Orthopedics 5th year, 1st lecture (Dr. Hamid)

Anatomy of the Cervical Spine

Cervical Spine Anatomy

bullPrimary functionndashMobility support and

protection of spinal canal and neural structures


bullVertebrae (7)

bullIntervertebral discs (6)

bullPairs of exiting nerve roots (8)

bullCervical lordosis Occ-C7 averages 40deg

ndashMost of the lordosis occurs at the C1-C2 segment

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Cervical Spine AnatomybullApproximately 50 of flexion-

extension motion occurs at occiput-C1

bullApproximately 50 of rotation occurs at C1-C2

bullLesser amounts of flexion-extension rotation and lateral

bending occur segmentally between C2-C7



bullAtypical vertebral

bullstructure C1 (atlas)

bullVertebral canalforamen

bullAnterior arch

bullAnterior tubercle

bullTransverse process

bullPosterior arch

bullTransverse foramen

bullLateral massOccipital condyles

Foramen magnum

Superior

Inferior


bullAtypical cervical

bullvertebra C2 (axis)

bullOdontoid process or dens


bullFacet joints



bullBifid spinous process

bullLamina

anterior view

posterior view


bullThe odontoid process of the axis (C2) extends

cranially to form the axis of rotation with atlas (C1)


bullLigamentsndashThe cervical spine also

features a complex arrangement of ligaments to supplement its structure and

mobility


bullLigamentsndashAnterior longitudinal

ligament

ndashPosterior longitudinal ligament

ndashLigamentum flavum

ndashIntertransverse ligaments

ndashInterspinous ligaments

ndashLigamentum nuchae



ligament








ligament








ligament








ligament








ligament







bull Neural elementsndash8 pair of cervical nervesndashExit the spinal canal

superior to the vertebrae for which they are

numberedbullC1 nerves exit the canal

between Occ amp C1bullC2 nerves exit the canal

between C1 amp C2bullC8 nerves exit the canal

between C7 amp T1


bull ArteriesndashCarotid arteries

bullLocated anterior and bilateral to the spine

ndashVertebral arteriesbullEnter the transverse

foramen at C6 and continue through C1


bull VeinsndashJugular veins

bullLocated bilateral and anterior to the spine

ndashVertebral veinsbullLocated within the

transverse foramen of C1-C7


Neural and Circulatory Elements

Torticollis

bullInfantile ndashcongenital ndash

bullCause and discription

bullClinical feature

DDXX-ray

Treatment

bullSecondary torticollis

bull

Prolapsed Intervertebral Discs

Introduction

bull Male predominance

bull 30 ndash 50 yrs

bull Smokers

bull Sudden flexionamp Twisting

bullFUNCTION OF SPINE

bullndashCombination of stability and

bullmobility due to 2 types of joints

bull1048708Facet Joints

bull1048708Intervertebral disc

bullTYPES OF JOINTSbullA- Facet joint- Typical (Diathrodial)

bull1048708 Lined with synovial membrane

bull1048708 Minimal resistance to movemetns

bullB- IVD

bulllining

bull1048708 Disc- Bears load associated with erect

bullpostur

bull1048708 Allows movements between hellip Bodies

bullANATOMY OF

bullINTERVERTEBRAL DISC

bull1 -Annulus- concentric laminae of collagen

bullfibrils

bull ndashOutermost ndash Sharpey fibers attached to bone

bullTough - type I collagen

bull ndashInner ndash less tough ndash type II collagen

bull2 -Nucleus pulposus

bullonly type II collagen

Nerve root

bull Medial amp inferior to the pedicle at

each level

bull More susceptiple for mechanical

deformation

--lack an epineurium

--reduced collagen content

--more parallel orientation of nfibres

fig

Pathology

bull Normal aging

bull -disc degeneration-displacement of facet joint

bull -acute disc herneation-pain

bull -2ndary effect-aquired SS

---Effects of pressure on the nerve root

Pathophysiology bull Effects of pressure on the nerve root

-Compressive

bull -Deformation-stramp funchanges

Classification

bull A-Site5-66-7

bull B-Direction posterolat

bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture

bullPressure on Dura

bullPressure on root

bullPressure on cord

bullMixed

Imagingbull X-raybull MRIbull CT scans with or without myelography -intolerant to MRI -Unsuitable for MRIbull gadolinium-enhanced MRI This will help to delineate which part of the

previous operation site is disc and which is epidural fibrosis (the latter enhancing)

DDX

bullAcute muscularampST strain

bullNeuralgic amyatrophy

bull Infection

Tumor

bullRotator cuff syndrome

Treatmentbull usually have a good prognosis

bull In up to four-fifths of patients symptoms

will resolve spontaneously within a 12-week

period

bull However if pain persists beyond this time

there is a slow resolution of pain in the

majority of patients

bull By approximately 4 years there is no difference in the incidence of pain in

patients treated non-operatively or surgically

bull Surgical results will deteriorate after

symptoms have been present for 1

year

Non-operative treatment

bull ANALGESICSampANTIINFLAMATORY

bull REST-collar

bull Reduce-traction

bull

Indications for diskectomybull Strong indications for surgical intervention

-Acute mylopathy or myloradiculopathy

-Progressive Neurological deficit

bull Relative indications

bull Failure of conservative treatment-refractory

bull Significant motor deficit

bull Severe incapacitating pain - does not respond to any form of treatment

surgical treatment--ANTERIOR OPEN APPROACH

--POSTERIOR OPEN APPROACH

--Microdisectomy

--Chemonucleolysis

--percutanious

Complications

1--Approach relatedbull 2--mechanical intraopbull 3-early postop wound infectionsDiscitis bull Haematoma-Airway obsbull 4-late postop-Non-union-Instability-deformity


bullPrimary functionndashMobility support and

protection of spinal canal and neural structures


bullVertebrae (7)





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bullAnterior arch



bullPosterior arch



Foramen magnum

Superior

Inferior






bullFacet joints




bullLamina

anterior view

posterior view







mobility



ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications



bullVertebrae (7)





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44

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bullAnterior arch



bullPosterior arch



Foramen magnum

Superior

Inferior






bullFacet joints




bullLamina

anterior view

posterior view







mobility



ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications












bullAnterior arch



bullPosterior arch



Foramen magnum

Superior

Inferior






bullFacet joints




bullLamina

anterior view

posterior view







mobility



ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications







bullFacet joints




bullLamina

anterior view

posterior view







mobility



ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications








mobility



ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament








ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament








ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament








ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament








ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament








ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




ligament












between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications








between C7 amp T1













Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications














Torticollis




DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications





DDXX-ray

Treatment


bull


Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications



Introduction



bull Smokers










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications










bullB- IVD

bulllining


bullpostur


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


bullANATOMY OF



bullfibrils






Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


Nerve root


each level


deformation




fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


fig

Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


Pathology

bull Normal aging






-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications



-Compressive


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


Classification

bull A-Site5-66-7


bull C-Amount

---Bulge

--Herniation

1-Protrusion

2-extrusion

3- sequestration

Effects of prolapse

Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


Clinical picture




bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications





bullMixed



DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




DDX



bull Infection

Tumor





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications





period








year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications






year



bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications




bull REST-collar


bull










--Microdisectomy

--Chemonucleolysis

--percutanious

Complications











--Microdisectomy

--Chemonucleolysis

--percutanious

Complications


Complications


Orthopedics 5th year, 1st lecture (Dr. Hamid)

Health & Medicine

Transcript of Orthopedics 5th year, 1st lecture (Dr. Hamid)