FIU - Thoracic and Lumbar Spine Special Tests and Pathologies
Anatomy of the Spine and Some Common Pathologies
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Transcript of Anatomy of the Spine and Some Common Pathologies
ANATOMY ANATOMY
OF THE SPINEOF THE SPINEReported By
MARIA THERESA M. NAVARRO, M.D.
OVERVIEWOVERVIEW
THREE MAJOR COMPONENTS
THE SPINAL COLUMN (bones and discs) NEURAL ELEMENTS (spinal cord and nerve
roots) SUPPORTING STRUCTURES (muscles and
ligaments)
VERTEBRAECORTICAL BONE
CANCELLOUS BONE
Typ ic al VER TE BRATyp ic al VER TE BRA1. VERTEBRAL BODY
2. SPINOUS PROCESS
3. TRANSVERSE FACET
4. PEDICLE
5. CENTRAL SPINAL CANAL
6. LAMINA
7. COSTOVERTEBRAL FACET
ATL AS AND AXI SATL AS AND AXI S
Cervical Spine X-ray
1 VERTEBRAL BODY
2 SPINOUS PROCESS
3 SUPERIOR ARTICULAR PROCESS
4 INFERIOR ARTICULAR PROCESS
5 PEDICLE
6 TRANSVERSE PROCESS
1
2
34
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Cervical Spine (Lateral view)
VERTEBRAL BODY
SPINOUS PROCESS
FACET JOINT
INTERVERTEBRAL DISC
FORAMEN TRANSVERSARIUM
SUPERIOR ARTICULAR FACET
INFERIOR ARTICULAR FACET
THO RAC IC VER TE BRATHO RAC IC VER TE BRA
Thoracic Spine
Thoracic Spine Lateral View
Thoracic CT scan (axial view)
LUMBAR VER TEB RALUMBAR VER TEB RA
LUMBAR SPINE X RAY
LUMBAR SPINE (LATERAL VIEW)
SCOTTIE DOG
PEDICLE
SUPERIOR ARTICULAR PROCESS
INFERIOR ARTICULAR PROCESS
FACET JOINT
PARS INTERARTICULARIS
TRANSVERSE PROCESS
SACRUM AND COCCYXSACRUM AND COCCYX
SPI NAL SPI NAL CU RVESCU RVES
CERVICAL 20-40 degreesTHORACIC 20-40 degreesLUMBAR 40-60 degreesSACRAL sacrum fused in a kyphotic curve
FUNCTIONS OF THE VERTEBRAL COLUMN
PROTECTIONBASE FOR ATTACHMENTSTRUCTURAL SUPPORTFLEXIBILITY AND MOBILITYOTHERS – production of red blood cells mineral storage
INTERVERTEBRAL DISCSTHREE COMPONENTS
1. CARTILAGINOUS ENDPLATE
- attaches firmly to the osseous endplate by means of numerous collagenous fibers (Sharpey’s fibers)
- strengthens the osseous endplate, which contains multiple perforations
- within the pores of the vertebral endplate are numerous vascular channels (major source of nutrients)
2. ANNULUS FIBROSUS
- complex fibrous and fibrocartilaginous structure that consists of 12 to 15 layers, each with well developed dense parallel fibrous bands.
- composed of collagen and proteoglycans
INTERVERTEBRAL DISCSTHREE COMPONENTS
3. NUCLEUS PULPOSUS
- composed of fibrocartilage
- mucopolysaccharide gel gives the disc its high intrinsic pressure, which allows it to resist compressive forces.
- contains realtively more proteoglycans giving it a looser gelatinous texture.
BASIC PRINCIPLES IN MRI IMAGING
T1 WI - water is black fat is white bone is blackT2 WI – water is white fat is white bone is black
color is referred to as increased or decreased signal or hypo or hyperintense
MRI IN FOR MAT IONMRI IN FOR MAT ION
Spinal alignmentDisc height and hydrationVertebral body configurationEvaluation of intervertebral discSpinal canal sizeNervesAbnormalities
T1 FAST SPIN ECHO OF THE LUMBAR SPINE
T2 FAST SPIN ECHO OF THE LUMBAR SPINE
DEGENERATIVE DISEASESOF THE SPINE
DISC DISEASEDISC DISEASE
DISC DEGENERATIONDISC DEGENERATION
DEGENERATION
CRACKS OR FISSURES IN THE INNER
LAYERS OF THE ANNULUS FIBROSUS
ALTERATIONS IN THE
PROTEOGLYCAN MATRIX
LOSS OF BOUND WATER
MOLECULES
LOSS OF DISC HEIGHT
DIMINISHED TURGOR
AND ELASTICITY
DECREASED CAPACITY
FOR SHOCK ABSORPTION
GREATER FORCES
TRANSMITTED INTO
ADJACENT VERTEBRAL
BODIES
OSTEOPHYTES
SCLEROSIS
MRI OF DEGENERATIVE DISC MRI OF DEGENERATIVE DISC DISEASEDISEASE
decrease in disc space vertical heightdecrease signal intensity on T2 weighted imagesdiffuse disc bulging may or may not be present
MARR OW CHA NG ESMARR OW CHA NG ES(I NTERV ERT EB RAL (I NTERV ERT EB RAL
OS TEOC HON DROS IS)OS TEOC HON DROS IS)
alterations of the adjacent vertebral body architecture
Edema pattern (TYPE I)TYPE I) decreased signal on T1WI increased signal on T2WI
Infiltration by fat (TYPE II)TYPE II) increased signal on T1WI Isointense or slightly hyperintense signal on
T2WI
Degenerative discogenic sclerosis (TYPE TYPE III)III)dense bone devoid of marrow
decreased signal on T1WI decreased signal on T2WI
DISC HERNIATIONDISC HERNIATION
CHRONIC REPETITIVE STRESS OR ACUTE INJURY MAY RESULT IN MARGINAL DISPLACEMENTS OF DISC MATERIAL
