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Presentation on theme: "The Spine MACAIRE GROBE, KATHERINE CALLAHAN, SOPHIA POWELL, BIN CHEN, AND THEO DIPAULI."— Presentation transcript:


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: ◦ 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

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

6 Curvature of the Spine spine-development

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 -visit

8 Classifications of Fractures: Three Column ConceptMajor and Minor Fractures

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

10 Spinal Cord Injury: What is spinal cord injury? ◦ 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

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: 1.Passive physical therapy (heat/ice packs, ultrasound) 2.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: 1.Rigid braces 2.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


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


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