Anatomy 2: Back, Spine and Spinal Cord

Question 1

What vertebrae can be palpated first on the back?

Answer 1

T1 spinous process

Question 2

What do skin dimples on the lower back represent?

Answer 2

PSIS

Question 3

What are the three parts of the trapezius, relative to their position on the back?

Answer 3

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

Question 4

Which rotator cuff muscle can be palpated on the back?

Answer 4

Teres major

Question 5

Which muscle may be affected in lower back pain?

Answer 5

Erector spinae

Question 6

What are the extrinsic back muscles (top - bottom), and what do they attach to?

Answer 6

Levator scapulae
Rhomboid major and minor
Trapezius
Latissimus dorsi
PECTORAL GIRDLE

Question 7

What is the function of the extrinsic back muscles?

Answer 7

Move upper limb

Question 8

What is the function of the intrinsic back muscles?

Answer 8

Maintain posture and extend the spine (ES) or rotate the spine (TVSPS)

Question 9

What is the main superficial intrinsic back muscle? Where does it attach inferiorly?

Answer 9

Erector spinae

Common tendon to sacrum and iliac crest

Question 10

What are the divisions of the erector spinae, and thus where do they attach superiorly?

Answer 10

Rib (Costalis)
Transverse process of vertebra (Longus)
Spinous process of vertebra (Spinous)

Question 11

What is the main deep intrinsic back muscle? Where is it located?

Answer 11

Transversospinalis

Within grooves between transverse and spinous processes

Question 12

Where do the muscle fibres of transversospinalis attach between?

Answer 12

Vertebra and skull
Vertebra and rib
One vertebra and another
Sacrum and vertebra

Question 13

What is the nerve supply to the back muscles?

Answer 13

Segmental (as per dermatome/ myotome)

Via posterior ramii branches (cervical , thoracic, lumbar)

Question 14

What muscles lie laterally to the vertebral column?

Answer 14

MUSCLES OF POSTERIOR ABDO WALL
Psoas major
Quadratus lomborum

Question 15

What muscles lie posterally to the vertebral column?

Answer 15

INTRINSIC BACK MUSCLES
Transversospinalis
Erector spinae

Question 16

What muscles lie laterally to the posterior abdominal wall muscles?

Answer 16

MUSCLE OF UL
Latissimus dorsi
MUSCLES OF ANTEROLATERAL ABDO WALL
Transverse abdominus
Internal oblique
External oblique

Question 17

If the erector spinae muscle contracts bilaterally the spine will undergo…

Answer 17

Extension

Question 18

If the erector spinae muscle contracts unilaterally the spine will undergo …

Answer 18

Lateral flexion

Question 19

What muscles control flexion of the spine?

Answer 19

Rectus abdominus

Psoas major

Question 20

How many vertebrae are there in the adult vertebral column?

Answer 20

33

Question 21

How are the vertebrae divided?

Answer 21

7 cervical (C1 - C8)
12 thoracic (T1 - T12)
5 lumbar (L1 - L5)
5 sacral (1 sacrum)
4 coccygeal (1 coccyx)

Question 22

What are the 3 functions of the vertebrae?

Answer 22

Support head and trunk when upright
Protect spinal cord and nerves
Allow movement of head on neck and trunk

Question 23

What are the main curvatures of the spine and are they primary or secondary?

Answer 23

Cervical lordosis (2)
Lumbar lordosis (2)
Thoracic kyphosis (1)
Sacral kyphosis (1)

Question 24

What curvature pathology is caused by excessive anterior weight e.g. in pregnancy or obesity?

Answer 24

Excessive lumbar lordosis

Question 25

What curvature pathology is caused by old age typically?

Answer 25

Excessive thoracic kyphosis

Question 26

List the parts of a vertebra

Answer 26

Spinous process x 1 Transverse process x 2 Inferior and superior articular processes x 4 Vertebral foramen Vertebral body Vertebral arch (made up of 2 x pedicle (superior) and 2 x lamina)

Question 27

What type of joint is the articulation between articular processes and adjacent vertebrae?

Answer 27

Synovial facet joint

Question 28

Which structure contains and protects the spinal cord and nerves?

Answer 28

Intervertebral foramen

Question 29

What joints are affected in arthritis of the spine?

Answer 29

Facet joint

Question 30

Where are IV discs found? What are they at risk of?

Answer 30

Between adjacent vertebral bodies | Disc herniation

Question 31

Where is there an abscence of IV discs?

Answer 31

Between C1 and C2

Question 32

Describe the structure of an IV disc

Answer 32

Outer fibrous ring - annulus fibrosis | Inner soft pulp - nucleus pulposis

Question 33

Which short ligament connects the adjacent lamina posteriorly to the spinal cord?

Answer 33

Ligamentum flavum

Question 34

What is the function of the posterior longitudinal ligament?

Answer 34

Narrow and weak | Prevents overflexion

Question 35

What is the function of the anterior longitudinal ligament?

Answer 35

Broad and strong | Prevents overextension

Question 36

What is the function of the supraspinous ligaments?

Answer 36

Strong, fibrous | Connects tips of spinous processes

Question 37

What is the function of the interspinous ligaments?

Answer 37

Weak, membranous | Connect superior and inferior parts of adjacent spinous processes

Question 38

List the ligaments of the vertebral column

Answer 38

``` Ligamentum flavum Posterior longitudinal ligament Anterior longitudinal ligament Supraspinous ligaments Interspinous ligaments ```

Question 39

Which vertebra are classed as atypical and why?

Answer 39

C1: ATLAS - no body or spinous process - A + P arch instead C2: AXIS - odontoid process, which projects superiorly from body C7: VERTEBRA PROMINENS - 1st palpable spinous process

Question 40

Which ligament connects C1 and C2 vertebra?

Answer 40

Transverse ligament

Question 41

Where does the atlanto-occipital joint connect?

Answer 41

Between occipital condyles of C1 and superior articular facets of atlas

Question 42

What type of joint is the atlanto-occipital joint? What is it's function?

Answer 42

Synovial joint Flexion and extension of neck (yes, no) Some lateral flexion and rotation

Question 43

Where does the atlanto-axial joint connect?

Answer 43

3 articulations 2 x inferior articular facets of atlas and superior articular facets of axis 1 x anterior arch of atlas and odontoid process of axis

Question 44

What is the main role of the atlanto-axial joint?

Answer 44

Rotation

Question 45

What are the names given to the area at the top and bottom of the sacral canal?

Answer 45

Sacral promontory | Sacral hiatus

Question 46

What are commonly classed as the 'wings' of the sacrum?

Answer 46

Left and right ala

Question 47

What exists within the sacral canal?

Answer 47

Cauda equina | Meninges

Question 48

Which part of the sacrum is palpable?

Answer 48

Sacral hiatus

Question 49

Which part of the sacrum is caudal anaesthesia inserted into to anaesthetise sacral spinal roots?

Answer 49

Sacral hiatus

Question 50

Where does the spinal cord start and end?

Answer 50

``` Foramen magnum (C1) Vertebral level L1/L2 (Co1 segment) ```

Question 51

What is the cauda equina?

Answer 51

All spinal nerve routes from L2 to Co that have descended to numbered vertebra where the spinal nerve is in IV foramen

Question 52

What is the spinal cord surrounded by?

Answer 52

``` 3 layers of meninges (dura, arachnoid matter, pia) Epidural fat (and venous plexuses) ```

Question 53

What is a laminectomy?

Answer 53

Removal of 1 or more spinous processes and adjacent lamina to relieve pressure on the spinal cord/ nerve roots