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REVIEW OF ANATOMY OF SPINE UNDERLYING INTERVERTEBRAL DISC REPAIR.

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Presentation on theme: "REVIEW OF ANATOMY OF SPINE UNDERLYING INTERVERTEBRAL DISC REPAIR."— Presentation transcript:

1 REVIEW OF ANATOMY OF SPINE UNDERLYING INTERVERTEBRAL DISC REPAIR

2 NOSE CERVICAL SPINE IS LOCATED IN CENTER OF NECK SURROUNDED BY MANY STRUCTURES THAT ARE ESSENTIAL, SMALL AND FRAGILE CERVICAL SPINE IS LOCATED IN CENTER OF NECK SURROUNDED BY MANY STRUCTURES THAT ARE ESSENTIAL, SMALL AND READILY DAMAGED THESE SLIDES REVIEW THE ANATOMY OF VERTEBRAE, STRUCTURE OF THE NECK AND SPINAL CORD TO APPRECIATE THE TECHNIQUE OF CERVICAL DISC REPAIR BODY OF CERVICALVERTEBRA INTERVERTEBRAL DISC

3 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 BODY VERTEBRAL ARCH PEDICLE TRANSVERSE PROCESS- LATERAL LAMINA 3. TRANSVERSE AND SPINOUS PROCESSES - projections from arch for muscle, ligament attach ANATOMY OF TYPICAL VERTEBRA SPINOUS PROCESS - POSTERIOR { anterior NOSE

4 LATERAL VIEW OF VERTEBRA 2. Spinal nerves leave vertebral canal via INTERVERTEBRAL FORAMINA - between vertebrae; bordered by – Superior and Inferior Vertebral Notches Sup. Vertebral Notch Inf. Vertebral Notch JOINTS BETWEEN VERTEBRAE PERMIT MOVEMENTS HOWEVER, CAN POTENTIALLY DAMAGE SPINAL NERVES NOSE 1. Location of Intervertebral Discs between bodies

5 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) vertebrae (Co1-Co3) VERTEBRA IN DIFFERENT REGIONS ARE SPECIALIZED 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

6 – body is small Foramen Transversarium - in transverse process (C1-C7) for Vertebral artery & veins ARTICULAR FACETS - angled superiorly & medially - PERMIT CONSIDERABLE MOVEMENT SPINOUS PROCESS – bifid (divided) for Ligamentum nuchae TRANSVERSE PROCESS BODY CERVICAL VERTEBRA - small and highly mobile ant. post. lat. view NOSE

7 Adjacent vertebrae held tightly together (protect spinal cord) 1. ANTERIOR LONGITUDINAL LIGAMENT - Strong band joins bodies on anterior side Anterior view VERTEBRAE ARE STABILIZE BY BEING LINKED BY LIGAMENTS, INTERVERTEBRAL DISCS

8 VIEW FROM INSIDE VERTEBRAL COLUMN 2. POSTERIOR LONGITUDINAL LIGAMENT- weaker, narrower band on posterior side of bodies On post. Side of bodies 3. LIGAMENTA FLAVA - yellow elastic bands connecting laminae LOOK ANTERIOR LOOK POSTERIOR

9 Intervertebral discs function as shock absorbers; there are strong but undergo degeneration with age (begins at about age 20) STRUCTURE/ FUNCTION OF INTERVERTEBRAL DISC a) Nucleus pulposus- inner gelatinous core b) Anulus fibrosus - collagen fibers & fibrocartilage

10 MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK ANTERIOR POSTERIOR HERNIATION OF NUCLEUS PULPOSUS

11 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 Postero- lateral lateral post DAMAGE TO INTERVERTEBRAL DISCS ANTERIOR LONGITUDINAL LIGAMENT POSTERIOR LONGITUDINAL LIGAMENT

12 C5 C6 C7 C8 T1 Ventral rami of spinal nerves: DAMAGE TO CERVICAL INTERVERTEBRAL DISCS CAN PRODUCE SYMPTOMS IN UPPER EXTREMITY LOWER CERVICAL SPINAL NERVES FORM BRACHIAL PLEXUS DAMAGE TO SPINAL NERVES CAN PRODUCE SENSORY AND MOTOR LOSS

13 Dermatomes of upper extremity: C6 - thumb C7 - middle finger C8 - little finger SENSORY LOSS - DERMATOME MAP THUMB = C6 LITTLE FINGER = C8 Questions: What is the level of a herniated disc that would produce numbness of thumb? Little finger?

14 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. LEVELS OF SPINAL NERVES Cervical (C1-C8) Thoracic (T1-T12) Lumbar (L1-L5) Sacral (S1-S5) Coccygeal (Co1) Spinal nerves C1-C7 above vertebra C8 and all others below vertebra NUMBERING OF CERVICAL SPINAL NERVES CONVENTION FOR NAMING LEVELS SPINAL NERVE C6 ARISES ABOVE VERTEBRA C6

15 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 Alpha motor neuron TENDON TAP TESTING OF SPINAL NERVE DAMAGE - STRETCH REFLEXES

16 REFLEXES USED FOR CLINICAL TESTS Nerve compressions can produce reduced spinal reflexes; also muscle weakness

17 COMMON CAROTID ARTERY INTERNAL JUGULAR VEIN NECK CONTAINS A NUMBER OF VITAL STRUCTURES SPINAL CORD TRACHEA ESOPHAGUS INTERVERTEBRAL DISC

18 1. Posterior Compartment - Vertebrae and muscles which support and move head & neck 2. Anterior Compartment- Viscera and rostral continuation GI & Respiratory Systems 3. Lateral Compartment- Blood vessels & nerve ANATOMY OF NECK: NECK IS COMPARTMENTALIZED Plane of section HORIZONTAL SECTION THROUGH NECK: NOTE VERTEBRAE ARE IN CENTER OF NECK POST. LAT. ANT.

19 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) Prevertebral layer Carotid Sheath NOSENOSE LOCATION OF INTERVERTEBRAL DISC LOCATION OF STRUCTURES IN NECK: COMPARTMENTALIZED BY FASCIA Plane of section Pretracheal layer

20 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

21 HOW IS DAMAGE TO CERVICAL INTERVERTEBRAL DISC REPAIRED? SEE DR. LECLERCQ'S LECTURE INTERVERTEBRAL DISC


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