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SECTION 2 — Back and Spinal Cord Study Guide

2  Back and Spinal Cord

Study Guide

2.1  TOPOGRAPHIC ANATOMY Vertebrae and Corresponding Structures

Level Corresponding Structure

Study Aims C2–C3 Mandible
C3 Hyoid bone
At the end of your study, you should be able to: C4–C5 Thyroid cartilage
• Identify posteromedian furrow C6 Cricoid cartilage
C7 Vertebra prominens
• Identify external occipital protuberance, vertebra promi-
T3 Spine of scapula
nens, iliac crests, posterior superior iliac spines
T4/5 Sternal angle (of Louis)
• Identify deltoid, latissimus dorsi, trapezius, erector spinae,
T7 Inferior angle of scapula
teres major, infraspinatus, gluteus maximus, and gluteus
T8 Inferior vena cava pierces diaphragm
T10 Xiphisternal junction
• Identify margins of scapula
T10 Esophagus enters stomach
T12 Aorta passes behind diaphragm
L1/2 Spinal cord ends (cauda equina starts)
L3 Subcostal plane
GUIDE L3–L4 Umbilicus
• Median line of back: posteromedian furrow overlies tips L4 Bifurcation of aorta
L4 Iliac crests—supracristal line
of spinous processes
S2 End of dural sac
• Deepest in lower thoracic/upper lumbar region S2 Level of posterior superior iliac spines
• Bordered by erector spinae
• Vertebra prominens = C7 spinous process (T1 may be more
• Scapula
• Superior angle at level of T2
• Medial end of scapular spine opposite spinous process CLINICAL POINTS
of T3
• Inferior angle at level of T7 LUMBAR PUNCTURE
• Medial border of scapula parallels sixth rib and approx- Lumbar puncture is performed for retrieval of cerebrospi-
imates oblique fissure of lung when arm is abducted by nal fluid (CSF) from the lumbar spinal cistern. The patient
placing hand on head. is placed in the left decubitus position, flexed in the fetal
• Iliac crests at level of L4 = supracristal line posture with the supracristal line vertical. Puncture should
• S2 spinous process lies level with a line joining posterior be made at the L3/4 (immediately superior) or L4/5
superior iliac spines. (immediately inferior) interspace in the midline of the
• Tip of coccyx approximately 2.5 cm posterosuperior to back, to avoid the spinal cord.
Anatomy of muscles of the back are covered in Section 2.4,
Muscles and Nerves. (Muscles that are readily visible are tra- Lumbar puncture: To keep the cord alive, keep the needle
pezius, latissimus dorsi, and teres major.) between L3 and L5!