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  <head>
    <title>076-01 Back, vertebral column, spinal canal, and axial support</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Back, vertebral column, and spinal canal">
      <outline text="Axial role of the back">
        <outline text="Mobile protective column linking skull, thorax, pelvis, limbs"/>
        <outline text="Balances stability, flexibility, load, neural protection">
          <outline text="Small changes affect pain, movement, nerves, mechanics"/>
        </outline>
      </outline>
      <outline text="Vertebral column by region">
        <outline text="Typical vertebra: anterior body, posterior arch">
          <outline text="Stacked vertebral foramina form the canal"/>
          <outline text="Pedicle notches form intervertebral foramina"/>
        </outline>
        <outline text="Cervical: small bodies, transverse foramina">
          <outline text="Vertebral artery usually enters at the sixth level"/>
          <outline text="Atlas lacks a body, supports occipital condyles"/>
          <outline text="Axis dens is the pivot for atlas rotation"/>
        </outline>
        <outline text="Thoracic: rib facets, coronal-oriented facets">
          <outline text="Favour rotation, limit flexion and extension"/>
        </outline>
        <outline text="Lumbar: large bodies, sagittal-oriented facets">
          <outline text="Permit flexion and extension, resist rotation"/>
        </outline>
        <outline text="Sacrum: five fused vertebrae">
          <outline text="Passes axial load to pelvic ring via sacroiliac joints"/>
        </outline>
        <outline text="Coccyx anchors pelvic-floor structures"/>
      </outline>
      <outline text="Curves and load transmission">
        <outline text="Primary kyphoses reflect fetal flexion"/>
        <outline text="Secondary lordoses develop with head lifting and standing"/>
        <outline text="Curves distribute load and add resilience">
          <outline text="Deviations judged against age and symptoms"/>
        </outline>
        <outline text="Bodies enlarge inferiorly as cumulative load rises"/>
        <outline text="Lumbosacral angle creates anterior shear">
          <outline text="Resisted by facets, discs, ligaments, muscle"/>
        </outline>
        <outline text="Sitting loads ischial tuberosities, standing acetabula"/>
        <outline text="Scoliosis: lateral curve with vertebral rotation">
          <outline text="Rib prominence from thoracic rotation"/>
          <outline text="Structural persists, functional may correct"/>
        </outline>
      </outline>
      <outline text="Discs and joints">
        <outline text="Annulus lamellae resist torsion and tension"/>
        <outline text="Nucleus distributes compression by hydrostatic pressure"/>
        <outline text="Largely avascular disc fed through endplates"/>
        <outline text="Imaging degeneration is common without pain"/>
        <outline text="Posterolateral herniation where PLL is weaker">
          <outline text="Can affect a traversing nerve root"/>
        </outline>
        <outline text="Facet orientation guides and limits movement"/>
        <outline text="Uncovertebral osteophytes can narrow foramina"/>
        <outline text="Atlanto-axial joints permit rotation">
          <outline text="Transverse ligament holds dens to atlas"/>
          <outline text="Disruption threatens the upper cord"/>
        </outline>
      </outline>
      <outline text="Spinal ligaments">
        <outline text="Anterior longitudinal ligament limits extension"/>
        <outline text="Posterior longitudinal ligament limits flexion"/>
        <outline text="Ligamenta flava recoil from flexion, prevent buckling"/>
        <outline text="Supraspinous ligament expands into ligamentum nuchae"/>
        <outline text="Passive stability and mechanosensory input">
          <outline text="Can calcify, thicken, tear, or become lax"/>
        </outline>
      </outline>
      <outline text="Spinal canal and coverings">
        <outline text="Cord ends near L1 or L2 as conus medullaris">
          <outline text="Cauda equina descends within the dural sac"/>
          <outline text="Filum terminale anchors cord and dura"/>
        </outline>
        <outline text="Spinal nerves split into dorsal and ventral rami">
          <outline text="Dorsal rami supply intrinsic back structures"/>
          <outline text="Ventral rami supply anterolateral trunk and limbs"/>
        </outline>
        <outline text="Meninges: pia, arachnoid, dura">
          <outline text="Epidural fat and internal vertebral venous plexus"/>
          <outline text="Denticulate ligaments stabilise the cord"/>
        </outline>
        <outline text="One anterior, two posterior spinal arteries">
          <outline text="Anterior territory covers much of anterior two-thirds"/>
          <outline text="Vulnerable in aortic disease or surgery"/>
          <outline text="Great medullary artery varies in side and level"/>
        </outline>
        <outline text="Lumbar puncture below usual cord termination">
          <outline text="Needle crosses ligaments, epidural space, dura"/>
        </outline>
      </outline>
      <outline text="Back muscles">
        <outline text="Extrinsic superficial: trapezius, latissimus dorsi"/>
        <outline text="Intermediate serratus posterior: ribs, respiration"/>
        <outline text="Intrinsic deep muscles supplied by dorsal rami">
          <outline text="Erector spinae: iliocostalis, longissimus, spinalis"/>
          <outline text="Transversospinalis: semispinalis, multifidus, rotatores"/>
          <outline text="Suboccipital muscles fine-tune head movement"/>
        </outline>
        <outline text="Stability is dynamic coordination">
          <outline text="Multifidus and abdominal wall add segmental stiffness"/>
          <outline text="Diaphragm and pelvic floor regulate pressure"/>
        </outline>
      </outline>
      <outline text="Anatomical syndromes">
        <outline text="Radiculopathy follows nerve-root irritation">
          <outline text="Dermatome and myotome overlap make patterns approximate"/>
        </outline>
        <outline text="Cervical or thoracic stenosis causes myelopathy">
          <outline text="Upper motor-neuron signs below the lesion"/>
        </outline>
        <outline text="Lumbar stenosis: claudication relieved by flexion"/>
        <outline text="Cauda equina: saddle loss, bladder, bowel">
          <outline text="Urgent localisation and decompression assessment"/>
        </outline>
        <outline text="Visible degeneration does not prove the pain generator"/>
      </outline>
    </outline>
  </body>
</opml>
