1. The Spine
Macaire Grobe, Katherine Callahan, Sophia Powell, Bin Chen, and Theo DiPauli

2. Evolution of the Human Spine
The structure of the spine has changed significantly over the course of millions of years of evolution.
Notochords in the first vertebrae
The development of the spinal cord
Transition for humans to walk upright

3. Walking Upright Bone and Joint Adaptions: Spine Adaptions:
Ability to lock our legs
Inward thigh bones
Arched foot
Gluteal Abductor
Spine Adaptions:
Curved structure of the spine
Foramen Magnum

4. Embryonic Development
Spine starts to form during 4th week of embryonic development
Notochord: Sclerotome have loosely and densely packed cells. Notochord expands to form the nucleus pulposus, which is later surrounded by circular fibers of the annulus fibrosis.
Neural Tube: Mesenchymal cells here forms the vertebral arch.
Body Wall: Mesenchymal Cells form the costal processes which develop into ribs in the thoracic region.
Chondrification: The centers in the vertebral arches fuse with each other and the centrum
The spinous and transverse processes develop from extensions of chondrification centers in the vertebral arch

5. Embryonic Development
Mesenchymal cells from the sclerotome of the somites start to form in three main areas: notochord, neural tube, and body wall
In the 6th week, chondrification occurs

6. Curvature of the Spine
Primary Curve: shaped like a C
Secondary Curve: Cervical Spine develops
Final Curve: lumbar spine develops

7. Biomechanics of Spinal Injuries
The spine shares a similar structure to a flexible segmented column.
Offers strong support
Prone to various kinds of injuries
Fractures of the spine can be classified by:
Causal Movement
Location
Shape
Severity

8. Classifications of Fractures:
Three Column Concept
Major and Minor Fractures
Stable vs. Unstable
Specific Fracture Types:
Compression
Flexion
Burst
Dislocation
Three Column Concept
Major and Minor Fractures

9. Classifications of Fractures:
Stable vs. Unstable
Specific Fracture Types

10. Spinal Cord Injury: What is spinal cord injury? Why is it significant?
A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection.
Why is it significant?
The spinal cord is incapable of healing itself.
Complete spinal cord injury: cannot send signals below the level of injury.
Incomplete spinal cord injury: some movement and sensation below the injury.

11. Spinal Cord Injury: Causes:
The most common cause of spinal cord injury is trauma.
Types of trauma include: falls from heights, violence (stabbing or gunshot wounds to the spine), or sporting injuries (diving, football, rugby, equestrian, etc.)
Spinal cord injury can also be caused by compression of the cord by a tumor, infection, or inflammation.
Spinal stenosis
Types of trauma include: falls from heights, violence (stabbing or gunshot wounds to the spine), or sporting injuries (diving, football, rugby, equestrian, etc.)

12. Conditions that affect the spinal cord:
Tumors
Infections such as meningitis and polio
Inflammatory diseases
Autoimmune diseases
Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy

13. Diseases of the Spinal Cord:
Meningitis
Polio
Amyotrophic lateral sclerosis (ALS)
Spinal muscular atrophy (SMA)

14. Spine Treatment Level 1: Mobilization and Physical Therapy
Level 2: Immobilization, Braces
Level 3: Spinal Surgery; Fusion, Disk Implants

15. Level 1: Mobilization and Physical Therapy
Two components:
Passive physical therapy (heat/ice packs, ultrasound)
Active Exercises (stretching)
Manual physical therapy:
Restore mobility
Reduce muscle tension

16. Level 2: Immobilization, Braces
Spinal bracing used for treatment of:
low back pain
trauma
infections
muscle weakness
neck conditions
osteoporosis

17. Cervical Braces Soft and hard collars Philadelphia collar
Sterno-occipital-mandibular immobilization device (SOMI)
Halo

18. Back Braces Two types of back braces commonly used: Rigid braces
Corset (elastic braces)

19. Level 3: Spinal Surgery; Fusion, Disk Implants
Spinal Fusion
Artificial Disk Replacement (ADR)

20. Fusion
Involves forming direct connection between vertebrae surrounding the painful disc(s)
Pain relief occurs by stopping the motion of the painful disc(s).

21. Fusion

22. Artificial Disk Replacement (ADR)
Alternative to spinal fusion
replaces damaged or worn out spinal disc with an artificial disc
The Charité artificial disc is made of two metallic endplates and a plastic center

23. Artificial Disk Replacement (ADR)

24. Christopher Reeve
In 1995, famous actor Christopher Reeve broke his neck in a horseback riding incident.
Paralyzed from neck down and unable to breathe

25. Background on the injury
Second vertebrate (C2) causes instant death if displaced laterally by 5mm
Fracture in any cervical vertebrate causes quadriplegia
Spinal cord injuries breaks nerve fibers
Destroys possible muscle movement in distal direction

26. Survived instant death
Survived 60-70% chance mortality rate over the following week
No recovery within 48 hours usually means no recovery

27. Spinal Cord Concussion
Cervical Cord neurapraxia (CNN)
Nerrowing of the spinal canal (stenosis)
Torg or Pavlov ratios:
Ratio of canal diamter to vertebral body
0.8< indicates significant for athletic
Instantaneous loss of function of limbs but followed with complet recovery
Most commonly occurs at the cervical vertabrates

29. Torg. J. et al, 1997

30. Both techniques share the same level of reoccurrence
Torg. J. et al, 1997

31. How does it happen?
Hyperextension, hyperflexion, axial load mechanisms on neck
Spear tackle
Occur in 7 out of 10,000 players per year
(1.8 million people) and rising

32. Why the rise?
Helmets are too safe!

33. Long term effects Symptoms subside usually after 24 hours
56% chance of reoccurrence
Repeat episode is directly proportional to diameter of player’s cervical spine canal
If neurologic symptoms persist  surgery
Second episode  termination of sport

34. Torg. J. et al, 1997

35. Case compilation of different CNN outcomes of athletes

36. Case Study Example 20 year old college defensive back
5 minutes of transient paralysis
C-3, 5 narrowing of 0.66
C-4 narrowing of 0.62
Minimal anterior subluxation
Returned to play after recovery

37. Minimal Flexion

38. … Fourteen months later
Contact is made with head
Classic spear tackle
Axial load
Fracture in the C4-C6 vertebrate

39. *Unilateral facet dislocation at C4-5 (C4 displaced anteriorly 25%) in sagittal plane
*Oblique fracture
*Three-part-two-plane fracture with small anterior fracture fragment
*Non-displaced sagittal fracture through the vertebral body and partial fracture of the right lamina

40. Help efforts Christopher and Dana Reeve Paralysis Resource Center
Located in New Jersey
Funds for research, treatments/cures, for CNS disorders
Advocate improvement of quality of life post-injury
22M to neuroscientist research

41. References
[1]
[2]
[3]
[4]
[5]
[6]