clinical aspect of spine palembang

8/13/2019 Clinical Aspect of Spine Palembang

1/77

Clinical Aspect of

Spine Disorders


2/77

The Spine

Important structure

Composed of 33

vertebrae

Act to support the trunkand transfer muscular

load


3/77

steven lee

M.S. Pathology

FTCC


4/77

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


5/77

steven lee

M.S. Pathology

FTCC


6/77

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

steven lee

M.S. Pathology

FTCC


7/77

steven lee

M.S. Pathology

FTCC


8/77

Axis, C2 cervical vertebrae Dens (odontoid process)

Superior

articular

facet

Vertebral foramen

Spinous

process

steven lee

M.S. Pathology

FTCC


9/77

steven lee

M.S. Pathology

FTCC


10/77

Axis, C2 cervical vertebrae

Dens

(odontoid process)

Superior

articular

facet

Vertebral foramen

Spinous

process

Transverse

foramina

Groove for atlantal

ligament attachment

Superior arterior process

steven lee

M.S. Pathology

FTCC


11/77

steven lee

M.S. Pathology

FTCC


12/77

Axis, C2 cervical vertebrae

Vertebral foramen

Spinous

process

Inferior

articularprocess

Transverse

process

Transverse

foramen

Body

(centrum)

dens

steven lee

M.S. Pathology

FTCC


13/77

biology1155

steven leeFTCC

steven lee

M.S. Pathology

FTCC


14/77

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

steven lee

M.S. Pathology

FTCC


15/77

steven lee

M.S. Pathology

FTCC


16/77

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


17/77

steven lee

M.S. Pathology

FTCC


18/77

Cervical vertebra

lateral view

Transverse foramen

Transverse

process Spinous

process

aArticular pillar

Sulcus for nerve

steven lee

M.S. Pathology

FTCC


19/77

steven lee

M.S. Pathology

FTCC


20/77

Thoracic vertebra

Superior view

Superior

articular

process

Transverse

process

body

Vertebral foramen

Spinousprocess

steven lee

M.S. Pathology

FTCC


21/77

steven lee

M.S. Pathology

FTCC


22/77

thoracic vertebrae

Inferiorr view

inferior

articularprocess

Transverse

process

body

Vertebral foramen

Spinousprocess

steven lee

M.S. Pathology

FTCC


23/77

steven lee

M.S. Pathology

FTCC


24/77

thoracic vertebra

lateral view

Costal facet on anterior aspect of

Transverse process

body

Spinousprocess

steven lee

M.S. Pathology

FTCC


25/77

steven lee

M.S. Pathology

FTCC


26/77

thoracic vertebra

lateral view

Transverse

process

body

Spinous

processdemifacet

steven lee

M.S. Pathology

FTCC


27/77

steven lee

M.S. Pathology

FTCC

Lumbar vertebrae


28/77

Lumbar vertebrae

Superior view

Superior

articular

process

Transverse

process

body

Vertebral foramen

Spinous

process

lamina

Facet of superior articular processsteven lee

M.S. Pathology

FTCC


29/77

steven lee

M.S. Pathology

FTCC


30/77

Lumbar vertebrae

inferior view

inferior

articular

process

Transverseprocess

body

Vertebral foramen

Spinous

process

steven lee

M.S. Pathology

FTCC


31/77

steven lee

M.S. Pathology

FTCC

lumbar vertebrae


32/77

lumbar vertebrae

lateral view

inferior

articular

process

Transverse

process

body

Spinous

process

Superior

articular

process

steven lee

M.S. Pathology

FTCC


33/77

steven lee

M.S. PathologFTCC


34/77

Lumbar vertebrae

thoracic

cervical

steven lee

M.S. PathologFTCC


35/77

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


36/77

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


37/77

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


38/77

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


39/77

Spinal cord

Extends from medulla oblongataL1

Lower part tapered to form conusmedullaris


40/77


41/77

Hence: 31 pairs of spinal nerves:

8 cervical

12 thoracic5 lumbar

5 sacral

1 coccygeal


42/77

Dorsal rootsensory fibres

Ventral root

motor fibres

Dorsal and ventral roots join at

intervertebral foramen to form the spinalnerve


43/77


44/77


45/77

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


46/77

Downloaded from: Rosen's Emergency Medicine (on 29 April 2009 06:34 PM)

2007 Elsevier


47/77

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


48/77

Lower Limbs :

L2 - Hip flexors

L3,4

- Knee extensors

L4,5S1 - Knee flexion

L5 - Ankle dorsiflexion

S1 - Ankle plantar flexion


49/77

Downloaded from: Rosen's Emergency Medicine (on 29 April 2009 06:34 PM)

2007 Elsevier


50/77

Symptoms

Pain

Stiffness

Deformity

Neurological disturbance Numbness

Paraesthesia

Weakness

Urinary/Faecal retention or incontinence


51/77

Examination

Look :

Scars, pigmentation, abnormal tufts of hair

Shape and posture

Symmetry

Normal curvature

Mass


52/77

Examination

Feel

Palpate the spinous processes

Prominence? Step offs?

Tenderness Bone

Intervertebral tissues

Paravertebral muscles


53/77

Examination

Move


54/77

Examination

Move


55/77

Examination

Special tests

Straight Leg test

Bowstring test


56/77

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


57/77


58/77

Imaging

Plain Radiographs

Computed Tomography

Magnetic Resonance Imaging

Radioisotope scanning

Discography/Arthrography


59/77

Etiology Spine Disorders

Congenital

Infection

Neoplastic

Trauma

Others Degenerative Spine Disease

Autoimmune disorders


60/77

Spina Bifida


61/77

Klippel-Feil Syndrome


62/77

Cervical Fracture


63/77

Cervical Fracture


64/77

Cervical Fracture


65/77

Intervertebral Disc Disorders


66/77


67/77

Open Discectomy & Stabilization


68/77

Spondylolisthesis


69/77

Senile Kyphosis


70/77

Spine Tuberculosis


71/77


72/77

Case preview

Post op X Ray


73/77

Case preview

Mr. H, 44 y.o. Spondilitis TB T12-L1, Frankle C


74/77

Case preview

Post op X Ray


75/77

Scoliosis

Instrumentation for Scoliosis


76/77

Instrumentation for Scoliosis

THANK YOU


77/77

THANK YOU

clinical aspect of spine palembang

Documents