Anatomy of the Spine
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Diapositiva 1
Thoracic Cage and Thoracic Inlet Professor Dr. Mario Edgar Fernández. Parts of the body The Thorax Is the part of the trunk betwen the neck and abdomen. Commonly the term chest is used as a synonym for thorax, but it is incorrect. Consisting of the thoracic cavity, its contents, and the wall that surrounds it. The thoracic cavity is divided into 3 compartments: The central mediastinus. And the right and left pulmonary cavities. Thoracic Cage The thoracic skeleton forms the osteocartilaginous thoracic cage. Anterior view. Thoracic Cage Posterior view. Summary: 1. Bones of thoracic cage: (thoracic vertebrae, ribs, and sternum). 2. Joints of thoracic cage: (intervertebral joints, costovertebral joints, and sternocostal joints) 3. Movements of thoracic wall. 4. Thoracic cage. Thoracic apertures: (superior thoracic aperture or thoracic inlet, and inferior thoracic aperture). Goals of the classes Identify and describe the bones of the thoracic cage. Identify and describe the joints of thoracic cage. Describe de thoracic cage. Describe the thoracic inlet and identify the structures passing through. Vertebral Column or Spine 7 cervical. 12 thoracic. 5 lumbar. 5 sacral 3-4 coccygeal Vertebrae That bones are irregular, 33 in number, and received the names acording to the position which they occupy. The vertebrae in the upper 3 regions of spine are separate throughout the whole of life, but in sacral anda coccygeal regions are in the adult firmly united in 2 differents bones: sacrum and coccyx. Thoracic vertebrae Each vertebrae consist of 2 essential parts: An anterior solid segment: vertebral body. The arch is posterior an formed of 2 pedicles, 2 laminae supporting 7 processes, and surrounding a vertebral foramen. -
Vertebral Column and Thorax
Introduction to Human Osteology Chapter 4: Vertebral Column and Thorax Roberta Hall Kenneth Beals Holm Neumann Georg Neumann Gwyn Madden Revised in 1978, 1984, and 2008 The Vertebral Column and Thorax Sternum Manubrium – bone that is trapezoidal in shape, makes up the superior aspect of the sternum. Jugular notch – concave notches on either side of the superior aspect of the manubrium, for articulation with the clavicles. Corpus or body – flat, rectangular bone making up the major portion of the sternum. The lateral aspects contain the notches for the true ribs, called the costal notches. Xiphoid process – variably shaped bone found at the inferior aspect of the corpus. Process may fuse late in life to the corpus. Clavicle Sternal end – rounded end, articulates with manubrium. Acromial end – flat end, articulates with scapula. Conoid tuberosity – muscle attachment located on the inferior aspect of the shaft, pointing posteriorly. Ribs Scapulae Head Ventral surface Neck Dorsal surface Tubercle Spine Shaft Coracoid process Costal groove Acromion Glenoid fossa Axillary margin Medial angle Vertebral margin Manubrium. Left anterior aspect, right posterior aspect. Sternum and Xyphoid Process. Left anterior aspect, right posterior aspect. Clavicle. Left side. Top superior and bottom inferior. First Rib. Left superior and right inferior. Second Rib. Left inferior and right superior. Typical Rib. Left inferior and right superior. Eleventh Rib. Left posterior view and left superior view. Twelfth Rib. Top shows anterior view and bottom shows posterior view. Scapula. Left side. Top anterior and bottom posterior. Scapula. Top lateral and bottom superior. Clavicle Sternum Scapula Ribs Vertebrae Body - Development of the vertebrae can be used in aging of individuals. -
5. Vertebral Column
5. Vertebral Column. Human beings belong to a vast group animals, the vertebrates. In simple terms we say that vertebrates are animals with a backbone. This statement barely touches the surface of the issue. Vertebrates are animals with a bony internal skeleton. Besides, all vertebrates have a fundamental common body plan. The central nervous system is closer to the back than it is to the belly, the digestive tube in the middle and the heart is ventral. The body is made of many segments (slices) built to a common plan, but specialised in different regions of the body. A “coelomic cavity” with its own special plan is seen in the trunk region and has a characteristic relationship with the organs in the trunk. This is by no means a complete list of vertebrate characteristics. Moreover, some of these features may be shared by other animal groups in a different manner. Such a study is beyond the scope of this unit. Vertebrates belong to an even wider group of animals, chordates. It may be difficult to imagine that we human beings are in fact related to some the earlier chordates! However, we do share, at least during embryonic development, an important anatomical structure with all chordates. This structure is the notochord. The notochord is the first stiff, internal support that appeared during the evolutionary story. As we have seen in early embryology, it also defines the axis of the body. The vertebral column evolved around the notochord and the neural tube, and we see a reflection of this fact during our embryonic development. -
