Spine Prof. Saeed Abuel Makarem. Spinal fractures Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can

$Page 1: Spine Prof. Saeed Abuel Makarem. Spinal fractures Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can$
Spine

Prof.Prof. Saeed Abuel MakaremSaeed Abuel Makarem

Spinal fractures• Spinal fractures are different than

a broken arm or leg.• A fracture or dislocation of a

vertebra can cause bone fragments that pinch or damage the spinal nerves or even the spinal cord.

• Most spinal fractures occur due to• Car accidents,• Falls,• Gunshot, or • Sports. • Injuries can range from mild ligament

or muscle strains, to fractures and dislocations of the vertebrae, and debilitating spinal cord damage.

Prof. Saeed Abuel Makarem

Spinal fractures• Depending on how severe your injury is, you may experience:

• Pain, • Difficulty walking, • Unable to move your arms

or legs (paralysis).• Many fractures heal with

conservative treatment.• However severe fractures

may require surgery.• To understand spinal

fractures, it is helpful to understand how your spine are formed and works.



• The vertebral column is a complex construct that includes a variety of:

• Bones,• Joints, • Tendons,• Nerves,• Ligaments,• Muscles and• Vessels• All woven together.

• The spines extends from the base of the skull to the pelvis.

• Ligaments, joints, muscles and tendons connect the bones together and keep them aligned.

SPINAL COLUMN


• It is consists of 24 single vertebrae and 2 bones,

•Sacrum and •Coccyx, which made from fused vertebrae.

• Of the 24 single bones, 7 vertebrae in the neck (cervical), 12 vertebrae in the chest (thoracic), and 5 supporting the lower back and are called (lumbar).

SPINAL COLUMN


One spinous process: single posterior projection arising from the vertebral arch. 2 Superior and 2 inferior articular processes: paired projections allowing a vertebra to articulate with adjacent vertebrae.

TYPICAL VERTEBRABody or Centrum: Anterior discoid, weight-bearing part of the vertebra. And Vertebral arch:2 pedicles and2 Laminae.They join together to complete the arch.

Vertebral foramen: Between body and the arch and contains the spinal cord, ligament, fat and blood vessels.The arch carries 7 processes. 2 Transverse processes: two lateral projections from the vertebral arch.


CERVICAL

VERTEBRA


The atlas has no body. The superior surfaces of its 2 lateral masses contain large kidney- shaped facet that articulate with the occipital condyles. This joint allows you to nod- that is to say "yes." –Atlanto-occipital joint.The axis acts as a pivot for the rotation of the atlas (and the skull above). It has a large upright process, called the odontoid process, or dens, which acts as the pivot joint. The atlantoaxialatlantoaxial joint allows you to rotate your head that is to say "no."

ATLAS & AXIS

The 7 cervical vertebrae (identified as C1 to C7). The first two (atlas & axis) are different because they perform functions not shared by the other cervical vertebrae. The neck has the greatest range of motion because of these 2 specialized vertebrae.

The vertebrae in each region have unique features that help them to perform their main functions.


The "typical" cervical vertebrae (C3 to C7) are the smallest, lightest vertebrae.

Their spinous processes are often short and bifid, except the 7th.

Its transverse processes contain foramina through which the vertebral vessels pass.

The main function of the cervical spine is to support the weight of the head (about 10 pounds).

Also, it is the most movable region of the spine.

TYPICAL CERVICAL VERTEBRAE


THORACIC VERTEBRAE

• The 12 thoracic vertebrae (T1 toT12) are larger than the cervical vertebrae.

• The body is somewhat heart-shaped and has two costal demifacets on each side, which receive the heads of the ribs.

• The spinous process is long and hooks sharply downward.

• The range of motion in the thoracic spine is limited.


LUMBAR VERTEBRAE

• The 5 lumbar vertebrae (L1-- L5) have massive, block like bodies.

• They have short, hatchet-shaped spinous processes.

• They are the most solid of all vertebrae.

• Their main function is to bear the weight of the body.

• They also have a moderate range of movements.


SACRUM

• The sacrum is formed of 5 fused vertebrae.

• It articulates with L5 above.• And below with the coccyx. • It also articulate with the

hip bones at the alae, to form the sacroiliac joints.

• The sacrum forms the

posterior wall of the pelvis.• Its dorsal midline surface is

roughened by the median sacral crest, (fused dorsal spines).

• The median sacral crest is flanked laterally by the dorsal sacral foramina.

• The sacral canal is the continuation of the vertebral canal.


COCCYX

The coccyx is formed of 3 to 5 (usually 4) tiny, irregularly shaped vertebrae.

