Chapter VI: The Back

=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.

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.

=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.

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.