Bootcamp.com Spine Radiology-Basics Bottom-up method Find the sacral promontory Count backwards from L5 Bootcamp.com Spine Radiology-Basics Top-down method C1/C2 articulation has no disc Can try using C7 Bootcamp.com Spine Radiology-Basics Discs: Between all except C1/C2 Relative height of disc space varies C spine about e ual T spine bigger than C and e ual L spine progressively bigger Bootcamp.com Spine Radiology-Basics How can I tell if I’m looking at a vertebrae or a disc? Look for pedicles Bootcamp.com Spine Radiology-Basics Disc vs. Vertebrae T1 vertebral bodies will be bright (bone marrow) and discs will be low intensity, CSF will be low intensity T2 vertebral body slightly lower in signal than disks, CSF will be bright (reverse of T1 Bootcamp.com Spine Radiology-Basics Bootcamp.com Spinal Cord: Sagittal Extends from medulla oblongata to L1-L2 Dark cord in white CSF on T2 MRI Ends as conus medullaris Cauda e uina inferiorly Each nerve root exits below respective vertebral body Pause & Practice: can you count vertebrae up to the L1 level and find the cauda e uina in this patient? Spine Radiology-Basics Spinal Cord: Axial T spine: dark spinal cord with light ring of CSF L spine: cauda e uina visible in the CSF Bootcamp.com Spine Radiology-Basics Case: Ms. SP comes to you after a motor vehicle accident with the attached imaging. Can you identify the name of the fractured structure(s)? Can you identify the vertebral level of the injury? Bootcamp.com Spine Radiology-Basics Bootcamp.com Case: Mr. HD complaining of chronic lower back pain and left-sided lower limb nerve pain. Can you identify the spinal level of the problem? What do you think is happening? Can you explain Mr. HD s pain? What do you think an axial cut of this problem section would look like? Spine Radiology-Basics Bootcamp.com Spine Radiology-Basics Bootcamp.com References: 🎱 REVIEW Lumbar Puncture & Epidural Anesthesia Lumbar Puncture & Epidural Anesthesia Lumbar Puncture Bootcamp.com Epidural Anesthesia - - - end of spinal cord L2 & beginning of cauda e uina Lumbar Puncture Bootcamp.com Potential Complications intracranial pressure lumbar puncture = pressure gradient between posterior fossa & spinal canal herniation of cerebellar tonsils through foramen magnum Knowledge Check Bootcamp.com A 45-year-old woman comes into the clinic complaining of a fever, neck pain, sleepiness, vomiting, and light sensitivity. Based on the symptoms, you suspect meningitis and decide to perform a lumbar puncture. At which vertebral level do you insert the needle and why? In which space do you insert the needle and why? Knowledge Check Bootcamp.com A 45-year-old woman comes into the clinic complaining of a fever, neck pain, sleepiness, vomiting, and light sensitivity. Based on the symptoms, you suspect meningitis and decide to perform a lumbar puncture. At which vertebral level do you insert the needle and why? Below the spinal cord: L3-L4, L4-L5 In which space do you insert the needle and why? Subarachnoid space References Bootcamp.com Slide 2 Lumbar Puncture: Cancer Research UK, CC BY-SA 4.0, via Wikimedia Commons Epidural Anesthesia: https://en.wikipedia.org/wiki/File:Epidural-anesthesia.png Slide 3 Chiari Malformation: see above, CC BY 2.0, via Wikimedia Commons MRI: Basket of Puppies, CC BY-SA 3.0, via Wikimedia Commons REVIEW Lumbar Puncture & Epidural Anesthesia REVIEW Abnormal Curvatures of the Spine & Intervertebral Disc Herniation OUTLINE 1. Types & Causes of Curvatures 2. Location & Direction of Herniation 3. Herniation Complications Abnormal Curvatures of the Spine Bootcamp.com Scoliosis Complex lateral deviation or torsion Caused by poliomyelitis, leg-length discrepancy or hip disease Normal Scoliosis Abnormal Curvatures of the Spine Bootcamp.com Lordosis Exaggeration of lumbar curvature Caused by pregnancy, spondylolisthesis or pot-belly Normal Lordosis Abnormal Curvatures of the Spine Bootcamp.com yphosis Exaggeration of thoracic curvature Caused by osteoporosis or disc degeneration Normal Kyphosis Herniated IV Disc Bootcamp.com Causes Degenerative changes to annulus fibrosus Sudden compression of nucleus pulposus Location & Direction Most commonly in lumbar & cervical spines Occurs posterolaterally due to PLL PLL ALL Herniated IV Disc Bootcamp.com L1 nerve exiting intervertebral foramen L2 nerve in lateral recess Knowledge Check Bootcamp.com An 85-year-old woman with osteoporosis comes into the clinic presenting with a humpback due to an abnormal curvature of the thoracic spine. Which condition does she present with? a. Lordosis b. Kyphosis c. Scoliosis A 29-year-old pregnant woman suffers from an exaggerated inward curve of the lumbar spine. Which condition does she present with? a. Lordosis b. Kyphosis c. Scoliosis Knowledge Check Bootcamp.com An 85-year-old woman with osteoporosis comes into the clinic presenting with a humpback due to an abnormal curvature of the thoracic spine. Which condition does she present with? a. Lordosis b. Kyphosis c. Scoliosis A 29-year-old pregnant woman suffers from an exaggerated inward curve of the lumbar spine. Which condition does she present with? a. Lordosis b. Kyphosis c. Scoliosis Knowledge Check Bootcamp.com Intervertebral discs often herniate in the cervical and lumbar spines. What is the reasoning for this? A 65-year-old man presents with low back pain, muscle weakness, and tingling down the anterior and medial thigh. You order an MRI and confirm a disc herniation at the level of L4-L5. Which spinal nerve is affected and why? Knowledge Check Bootcamp.com Intervertebral discs often herniate in the cervical and lumbar spines. What is the reasoning for this? Mobility: cervical & lumbar spines > thoracic spine Forcible hyperextension of the neck (whiplash) = rupture disc A 65-year-old man presents with low back pain, muscle weakness, and tingling down the anterior and medial thigh. You order an MRI and confirm a disc herniation at the level of L4-L5. Which spinal nerve is affected and why? L5 affected – L4 exits through intervertebral foramen & L5 located in lateral recess within spinal canal References Bootcamp.com Slide 2 Normal vs Scoliosis: Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons Scoliosis Patient & X-Ray: Weiss HR, CC BY 2.0, via Wikimedia Commons Slide 3 Normal vs Lordosis: Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons Lordosis Patient: CarpalTunnelEx, CC0, via Wikimedia Commons Slide 4 Normal vs Kyphosis: Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons Kyphosis Patient: Mehlauge, CC BY-SA 3.0, via Wikimedia Commons Slide 5 Superior View of Disc: https://www.flickr.com/photos/mandj98/3577200638 Sagittal View of Vertebral Column: Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons Scan: Φωτογραφία ασθενούς Δρ. Χαράλαμπου Γκούβα (Dr. Harrygouvas), Public domain, via Wikimedia Commons Slide 6 David Nascari and Alan Sved, CC BY-SA 4.0, via Wikimedia Commons REVIEW Abnormal Curvatures of the Spine & Intervertebral Disc Herniation OUTLINE 1. Types & Causes of Curvatures 2. Location & Direction of Herniation 3. Herniation Complications

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