Surgery for Lumbar Radiculopathy/ Sciatica Final Evidence Report
Surgery for Lumbar Radiculopathy/ Sciatica Final evidence report April 13, 2018 Health Technology Assessment Program (HTA) Washington State Health Care Authority PO Box 42712 Olympia, WA 98504-2712 (360) 725-5126 www.hca.wa.gov/hta [email protected] Prepared by: RTI International–University of North Carolina Evidence-based Practice Center Research Triangle Park, NC 27709 www.rti.org This evidence report is based on research conducted by the RTI-UNC Evidence-based Practice Center through a contract between RTI International and the State of Washington Health Care Authority (HCA). The findings and conclusions in this document are those of the authors, who are responsible for its contents. The findings and conclusions do not represent the views of the Washington HCA and no statement in this report should be construed as an official position of Washington HCA. The information in this report is intended to help the State of Washington’s independent Health Technology Clinical Committee make well-informed coverage determinations. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients). This document is in the public domain and may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. -
Anatomic Mapping of Lumbar Nerve Roots During a Direct Lateral Transpsoas Approach to the Spine a Cadaveric Study
SPINE Volume 36, Number 11, pp E687–E691 ©2011, Lippincott Williams & Wilkins ANATOMY Anatomic Mapping of Lumbar Nerve Roots During a Direct Lateral Transpsoas Approach to the Spine A Cadaveric Study Kelley Banagan , MD, Daniel Gelb , MD, Kornelis Poelstra , MD, PhD, and Steven Ludwig , MD longitudinal ligament at the level of the disc to the sympathetic chain Study Design. Cadaveric study. averaged 9.25 mm. The nerve roots and genitofemoral nerve were Objective. Identifying anatomic structures at risk for injury during placed at risk in all dissections in which the approach was recreated. direct lateral transpsoas approach to the spine. Damage secondary to K-wire placement occurred in 25% of cases Summary of Background Data. Direct lateral transpsoas at L3–L4 and L4–L5; in one case, L4 nerve root was pierced, and approach is a novel technique that has been described for anterior in another, genitofemoral nerve was pierced. K-wire was posterior lumbar interbody fusion. Potential risks include damage to to the nerve roots in 25% of cases at L3–L4 and in 50% of cases genitofemoral nerve and lumbar plexus, which are not well visualized at L4–L5. The lumbar plexus was placed under tension because of during small retroperitoneal exposure. Previous cadaveric studies did sequential dilator placement. not evaluate the direct lateral transpsoas approach, and considering Conclusion. On the basis of our results, there is no zone of absolute the approach being used in clinical practice, the current study was safety when using the direct lateral transpsoas approach. The potential undertaken in an effort to identify the structures at risk during direct for nerve injury exists when using this approach, and consequently, we lateral transpsoas approach. -
Sacral Dimple – Tethered Cord Pathway V3.0: Diagnosis
Sacral Dimple – Tethered Cord Pathway v3.0: Diagnosis Approval & Citation Summary of Version Changes Explanation of Evidence Ratings REFERRAL AND DIAGNOSIS More Information Inclusion Criteria • PE056 Spina Bifida • All patients considered • PE589 Tethered Spinal Cord or referred in for • PE1999 Anesthesia for Radiology 1) cutaneous sacral, Tests coccygeal, and/or gluteal anomaly OR 2) closed spinal dysraphism Simple Sacral Dimple (radiographic) All 3 criteria must be met. A simple sacral dimple is: Exclusion Criteria • No more than 2.5 cm from anus • Patients with open • Less than 5 mm diameter spinal dysraphism • Localized in gluteal cleft Referral to Cutaneous anomaly Neurosurgery / Referral for MRI Neurodevelopment Review at Babies Further workup needed Conference Further workup needed Urgent? No intervention needed No Yes Not urgent Urgent Referring provider to Yes Age < 4 months? Age < 6 months? observe Age < 4 months (more info) (more info) Negative Referring provider No Yes No to order Age ≥ 4 months Age < 6 months Age ≥ 6 months spinal ultrasound Spinal • Imaging done at ultrasound Seattle Children’s if results possible • Imaging results reviewed by referring Referring provider provider to consult • (more info) Neurosurgery Positive Schedule MRI and Schedule MRI and Neurosurgery visit Neurosurgery visit Schedule MRI for when now age > 6 months Yes Positive or concerning MRI results MRI? No Treatment Phase Off Pathway For questions concerning this pathway, Last Updated: July 2021 contact: [email protected] -
Occipital Neuralgia: a Literature Review of Current Treatments from Traditional Medicine to CAM Treatments
