Transcript Final spine

Spine
Prof. Saeed Abuel Makarem
• Spinal fractures are different than
a broken arm or leg.
• A fracture or dislocation of a
vertebra can cause bone
fragments that pinch or damage
the spinal nerves or even the
spinal cord.
• Most spinal fractures occur due to
• Car accidents,
• Falls,
• Gunshot, or
• Sports.
• Injuries can range from mild ligament
or muscle strains, to fractures and
dislocations of the vertebrae, and
debilitating spinal cord damage.
Spinal fractures
Prof. Saeed Abuel Makarem
• Depending on how severe
your injury is, you may
experience:
• Pain,
• Difficulty walking,
• Unable to move your arms
or legs (paralysis).
• Many fractures heal with
conservative treatment.
• However severe fractures
may require surgery.
• To understand spinal
fractures, it is helpful to
understand how your spine
are formed and works.
Spinal fractures
Prof. Saeed Abuel Makarem
SPINAL COLUMN
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The vertebral column is a complex
construct that includes a variety of:
Bones,
Joints,
Tendons,
Nerves,
Ligaments,
Muscles and
Vessels
All woven together.
The spines extends from the base of
the skull to the pelvis.
Ligaments, joints, muscles and
tendons connect the bones together
and keep them aligned.
Prof. Saeed Abuel Makarem
SPINAL COLUMN
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It is consists of 24 single vertebrae
and 2 bones,
•Sacrum and
•Coccyx, which made from fused
vertebrae.
Of the 24 single bones,
 7 vertebrae in the neck
(cervical),
 12 vertebrae in the chest
(thoracic), and
 5 supporting the lower back and
are called (lumbar).
Prof. Saeed Abuel Makarem
TYPICAL VERTEBRA
Body or Centrum:
 Anterior discoid,
weight-bearing part of
the vertebra.
And
 Vertebral arch:
2 pedicles and
2 Laminae.
They join together to
complete the arch.
 Vertebral foramen:
Between body and the
arch and contains the
spinal cord, ligament, fat
and blood vessels.
 One spinous process: single posterior projection
arising from the vertebral arch.
 2 Superior and 2 inferior articular processes:
paired projections allowing a vertebra to articulate with
adjacent vertebrae.
The arch carries 7
processes.
 2 Transverse
processes: two lateral
projections from the
vertebral arch.
Prof. Saeed Abuel Makarem
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VERTEBRA
Prof. Saeed Abuel Makarem
ATLAS & AXIS
The vertebrae in each region have
unique features that help them to
perform their main functions.
The 7 cervical vertebrae
(identified as C1 to C7).
The first two (atlas & axis)
are different because they
perform functions not shared
by the other cervical vertebrae.
 The neck has the greatest
range of motion because of
these 2 specialized vertebrae.
The atlas has no body. The superior surfaces of its 2 lateral masses contain
large kidney- shaped facet that articulate with the occipital condyles.
This joint allows you to nod- that is to say "yes." –Atlanto-occipital joint.
The axis acts as a pivot for the rotation of the atlas (and the skull above).
It has a large upright process, called the odontoid process, or dens, which
acts as the pivot joint.
The atlantoaxial joint allows you to rotate your head that is to say "no."
Prof. Saeed Abuel Makarem
 The "typical" cervical
vertebrae (C3 to C7)
are the smallest,
lightest vertebrae.
 Their spinous
processes are often
short and bifid, except
the 7th.
 Its transverse
processes contain
foramina through
which the vertebral
vessels pass.
 The main function of
the cervical spine is to
support the weight of
the head (about 10
pounds).
 Also, it is the most
movable region of the
spine.
TYPICAL CERVICAL VERTEBRAE
Prof. Saeed Abuel Makarem
THORACIC VERTEBRAE
• The 12 thoracic vertebrae
(T1 toT12) are larger than
the cervical vertebrae.
• The body is somewhat
heart-shaped and has two
costal demifacets on each
side, which receive the
heads of the ribs.
• The spinous process is
long and hooks sharply
downward.
• The range of motion in the
thoracic spine is limited.
Prof. Saeed Abuel Makarem
LUMBAR VERTEBRAE
• The 5 lumbar
vertebrae (L1-- L5)
have massive, block
like bodies.
• They have short,
hatchet-shaped
spinous processes.
• They are the most
solid of all vertebrae.
• Their main function is
to bear the weight of
the body.
• They also have a
moderate range of
movements.
Prof. Saeed Abuel Makarem
SACRUM
• The sacrum is formed of 5
fused vertebrae.
• It articulates with L5 above.
• And below with the coccyx.
• It also articulate with the
hip bones at the alae, to
form the sacroiliac joints.
Prof. Saeed Abuel Makarem
• The sacrum forms the
posterior wall of the pelvis.
• Its dorsal midline surface is
roughened by the median
sacral crest, (fused dorsal
spines).
• The median sacral crest is
flanked laterally by the
dorsal sacral foramina.
• The sacral canal is the
continuation of the
vertebral canal.
COCCYX
The coccyx is formed
of 3 to 5 (usually 4)
tiny, irregularly
shaped vertebrae.
