SM MSK Anatomy - Back and Spine Flashcards
SM 221a, Lab 1
What are the functions of the intrinsic back muscles?
Move the vertebral column
Extension, lateral bend, rotation
Which structure is labeled by #3?
Vertebral foramen
(Spinal cord runs through here)
The intrinsic muscles of the back attach to the ______
The intrinsic muscles of the back attach to the vertebral column
Identify the follwing on both the MRI and the bone
- Vertebral body
- Vertebral foramen
- Spinous process
https://www.researchgate.net/publication/224950784_Unexpected_neuroimaging_abnormalities_in_patients_with_apparent_C8_radiculopathy_Broadening_the_clinical_spectrum/figures?lo=1
How many sacral vertebrae are there?
4-5
Which structure is indicated by #2?
Nucleus Pulposus
Gelatinous remnant of the embryonic notochord
True or false?
Back muscles attaching to the scapula will receive innervation from dorsal rami of the appropriate thoracic level
False
- Back muscles attaching to the scapula are extrinsic muscles
- They are innervated by ventral rami
- Except trapezius, which is innervated by CN XI (the spinal accessory)
Where could this portion of spinal cord be taken from?
T1 through L1
Spinal nerves do not originate from cervical vertebrae
(cranial nerves exit cervical vertebrae)
The spinal cord ends at L1. The cauda equina takes spinal roots down to the lumbar and sacral vertebrae, where they exit as spinal nerves
What are the 3 groups of intrinsic muscles of the back?
(From superficial to deep)
- Splenius
- Erector spinae
- Transversospinalis
What structure is labeled by #5?
Spinal nerve
Emerges from the vertebral column through the intervertebral foramen
True or False?
The iliocostalis and the splenius are both extensors of the spine
True
- Iliocostalis extends the lumbar and thoracic regions
- Part of the erector spinae
- Splenius extends the head and neck
- All intrinsic back muscles function as extensors
Which structure is labeled by #2?
Lamina (part of vertebral arch)
Which structure attaches the pia mater to the coccyx?
Filum terminale
What is inside of the dural sac at the level of L3?
Cauda equina + arachnoid mater
The spinal cord ends at L1, giving rise to spinal roots that bundle together to form the cauda equina
Which structure is labeled by #4?
Spinous process
Which structure is labeled by #6?
Vertebral foramen
(This is where the spinal cord would be)
What are the most common sites for herniated discs?
Between L4-L5 in the lumbar region -> lower back/leg pain
May also occur in the cervical region -> neck/arm pain
Which structures hold the vertebrae together?
Ligaments and vertebral disks
What structure is labeled by #1?
Scapular spine
Which muscle is indicated by #1?
What is its function?
Attachments?
Innervation?
- Muscle: Serratus posterior superior
- Thin sheet of muscle underneath the trapezius and rhomoboids
- Poorly developed
- Function: Nobody knows!
- Possible accessory respiratory function
- Attachments: Ribs, spinous process
- Innervation: Ventral rami of spinal nerves
Which structure is labeled by #1?
Pedicle
Which structures make up the vertebral arch?
Lamina + pedicle
While stopped at a light, a man’s car is rear-ended at high speed. He is brought to the emergency room with difficulty breathing and a severe hyperextension neck injury. His MRI shows a rupture of the anterior annulus of C4-5 intervertebral disc, inflammation of the disc, and a preverterbal hematoma (the cause of his breathing difficulty). Which of the following ligaments was likely disrupted?
- Anterior longitudinal
- Ligamentum flavum
- Interspinous
- Supraspinous
- Posterior longitudinal
a. Anterior longitudinal
Often injured in whiplash injuries
This is an axial T2 MRI of the lumbar spine
How is the muscle group outlined in red innervated?
Dorsal rami of the spinal nerves
These are intrinsic back muscles
Which structure is labeled by #4?
Vertebral foramen
(Spinal cord runs through here)
When does lordosis of the cervical and lumbar regions develop?
When a child starts to walk
Development continues for 1-2 years
Which group of the intrinsic back muscles is shown in this image (outlined in blue)?
What is its function?
Attachments?
Innervation?
- Muscle: Transversospinalis
- Found in the notch between the transverse process and spinous process
- Function: Extension, rotation, and lateral bending
- Attachments: Spinous process, transverse process
- Innervation: Dorsal rami of spinal nerves
Which muscles are active when you shrug your shoulders?
Levator scapulae (main)
Trapezius helps a bit
Which vertebrae are the smallest?
