Story of Lumbar Spine: page 1 of 13 1) Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Goal Objectives Spine is at our Core Central Better a)Illustrate Central Entire skeleton attaches Structural anatomy Structural Flexible understanding Bones Flexible to the spine Anatomy structure & Nerves Anatomy Axial Skeleton Canal & Foramen Spine Radiographs function b)Importance of Radiographs 1.Labeling Spine Radiographs 1.Labeling Head 2.Body Height Lumbar Big Picture 2.Body Height Ribs 3.Alignment Alignment 3.Alignment Appendicular Skeleton Spondylo… Spondylolysis Spondylo… Spondylolisthesis Shoulder girdle Arms 4.Disc Narrow 4.Disc Narrow c)What Order When Pelvic girdle Legs ACR Approp. ACR ACR Approp. Criteria Criteria www.schreibman.info www.schreibman.info © 2014 Ken L Schreibman, PhD/MD 1 of 77 © 2014 Ken L Schreibman, PhD/MD 2 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine defines our place in the world Spine Clinically Important Central Taxonomy of Life on Earth Central Back pain 2nd most common neurological ailment Structural Structural (headache most common) Flexible Flexible Anatomy Kingdoms: Plants Animals Microbes Anatomy Most common job-related disability Radiographs Radiographs American spend >$50 billion annually on LBP 1.Labeling Phylum: Vertebrates Arthropods 1.Labeling “Nearly everyone at some point has back pain that 2.Body Height 2.Body Height interferes with work, routine daily activities, or recreation” Mammals Insects 3.Alignment Crabs 3.Alignment Half of what MSK does is the spine Spondylo… Birds Spondylo… Reptiles Acute trauma (ER, Clinics, Outside studies) 4.Disc Narrow Amphibians 4.Disc Narrow ACR Approp. ACR Approp. Chronic LBP (Spine Clinic, PCPs) Criteria Criteria Image guided injections for pain www.schreibman.info www.schreibman.info NIH Low Back Pain Fact Sheet © 2014 Ken L Schreibman, PhD/MD 3 of 77 © 2014 Ken L Schreibman, PhD/MD 4 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine has four functions Spine as a structural element Central Structural Central If I were to build a statue, Structural Everything connects to the spine Structural especially one I’d have to Flexible Flexible move across an ocean… Anatomy Protective Anatomy Radiographs Protects spinal cord and nerves Radiographs I’d start with a central 1.Labeling Hemopoietic 1.Labeling spine (2 columns) 2.Body Height 2.Body Height I’d hang a skeletal 3.Alignment Much of the red bone marrow in spine 3.Alignment Vertebral bodies framework from spine Spondylo… Prone to metastases, multiple myeloma Spondylo… Cover with skin 4.Disc Narrow 4.Disc Narrow ACR Approp. Calcium storage ACR Approp. Rigid Central Spine Criteria Osteoporosis spinal fractures Criteria Statue of Liberty Statue of Liberty www.schreibman.info www.schreibman.info © 2014 Ken L Schreibman, PhD/MD 5 of 77 © 2014 Ken L Schreibman, PhD/MD 6 of 77 ©Ken L Schreibman, PhD/MD 9/1/14 www.schreibman.info Story of Lumbar Spine: page 2 of 13 1) Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine as a structural element Robots have rigid spines Central If I were to build an Central Structural imaginary robot… Structural Flexible Flexible Anatomy with a head… Anatomy Radiographs and feet… Radiographs 1.Labeling It might require hinged 1.Labeling 2.Body Height arms & legs… 2.Body Height 3.Alignment 3.Alignment Spondylo… With lots of wires… Spondylo… 4.Disc Narrow Rigid central conduit 4.Disc Narrow ACR Approp. via which wires pass ACR Approp. Criteria Criteria www.schreibman.info C3P0 www.schreibman.info YouTube © 2014 Ken L Schreibman, PhD/MD Ep1 7 of 77 © 2014 Ken L Schreibman, PhD/MD 8 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine as Structural Conduit Humans arehave not a flexiblerobots spine Central If I were to build a Central Structural real robot… Structural Flexible Flexible Anatomy iPad for a head Anatomy Radiographs Segway-like wheels Radiographs 1.Labeling Rigid pipe (spine) 1.Labeling 2.Body Height for the wires to pass 2.Body Height 3.Alignment 3.Alignment Spondylo… “Ultimate tool for Spondylo… telecommuting” 4.Disc Narrow 4.Disc Narrow ACR Approp. ACR Approp. Criteria Criteria www.schreibman.info doublerobotics YouTube www.schreibman.info YouTube © 2014 Ken L Schreibman, PhD/MD 9 of 77 © 2014 Ken L Schreibman, PhD/MD 10 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine flexibility from individual vertebrae Trivia: All mammals have 7 cervical vertebrae Central Vertebra: [L] vertere “to turn, bend” Central Somali Amphibians Structural Structural Reticulated have just Same root as versus Giraffe one cervical Flexible Flexible vertebra… Anatomy Literally: “Joints in the spine” Anatomy Radiographs Joints between every vertebrae Radiographs Goliath Frog 1.Labeling 24 (±1) vertebrae between skull/sacrum 1.Labeling 2.Body Height Ribs define the parts of the spine 2.Body Height 3.Alignment 3.Alignment N. American Spondylo… 12 with ribs = Thoracic vertebrae Variable Spondylo… Mastodon Swans have 5 below ribs = Lumbar vertebrae number 4.Disc Narrow 4.Disc Narrow 25 cervical ACR Approp. 