CHAPTER VI.
THE BACK.

Fig. 31.
The spinal column.
(Church and Peterson.)

The Spine.—The trunk may be roughly divided into the back, the chest or thorax, the abdomen, and the pelvis. By the back is denoted the spinal column with its muscles, blood-vessels, etc., and the spinal cord already described. The spine or vertebral column, which serves the double purpose of holding the body erect and of protecting the cord, is usually about two feet, two inches in length. In its course there occur several curves, which serve to give springiness and strength and, with the intervertebral cartilages, to mitigate the force of concussion from blows and falls. The curve is convex forward in the cervical region, convex backward in the dorsal, forward in the lumbar, and backward again in the sacral region. There is most freedom of motion in the cervical region.

As is the case with the other bones, the vertebræ are specially adapted in shape and size to the needs they are called upon to fill. Strength and flexibility, with a minimum bulk, a channel for the cord, and passages for the numerous nerves and blood-vessels are some of the requirements which, in combination, they meet to an astonishing degree. They are thirty-three in all, and are divided into groups according to the region in which they occur: seven cervical in the neck, twelve dorsal or thoracic, five lumbar, five sacral, and four coccygeal.

Although the vertebræ of the different groups differ more or less in size and shape in accordance with the various demands of their positions, they all have certain general characteristics. Each has a body, two laminæ, two pedicles, two transverse processes, and one spinous process. The pedicles extend back from the body on either side and support two broad plates of bone, the laminæ, whose juncture at the back completes the spinal foramen for the passage of the cord. At their juncture is the spinous process, which can be felt beneath the skin, while the transverse processes project from the juncture of the laminæ with the pedicles. All the processes are for the attachment of muscles that move the spine. The body is formed of cancellous bone with a compact layer outside. Transversely it is slightly oval, while its upper and lower surfaces are flat, except in the cervical region, where the upper surface is concave laterally and the under convex laterally and concave from before back. Between the bodies are disks of fibro-cartilage, which increases motion and springiness. The spinous process or spine is short in the cervical region, long and directed downward in the dorsal region, thick and projecting almost straight out in the lumbar region. The pedicles are notched above and below so that when articulated the notches of two vertebræ join to form the intervertebral foramen for the outward passage of nerves and the inward passage of blood-vessels.

The distinguishing mark of the cervical vertebræ is the foramen in each transverse process, through which the vertebral arteries run to the skull. They are also smaller than the dorsal and lumbar vertebræ. The dorsal vertebræ are distinguished by having on the transverse processes and on the body smooth articular surfaces called facets and demi-facets for articulation with the ribs. The lumbar vertebræ are the largest and heaviest and have the thickest spine. By the time the sacral region is reached, however, the vertebræ have only a rudimentary spinous process. Moreover, in adult age the sacral bones grow together and form one triangular bone, the sacrum, which has a broad base called the promontory of the sacrum and a blunt apex. It is concave in front and convex behind and has an articulating surface for joining the pelvic bones. In the case of the coccyx also the four original bones, all rudimentary in character and supposed to be the survival of a tail, grow together to form one bone. Together the sacrum and coccyx form the posterior wall of the true pelvis.

Fig. 32.—A type of vertebra. (Leidy.) 1, Body; 2, pedicle; 3, lamina; 4, spinal foramen; 5, spinous process; 6, transverse process; 7, articular process.

Fig. 33.—The sacrum, from before.
(Drawn by D. Gunn.)

Some of the dorsal vertebræ are peculiar in the arrangement of their facets and demi-facets, while among the cervical vertebræ are several whose peculiarities should be more carefully noted. Thus, the first cervical vertebra or atlas supports the head and has practically no body, the place of the body being taken by a narrow anterior arch of bone and an opening, continuous with the spinal foramen, into which the odontoid process of the axis fits, being held in place by ligaments. At either side on top is a facet for articulation with the occipital bone. There is almost no spine. The second vertebra or axis has surmounting the body the odontoid process, with a facet in front for articulation with the atlas and one behind for the transverse ligament to move over. The seventh cervical vertebra or vertebra prominens has a very long spinous process—hence name—to which is attached the ligamentum nuchæ. It can be felt very distinctly on the living.

Running from the skull down through the spinal column into the sacral vertebræ and formed by the joining of the spinal foramina of the individual vertebræ is an opening called the spinal canal, which holds the cord. The cord, however, stops practically at the first lumbar vertebra, where it splits up into the cauda equina, only the filum terminate extending farther down.

Occasionally the laminæ do not form completely and the membranes of the cord may bulge out and form a tumor, or the cord itself may come out also. This generally occurs in the lumbar region, where it is known as spina bifida. If in case of fracture of a vertebra there is paralysis of the parts below due simply to the pressure of a fragment of bone upon the cord, it may be completely cured by removal of the fragment. If, however, the cord suffers injury, the paralysis will remain. Humpback or Pott’s disease is caused by the tubercle bacillus, which eats away the bodies of the vertebræ so that the column caves in and the spinous processes are thrown out in a hump or kyphos.

