MD Bones & Joints of the Back. A/Prof Chris Briggs Department of Anatomy & Neuroscience
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1 MD 2017 Bones & Joints of the Back A/Prof Chris Briggs Department of Anatomy & Neuroscience
2 WARNING This material has been provided to you pursuant to section 49 of the Copyright Act 1968 (the Act) for the purposes of research or study. The contents of the material may be subject to copyright protection under the Act. Further dealings by you with this material may be a copyright infringement. To determine whether such a communication would be an infringement, it is necessary to have regard to the criteria set out in Part 3, Division 3 of the Act.
3 Learning Objectives Appreciate the normal curvatures of the vertebral column and abnormal curves Describe the features of typical thoracic and lumbar vertebrae and the sacrum. Appreciate the location of centres of ossification. Describe the features and functions of intervertebral discs and (zygapophyseal) joints of vertebral arches Describe the attachments & functions of vertebral ligaments Describe the boundaries & contents of the vertebral canal & intervertebral foramen Suggested pre-reading Clinically Orientated Anatomy, Moore 7 th ed. Chapter 4, Back.
4 Bony landmarks T1 vertebra - coccyx Medial border scapula Posterior surfaces ribs Iliac crest Skin of back
5 Arrangement: Vertebral column (supporting axis) - intervertebral joints (& discs) - vertebral canal & intervertebral foramen 2 x muscle compartments: - superficial (extrinsic) muscles - deep (intrinsic) muscles Back
6 Bony framework vertebral column From primary (foetal) C- shaped curvature, secondary (lordotic) curves develop in cervical & lumbar regions. Abnormal curves may develop Basmajian J & Slonecker C Grant s Method of Anatomy 11 th ed Williams & Wilkins 1986 Ch 1 Fig 1.19 ISBN
7 Typical lumbar vertebra epiphyseal ring Basmajian J & Slonecker C Grant s Method of Anatomy 11 th ed Williams & Wilkins 1986 Ch 1 Fig 1.19 ISBN Pars inter-articularis
8 Typical thoracic vertebra foraminae for basivertebral veins Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Figs. 143A
9 Sacrum & coccyx Note: -orientation of S1 facet surfaces (in coronal plane) -anterior & posterior sacral IV foraminae for nerve roots & vessels (including sacral veins) -sacral canal & hiatus -variable # coccygeal vertebrae Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Figs. 145
10 Spina Bifida (from L: split spine) Anatomedia Back Systems Frame 9 2% hidden sac 0.1% - meningocele - meningomyelocele Defect usually L5/S1
11 Centres of ossification 3 primary centres in body and each neural arch. 5 secondary centres (at puberty) at tips of spinous & transverse processes, + upper and lower margins of body (annular epiphysis). Secondary centres normally close during late adolescence, when vertebral growth is complete. Clinical significance? Moore KL, Before we are born WB Saunders 1989 Fig 16.4
12 Joints of Vertebral Bodies (intervertebral discs) Visible Human Project - National Library of Medicine
13 Intervertebral disc Kapandji IA, The Physiology of the Joints Fig 25 Churchill Livingstone1980 Annulus fibrosus (fibrocartilage) Nucleus pulposus (remnant of notochord) Image from Anatomedia Back module Cartilage end-plate (epiphyseal ring)
14 Functions of intervertebral discs Weight-bearing forces cause nucleus to bulge resisted by annular fibres Some loads also supported by cartilage end-plate Annulus in layers ~ perpendicular to each other. Twisting movements while lifting are hazardous as only 50% annular fibres positioned to resist load Basmajian J & Slonecker C Grant s Method of Anatomy 11 th ed Williams & Wilkins 1986 Ch 1 Fig 1.19 ISBN
15 Interspinous ligaments Lumbar Joints & Ligaments Joints & ligaments Posterior Longitudinal ligament Facet or zagopophyseal joints Intertransverse ligaments Intervertebral disc Anterior Longitudinal ligament Supraspinous ligament Primal Pictures 2007
16 Ligaments within vertebral canal Posterior longitudinal Ligamentum flavum (yellow elastic) Note expansion over IV disc Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Figs. 146B & C
17 Iliolumbar ligament
18 Nerve & blood supply to disc Recurrent meningeal nerve - contains sensory & sympathetic fibres Vessels & nerves only to outer third Images from Anatomedia Back module
19 Joints of vertebral arches Synovial joints Fibrous capsule lax to permit movement Basmajian J & Slonecker C Grant s Method of Anatomy 11 th ed Williams & Wilkins 1986 Ch 1 Fig 1.20 ISBN
20 Joints of vertebral arches Orientation of facet surfaces dictates direction of movement: thoracic mainly in coronal plane, lumbar facets mainly in sagittal plane. Note changed orientation at L5/S1 Image from Anatomedia Back module Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. New Jersey, Icon Learning Systems, 2003, ISBN: , Figs. 143A & 144A 145D
21 Regions & Viscera Intervertebral foramen - boundaries - contents Vertebral canal - boundaries - contents
22 Vertebral canal End 1 st trimester S5 Netter, F.H. Interactive Atlas of Human Anatomy. 3rd ed. End 2 nd trimester S1 Birth L3
23 Intervertebral foramen Image from Anatomedia Back module (Note L5/S1 foramen)
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