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Clinical Aspect of
Spine Disorders
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The Spine
Important structure
Composed of 33
vertebrae
Act to support the trunkand transfer muscular
load
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FTCC
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Atlas, C1, cervical vertebrae
Inferior view
Transverse foramen
Inferior
articular facet
Vertebral foramen
Transverse process
Anterior arch
Posterior arch
Anterior tubercle
Posterior tuberclesteven lee
M.S. Pathology
FTCC
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Atlas, C1, cervical vertebrae
superior vie
Transverse foramen
facet
Vertebral foramen
Transverse process
Anterior arch
Posterior arch
Anterior tubercle
Groove for vertebra
artery and first
cervical nerve
Posterior tubercle
Superior
articular
process
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FTCC
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Axis, C2 cervical vertebrae Dens (odontoid process)
Superior
articular
facet
Vertebral foramen
Spinous
process
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FTCC
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Axis, C2 cervical vertebrae
Dens
(odontoid process)
Superior
articular
facet
Vertebral foramen
Spinous
process
Transverse
foramina
Groove for atlantal
ligament attachment
Superior arterior process
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FTCC
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Axis, C2 cervical vertebrae
Vertebral foramen
Spinous
process
Inferior
articularprocess
Transverse
process
Transverse
foramen
Body
(centrum)
dens
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FTCC
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biology1155
steven leeFTCC
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biology1155
steven leeFTCC
Cervical vertebra
Superior view
Transverse foramen
Superior
articular
process
Transverse
processbody
Vertebral foramen
Spinousprocess
Anterior tubercle of transverse process
Posterior tubercle of
transverse process
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FTCC
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Cervical vertebra
Inferior view
Transverse
foramen
Inferior
articular
process
Transverse
process
body
Vertebral foramen
Spinous
process
Anterior tubercle of transverse process
Posterior tubercle of
transverse process
facet
steven lee
M.S. Pathology
FTCC
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Cervical vertebra
lateral view
Transverse foramen
Transverse
process Spinous
process
aArticular pillar
Sulcus for nerve
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Thoracic vertebra
Superior view
Superior
articular
process
Transverse
process
body
Vertebral foramen
Spinousprocess
steven lee
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FTCC
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thoracic vertebrae
Inferiorr view
inferior
articularprocess
Transverse
process
body
Vertebral foramen
Spinousprocess
steven lee
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FTCC
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thoracic vertebra
lateral view
Costal facet on anterior aspect of
Transverse process
body
Spinousprocess
steven lee
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FTCC
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thoracic vertebra
lateral view
Transverse
process
body
Spinous
processdemifacet
steven lee
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FTCC
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Lumbar vertebrae
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Lumbar vertebrae
Superior view
Superior
articular
process
Transverse
process
body
Vertebral foramen
Spinous
process
lamina
Facet of superior articular processsteven lee
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FTCC
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Lumbar vertebrae
inferior view
inferior
articular
process
Transverseprocess
body
Vertebral foramen
Spinous
process
steven lee
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FTCC
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lumbar vertebrae
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lumbar vertebrae
lateral view
inferior
articular
process
Transverse
process
body
Spinous
process
Superior
articular
process
steven lee
M.S. Pathology
FTCC
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Lumbar vertebrae
thoracic
cervical
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Regional Characteristics of Vertebrae
Sacrum
Composed of five fused
sacral vertebrae
Provide strength &stability to the pelvis
Sacral canal contains
nerve root of the cauda
equina
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Regional characteristics of Vertebrae
Coccyx Formed by four
rudimentary vertebrae
Remnant of the sceleton
of the tail
Pelvic surface is concave
& smooth
Dorsal surface is convex
& rough
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Atlanto-occipital joints
Atlantoaxial joints
Costovertebral joints
Joints of the vertebralbodies
Joints of the vertebral
arches (zygapophysialjoints/facet joints)
Sacroiliac joints
Joints of the Spine
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Intervertebral Disc
Intervertebral disc - comprised
of three parts :
nucleus pulposus
annulus fibrosus
hyaline cartilage end plates
Acts as a thick-walled cylinder
to distribute load
A pair of vertebral bodies with
the intervening disc is called Motion segmen
Functional unit
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Spinal cord
Extends from medulla oblongataL1
Lower part tapered to form conusmedullaris
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Hence: 31 pairs of spinal nerves:
8 cervical
12 thoracic5 lumbar
5 sacral
1 coccygeal
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Dorsal rootsensory fibres
Ventral root
motor fibres
Dorsal and ventral roots join at
intervertebral foramen to form the spinalnerve
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Dermatomes
Area of skin innervated by sensory axons
within a particular segmental nerve root
Knowledge is essential in determining
level of injury
Useful in assessing improvement or
deterioration
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Downloaded from: Rosen's Emergency Medicine (on 29 April 2009 06:34 PM)
2007 Elsevier
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Myotomes :
Segmental nerve root innervating a muscle
Again important in determining level of injury
Upper limbs:
C5 - Deltoid
C6 - Wrist extensors
C7 - Elbow extensors
C8 - Long finger flexors
T 1 - Small hand muscles
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Lower Limbs :
L2 - Hip flexors
L3,4
- Knee extensors
L4,5S1 - Knee flexion
L5 - Ankle dorsiflexion
S1 - Ankle plantar flexion
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Downloaded from: Rosen's Emergency Medicine (on 29 April 2009 06:34 PM)
2007 Elsevier
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Symptoms
Pain
Stiffness
Deformity
Neurological disturbance Numbness
Paraesthesia
Weakness
Urinary/Faecal retention or incontinence
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Examination
Look :
Scars, pigmentation, abnormal tufts of hair
Shape and posture
Symmetry
Normal curvature
Mass
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Examination
Feel
Palpate the spinous processes
Prominence? Step offs?
Tenderness Bone
Intervertebral tissues
Paravertebral muscles
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Examination
Move
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Examination
Move
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Examination
Special tests
Straight Leg test
Bowstring test
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Sensory Examination
Cervical Thoracic Lumbosacral
C-5 Deltoid
C-6 Thumb
C-7 Middle
finger
C-8 Little finger
T-4 Nipple
T-8 Xiphoid
T-10 Umbilicus
T-12
Symphysis
L-4 Medial Leg
L-5 1st/2ndtoes
S-1 Lateral foot
S-4 Perianal
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Imaging
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Radioisotope scanning
Discography/Arthrography
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Etiology Spine Disorders
Congenital
Infection
Neoplastic
Trauma
Others Degenerative Spine Disease
Autoimmune disorders
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Spina Bifida
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Klippel-Feil Syndrome
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Cervical Fracture
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Cervical Fracture
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Cervical Fracture
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Intervertebral Disc Disorders
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Open Discectomy & Stabilization
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Spondylolisthesis
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Senile Kyphosis
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Spine Tuberculosis
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Case preview
Post op X Ray
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Case preview
Mr. H, 44 y.o. Spondilitis TB T12-L1, Frankle C
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Case preview
Post op X Ray
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Scoliosis
Instrumentation for Scoliosis
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Instrumentation for Scoliosis
THANK YOU
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THANK YOU