Fig. 34.—Muscles of the right side of the head and neck: 1, Frontalis; 2, superior auricular; 3, posterior auricular; 4, orbicularis palpebrarum; 5, pyramidalis nasi; 6, compressor naris; 7, levator labii superioris alæque nasi; 8, levator labii superioris; 9, zygomaticus major; 10, orbicularis oris; 11, depressor labii inferioris; 12, depressor anguli oris; 13, anterior belly of digastric; 14, mylohyoid; 15, hyoglossus; 16, stylohyoid; 17, posterior belly of digastric; 18, the masseter; 19, sternohyoid; 20, anterior belly of omohyoid; 21, thyrohyoid; 22, 23, lower and middle constrictors of pharynx; 24, sternomastoid; 25, 26, splenius; 27, levator scapulæ; 28, anterior scalenus; 29, posterior belly of omohyoid; 30, middle and posterior scalenus; 31, trapezius. (Dorland’s Dictionary.)

Muscles of the Neck.—Before speaking of the muscles of the back a few of those of the neck had best be taken up. They are numerous but mostly of minor importance. Largest and most important is the sterno-cleido-mastoid muscle, which has its origin on the upper part of the sternum and the inner third of the clavicle and is inserted into the mastoid process of the temporal bone. It passes obliquely across the side of the neck and serves to flex the head to the side and to draw the face in the opposite direction. When both muscles contract the head is flexed on the neck and the neck on the chest. In wry neck or torticollis this muscle is constantly contracted. The platysma myoides arises from the fascia over the pectoral, deltoid, and trapezius muscles and is inserted into the lower jaw, the angle of the mouth, and the loose tissue in the lower part of the face. It wrinkles the skin of the neck and depresses the lower jaw. In the cow and horse it is so highly developed that by it the skin can be contracted all over the body to drive off flies. The rectus capitis anticus major arises from the third to the sixth cervical vertebræ and is inserted into the occipital bone, serving to flex the head. The scalenus muscles have their origin on the lower cervical vertebræ and are inserted into the first and second ribs, thus aiding in the elevation of the ribs as well as in lateral flexion of the neck. The head is held upright by the ligamentum nuchæ, which rises from the external occipital protuberance and is inserted into the spinous processes of all the cervical vertebræ except the first.

Muscles of the Back.—The chief back muscles are the trapezius and the latissimus dorsi, which together cover in the back pretty thoroughly. The trapezius arises from the occipital bone, the ligamentum nuchæ, and the spinous processes of the seventh cervical and all the dorsal vertebræ and is inserted into the outer third of the clavicle or collar bone and the acromion process and spine of the scapula or shoulder blade. It is thus triangular in shape and covers in the neck and shoulders, serving to draw the head back and to the side. It overlaps the latissimus dorsi.

The latissimus dorsi has its origin by aponeurosis from the spinous processes of the six lower dorsal and all the lumbar and sacral vertebræ, from the crest of the ilium or hip bone, and from the three or four lower ribs, swings across the side, dwindling in size, and is inserted by a small tendon into the bicipital groove of the humerus or upper arm bone, thus covering in the part of the back not covered by the trapezius. It draws the arm down and back, raises the lower ribs, and draws the trunk forward, as in climbing. The flat muscles of the back and abdomen have a tendency to flatten out into aponeuroses, such as occurs in the origin of the latissimus dorsi.

The levator scapulæ, from the transverse processes of the upper cervical vertebræ to the posterior border of the scapula, serves to raise the angle of the scapula, and the rhomboideus major and minor, from the ligamentum nuchæ, the seventh cervical, and the upper dorsal vertebræ to the root of the spine of the scapula, draw the inferior angle back and up.

Fig. 35.—Muscles of the trunk from behind (left side, superficial; right side, deep): 1, Sternomastoid; 2, splenius; 3, trapezius; 4, latissimus dorsi; 5, infraspinatus; 6, teres minor; 7, teres major; 8, deltoid; 9, external oblique of abdomen; 10, gluteus medius; 11, gluteus maximus; 12, levator anguliscapulæ; 13, rhomboideus minor; 14, rhomboideus major; 15, part of longissimus dorsi; 16, tendons of insertion of iliocostalis; 17, supraspinatus; 18, infraspinatus; 19, teres minor; 20, teres major; 21, serratus magnus; 22, upper, and 22´, lower part of serratus posticus inferior; 23, internal oblique; 24, gluteus medius; 25, pyriformis and superior and inferior gemelli; 26, 26´, portions of obturator internus; 27, tendon of obturator internus; 28, quadratus femoris. (Dorland’s Dictionary.)

The blood supply in the cervical region and about the shoulders comes from branches of the subclavian artery, such as the suprascapular and the transversalis colli. Lower down the supply comes from the posterior branches of the intercostals, dorsal branches of the lumbar, and branches of the internal iliac.

The muscles of the back are supplied by the spinal nerves, the spinal accessory also going to the trapezius muscle.