DISC BULGECIRCUMFERENTIAL EXTENSION OF THE DISC MARGIN BEYOND THE VERTEBRAL BODY MARGINS
DISC HERNIATION
FOCAL DISPLACEMENT OF DISC MATERIAL (NUCLEUS PULPOSUS AN/OR ANNULUS) BEYOND THE MARGINS OF THE DISC SPACE
A BULGING DISC THAT IS ECCENTRIC TO ONE SIDE BUT > 3 mm BEYOND VERTEBRAL MARGIN
DISC HERNIATIONDISC PROTRUSION
A DISC HERNIATION THAT EXTENDS BEYOND THE VERTEBRAL MARGINS BUT RETAINS A BASE AGAINST THE INTERVERTEBRAL DISC MARGIN THAT IS WIDER THAN THE MAXIMUM DIAMETER OF THE PROTRUDING DISC
A BULGING DISC THAT IS ECCENTRIC TO ONE SIDE BUT < 3 mm BEYOND VERTEBRAL MARGIN
DISC EXTRUSION
FOCAL HERNIATION ASSOCIATED WITH EXTENSION OF THE NUCLEAR MATERIAL COMPLETELY THROUGH THE OUTER ANNULUS INTO THE EPIDURAL SPACE
DISC HERNIATION
DESSICATIONLOSS OF DISC WATER
• FREE FRAGMENT
EPIDURAL FRAGMENT OF DISC NO LONGER ATTACHED TO THE PARENT DISC
DISC HERNIATION
LUMBAR SPINE90% L4-L5 or L5-S1the rest L3-L4disc annulus most frequently falls posterolaterally where it is weakest (PARACENTRAL HERNIATION)
DISC HERNIATION
CERVICAL SPINEdisc herniation and degeneration most common at C5-C6 and C6-C7.
SPONDYLOSISSPONDYLOSISOSTEOARTHRITISOSTEOARTHRITIS SPINAL STENOSIS SPINAL STENOSIS
SPONDYLOSIS DEFORMANSMost COMMON degenerative process of the spineOsteophytes arise secondary to degenerative disc disease
•When Sharpey’s fibers are torn from their attachments along the vertebral body margins, stress is placed on bone as the disc moves and osteophytes form in reaction to stress
can take the form of marginal end plate osteophytes, enlarged uncinate processes, or facet arthrosis.
SPONDYLOSIS DEFORMANS
• Osteophytes are hypointense on all pulse sequences
OSTEOARTHRITIS
Degenerative arthritis involving synovial jointsIn the spine, affected is the apophyseal or facet joints
Spondylosis and osteoarthritis are terms used synonymously because often coexist
OSTEOARTHRITISnot all back pain or sciatica is due to intervertebral disc disease
degeneration of the facet joint can cause facet arthrosis syndrome
Facet joint hypertrphy + osteophyte formation along the posterior lateral margins of the vertebral body can encroach upon the lateral recesses of the spinal canal and neural foramina.
SPINAL STENOSISREFERS TO BONY OR SOFT TISSUE NARROWING OF THE SPINAL CANAL OR NEURAL FORAMINA
• can compress neural structures within the spine and cause neurological symptoms
• can involve the spinal canal, the lateral recesses or the neuroforamina.
CAUSES
DEGENERATIVE DISEASE OF THE DISC SPACE AND FACET JOINTSSPONDYLISTHESISTRAUMAPAGET’S DISEASEPOST SURGICAL COMPLICATION
LATERAL RECESS STENOSIS
MOST COMMON CAUSE is Hypertrophy of the superior articular processes of facet jointsDisc protrusionsPost operative scars
NEURAL FORAMINAL STENOSIS
MOST COMMON CAUSE isDegenerative hypertrophy of the uncinate process and posterior facet joints in the cervical spineHypertrophic osteophytes from facet joints and bulging discs in the lumbar spine
SPONDYLOLISTHESISSPONDYLOLISTHESIS
Displacement of a vertebra with respect to the subjacent vertebraDEGENERATIVE SPONDYLISTHESIS Most common type Degenerative changes of both the facet joints
and intervertebral disc. Most common in the lumbar spine
SPONDYLOLYSISSPONDYLOLYSIS
Bilateral pars defectMost frequently seen in the neural arch of the 5th lumbar vertebraC6 is the most common cervical site of spondylolytic spondylolisthesisSeen in the oblique viewsLUCENCY ACROSS THE NECK OF THE SCOTTIE DOG
DISC HERNIATION
SPONDYLISTHESISTraumatic subluxation of the cervical spine in a 51-year-old man with quadriparesis following an automobile crash. Spin-density weighted MRIs show anterior subluxation of C4 (top arrow) on C5 (bottom arrow), associated with marked narrowing of the spinal canal and compression of the thecal sac and spinal cord. The hyperintensity of the disc and adjacent prevertebral and ventral epidural soft tissues likely represents a combination of edema and hemorrhage.
COLLAPSE L5 WITH SPINAL STENOSIS
DEGENERATIVE SPINAL STENOSIS
SPINAL STENOSIS DUE TO TUMOR
POSTEROLATERAL DISC HERNIATION
MULTILEVEL SPINAL STENOSIS
SEVERE LUMBAR SPINAL STENOSIS AND FACET DISEASE
LUMBAR SPINAL STENOSIS AND SYNOVIAL CYST
LATERAL RECESS STENOSIS