Occipital Neuralgia: A Literature Review of Current Treatments from Traditional Medicine to CAM Treatments By Nikole Benavides Faculty Advisor: Dr. Patrick Montgomery Graduation: April 2011 1 Abstract Objective. This article provides an overview of the current and upcoming treatments for people who suffer from the signs and symptoms of greater occipital neuralgia. Types of treatments will be analyzed and discussed, varying from traditional Western medicine to treatments from complementary and alternative health care. Methods. A PubMed search was performed using the key words listed in this abstract. Results. Twenty-nine references were used in this literature review. The current literature reveals abundant peer reviewed research on medications used to treat this malady, but relatively little on the CAM approach. Conclusion. Occipital Neuralgia has become one of the more complicated headaches to diagnose. The symptoms often mimic those of other headaches and can occur post-trauma or due to other contributing factors. There are a variety of treatments that involve surgery or blocking of the greater occipital nerve. As people continue to seek more natural treatments, the need for alternative treatments is on the rise. Key Words. Occipital Neuralgia; Headache; Alternative Treatments; Acupuncture; Chiropractic; Nutrition 2 Introduction Occipital neuralgia is a type of headache that describes the irritation of the greater occipital nerve and the signs and symptoms associated with it. It is a difficult headache to diagnose due to the variety of signs and symptoms it presents with. It can be due to a post-traumatic event, degenerative changes, congenital anomalies, or other factors (10). The patterns of occipital neuralgia mimic those of other headaches. -
Lumbar Spine Nerve Pain
Contact details Physiotherapy Department, Torbay Hospital, Newton Road, Torquay, Devon TQ2 7AA PATIENT INFORMATION ( 0300 456 8000 or 01803 614567 TorbayAndSouthDevonFT @TorbaySDevonNHS Lumbar Spine www.torbayandsouthdevon.nhs.uk/ Nerve Pain Useful Websites & References www.spinesurgeons.ac.uk British Association of Spinal Surgeons including useful patient information for common spinal treatments https://www.nice.org.uk/guidance/ng59 NICE Guidelines for assessment and management of low back pain and sciatica in over 16s http://videos.torbayandsouthdevon.nhs.uk/radiology Radiology TSDFT website https://www.torbayandsouthdevon.nhs.uk/services/pain- service/reconnect2life/ Pain Service Website Reconnect2Life For further assistance or to receive this information in a different format, please contact the department which created this leaflet. Working with you, for you 25633/Physiotherapy/V1/TSDFT/07.20/Review date 07.22 A Brief Lower Back Anatomy Treatment The normal lower back (lumbar spine) has 5 bones When the clinical diagnosis and MRI findings correlate, (vertebrae) and a collection of nerves which branch out in a target for injection treatment can be identified. This pairs at each level. In between each vertebra there is a disc is known as a nerve root injection, and can both which acts as a shock absorber and spacer. improve symptoms and aid diagnosis. The spinal nerves are like electrical wiring, providing Nerve root injections or ‘nerve root blocks’ are used to signals to areas within the leg. These control sensation and reduce pain in a particular area if you have lower limb pain movement but can cause pain when they are affected. such as sciatica. The injection is done in Radiology. -
Changes in L4/5 Intervertebral Foramen Bony Morphology With
www.nature.com/scientificreports OPEN Changes in L4/5 Intervertebral Foramen Bony Morphology with Age Received: 7 September 2017 Shuaifeng Yan, Kai Wang, Yunfan Zhang, Song Guo, Yan Zhang & Jun Tan Accepted: 1 May 2018 The purpose of this study was to explore the morphological changes in L4/5 intervertebral foramen Published: xx xx xxxx with age using a digital method. The closed boundaries of the intervertebral foramen (IGES) in diferent sagittal slices (inside, middle and outside) were obtained from Mimics, and then imported to a custom- written program, which provided quantitative distance between the nerve root and the closed curves. The quantitative information of each age group was used to produce radar chart and line chart for morphological and statistical analyses. Overall, the intervertebral foramen changes mainly occurred in the inner part from middle age to old age. The foraminal height decreased with age in the inside sagittal slice, while no signifcant diference was found in the middle sagittal slice or the outside sagittal slice. The foraminal width showed no decrease in each age group or each sagittal plane. The present study described foraminal geometry of asymptomatic males in diferent sagittal slices with age. This information enhances the knowledge of anatomical changes in intervertebral foramen with age, which provides better understanding of the pathology of intervertebral foramen diseases. Low back pain (LBP) is a global health problem, causing enormous fnancial burden1,2. Te lifetime prevalence of LBP is reported to be as high as 84%3. Radiculopathy is a common cause of low back and leg pain4. In general, radiculopathy caused by foramen stenosis consists of 8–11% nerve root compression5, and shows an increasing trend6. -
