1. Sylvie Kalikoff & Brad Leavitt
The Spine
Sylvie Kalikoff & Brad Leavitt

2. “In a way, your spine is the keystone that holds your body together
“In a way, your spine is the keystone that holds your body together. It's at the center of your axial skeleton... At the top of your axial skeleton is your skull, and your coccyx, or tailbone, is at the other end. Together, all these bones shelter some of the most important organs in your body. Your brain sits in its protective skull casing, and the organs in your chest are protected by 12 pairs of ribs, all of which attach directly to your spine... As if that wasn't enough, your spine is also what lets you move your arms and legs. Your arms attach to your spine and ribs via the collarbones and shoulder blades. Your legs attach to the spine through your hips. When you want to move your arms and legs, signals travel down your spinal cord, which is enclosed in your spine. Nerves carry the signals from the spinal cord to the muscles you want to move.” - Tracy Wilson

3. Anatomy Review Regions of the spine: Cervical Thoracic Lumbar Sacral
Structure of the Discs:
Discs between vertebrae allows for some motion, acting like a joint and shock absorber
Outer fibrous ring: annulus fibrous
Inner circle: nucleus pulposus
Regions of the spine:
Cervical
Thoracic
Lumbar
Sacral
Coccygeal

4. Spinal Development Babies are born with a C-shaped spine
Spine first developing S-Shape curve to balance head
Lumbar curve develops last
develops during crawling
Finish spinal development curves between months when baby starts walking upright
**One big thorac curve**
Babies are born with C-Shaped curve
Gravity helps developing the S-Shape curve as baby matures
First starts developing the cervical curve
**Does this out of curiosity of the world around them**
Thoracic -> Cervical -> Lumbar
** tuck her legs into a frog leg position, thighs pulling up toward the chest, while laying on her belly or when you pick her up. This fetal tuck allows your baby to maintain her primary curve alignment, reducing the pressure on the spine and hips **

5. Importance of Good Posture

6. Diseases of the spine

7. Scoliosis Abnormal curvature of the spine Can worsen during puberty
Can be genetic
Neuromuscular scoliosis
Idiopathic scoliosis
Degenerative scoliosis
puberty because rapid growth
neuromuscular: poor muscle control→ CP, spina bifida
idiopathic= no known cause, most common form in children
degenerative= gets worse with age, most common form in adults

8. Types: Dextroscoliosis and Levoscoliosis
dextro = right
usually in the thoracic spine
most common
“S” or backward “C”
levo = left
usually in the lumbar spine
“C” shape

9. Treatment back braces measuring and tracking
surgical→ when the degree of curvature is large in a person before reaching skeletal maturity
Instrumentation with or without fusion: the insertion of metal rods to straighten the back
With fusion: spinal fusion eliminates motion between vertebrae. A bone graft is used to fuse the vertebrae.
<10 degrees is not scoliosis
curves beyond 20 to 30 degrees should be monitored, if changes of more than 5 degrees between observations, see a surgeon
braces prevent further movement, surgery can fix the curved spine
grafts generally from iliac crest of the hip

10. Can you diagnose these X-rays?
levoscoliosis of lumbar spine: L
dextroscoliosis of thoracic spine: R

11. Ankylosing Spondylitis (Arthritis of the Spine)
Gradually causes new bone to start to form in between the joints of the spine
Disease affects males 2-3x more often than females
Genetically inherited- HLA-B27 gene
Chronic inflammation of the spine

12. Ankylosing Spondylitis (Arthritis of the Spine)
Symptoms:
Pain in back
Pain in hips, knees or ankles
Stiffness
Fatigue
Treatment:
Medication
Physical Therapy
Maintaining a healthy weight
Medication is used to reduce inflammation
physical therapy to aid in better posture

13. Ankylosis Advancement of Ankylosing Spondylitis
Advancing fusion of spine reduces flexibility
Can lead to complete loss of mobility of spine
Important to stand with good posture!
Ankylosis- Inflammation can lead to complete fusion of the vertebrae
Spine is more brittle, (What could be a result of the spine fusing of becoming more brittle? --easier to fracture)
causes forward curvature thoracic spine and limits breathing capacity
If you have the disease inheritely, if you stand with bad posture then once the disease hits you’ll have permently bad posture
** No pain is associated during fusion**

14. X-Ray of Ankylosis

15. Spinal Stenosis Stenosis= abnormal narrowing Causes:
overgrowth of bone: bone spur formation, Paget’s disease
herniated disks
trauma: dislocations, fractures
tumors
aging
osteoarthritis/wear and tear can cause bone spur formation→ grow in spinal canal and take up room
Paget’s disease: abnormal breakdown of bone followed by abnormal growth of bone
herniated disk: wear of the soft cushions between vertebrates
the older you get, the more likely

16. Lumbar Spinal Stenosis
lumbar = lower back
nerve compression in the lower back due to narrowing of the spinal canal
Symptoms:
sciatica: pain, tingling, cramping, weakness and numbness due to a compressed sciatic nerve
lower back, butt, leg pain
sciatica: pain in lower back, butt and leg

17. Cervical Spinal Stenosis
cervical = upper back
narrowing of the spinal canal in the neck region
symptoms:
symptom free unless nerves get compressed
pain, tingling, cramping, weakness and numbness
neck, arms, hands
loss of balance and coordination
loss of bladder control

18. Treatment Epidural injections Physical therapy and exercise
Spinal cord stimulation
Radiofrequency neurotomy
Anti-inflammatory medication
exercise and physical therapy: not a cure but prevents further debilitation
epidural = around the spinal cord
injections of cortisone: corticosteroid+ numbing agent, temporary pain relief→ days or years, depends
spinal cord stimulation is for chronic pain: implanted device that generates pulsed electrical signals that make pain feel numbed to a tingling sensation
radiofrequency neurotomy: thermal denervation, needle injected at nerve source of pain, pain is temporarily relieved

