The SpineSylvie Kalikoff & Brad Leavitt

“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

Anatomy ReviewRegions of the spine:

• Cervical

• Thoracic

• Lumbar

• Sacral

• Coccygeal

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

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 12-18 months when baby starts walking upright

Importance of Good Posture

Diseases of the spine

Scoliosis

• Abnormal curvature of the spine

• Can worsen during puberty

• Can be genetic

• Neuromuscular scoliosis

• Idiopathic scoliosis

• Degenerative scoliosis http://www.medicinenet.com/scoliosis/article.htm

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

http://www.buzzle.com/articles/scoliosis-causes-symptoms-and-treatment.html

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.

http://abcnews.go.com/topics/lifestyle/health/scoliosis.htm

http://www.hkjpaed.org/details.asp?id=94&show=1234

Can you diagnose these X-rays?

http://www.eatingbirdfood.com/my-scoliosis-story-and-where-yoga-fits-in/

http://mpr-spicesofmylife.blogspot.com/2009/11/levoscoliosis.html

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

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

- 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

X-Ray of Ankylosis

Spinal Stenosis• Stenosis= abnormal narrowing

• Causes:

overgrowth of bone: bone spur formation, Paget’s disease

herniated disks

trauma: dislocations, fractures

tumors

aging

http://www.spinecenteroftexas.com/spinal-stenosis/

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 http://www.basicspine.com/blog/lumbar-spinal-stenosis-narrowing-spine/

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

http://clinicalcases.org/2004/09/spinal-cord-compression-presenting.html

Treatment• Epidural injections

• Physical therapy and exercise

• Spinal cord stimulation

• Radiofrequency neurotomy

• Anti-inflammatory medication

http://www.vancouverspinedoctor.com/spinal-stenosis.php

Spina BifidaFour 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

Spina BifidaTreatment:

• 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

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

Injuries of the Spine

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

Symptoms

• Pain depends on location of herniated disc

• upper back→ arm, hand, shoulder pain

• lower back→ butt, leg pain

• numbness, tinglinghttp://www.livewellpainclinic.com/slipped_disc.aspx

Treatment

Surgical

• Only if non surgical treatments do not work after an extended period of time

• Microdiscectomy

• Artificial disc replacement

• Spinal Fusion

Non-surgical

• Physical therapy, exercise• Anti-inflammatory pain medication• Epidural injections

Microdiscectomy

• 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.

Spinal FracturesTypes:

• 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

Flexion FractureCompression 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

Extension Fracture

• Vertebrae pulled apart

• Common in car accidents

http://www.scientificspine.com/spinal-diseases/seat-belt-fracture.html

Rotation FractureTransverse Process Fracture

• Fracture to a bony protrusion

Rare

Result of extreme sideways bending of the spine

Fracture-Dislocation• Both fracture and dislocation occur

simultaneously• One vertebrae pushes another• Spinal cord compression

TreatmentNon-surgical Treatment

• Rest and ice

• Bracing or casting

• Rehabilitation

exercises, slow return

to mobility

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.

http://orthoinfo.aaos.org/topic.cfm?topic=a00368

Stabilization after burst fracture

What kinds of fractures are these?

http://radiopaedia.org/articles/cervical-spine-fractures http://www.radpod.org/2007/04/27/teardrop-fracture/http://learningradiology.com/archives2013/COW%20566-Burst%20fx/burstcorrect.html

Paralysis- Incomplete 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

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

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

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

Sacral Spinal Cord Injury• S1- S5

• Weakness or paralysis in hips and legs

• Symptoms: Sexual dysfunction, loss of bladder and bowel function

Referenceshttp://www.mayoclinic.org/diseases-conditions/spinal-stenosis/basics/causes/con-20036105

http://www.spine-health.com/conditions/spinal-stenosis/what-spinal-stenosis

http://www.spine-health.com/conditions/spinal-stenosis/what-spinal-stenosis

http://www.mayoclinic.org/diseases-conditions/spinal-stenosis/basics/symptoms/con-20036105

http://www.spine-health.com/conditions/spinal-stenosis/spinal-stenosis-treatment

http://www.mayfieldclinic.com/PE-ESI.htm#.VicVNBCrTVp

https://treatingpain.com/treatment/spinal-cord-stimulation

http://www.mayoclinic.org/diseases-conditions/herniated-disk/basics/symptoms/con-20029957

http://www.ajnr.org/content/20/4/697.full

http://orthoinfo.aaos.org/topic.cfm?topic=a00348

http://orthoinfo.aaos.org/topic.cfm?topic=a00368

http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4514603/k.77E9/Spinal_Cord_Injury_Types.htm

http://blog.intellidance.ca/blog/2-15-2011/c-s-how-nurture-your-babys-spine-development

http://spinabifidaassociation.org/

https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Folic_Acid_and_Neural_Tube_Defects

http://www.medicinenet.com/ankylosing_spondylitis/page4.htm