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Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy

Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy






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  • Highlights : Slide 27, slide 34

Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy Kin191 A.Ch.10. Lumbar. Thoracic. Anatomy Presentation Transcript

  • KIN 191A Advanced Assessment of Lower Extremity Injuries THE THORACIC AND LUMBAR SPINE ANATOMY
    • C ervical spine (7)
      • G reatest ROM
      • S pinal cord is the most vulnerable
    • T horacic spine (12)
      • G reatest protection of the spinal cord  expense of ROM because of large spinous process
    • L umbar spine (5)
      • An equal balance between protection of the spinal cord and available ROM
    • S acrum (5) and coccyx (3~4)
      • C omposed of fused bone
      • T o affix the spinal column to the pelvis
      • S erve as a site for muscle attachment
  • Spinal Column
    • The segments of the mobile spinal column
    • C ervical (n=7), thoracic (n=12), and lumbar (n=5) vertebrae
    • Discs: 23
  • Bony Anatomy (Lumbar)
    • Total of 5 lumbar vertebrae
    • Components
      • Vertebral body
      • Transverse processe s
      • Spinous process
      • Neural arch
      • Pedicle
      • Lamina
      • Pars interarticularis
      • Intervertebral foramen
      • Facet joints (superior and inferior)
  • Vertebral Body Transverse Processes Inferior Articular Facets Spinous Process Superior Articular Process Lamina Pedicle
    • Vertebral body
      • Primary weight-bearing structure of spine
    • Transverse processes
      • Attachment site for ligaments/muscles
      • Long for leverage/increasing mechanical advantage
    • Spinous process
      • Attachment site for ligaments/muscles
      • Posterior projection (no inferior slant)
    • The Neural Arch
      • Formed by the pedicle and lamina on each side
        • Pedicle – vertebral body to transverse process
        • Lamina – transverse process to spinous process
      • Serves as the protective tunnel through which the spinal cord passes
    Pedicle Lamina
    • Pars Interarticularis
      • B etween the superior and inferior facets of the vertebra
      • A common site of stress fractures in lumbar spine
    • Intervertebral Foramen
      • The vertebral notch on the inferior portion of one pedicle is matched with the vertebral notch on the superior portion of the pedicle below
      • Nerve roots existing between the vertebrae
    • Facet joints (superior and inferior)
      • 2 sets for each vertebrae – articulation between vertebral segments
      • Lumbar facet orientations
        • L1-L3 – sagittal plane
        • L4-L5 – frontal plane
  • Intervertebral Disc
    • Dual purposes
      • Shock absorption (longitudinal and rotational)
      • Increase available ROM
    • Components
      • Annulus (ring) fibrosus – tough/dense outer layer
      • Nucleus (cell)pulposus – flexible inner layer
      • “ J elly doughnut”
    • 23 intervertebral discs are found along the spinal column
    • No disc between
      • C0-C1 (the skull and the first cervical vertebrae)
      • C1-C2
    • Individual disc are referenced by the vertebrae between which they are found
      • The disc located between the fourth and fifth lumbar vertebrae is known as the L4-L5 intervertebral disc
    • Permanent dehydration
      • Occurs through the aging process
      • Until the age of approximately 40 years, the disc is fully hydrated  after this age dehydration begins
      • By age 60 years, the disc have reached their maximum state of dehydration
        • Decreasing ROM
        • A slight narrowing of the intervertebral foramen
  • Nucleus Pulposus
    • Elastic/gelatinous substance – 60-70 % of H 2 0 content
    • Deformable but resistant to compression
    • Affects of bipedal ambulation and aging
  • Bony Anatomy (Thoracic)
    • Vertebral bodies
      • Smaller in thickness and diameter than lumbar vertebral bodies
    • Spinous processes
      • Project inferiorly to limit extension ROM
      • Continue to serve as muscular and ligamentous attachment sites