- Cervical
- Thoracic
- Lumbar
- Sacral
a. Cervical
What structure is labeled by #9?
Arachnoid mater
Middle layer of the meninges covering the spinal cord
What structure is labeled by #2?
Inferior articular facet
Identify the following in the image
- Spinal cord
- CSF
- Cauda equina
- L1
The spinal cord ends at L1
Which structure is labeled by #6?
Pedicle (part of the vertebral arch)
Which muscles elevate the scapula?
Levator scapulae
Rhomboids
Trapezius
Which ligament is labeled by #3?
Ligamentum flavum
Which ligament is labeled by #4?
Supra-spinous ligament
What structures are indicated by the yellow arrows?
Osteophytes
Sign of osteoporosis
http://rad.washington.edu/about-us/academic-sections/musculoskeletal-radiology/teaching-materials/online-musculoskeletal-radiology-book/osteopenia/
Which section of the spine is shown in this image?
How do you know?
Lumbar
Look for the “scotty dog” feature
- Ear (D) = superior articular facet
- Front leg (C) = inferior articular facet
- Eye (B) = pedicle
- (A) is the intervertebral disk
Which nerves innervate the extrinsic muscles of the back?
Ventral rami of the spinal nerve
(Anterior rami)
A hyperextension injury is most likely to injure which spinal ligament?
Anterior longitudinal ligament
(a whiplash injury)
What structure is labeled by #3?
Acromion of the scapula
Which lines correspond with the following structures?
- Line of the spinous process
- Articular line
- Anterior veterbral body line
- Posterior vertebral body line
(In order from left to right)
- Blue = Anterior vertebral body line
- Red = Posterior vertebral body line
- Orange = Articular line
- Green = Line of the spinous process
Where is an epidural administered?
Outside of the dural sack - anesthetizes the nerve roots
Usually accessed through lumbar vertebrae (L4-L5), sacral hiatus, or posterior sacral foramina (but can theoretically be done anywhere along the column - there is less risk of spinal cord injury because you are not puncturing the dural sac)
Which structure is labeled by #1?
Pedicle (part of vertebral arch)
Which intrinsic back muscle has fibers that extend superio-laterally?
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Splenius
An 81 yo woman complains of weakness and loss of sensation in her legs. Radiological studies show bony spurs (osteophytes) narrowing the intervertebral foramina at levels T12-L3. Which of the following structures is most likely to be impinged by the osteophytes?
A. Spinal cord
B. Spinal nerve
C. Sympathetic trunk ganglion
D. Anterior rootlets of spinal nerve
E. Ventral ramus of spinal nerve
B. Spinal nerve
Dorsal root ganglion may also be affected
These structures must pass through the intervertebral foramina - if the opening is smaller, they may be impinged
Which muscles are active when the scapula retracts?
Trapezius and rhomboids
Which extrinsic back muscle does NOT attach to the humorous?
Serratus posterior (inferior and superior)
Attach to spinous process + ribs
What structure is labeled by #2?
Dura mater
Outermost layer of meninges covering the spinal cord
Which muscle is outlined in yellow (labeled 2)?
What is its function?
Attachments?
Innervation?
- Muscle: Rhomboids
- Function: Retract the scapula
- Attachments: Scapula, spinous process
- Innervation: Ventral rami of spinal nerves
What structure is labeled by #1?
Superior articular facet
How many lumbar vertebrae are there?
Usually 5
May be 4-6
Which back muscles are derived from the hypomere?
Extrinsic muscles of the back
How many cervical vertebrae are there?
7
Which structure is labeled by #4?
Articular process
What is the deepest layer of the intrinsic back muscles?
Transversospinalis
Which muscles are found underneath the trapezius?
Levator scapulae
Rhomboids
Describe the distinguishing features of the cervical vertebrae
- Smallest kind of vertebra
- Small body relative to vertebral foramen
- Has transverse foramen
Which muscle is indicated by #2?
What is its function?
Attachments?
Innervation?
- Muscle: Erector spinae
- Function: Lateral bending, rotation, extension of the back
- Attachments: Spinous process, transverse process, ribs
- Innervation: Dorsal rami of spinal nerves
Which muscle group is shown?
Identify each part
Erector Spinae (intrinsic back muscle)
- Spinalis
- Longissimus
- Illiocostalis
Functions in extension, lateral flexion, rotation
Which intrinsic back muscle has fibers that are straight up and down?
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Erector spinae