dissa_s spine lecture
TRANSCRIPT
-
8/10/2019 Dissa_s Spine Lecture
1/17
7/05/2
Griffith School of Medicine
Anatomy of the SpineDr. Lakal Dissabandara
Presented on 13/04/2010
Griffith School of Medicine
Copyright
Copyright Griffith University
Griffith University claims copyright ownership of all material in this online teaching material unless expressly statedotherwise. No part of the program nor the material contained in it may be copied (except as allowed by the copyrightlaw of your country) or further disseminated without the express and written permission of Griffith University.
To seek copyright permission, email: [email protected]
COMMONWEALTH OF AUSTRALIA
Copyright Regulations 1969
WARNING
This material has been reproduced and communicated to you by or on behalf of Griffith Universitypursuant to Part VB of the Copyright Act 1968 (the Act).
The material in this communication may be subject to copyright under the Act. Any further reproductionor communication of this material by you may be the subject of copyright protection under the Act.
Do not remove this notice.
-
8/10/2019 Dissa_s Spine Lecture
2/17
7/05/2
Functions of the Spine
Support upright position of the trunk and the
cranium
Transmission of weight of the trunk to the
inferior extremities/shock absorption
Provides articular surfaces for the attachment
of the ribs/muscles
Protection of the spinal cord
Haemopoisis
Parts of Vertebra
-
8/10/2019 Dissa_s Spine Lecture
3/17
7/05/2
Types of Vertebrae
Cervical transverse foramina
for the vertebral artery, bifid
spine
Thoracic Articular demi
facets for ribs on the body and
transverse processes
Lumbar large vertebral
bodies for wt bearing, straight
spine
Inter-vertebral Joints
Two types Anterior IV joint (Between the vertebral bodies
Symphyses) allow slight movement in all directions Reinforced by the anterior and posterior longitudinal
ligaments Weight bearing and shock absorption
Initially nucleus pulposus absorb the force andthen transmitted to annulus
Posterior IV joint - Facet joints (Zygapophyseal)
Synovial Normal synovial joint structureAllow gliding movements
Thoracic spine has joints with ribs
-
8/10/2019 Dissa_s Spine Lecture
4/17
7/05/2
Inter Vertebral Disc
Parts
Annulus fibrosus fibrocartilageconsisting of concentric lamellae ofCollagen (65% water)
Outer margin is tightly attachedto the vertebra
Nucleus Pulposus jeatinousProteoglycans and some Collagen(80% water)
Secreted by cells in the annulus
Proteoglycans responsible forthe strength and pliability
End plates
A hyaline cartilageAttached to the disc tightly, and
loosely to the vertebral body
Important for vertical growth ofIVD.
Annulus facilitate torsional movements
IVD s account for 25% of height of spine
IVD s are also supported by ALL and PLL of spine.
-
8/10/2019 Dissa_s Spine Lecture
5/17
7/05/2
Ligaments
Anterior longitudinal lig.
Posterior longitudinal lig.
Ligamentum flavum lig.
Supraspinous lig. Ligamentum Nuchae in Cervicalspine
Interspinous lig.
Intertransverse lig.
Facet capsular lig.
Supports
IVD as well
http://www.hkeducationcenter.com/courses/OEC_Previews/hf-ft101ue_preview/images/Fig_28.png
-
8/10/2019 Dissa_s Spine Lecture
6/17
7/05/2
Curves of the spine
Primary curvature At birth the spine is concave
forwards
Secondary curvatures
With lifting of head forward convexity of cervical
spine
With standing forward convexity of lumbar spine
2ry curvatures are primarily due to the shape of the
IVD s.
Curvatures increase the shock absorbing capacity and facilitate stability &
equilibrium of spine
(Resistance of a system of column = number of curvature2+ 1)
http://www.emory.edu/back.html
Kyphosis
Increased forward
concavity
Scoliosis
Sideward deviation
Increased Lordosis
Increased forward
Convexity of L spine
Normal Curvatures Abnormal Curvatures
1ry forward
concavity
2ry cervicalforward convexity
2ry Lumbar
forwardconvexity
-
8/10/2019 Dissa_s Spine Lecture
7/17
7/05/2
Movements
AIVJ restricts movements & the ligaments restrict movements
Cervical
Very mobile tall IVD s, smaller bodies, morphology of C1 &C2
Flexion, extension, lateral flexion, rotation
Thoracic
Rotation
Other movements are restricted
Presence of ribs
IVD s are thin
Long spines
Orientation of facets
Lumbar
Flexion & extension
Direction of articular facets makes rotation difficult
Flexion/Extension Yes
Rotation No
Transverse Lig
Alar Lig
-
8/10/2019 Dissa_s Spine Lecture
8/17
7/05/2
Lumbar vertebra
`
`Thoracic vertebra
Articular facets more
in a sagittal plain
Limit Rotation
Articular facets more in
a coronal plain
Rotation possible
ExtrinsicBack
Muscles
Trapezius
Rhomboids major
Rhomboids minor
Levator scapulae
Latissimus dorsi
Back Muscles
Prevertebral muscles
Scalenes - Cervical region
Psoas/Quadratus lumborum
Anterior abdominal muscles
Muscles moving vertebral column
Superficial
Erector spinae
- Illiocostalis
- Longissimus
- Spinalis
Splenius
(Vertical)
Intermediate
(Transversospin
ales)
Rotators
Multifidus
Semispinales
Deep
Interspinales
Intertransversales
Intrinsic Back Muscles
-
8/10/2019 Dissa_s Spine Lecture
9/17
7/05/2
Superficial Back Muscles
Trapezius
Latissimus dorsi
Rhomoboids major
Rhomoboids minor
Thoracolumbar fascia
Serratus
posterior
superior
/inferior
How are these
muscles innervated?