Chapter 02: Netter's Clinical Anatomy, 2Nd Edition
Hansen: Netter's Clinical Anatomy, 2nd Edition - with Online Access 2 BACK 1. INTRODUCTION 4. MUSCLES OF THE BACK REVIEW QUESTIONS 2. SURFACE ANATOMY 5. SPINAL CORD 3. VERTEBRAL COLUMN 6. EMBRYOLOGY FINAL 1. INTRODUCTION ELSEVIERl VertebraeNOT prominens: the spinous process of the C7- vertebra, usually the most prominent The back forms the axis (central line) of the human process in the midline at the posterior base of body and consists of the vertebral column, spinal cord, the neck supporting muscles, and associated tissues (skin, OFcon- l Scapula: part of the pectoral girdle that sup- nective tissues, vasculature, and nerves). A hallmark of ports the upper limb; note its spine, inferior human anatomy is the concept of “segmentation,” and angle, and medial border the back is a prime example. Segmentation and bilat l Iliac crests: felt best when you place your eral symmetry of the back will be obvious as you hands “on your hips”; an imaginary horizontal study the vertebral column, the distribution of the line connecting the crests passes through the spinal nerves, the muscles of th back, and its vascular spinous process of the L4 vertebra and the supply. intervertebral disc of L4-L5, a useful landmark Functionally, the back is involved in three primary for a lumbar puncture or epidural block tasks: l Posterior superior iliac spines: an imaginary CONTENThorizontal line connecting these two points l Support: the vertebral column forms the axis of passes through the spinous process of S2 (second the body and is critical for our upright posture sacral segment) (standing or si ting), as a support for our head, as an PROPERTYattachment point and brace for move- 3. -
Vertebral Column
Vertebral Column • Backbone consists of Cervical 26 vertebrae. • Five vertebral regions – Cervical vertebrae (7) Thoracic in the neck. – Thoracic vertebrae (12) in the thorax. – Lumbar vertebrae (5) in the lower back. Lumbar – Sacrum (5, fused). – Coccyx (4, fused). Sacrum Coccyx Scoliosis Lordosis Kyphosis Atlas (C1) Posterior tubercle Vertebral foramen Tubercle for transverse ligament Superior articular facet Transverse Transverse process foramen Facet for dens Anterior tubercle • Atlas- ring of bone, superior facets for occipital condyles. – Nodding movement signifies “yes”. Axis (C2) Spinous process Lamina Vertebral foramen Transverse foramen Transverse process Superior articular facet Odontoid process (dens) •Axis- dens or odontoid process is body of atlas. – Pivotal movement signifies “no”. Typical Cervical Vertebra (C3-C7) • Smaller bodies • Larger spinal canal • Transverse processes –Shorter – Transverse foramen for vertebral artery • Spinous processes of C2 to C6 often bifid • 1st and 2nd cervical vertebrae are unique – Atlas & axis Typical Cervical Vertebra Spinous process (bifid) Lamina Vertebral foramen Inferior articular process Superior articular process Transverse foramen Pedicle Transverse process Body Thoracic Vertebrae (T1-T12) • Larger and stronger bodies • Longer transverse & spinous processes • Demifacets on body for head of rib • Facets on transverse processes (T1-T10) for tubercle of rib Thoracic Vertebra- superior view Spinous process Transverse process Facet for tubercle of rib Lamina Superior articular process -
Is It Really Sciatica August, 2017
Is It Really Sciatica August, 2017 By Dr. Derek Conte One of the most common complaints we see from patients is that of sciatic pain. They will say, “I have sciatica!” And when I ask, “How do you know it is sciatica?” they will say that’s what their friend said, or that they went online and did a medical search, or my favorite: that their “regular” doctor told them. So, what is sciatica, what are its symptoms, and what exactly is the sciatic nerve? I’ll tell you that sciatica is one for the most misdiagnosed conditions we see. The sciatic nerve is the largest nerve in the body and is made up of five nerves which arise from the low back and sacrum. These nerves converge and travel beneath the buttocks and down the outside rear of the thigh to the back of the knee, where they divide. The tibial nerve goes straight down the back of the calf around the inside of the ankle and on to the underside of the foot. The two peroneal nerves cover the rest of the lower leg and top of the foot (see chart). Sciatica is the irritation of the sciatic nerve and can be caused in several ways. First, compression of the nerve must be present or there would be no pain. Beginning centrally and going out from the spinal cord the causes may be 1) Central canal stenosis which squeezes the entire cord and produces bilateral symptoms. 2) A subluxation (malposition of vertebrae) compresses nerves at the spine. 3) A bulging disc or osteophyte (bony spur) causing stenosis of intervertebral foramen, or a dramatic loss of disc height can also leave too little room for the nerves to exit the spine.