19. Spina Bifida Four Types: Occult Spinal Dysraphism (OSD)
Dimple in lower back of baby’s back
Spina Bifida Occulta
Meningocele
spinal cord is pushed out through the spine like a sac
Spina Bifida Cystica (Myelomeningocele)
most severe case of spina bifida
spinal column does not close all the way while in the womb
(No known cause)
Occult Spinal Dysraphism (OSD)- infant's spine does not grow the proper way.
Can cause harm to the spinal cord as the child grows
Spina Bifida Cystica (Myelomeningocele)- most severe case of spina bifida
spinal cord and nerves go through the Meningocele
causes nerve damage
Causes fluid to go to a child's head, head grows too big, and it results in brain damage

20. Spina Bifida Treatment: OSD requires surgery to prevent nerve damage
Myelomeningocele requires surgery within 2 or 3 days after birth
Prevention
Recommended that women take 400 micrograms of folic acid daily during pregnancy
Prevent nerve damage as the child develops

21. Prevention of Spina Bifida
January 1998: folic acid was mandatorily fortified in cereal enriched grain products by the FDA

22. Injuries of the Spine

23. Herniated Disc:
A herniated disc is the result of a ruptured nucleus pulposa, or disc degeneration
Can put pressure on spinal nerves leading to pain
Risk factors: improper lifting, gender, weight, lifestyle, repeated strain on back
men are more prone, being overweight, sedentary lifestyle
VIDEO

24. Symptoms Pain depends on location of herniated disc
upper back→ arm, hand, shoulder pain
lower back→ butt, leg pain
numbness, tingling
VIDEO

25. Treatment Surgical Non-surgical Physical therapy, exercise
Anti-inflammatory pain medication
Epidural injections
Surgical
Only if non surgical treatments do not work after an extended period of time
Microdiscectomy
Artificial disc replacement
Spinal Fusion
physical therapy and exercise can relieve pressure on nerve root

26. Microdiscectomy Artificial Disc Replacement Spinal Fusion
Lumbar herniated disc
gently moves nerve root to release pressure
90-95% success rate, 5% develop recurrent herniated disc
PT rehabilitation
Artificial Disc Replacement
new procedure
allows for more back flexibility than spinal fusion
Spinal Fusion
old, traditional procedure
generally lumbar spine
eliminates motion between vertebrae, eliminating the rubbing of the disk and pinching of a nerve.
recurrent herniated disc commonly occurs within the first 3 months post operatively
microdisectomy often cures leg pain but there is remaining lower back pain
VIDEO

27. Spinal Fractures Types:
Flexion Fracture: compression fracture or axial burst fracture
Extension Fracture
Rotation Fracture: transverse process fracture, fracture-dislocation
Causes:
Trauma→ car accident, fall from height, sports injury
Symptoms:
Back pain ranging in severity and location depending on location of the fracture

28. Flexion Fracture Compression Fracture thoracic or lumbar spine
caused by osteoporosis
weakening of the bone causes the front of the vertebrae to break down
Axial Burst Fracture
results from high force axial loading
vertebrae loses height in front and back

29. Extension Fracture Vertebrae pulled apart Common in car accidents
in car accidents: seat belt keeps lower body in place but upper body moves forward at high speed

30. Rotation Fracture Fracture-Dislocation Transverse Process Fracture
Both fracture and dislocation occur simultaneously
One vertebrae pushes another
Spinal cord compression
Rotation Fracture
Transverse Process Fracture
Fracture to a bony protrusion
Rare
Result of extreme sideways bending of the spine

31. Treatment Non-surgical Treatment Surgical Treatment
Generally required when there are bone fragments, nerve injury, extreme loss of vertebral height.
If nerve injury, remove pressure from spinal cord
Return bone to proper position using screws, rods, or cages.
Non-surgical Treatment
Rest and ice
Bracing or casting
Rehabilitation exercises, slow return to mobility
Stabilization after burst fracture

32. What kinds of fractures are these?
L: fracture/dislocation
M: extension fracture
R:axial burst fracture

33. Paralysis Incomplete Injury Complete Injury
Ability for the spinal cord to and from the brain is not completely lost
Sensation and movement is weakened
Complete Injury
Complete lack of sensory and motor functions
Paralysis

34. Cervical Spinal Cord Injury
C1 - C7
Cause weakness or paralysis in the arms and legs
Symptoms: respiratory issues, sexual dysfunction, loss of physical sensation, bladder, and bowel problems
Treatment: Neck brace
neck is very flexible, hard to stabilize
-Quadriplegia - Paralysis in the arms and legs
- Cervical Spinal Cord controls signals to the back of the head, neck and shoulders, arms and hands, and diaphragm

35. Thoracic Spinal Cord Injury
T1-T12
Paralysis or weakness in legs
Symptoms: Loss of physical sensation, sexual dysfunction, bladder, and bowel problems
Trunk brace to improve stability after injury
Paraplegia- Paralysis in the legs
**Less common because it is protected by the rib cage
Thoracic Spinal Cord controls signals to back and part of the abdomen

36. Lumbar Spinal Cord Injury
L1-L5
Paralysis or weakness in the legs
Symptoms: Loss of physical sensation, sexual dysfunction, bladder, and bowel problems
These injuries require surgery and external stabilization
Lumbar Spinal Cord controls lower part of admonmen, the back, the buttocks, external genital organs, and parts of the legs

37. Sacral Spinal Cord Injury
S1- S5
Weakness or paralysis in hips and legs
Symptoms: Sexual dysfunction, loss of bladder and bowel function
Sacral spinal cord sends signals to the thighs, lower part of the legs, the feet, and genital organs

38. References