Intrinsic Back Muscles
-
8/10/2019 Dissa_s Spine Lecture
10/17
7/05/2
Back Pain
Mechanical due to injury of constituents of spine(bones, ligaments or muscles)
Usually localized
SLRT Negative**** ????
Inflammatory
IVD prolapse/narrowing of IV foramen
Can cause nerve root compression
Radiating pain
+ ve SLRT/femoral stretch test Neurological signs
Sensory Innervation of Vertebral column
All the ligaments,
facet joints, IVD
are richly
innervated.
Sympathetic
visceral sensory
fibres also
important for the
innervation -
Annulus
Back pain may occur due to pathology of any of these structures or due to
referred pain from viscera pancreas, kidneys
-
8/10/2019 Dissa_s Spine Lecture
11/17
7/05/2
Straight Leg Raising Test
Facet joints
SI joint
Muscle tightness
Hip joint pain
Roots become
increasingly tensed
Start applying tension
on Roots
No further deformation
of roots beyond this
point
No tension on roots
-
8/10/2019 Dissa_s Spine Lecture
12/17
7/05/2
Pain may be exacerbated by movements that transmit pressure to the nerve root
through the subarachnoid space (eg, moving the spine, coughing, sneezing, doing the
Valsalva maneuver). Lesions of the cauda equina, which affect multiple lumbar and
sacral roots, cause radicular symptoms in both legs and may impair sphincter and
sexual function.
Griffith School of Medicine
Femoral stretch test
Tests irritation of L2,3,4
roots
Patient feels pain on
anterior thigh
-
8/10/2019 Dissa_s Spine Lecture
13/17
7/05/2
IV Disc Prolapse
If the pressure on nucleus pulposus cannot be resistedby the anulus, it will give away, releasing the nucleusfree impinge on nerve roots
3 stages BulgingProtrusionSequestration
Common at regional junctions where more movablespine and relatively less mobile spine meets
Cervico thoracic
Lumbosacral
Sensory, Motor, Reflex testing would help to localizethe lesion
Compressed nerve root can be made to stretch bydoing SLRT/FST which elicit pain
Anatomy of IV Disc
L4-5
Exiting root L4
Traversing root L5
Nerve roots of thecal sac
PLL
Lamina
Think about thedermatomes, myotomes
and otherimportant
structures (eg.sphinctors)
innervated by these roots.Chirogeek.com
-
8/10/2019 Dissa_s Spine Lecture
14/17
7/05/2
Bulging of the disc
For disc herniation to occur, the disc must degenerate first. Drying of theannulus makes it brittle and unable to retain the bulging nucleus.
Note the PLL (Blue), redened nerve roots supplying annulus (one cause
of back pain).
Chirogeek.com
Protrusion
The nuclear material is pressing on PLL and its bulging out now
(Still connected to main mass of NP). Note the resultant Pressure
on L4, L5, S1 (become inflamed).
Extrusion
-
8/10/2019 Dissa_s Spine Lecture
15/17
7/05/2
A portion of nuclear material (blue star) detached from the main mass.
Now more compression on traversing root (white star) and exiting root
(green star).
Also note compression of thecal sac by sequestered nuclear material.
Which nerve roots can be compressed by this? (refer to the fig 1)
What would be the effect?
Sequestration
Chirogeek.com
Distribution of radicular painS1
L5
L4
Note the red areas
Chirogeek.com
-
8/10/2019 Dissa_s Spine Lecture
16/17
7/05/2
Thoracolumbar fascia
Functions Stabilization ofspine
Help transfer ofload throughdifferent musclegroups
Attachment ofmuscles
Limit flexion
Surface Anatomy
C7
T3
T8
L4-5
Pos sup iliac
spine S2
Sacral Hiatus
Posterior Sup Iliac spine and sacral hiatus form and equilateral triangle
Surface Anatomy
-
8/10/2019 Dissa_s Spine Lecture
17/17