1. Dr. SREEKANTH THOTA DEPARTMENT OF ANATOMY Back

2. The back comprises the posterior aspect of the trunk, inferior to the neck and superior to the buttocks. The back includes the 1. Vertebral column: the vertebrae, intervertebral (IV) discs, and associated ligaments 2. Muscles: superficial layer and deep layer 3. Spinal cord and meninges (membranes that cover the spinal cord).

3. Vertebrae Vertebrae: (33) 7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal

5. Abnormal Curvatures: Kyphosis Lordosis Scoliosis Excess of Thoracic Curvature

6. Scoliosis Excess of Lateral Curvature

7. Ligaments of the vertebral column Anterior longitudinal. Posterior longitudinal Ligamentum flava Ligamentum nuchae Supra spinous Interspinous Intertransverse

8. Anterior and posterior longitudinal ligaments, Ligamenta flava

9. Supraspinous ligament and ligamentum nuchae

10. Interspinous ligaments

11. Laminectomy The surgical excision of one or more spinous processes and the adjacent supporting vertebral laminae in a particular region of the vertebral column is called a laminectomy Surgical laminectomy is often performed to relieve pressure on the spinal cord or nerve roots caused by a tumor, herniated IV disc, or bony hypertrophy (excess growth).

12. Back Muscles Muscles of the back are organized into superficial, intermediate, and deep groups. Muscles in the superficial and intermediate groups are extrinsic muscles because they originate embryologically from locations other than the back. They are innervated by anterior rami of spinal nerves Muscles of the deep group are intrinsic muscles because they develop in the back. They are innervated by posterior rami of spinal nerves.

13. Superficial Group: (attach upper extremity to the vertebral column) Trapezius Latissimus dorsi Levator scapulae Rhomboid major & minor

14. Intermediate group of back muscles 1.Serratus posterior superior 2.Serratus posterior inferior

15. Deep Layer: (postural in function) Erector spinae – iliocostalis, longissmus, spinalis Splenius capitis & splenius cervicis

19. Deepest Layer : Transverso spinalis group Semispinalis Multifidus Rotators

23. Spinal Cord & the Meninges

24. Spinal Cord The spinal cord begins as a continuation of the medulla oblongata the caudal part of the brainstem. In adults, the spinal cord is 42 to 45 cm long and extends from the foramen magnum in the occipital bone to the level of the L1 or L2 vertebra. In newborns extends till lower border of L3 Beyond this level a thin filament extends, which is Filum Terminale

26. Spinal Cord The spinal cord is enlarged in two regions in relationship to innervation of the limbs. The cervical enlargement extends from the C4 through T1 segments of the spinal cord. The lumbosacral (lumbar) enlargement extends from T11 through S1 segments of the spinal cord.

27. Spinal Meninges and Cerebrospinal Fluid Spinal Dura Mater: The spinal dura mater is separated from the periosteum-covered bone and the ligaments that form the walls of the vertebral canal by the epidural space. This space is occupied by the internal vertebral venous plexus embedded in a fatty matrix (epidural fat).

30. Arachnoid Mater Delicate, fibroelastic layer Separated from the dura by the subdural space Separated from the piamater by the subarachnoid space Connected to the pia by fibrous strands called Arachnoid Trabeculae.

31. Spinal Pia Mater The spinal pia mater, the innermost covering membrane of the spinal cord. The spinal cord is suspended in the dural sac by the terminal filum and especially by the right and left sawtooth denticulate ligaments which run longitudinally along each side of the spinal cord

32. Spinal Nerves 31 pairs of spinal nerves: Cervical – 8 Thoracic – 12 Lumbar – 5 Sacral – 5 Coccygeal – 1 Each spinal nerve has a dorsal & ventral root. C1 lacks a dorsal root in 50% of the cases. Spinal roots unite at the intervertebral foramen to form a spinal nerve

34. Blood Supply of the Spinal Cord Arterial supply Ant spinal artery Post spinal artery Br of vertebral Br of vertebral or Post inf cerebellar artery (PICA) These vessels are reinforced by blood from segmental arteries called Radicular arteries.

37. Lumbar puncture Introduction of long needle into lumbar subarachnoid space to either draw CSF out or put drugs into the CSF. 3rd and 4 th lumbar spines are marked  4 th lumbar spine usually lies on a line joining iliac crests Lumbar Puncture Layers 1. Skin 2. Superficial fascia 3. Supraspinous ligament 4. Interspinous ligament 5. Ligamentum flavum 6. Epidural space containing the internal vertebral venous plexus 7. Dura mater 8. Arachnoid 9. Subarachnoid space containing cerebrospinal fluid. And remember Pia is not Pierced

38. Lumbar Puncture Layers Mnemonic Some Super Supra Long L E Ds Are Substitutes.

40. Epidural block Anaesthetic injected into epidural space of sacral canal – either of the following 3 ways… ▫Sacral hiatus (caudal epidural) using sacral cornua as landmarks ▫Posterior sacral foramina (transsacral epidural) ▫Lumbar region Surgery below diaphragm, childbirth, caesarian Anesthetic solution spreads superiorly to act on spinal nerves S2 to Co1

41. Epidural block

43. Sacral hiatus (caudal epidural)