Clinical Anatomy of the Dorsum, Spine and Spinal Cord

Question 1

List the surface muscles of the trunk dorsum

Answer 1

Trapezius

• Descending (superior)
• Transverse (middle)
• Ascending (inferior)

Teres Major

Latissimus dorsi

Erector spinae

Question 2

What are the extrinsic back muscles? List them

Answer 2

Muscles of the back which attach to the pectoral girdle and move the upper limb

Trapezius

Levator scapulae

Rhomboids

Latissimus dorsi

Question 3

What are the intrinsic back muscles? List them

Answer 3

Muscles of the back which are and only act in the back

Erector spinae (superficial)

Transversospinalis (deep)

Question 4

Name the three components of Erector spinae and where they attach

Answer 4

Iliocostalis: ribs superiorly

Longissimus: transverse process of vertebra

Spinalis: Spinous process of vertebra

Inferior attachments: common tendon to sacrum & Iliac crests

Question 5

Where is Transversospinalis located and where do its fibres attach?

Answer 5

Located within the grooves between transverse & spinous processes

Individual fibres attach between:

• a vertebra and the cranium
• a vertebra and a rib
• one vertebra and another vertebra
• the sacrum and a vertebra

Question 6

How are the intrinsic back muscles innervated?

Answer 6

Segmental nerve supply as the dermatome & myotome map

Posterior rami branches from cervix, thorax and lumborum

Question 7

Label the dorsal muscles

Answer 7

Question 8

Which muscles flex the spinal column?

Answer 8

Rectus abdominis

Psoas major

Question 9

List the vertebrae found within the spinal column

Answer 9

33 vertebrae in total

• 7 cervical (C1-C7)
• 12 thoracic (T1-T12
• 5 lumbar (L1-L5)
• 5 sacral (fused to form 1 sacrum)
• 4 coccygeal (fused to form 1 coccyx)

Question 10

Describe the ligamentum flavum

Answer 10

Short individual pieces connect laminae between vertebrae, posterior to the spinal cord

Question 11

Describe the physiological sagittal curvatures of the spinal column

Answer 11

Two primary curvatures (flexures)

• Thoracic Kyphosis
• Sacral Kyphosis

Two secondary Curvatures (extensions)

• Cervical Lordosis
• Lumbar Lordosis

Question 12

Label the vertebra (thoracic)

Answer 12

Question 13

Describe the intervertebral foraminae

Answer 13

Found between adjacent vertebrae

Spinal nerves are found within

Question 14

What form of joint is formed between adjacent articular processes of vertebrae?

Answer 14

A facet joint

Hence vulnerable to osteoarthritis

Question 15

Where in the spinal column are intervertebral discs not located?

Answer 15

None betwenn C1 - C2

None within the sacrum and coccyx as these are fused

Question 16

Describe the physiology of intervertebral discs

Answer 16

Outer layer ‘Annulus fibrosis’

-Fibrous and strong

Inner core ‘nucleus pulposus’

• soft pulp for flexibility
• can herniate

Question 17

List the ligaments which support the spinal column

Answer 17

Ligamentum flavum

Anterior longitudinal ligament

Posterior longitudinal ligament

Supraspinous ligament

Interspinous ligament

Question 18

Describe the anterior longitudinal ligament

Answer 18

Anterior to the vertebral body

Broad and strong protection for dics

Prevents over-extension of the column

Question 19

Describe the posterior longitudinal ligament

Answer 19

Posterior to vertebral body

Narrow and week

Prevents over flexion of the column

Question 20

Describe the supraspinous ligament

Answer 20

Connects the tip of each spinous processes vertically

Strong and fibrous

Question 21

Describe the interspinous ligament

Answer 21

Connects superior and inferior surfaces of adjacent spinous processes

Weak and membranous

Question 22

Desccribe the C1 vertebra

Answer 22

‘Atlas’

No vertebral body or spinous process

instead has a posterior and anterior arch

Question 23

Describe the C2 vertebra

Answer 23

‘Axis’

Has an odontoid process whihc projects superiorly from the vertebral body to articulate with C1

Question 24

Describe the Atlanto-occipital joint

Answer 24

The Joint between the occipital condyles and superior articular facets of the atlas

Loose synovial joint with a loose capsule

Allows:

• flexion/extension
• lateral rotation
• some lateral flexion`

Question 25

Label the vertebral column

Answer 25

Question 26

Describe the types of Cervical Vertebral Dislocation

Answer 26

• A - Stage I- flexion sprain
• B - Stage II – anterior subluxation, 25% translation
• C - Stage III – 50% translation
• D - Stage IV – complete dislocation

Question 27

Descirbe the atlanto-axial joints

Answer 27

3 articulations which are all synovial

• bilateral joints between superior/inferior articular facets
• midline joint between odontoid process and anterior arch

Mainly rotation movement

Question 28

Label the Sacrum

Answer 28

Question 29

How is caudal anaesthesia achieved?

Answer 29

In caudal anaesthesia local anaesthetic is injected into the sacral hiatus to anaesthetise the sacral spinal nerve roots of the cauda equina

Question 30

Describe the course of the spinal cord

Answer 30

Begins rostrally at the level of the foramen magnum, being continuous with the medulla oblongata

Ends caudally around L1-L2 as the conus medullaris

Question 31

Detail the spinal cord structure

Answer 31

A segmented structure, corresponding to the vertebral level of spinal nerves which origionate from its surface

Cervical cord segments lie roughly one spine higher than their corresponding vertebra

Thoracic, two

Lumbar, three to four

Enlarges in diameter at segments:

C4-T1

L1-S3

Question 32

Describe the cauda equina

Answer 32

All the spinal nerve roots from L2 to C0 that have to descend to their numbered vertebrae where their spinal nerve is located within the intervertebral foramen

Question 33

Label the spinal meninges

Answer 33

Question 34

Describe the layering approached during a laminectomy

Answer 34

Skin, superficial fascia, aponeurotic origin of trapezius/thoracolumbar fascia of latisimus dorsi, intrinsic muscles, ligaments (ligamentum flavum, supraspinous , interspinous), lamina, spinous process

-Epidural fat, dura mater and arachnoid mater