Transcript Anatomy of Cervical Spine and Intervertebral Disc Repair

REVIEW OF ANATOMY OF
SPINE UNDERLYING
INTERVERTEBRAL DISC
REPAIR
CERVICAL SPINE IS
NOSE
CERVICAL
SPINE
LOCATED IN CENTER
ISOF
LOCATED
IN
NECK
CENTER
OF NECK
SURROUNDED
BY
SURROUNDED
BY
MANY STRUCTURES
THAT STRUCTURES
ARE
MANY
ESSENTIAL,
SMALL
THAT
ARE ESSENTIAL,
AND READILY
SMALL
AND FRAGILE
DAMAGED
BODY OF
CERVICALVERTEBRA
INTERVERTEBRAL
DISC
THESE SLIDES
REVIEW THE
ANATOMY OF
VERTEBRAE,
STRUCTURE OF THE
NECK AND SPINAL
CORD TO
APPRECIATE THE
TECHNIQUE OF
CERVICAL DISC
REPAIR
ANATOMY OF TYPICAL VERTEBRA
1. BODY – anterior, solid transmits weight
2. VERTEBRAL ARCH – posterior, surrounds vertebral canal, spinal
cord; consists of a) PEDICLES – project from body
b) LAMINAE – unite to form arch posteriorly
anterior
NOSE
BODY
{
VERTEBRAL
ARCH
PEDICLE
LAMINA
TRANSVERSE
PROCESSLATERAL
SPINOUS PROCESS POSTERIOR
3. TRANSVERSE AND SPINOUS PROCESSES - projections
from arch for muscle, ligament attach
LATERAL VIEW OF VERTEBRA
JOINTS
BETWEEN
VERTEBRAE
PERMIT
MOVEMENTS
HOWEVER,
CAN
POTENTIALLY
DAMAGE
SPINAL
NERVES
1. Location of
Intervertebral
Discs between
bodies
NOSE
Sup. Vertebral Notch
Inf. Vertebral Notch
2. Spinal nerves leave
vertebral canal via
INTERVERTEBRAL
FORAMINA - between
vertebrae;
bordered by – Superior
and Inferior Vertebral
Notches
VERTEBRA IN DIFFERENT REGIONS ARE SPECIALIZED
Cervical (neck) - 7 vertebrae (C1-C7)
Thoracic (chest) - 12 vertebrae (T1-T12)
Lumbar (lower back) - 5 vertebrae (L1-L5)
Sacral (pelvis) - 5 fused vertebrae (S1-S5)
Coccygeal (tail) - 3-5 vertebrae (Co1-Co3)
Vertebral column functions like structural
support column
Most weight is supported at base of column
(lumbar and sacral vertebrae are large)
Cervical vertebrae are relatively small
NOSE
CERVICAL VERTEBRA - small and highly mobile
BODY
ant.
– body is small
Foramen Transversarium - in
transverse process (C1-C7) for
Vertebral artery & veins
TRANSVERSE
PROCESS
post.
SPINOUS PROCESS – bifid (divided) for Ligamentum nuchae
lat.
view
ARTICULAR FACETS
- angled superiorly &
medially - PERMIT
CONSIDERABLE
MOVEMENT
VERTEBRAE ARE STABILIZE BY
BEING LINKED BY LIGAMENTS,
INTERVERTEBRAL DISCS
1. ANTERIOR
LONGITUDINAL
LIGAMENT Strong band joins
bodies on anterior
side
Adjacent vertebrae held tightly
together (protect spinal cord)
Anterior view
VIEW FROM INSIDE VERTEBRAL
COLUMN
On post. Side of bodies
LOOK
ANTERIOR
LOOK
POSTERIOR
2. POSTERIOR
LONGITUDINAL LIGAMENTweaker, narrower band on
posterior side of bodies
3. LIGAMENTA FLAVA yellow elastic bands
connecting laminae
STRUCTURE/
FUNCTION OF
INTERVERTEBRAL
DISC
Intervertebral discs function as shock absorbers; there are strong
but undergo degeneration with age (begins at about age 20)
a) Nucleus
pulposusinner
gelatinous
core
b) Anulus fibrosus collagen fibers &
fibrocartilage
MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK
ANTERIOR
POSTERIOR
HERNIATION
OF
NUCLEUS
PULPOSUS
DAMAGE TO INTERVERTEBRAL DISCS
Posterolateral post
POSTERIOR
LONGITUDINAL
LIGAMENT
lateral
ANTERIOR
LONGITUDINAL LIGAMENT
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal
Ligament (Anterior Longitudinal Ligament is broad and strong)
Disc herniation can lead to nerve compression at intervertebral
foramen
DAMAGE TO CERVICAL INTERVERTEBRAL
DISCS CAN PRODUCE SYMPTOMS IN UPPER
EXTREMITY
Ventral rami of
spinal nerves:
C5
LOWER
CERVICAL
SPINAL NERVES
FORM
BRACHIAL
PLEXUS
C6
C7
C8
T1
DAMAGE TO SPINAL NERVES CAN PRODUCE SENSORY AND MOTOR LOSS
SENSORY LOSS - DERMATOME MAP
THUMB = C6
LITTLE FINGER
= C8
Dermatomes of upper
extremity:
C6 - thumb
C7 - middle finger
C8 - little finger
Questions: What is the level of a herniated disc that would produce
numbness of thumb? Little finger?