Also called the tailbone it provides attachment for ligaments and muscles of the pelvic floor.


• The vertebral bodies are separated by pads of flexible fibrocartilage called intervertebral discs.

• The discs looks like a jelly doughnut • There are a total of 23 discs in the

spinal column.• There are no discs between the Atlas

& Axis and Sacrum & Coccyx.• The intervertebral discs forms about

one fourth of the whole length of the spinal column.

Its primary function:1. It act as a shock absorber between 2

adjacent vertebrae. 2. It also acts as a cartilaginous joints

that allow for slight mobility.3. It also acts as ligaments that hold the

vertebrae together.• Intervertebral discs are avascular and

receive its nutrition from the vertebral end plates.

Intervertebral Discs

Intervertebral Discs

The intervertebral discs are formed of an outer annulus fibrosus and an inner soft, jelly-like material (nucleus pulposus).

The annulus fibrosus is a strong radial tire–like structure made up of concentric lamellae of collagen fibers connected to the vertebral end plates.

The nucleus pulposus contains a mucoprotein gel–like material that is sealed by the annulus fibrosus.

The nucleus pulposus needs to be well-hydrated in order to maintain its strength and softness.

It serve as the major carrier of the body’s axial load that resists compression.Prof. Saeed Abuel Makarem

Intervertebral Discs • Both the annulus fibrosus and nucleus pulposus are composed of:

1. Water, 2. Collagen, and 3. Proteoglycans (PGs).• The amount of fluid (water & PGs)

is greatest in the nucleus pulposus. • PG molecules are important as

they can attract and retain water in the discs.

• The amount of water in the nucleus varies throughout the day depending on the body activity.

• Unfortunately, the amount of water becomes less by old age.


Intervertebral Discs• The vertebral discs in the

spine is an interesting and unique structure.

• The nucleus acts like a ball-bearing when you move, allowing the vertebral bodies to roll over the incompressible gel.

• The gel-filled nucleus is composed mostly of fluid.

• This fluid absorbed during the night as you lie down and is pushed out during the day as you move upright.


HERNIATED DISC• With age, our discs increasingly

lose the ability to reabsorb fluid and become brittle and flatter.

• This is why we get shorter as we grow older.

• Also diseases, such as osteoarthritis & osteoporosis, can cause bone spurs (osteophytes) to grow.

• Injury and strain can cause the nucleus to herniate, out of the annulus and compresses the nerve roots causing back pain.


HERNIATED DISC• The herniated disc is usually prevented to herniate posteriorly because of the presence of the posterior longitudinal ligament,(PLL).

• Herniation is mostly posterolateral.

• So disk herniation impinge on a spinal nerves rather than on the spinal cord itself!


Curvatures• The S-shaped curves of the vertebral column

work together with the discs to prevent shock to the head when we walk or run.

• They also make the body trunk flexible. • Curves act like a coiled spring to absorb

shock, maintain balance, and allow range of motion throughout the spinal column.

• The spinal curves in the thoracic and sacral regions are referred to as primary curves as they are present when we are born.

• Later, the secondary curves develop.• The cervical curve appears by the 6th month,

when the baby begins to set and hold his head.

• While the lumbar curve develops by the end of the 1st year, when the baby begins to walk.

Prof. Saeed Abuel Makarem.

Muscles and Posture• Muscles and correct posture

maintain the natural spinal curves.

• Good posture involves training your body:

• To stand up, • To walk,• To sit,• To lie down, and• To carry weight.• So that the least amount of strain

are placed on the spine during movement or weight-bearing activities.

• Excess body weight, big abdominal belly, weak muscles, and other factors can affect the spinal alignment.


Spine• It is important to know

that: • Strong Bones• Strong Muscles,• Flexible Tendons, • Flexible Ligaments & • Sensitive Nerves. All Contribute to a healthy

spine.• Keeping your spine healthy is

vital if you want to live an active life without back pain.


Abnormal Spinal Curves• An icreased

curvature of the thoracic spine is called kyphosis, or hunch back.

• An abnormal curve of the lumbar spine is called lordosis, or sway back.

• An abnormal curve from side-to-side is called scoliosis.


Kyphosis Lordosis Scoliosis

Muscles

Two main muscle groups that affect the spine are extensors and flexors.

Extensor muscles enable us to stand up & lift objects.

Extensors are attached to the back of the spine.