Also called the
tailbone it provides
attachment for
ligaments and
muscles of the pelvic
floor.
Prof. Saeed Abuel Makarem
Intervertebral
Discs
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The vertebral bodies are separated by
pads of flexible fibrocartilage called
intervertebral discs.
• The discs looks like a jelly doughnut
• There are a total of 23 discs in the
spinal column.
• There are no discs between the Atlas
& Axis and Sacrum & Coccyx.
• The intervertebral discs forms about
one fourth of the whole length of the
spinal column.
Its primary function:
1. It act as a shock absorber between 2
adjacent vertebrae.
2. It also acts as a cartilaginous joints
that allow for slight mobility.
3. It also acts as ligaments that hold the
vertebrae together.
• Intervertebral discs are avascular and
receive its nutrition from the vertebral
Prof. Saeed Abuel Makarem
end plates.
Intervertebral
Discs
Prof. Saeed Abuel Makarem
 The intervertebral discs are
formed of an outer annulus
fibrosus and an inner soft, jellylike material (nucleus pulposus).
 The annulus fibrosus is a strong
radial tire–like structure made up
of concentric lamellae of collagen
fibers connected to the vertebral
end plates.
 The nucleus pulposus contains a
mucoprotein gel–like material that
is sealed by the annulus fibrosus.
 The nucleus pulposus needs to be
well-hydrated in order to maintain
its strength and softness.
 It serve as the major carrier of the
body’s axial load that resists
compression.
Intervertebral Discs
Prof. Saeed Abuel Makarem
• Both the annulus fibrosus and
nucleus pulposus are composed of:
1. Water,
2. Collagen, and
3. Proteoglycans (PGs).
• The amount of fluid (water & PGs)
is greatest in the nucleus pulposus.
• PG molecules are important as
they can attract and retain water in
the discs.
• The amount of water in the nucleus
varies throughout the day
depending on the body activity.
• Unfortunately, the amount of
water becomes less by old age.
Intervertebral Discs
• The vertebral discs in the
spine is an interesting and
unique structure.
• The nucleus acts like a ballbearing when you move,
allowing the vertebral
bodies to roll over the
incompressible gel.
• The gel-filled nucleus is
composed mostly of fluid.
• This fluid absorbed during
the night as you lie down
and is pushed out during
the day as you move
upright.
Prof. Saeed Abuel Makarem
HERNIATED DISC
• With age, our discs increasingly
lose the ability to reabsorb fluid
and become brittle and flatter.
• This is why we get shorter as
we grow older.
• Also diseases, such as
osteoarthritis & osteoporosis,
can cause bone spurs
(osteophytes) to grow.
• Injury and strain can cause the
nucleus to herniate, out of the
annulus and compresses the
nerve roots causing back pain.
Prof. Saeed Abuel Makarem
• The herniated disc is
usually prevented to
herniate posteriorly
because of the
presence of the
posterior longitudinal
ligament,(PLL).
• Herniation is mostly
posterolateral.
• So disk herniation
impinge on a spinal
nerves rather than on
the spinal cord itself!
HERNIATED DISC
Prof. Saeed Abuel Makarem
Curvatures
• The S-shaped curves of the vertebral column
work together with the discs to prevent shock
to the head when we walk or run.
• They also make the body trunk flexible.
• Curves act like a coiled spring to absorb
shock, maintain balance, and allow range of
motion throughout the spinal column.
• The spinal curves in the thoracic and sacral
regions are referred to as primary curves as
they are present when we are born.
• Later, the secondary curves develop.
• The cervical curve appears by the 6th month,
when the baby begins to set and hold his
head.
• While the lumbar curve develops by the end
of the 1st year, when the baby begins to walk.
Prof. Saeed Abuel Makarem.
Muscles and Posture
• Muscles and correct posture
maintain the natural spinal
curves.
• Good posture involves training
your body:
• To stand up,
• To walk,
• To sit,
• To lie down, and
• To carry weight.
• So that the least amount of strain
are placed on the spine during
movement or weight-bearing
activities.
• Excess body weight, big
abdominal belly, weak muscles,
and other factors can affect the
spinal alignment.
Prof. Saeed Abuel Makarem
Spine
• It is important to know
that:
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Strong Bones
Strong Muscles,
Flexible Tendons,
Flexible Ligaments &
Sensitive Nerves.
All Contribute to a healthy
spine.
• Keeping your spine healthy is
vital if you want to live an
active life without back pain.
Prof. Saeed Abuel Makarem
Abnormal Spinal Curves
• An icreased
curvature of the
thoracic spine is
called kyphosis,
or hunch back.
• An abnormal
curve of the
lumbar spine is
called lordosis,
or sway back.
• An abnormal
curve from sideto-side is called
scoliosis.
Kyphosis
Prof. Saeed Abuel Makarem
Lordosis
Scoliosis
Muscles
 Two main muscle
groups that affect
the spine are
extensors and
flexors.
 Extensor muscles
enable us to stand
up & lift objects.
 Extensors are
attached to the
back of the spine.
Flexor are in the front and
include the abdominal
muscles.
