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muscles that really belong to the shoulder and to some extend have migrated there, control the upper limb, rhomboids, infraspinatus, trapezius and so on- superficial back muscles that move the shoulder or the humerus and all except the trapezius are supplied by ventral rami of spinal nerves
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muscles deep to these muscles of the shoulder girdle, called the erector spinae, cllect along the vertebral column starting with the ilium and connect some of the ribs, connect the skull, extend the spinal cord ex lets us arch our back. these muscles need to be incised and reflected when performing a laminectomy- dividing the lamina in order to gain access to the vertebral canal- innervated by the dorsal rami of spinal nerves. these extrinsic muscles are innervated, except the trapezius by the brachial plexus
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| T/F The intervetebral disc allows some movement between adjacent vertebrae and supports weight transfer |
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| T/F Facet joints permit more movement in the lumbar region than in the cervical region |
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| spinal cord requirements, at each spinal level |
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Definition
So the spinal cord, as part of the nervous system, requires a continuous and high blood flow. And at each spinal level, there's a small vessel that's a branch of the segmental vessels of the aorta, or of the vertebral artery that pass in through the intervertebral foramen. And as they enter the intervertebral foramen, they branch in to supply an anterior vessel, and one of two dorsal vessels.
So we have a vascular supply running up and down the spinal cord, which is fed by vessels entering at different levels. So for instance, if there's an obstruction here in this vessel, this region of the chord can be profused by blood coming from above or coming from below. Now not all of these spinal arteries are equal in terms of the amount of blood they supply.
In truth, the main blood supply, of at least the upper part of the spinal cord comes from the vertebral arteries just before they enter the foramen magnum. And there is a major artery, usually a branch of the lumbar or lower thoracic segmental artery, that supplies the rest of the spinal cord. So some of these arteries are more important than others. But at least in principle, the spinal cord gets a blood supply along with each spinal nerve as it branching, one following the dorsal root over to the dorsum of the spinal cord, and the other following the ventral route.
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Now just as the brain is, the spinal cord is surrounded by meninges. There are three meninges. There's an outer layer called the called the dura mater, durable as in strong. And deep to that, a filmier layer called the arachnoid mater. The early anatomists study looked somehow like a spider's web. And then attached to the spinal cord itself, in the same way that visceral pleura or visceral peritoneum are attached to the corresponding structures.
There is a pia mater, which is attached firmly to the spinal cord. But between them, however, is a space, between arachnoid and the pia called the subarachnoid space, and what expands that space is a presence of CSF, cerebral spinal fluid. This fluid is generated in the ventricles of the brain, and flows down between the arachnoid and the pia two perfuse the subarachnoid space and this subarachnoid space extends as far inferior as the S2 vertebra.
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So this cartoon here shows the conus medullaris here, and the causa equina, and the artist has taken away some of the vertebrae here to show here the L4 vertebra and L5 vertebra. And the reason we know it's the L4 vertebra is because we see, if we draw a line across from the iliac crests to the midline, we know that we're crossing the L4 vertebra. So if you're wondering when you do lumbar puncture, where should I go?
The answer is you should identify the L4 vertebra, and you should go into this space here, between the L4 and L5 vertebra, and you would pierce the dura and the arachnoid and you'd enter the subarachnoid space, and you would simply, in most cases, just simply push aside the cauda equina, because it's flexible.
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| T/F at most spinal levels, arteries pass into the vetebral canal through the intervetebral foramina |
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| layers of spinal cord from superficial to deep |
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| T/F The iliac crests mark the position of the L4 vertebra and the site for a lumbar puncture. |
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| hip flexor vertebrae and spinal levels of innervation |
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| knee extensors vertebrae and spinal levels of innervation |
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| (L2–L4) and ankle dorsiflexors L4–L5 are 2/5 |
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| hip extensors, knee flexors and ankle plantar felxors vertebrae and spinal levels of innervation |
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| bladder and anal sphincters vertebrae and spinal levels of innervation |
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| conus medullaris, spinal serves and subarachnoid space |
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Definition
Conus medullaris (tip of the spinal cord) is at the L2 vertebral level.
Spinal nerves are named for the vertebra below which they exit.
Subarachnoid space ends at the S2 vertebral level |
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T12 and L1 findings |
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Definition
| near normal at T12, narrowed vertebral canal at L1 |
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| vetebral level of L1 spinal nerve |
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| a fracture at L1 would affect |
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Definition
| L5 to S2 spinal segments are maximally affected by the fracture |
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spinal nerve -D
thoracic vertebra- A
lumbar vertebra- C
intervertebral disc- B |
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intervertebral foramen- D
cauda equina- C
Dura mater- B
Spinal cord- A |
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filum terminale- E
ventral root- B
dura mater- A
dorsal root- D |
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