NUMBERING OF CERVICAL SPINAL NERVES
LEVELS
OF SPINAL
NERVES
Cervical
(C1-C8)
CONVENTION FOR
NAMING LEVELS
Thoracic
(T1-T12)
Lumbar
(L1-L5)
Sacral
(S1-S5)
Coccygeal
(Co1)
Spinal
nerves
C1-C7
above
vertebra
C8
and
all
others
below
vertebra
Spinal nerves - arise
from/project to
spinal cord; there are
31 spinal nerves (8
cervical, 12 thoracic, 5
lumbar, 5 sacral and 1
coccygeal).
Note: Cervical spinal
nerves 1-7 (C1-C7)
exit above
corresponding
vertebrae; Spinal
nerve C8 exits below
vertebra C7; All other
spinal nerves exit
below corresponding
vertebrae.
SPINAL NERVE C6 ARISES ABOVE VERTEBRA C6
TESTING OF SPINAL
NERVE DAMAGE STRETCH REFLEXES
CLINICAL TESTING OF STRETCH
REFLEX: TENDON TAP
1- Tendon tap elicits twitch
because it excites almost all muscle
spindles simultaneously
2- Use stretch reflexes to test nerve
function at different spinal levels
Ia sensory
neuron
TENDON
TAP
Alpha
motor
neuron
REFLEXES USED FOR CLINICAL TESTS
Nerve compressions can produce reduced spinal reflexes; also
muscle weakness
NECK CONTAINS A NUMBER OF VITAL STRUCTURES
SPINAL
CORD
TRACHEA
COMMON
CAROTID
ARTERY
INTERNAL JUGULAR
VEIN
ESOPHAGUS
INTERVERTEBRAL
DISC
ANATOMY OF NECK: NECK IS COMPARTMENTALIZED
1. Posterior Compartment Vertebrae and muscles
which support and move
head & neck
Plane of section
ANT.
LAT.
2. Anterior CompartmentViscera and rostral
continuation GI &
Respiratory Systems
3. Lateral CompartmentBlood vessels & nerve
POST.
HORIZONTAL SECTION THROUGH NECK: NOTE VERTEBRAE ARE IN
CENTER OF NECK
Plane of section
N
O
S
E
LOCATION OF STRUCTURES IN NECK:
COMPARTMENTALIZED BY FASCIA
Carotid
Sheath
Pretracheal
layer
Prevertebral Layer- surrounds
vert. column & muscles back of
neck, prevertebral, lateral
vertebral and suboccipital m.
Pretracheal Layer- surrounds
trachea, esophag. & thyroid
continues to mediastinum
Carotid Sheath- surrounds
common & int carotid, int jugular
and X (not: Symp. Chain)
LOCATION OF INTERVERTEBRAL
DISC
Prevertebral layer
DISCS ARE POSTERIOR TO PREVERTEBRAL MUSCLES
ACT - FLEX NECK/HEAD
INN - CERVICAL VENTRAL RAMI
2. Longus capitis
O - Trans processes C3-C6
I - Occipital bone
1. Longus colli muscle O- Trans processes Lower
cervical vertebrae
I - Bodies upper cervical
vertebrae
Colli = neck in Latin
View of anterior side of Cervical Vertebrae
with structures of Anterior and Lateral
Compartments removed
HOW
IS
DAMAGE
TO
CERVICAL
INTERVERTEBRAL
DISC
REPAIRED?
SEE
DR.
LECLERCQ'S
LECTURE
INTERVERTEBRAL
DISC