These muscles enable us to
flex, or bend forward, and are
important in lifting and
controlling the arch in the
lower back.
Prof. Saeed Abuel Makarem
MUSCLES OF THE BACK
• Most of the body weight lies anterior to the
spinal column.
• So the axis of gravity descends anterior to the
vertebral column, knee and ankle.
• The deep muscles of the back are important in
maintaining the spinal alignment and the
normal postural curves of the spinal column in
the standing position.
• There are 3 groups of muscles in the back:
– Superficial muscles associated with the
shoulder girdle.
– Intermediate muscles involved in
respiration.
– Deep muscles belonging to the spinal
column.
SUPERFICIAL
MUSCLES
The superficial muscles
belong to the upper
limb.
These are:
• Trapezius
• Latissimus dorsi
• Levator scapulae
• Rhomboids minor
• Rhomboids major
INTERMEDIATE
MUSCLES
The intermediate
muscles are associated
with respiration.
These are:
• Serratus posterior
superior.
• Serratus posterior
inferior.
• Levatores costarum.
DEEP MUSCLES
• The deep muscles of the back form a deep, broad muscular column, which
occupies the hollow on each side of the spinous processes.
• They extend from the sacrum to the skull.
• This muscle mass is composed from many small muscles of different length.
• Each individual muscle causes one or several vertebrae to be extended or
rotated on the vertebra below.
CLASSIFICATION OF THE DEEP
MUSCLES OF THE BACK
• Superficial vertically running muscles:
– Erector spinae
• Iliocostalis
• Longissimus
• Spinalis
• Intermediate oblique running muscles:
– Transversospinalis
• Semispinalis
• Multifidus
• Rotatores
• Deepest muscles
– Interspinalis
– Intertransversarii
BLOOD AND NERVE
SUPPLY
• Arterial supply:
Dorsal branches of
the posterior
intercostal arteries.
• Venous drainage:
Posterior
intercostal veins.
• Nerve supply:
Posterior rami of
the spinal nerves
Misalignment
• Back muscles stabilize your spine.
• Poor muscle tone or a large belly can pull your
entire body out of alignment.
• Misalignment puts incredible strain on the spine.
Facet joints
• The facet joints of the
spine allow spinal
motion.
• Each vertebra has
four facet joints,
• One pair that
connects to the
vertebra above
(superior facets)
• One pair that
connects to the
vertebra below
(inferior facets).
Prof. Saeed Abuel Makarem
Ligaments
• The ligaments are strong fibrous
bands that hold the vertebrae
together, stabilize the spine, and
protect the discs.
• The three major ligaments of the
spine are:
• Anterior longitudinal ligament (ALL),
• Posterior longitudinal ligament (PLL).
• The ALL and PLL are continuous bands
that run from the top to the bottom
of the spinal column along the
vertebral bodies.
• They prevent excessive movement of
the vertebrae, and hold the vertebral
bodies and discs together.
• Ligamentum flavum,
• The ligamentum flavum attaches
between the lamina of all vertebrae.
Prof. Saeed Abuel Makarem
What Types of Vertebral Injuries May Occur?
• The two main types of injuries to
the spinal bones (vertebrae) are
fractures and dislocations.
• A fracture is a break to any part
of the vertebra.
• A dislocation is when the
vertebrae do not line up
correctly or are out of place.
• These injuries may cause
damage to the spinal nerves or
the spinal cord.
• There are several types of
fractures and dislocations that
can occur.
Prof. Saeed Abuel Makarem
Compression fracture
• This usually results
from a hyperflexion
(front to back) injury
where part of the
vertebral column is
forced forward and
downward.
Prof. Saeed Abuel Makarem
Burst Fracture
• A burst fracture is a very
serious form of compression
fracture.
• In this type the bone is
shattered from the injury.
• Bone fragments may pierce
the spinal cord.
• The injury usually occurs
from a downward or upward
force along the spine.
• It is often result in serious
spinal cord injury.
Prof. Saeed Abuel Makarem
Subluxation
• In subluxation, the
joints in the back of the
vertebrae are weakened
by abnormal movement
of the bones.
• It is a partial dislocation
of the vertebrae.
• It happens if the
muscles and ligaments
in the spine are injured.
• It may also cause injury
to the spinal cord.
Prof. Saeed Abuel Makarem
• A dislocation also may occur when
ligaments are badly stretched from
the injury.
• This allows too much movement of
the vertebrae.
• The vertebrae may "lock" over each
other on one or both sides.
• A spinal cord injury may occur,
depending on how much extra
movement is allowed by the torn
ligaments.
• The vertebrae that are not lined up
correctly are returned to a normal
position by a "reduction". Traction or
surgery is often required for a
reduction.
• A brace, vest, or surgery to fuse the
vertebrae is sometimes needed to
keep the vertebrae lined up
correctly.
Dislocation
Prof. Saeed Abuel Makarem
Fracture- Dislocation
• This occurs when
there is a fracture
and a dislocation
of the vertebrae.
• There is usually
serious ligament
and soft tissue
injury and this may
also cause injury
to the spinal cord
Prof. Saeed Abuel Makarem