7 above ribs = Cervical vertebrae ACR Approp. vertebrae! Criteria Constant number Criteria earthlife.net Wikipedia Mute Swan www.schreibman.info www.schreibman.info Journal of Experimental Zoology 1999; 285:19-26 © 2014 Ken L Schreibman, PhD/MD 11 of 77 © 2014 Ken L Schreibman, PhD/MD 12 of 77 ©Ken L Schreibman, PhD/MD 9/1/14 www.schreibman.info Story of Lumbar Spine: page 3 of 13 1) Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Vertebrae Permit Bending: Right/Left Vertebrae Permit Bending: Back/Front C C Central E Central E R R Structural V Structural V I I Flexible C Flexible C A A Anatomy L Anatomy L T Radiographs H Radiographs O Thoracic spine has 1.Labeling R 1.Labeling Left Right A limited bending Flexion Extension Flexion Extension 2.Body Height C 2.Body Height I 3.Alignment C Ribs 3.Alignment Spondylo… Spondylo… L L U U 4.Disc Narrow M 4.Disc Narrow M B B ACR Approp. A ACR Approp. A Posterior R Side R Criteria View 8° 4° 4° 8° Criteria View 12° 8° 4° 4° 8°12° www.schreibman.info The Western Journal of paulmanley.co.uk www.schreibman.info The Western Journal of paulmanley.co.uk © 2014 Ken L Schreibman, PhD/MD Emergency Medicine 13 of 77 © 2014 Ken L Schreibman, PhD/MD Emergency Medicine 14 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Vertebral Flexion/Extension Not Uniform Spine is Straight (from the back) C Central E Central Most of the spine’s ROM R Vertical line all vertebrae Structural V Structural Lower Cervical spine I Flexible C Flexible Scoliosis: Curved spine A C5-C6* L Anatomy Anatomy Right curve: “Dextroscoliosis” Radiographs *Where DDD Occurs Radiographs [L] dexter: “dexterity” 1.Labeling 1.Labeling Dextro Flexion Extension Left curve: “Levoscoliosis” 2.Body Height 2.Body Height [L] laevus: “lame, weak” 3.Alignment 3.Alignment Note: By convention, This patient has Spondylo… Spondylo… Levo L scoliosis radiographs Dextroscoliosis of U are displayed like the T-spine… 4.DiscNarrow M 4.DiscNarrow B we’re looking at the and Levoscoliosis ACR Approp. Lower Lumbar spine A ACR Approp. R patient from the back of the L-spine Criteria L4-L5* 12° 8° 4° 4° 8°12° Criteria M,B 13yoF www.schreibman.info Yudaev-Racei Yuri paulmanley.co.uk www.schreibman.info K,K 14yoF © 2014 Ken L Schreibman, PhD/MD 15 of 77 © 2014 Ken L Schreibman, PhD/MD 16 of 77 Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Spine is NOT Straight (from the side) Lumbar Vertebrae Central Central T12 5 Lumbar Vertebrae (usually) Structural Lordosis C-spine: Normal forward curve Structural Flexible Flexible TP L1 TP Named: L1-L5 Anatomy “Cervical Lordosis” Anatomy Don’t have ribs (usually) TP L2 TP Radiographs Kyphosis T-spine: Normal back curve Radiographs Thoracic vertebrae have ribs TP 1.Labeling “Thoracic Kyphosis” 1.Labeling TP L3 Lowest is T12 (usually) 2.Body Height 2.Body Height Have Transverse Processes 3.Alignment L-spine: Normal forward curve 3.Alignment TP L4 TP Spondylo… Spondylo… Lowest Lumbar (L5 usually) Lordosis “Lumbar Lordosis” TP TP 4.Disc Narrow 4.Disc Narrow L5 Articulates with Sacrum ACR Approp. ACR Approp. S1 Criteria Criteria S1 www.schreibman.info B,J 15yoM www.schreibman.info Anterior View © 2014 Ken L Schreibman, PhD/MD 17 of 77 © 2014 Ken L Schreibman, PhD/MD 18 of 77 ©Ken L Schreibman, PhD/MD 9/1/14 www.schreibman.info Story of Lumbar Spine: page 4 of 13 1) Variations of Normal Story of the Lumbar Spine:1 Variations of Normal Story of the Lumbar Spine:1 Variations of Normal 2 Lumbar Articulations Parts of Vertebra: Processes Central Discs T12T12 Central Side View Top (Axial) View Disc Structural Facet Facet Structural Flexible Between L1L1 Flexible Posterior Disc Vertebral Anatomy “vertebral Facet Facet Anatomy Elements Vertebral bodies” L2L2 TP Radiographs Disc Radiographs Body Body Facet Facet 1.Labeling Facets L3L3 1.Labeling Body: Primary L3 Facet 2.Body Height Between Disc Disc Facet 2.Body Height structural 3.Alignment L4 3.Alignment component “posterior L4 Facet Facet Spine: [Old French] Spondylo… Disc Spondylo… espine “Thorn-like” elements” Facet 4.Disc Narrow L5 4.Disc Narrow Posterior ACR Approp.