    • Transverse processes
      • Thicker to allow for formation of costotransverse joints on ribs 1-10
      • Ribs 11-12 are “floating” so no articulation with transverse processes
    • Costovertebral joints
      • Articulation between each rib and thoracic spine vertebral bodies
      • For T1 and T10-12, articulation with 1 rib on each side (1 facet in middle)
      • For T2-T9, articulation with 2 ribs on each side at inferior and superior costal facets
    • Ribs
      • True ribs (1-7) articulate with sternum through own costal cartilages
      • False ribs (8-10) articulate with sternum through conjoined costal cartilage
      • Floating ribs (11-12) have no anterior articulation
    • Sternum
      • Manubrium (superior)
      • Body
      • Xiphoid process (inferiorly)
    • Synovial joints (joint capsule)
      • Superior and inferior facet joints
    • Cartilaginous joints
      • Intervertebral disc and superior/inferior vertebral bodies
    • Each segment has relatively little individual mobility, but in combination allow for significant trunk/spine ROM
  • Ligamentous Anatomy
    • Anterior longitudinal ligament
      • Broad/thick, attaches to anterior aspect of vertebral bodies and intervertebral discs
      • Limits spine extension (thinnest in lumbar area)
    • Posterior longitudinal ligament
      • Thins distally, lines anterior portion of vertebral foramen, limited intervertebral disc attachment
      • Limits spine flexion
  • Ligamentous Anatomy
    • Supraspinous ligament
      • Attaches tips of spinous processes together
    • Interspinous ligaments
      • Fills space between adjacent spinous processes
      • Limit spine flexion and rotation
    • Ligamentum flavum
      • Connect laminae of adjacent vertebrae
      • Reinforces facet joints
    • A: Ligamentum flavum
    • B: Interspinous ligament
    • C: Supraspinous ligament
    • Extrinsic muscles
      • Rectus abdominus
        • Responsible primarily for trunk flexion
      • Internal/external obliques (pocket muscle)
        • Responsible for lateral bending and/or spine rotation
      • Transvers e abdominus
        • Trunk stabilization
      • Latissimus dorsi
        • Trunk stabilization via thoracolumbar fascia
  • Abdominal Muscles
    • Intrinsic muscles
      • Quadratus lumborum – pelvis to transverse processes
      • Erector spinae muscles (lumborum categorization) – pelvis/sacrum and spinous processes to transverse processes)
        • Iliocostalis – most lateral
          • Lumborum/Thoracis/Cervicis
        • Longissimus – intermediate
          • Thoracis/Cervicis/Capitis
        • Spinalis – medial
          • Thoracis/Cervicis/Capitis
      • Transversospinal muscles – transverse process to spinous process
        • Multifidus
        • Rotatores
        • Semispinalis
          • Thracis/Cervicis/Capitis
  • Muscular Anatomy
    • Extrinsic muscles – indirect effect on spinal column
      • Latissimus dorsi
        • Spine extension and stabilization via fascia
      • Rhomboid major and minor
        • Stabilization of thoracic spine and scapular adduction
      • Trapezius (middle and lower fibers)
        • Stabilization of thoracic spine
    • Will be covered in KIN 191B
    • Lumbar plexus
    • Sacral plexus
    • Nerve roots named for spinal segment superior to corresponding nerve root level
      • L4 nerve root exits spinal column below 4 th lumbar vertebrae
  • Lumbar Plexus
    • Primarily arises from L2, L3, L4 nerve roots
    • Posterior (dorsal) branches combine to form femoral nerve
      • Femoral nerve – posterior division of L2-L4
    • Anterior (ventral) branches combine to form obturator nerve
      • Obturator nerve – anterior division of L2-L4
  • Lumbar Plexus
  • Sacral Plexus
    • Primarily arises from anterior branches of L4 and L5 as well as S1 through S3
    • Anterior (ventral) branches of L4-S3 combine to form tibial nerve
      • Tibial nerve – anterior division of L4-S3
    • Posterior (dorsal) branches of L4-S2 combine to form common peroneal nerve
      • Common peroneal nerve – posterior division of L4-S2
  • Sacral Plexus
  • Sacral Plexus