Flexor are in the front and include the abdominal muscles. These muscles enable us to flex, or bend forward, and are important in lifting and controlling the arch in the lower back.

http://www.muscleandfitness.com/videos/mf-raw

MUSCLES OF THE BACK• Most of the body weight lies anterior to the

spinal column.• So the axis of gravity descends anterior to the

vertebral column, knee and ankle.• The deep muscles of the back are important in

maintaining the spinal alignment and the normal postural curves of the spinal column in the standing position.

• There are 3 groups of muscles in the back:– Superficial muscles associated with the

shoulder girdle.– Intermediate muscles involved in

respiration.– Deep muscles belonging to the spinal

column.

SUPERFICIAL MUSCLES

The superficial muscles belong to the upper limb.

These are:• Trapezius• Latissimus dorsi• Levator scapulae• Rhomboids minor• Rhomboids major

INTERMEDIATE MUSCLES

The intermediate muscles are associated with respiration.

These are:• Serratus posterior

superior.• Serratus posterior

inferior.• Levatores costarum.

DEEP MUSCLES

• The deep muscles of the back form a deep, broad muscular column, which occupies the hollow on each side of the spinous processes.

• They extend from the sacrum to the skull.• This muscle mass is composed from many small muscles of different length.• Each individual muscle causes one or several vertebrae to be extended or

rotated on the vertebra below.

CLASSIFICATION OF THE DEEP MUSCLES OF THE BACK

• Superficial vertically running muscles:– Erector spinae

• Iliocostalis• Longissimus• Spinalis

• Intermediate oblique running muscles:– Transversospinalis

• Semispinalis• Multifidus• Rotatores

• Deepest muscles– Interspinalis– Intertransversarii

BLOOD AND NERVE SUPPLY

• Arterial supply: Dorsal branches of the posterior intercostal arteries.

• Venous drainage: Posterior intercostal veins.

• Nerve supply: Posterior rami of the spinal nerves

Misalignment

• Back muscles stabilize your spine. • Poor muscle tone or a large belly can pull your

entire body out of alignment.• Misalignment puts incredible strain on the spine.

Facet joints

• The facet joints of the spine allow spinal motion.

• Each vertebra has four facet joints,

• One pair that connects to the vertebra above (superior facets)

• One pair that connects to the vertebra below (inferior facets).


Ligaments • The ligaments are strong fibrous bands that hold the vertebrae together, stabilize the spine, and protect the discs.

• The three major ligaments of the spine are:

• Anterior longitudinal ligament (ALL), • Posterior longitudinal ligament (PLL).• The ALL and PLL are continuous bands

that run from the top to the bottom of the spinal column along the vertebral bodies.

• They prevent excessive movement of the vertebrae, and hold the vertebral bodies and discs together.

• Ligamentum flavum, • The ligamentum flavum attaches

between the lamina of all vertebrae.


What Types of Vertebral Injuries May Occur?

• The two main types of injuries to the spinal bones (vertebrae) are fractures and dislocations.

• A fracture is a break to any part of the vertebra.

• A dislocation is when the vertebrae do not line up correctly or are out of place.

• These injuries may cause damage to the spinal nerves or the spinal cord.

• There are several types of fractures and dislocations that can occur.


Compression fracture

• This usually results from a hyperflexion (front to back) injury where part of the vertebral column is forced forward and downward.


Burst Fracture

• A burst fracture is a very serious form of compression fracture.

• In this type the bone is shattered from the injury.

• Bone fragments may pierce the spinal cord.

• The injury usually occurs from a downward or upward force along the spine.

• It is often result in serious spinal cord injury.


Subluxation• In subluxation, the joints

in the back of the vertebrae are weakened by abnormal movement of the bones.

• It is a partial dislocation of the vertebrae.

• It happens if the muscles and ligaments in the spine are injured.

• It may also cause injury to the spinal cord.


Dislocation• A dislocation also may occur when

ligaments are badly stretched from the injury.

• This allows too much movement of the vertebrae.

• The vertebrae may "lock" over each other on one or both sides.

• A spinal cord injury may occur, depending on how much extra movement is allowed by the torn ligaments.

• The vertebrae that are not lined up correctly are returned to a normal position by a "reduction". Traction or surgery is often required for a reduction.

• A brace, vest, or surgery to fuse the vertebrae is sometimes needed to keep the vertebrae lined up correctly. Prof. Saeed Abuel Makarem

Fracture- Dislocation

• This occurs when there is a fracture and a dislocation of the vertebrae.

• There is usually serious ligament and soft tissue injury and this may also cause injury to the spinal cord



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Spine Prof. Saeed Abuel Makarem. Spinal fractures Spinal fractures are different than a broken arm or leg. A fracture or dislocation of a vertebra can