Seminar on Anatomy of Spine

8/8/2019 Seminar on Anatomy of Spine

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On 3rd Dec 2009

Presented By Chairperson

Dr. Sujan Singh Asst Prof. Dr. C Patil

Dept Of Ortho Dept Of Ortho

VIMS & RC VIMS & RC


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It consists of 33 vertebrae and 31 pairs ofspinal nerves. Each pair of nervecorresponds to one spinal cord segment.

There are 2 types of curves: Primary Curves:It is present in new borns,

having a gentle kyphotic curve.

Secondary curve:As the child attainsupright posture. Cervical spine & LumbarSpins attains a lordotic curve.These curvesprovide a perfect balance for bipedalupright posture & progression.This is calledRachiGraph


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Divided into four stages:

Stage 1 :The development of human spine beginon 15th day of gestation,&called notocord whichdevelops from endoderm.

Stage 2 : Membrane Stage, 21st day of gestation.

Stage 3: Cartilage Stage, 5 to 6 weeks andcontinue throughout the foetal stages.

Stage 4: Bony Stage, 2nd Month of gestation.

The neural tube develop from ectoderm in 2nd to3rd week of gestation.

Contd


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Around the notocord, which forms the primitive axial

supportformation of 30 or more somites occur. Dorsomedial part

of

somites forms skeletal muscles and is known as

Myotomes.

The ventrolateral portion forms vertebral body and

known as

Sclerotome.

Congenital anomalies occur mainly in membrane

stage.


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Having one body,one pair of cylindricalpedicles,a pair of flat laminae. These 2laminae joins to form a spinous processposteriorly in the mid line.

At the junction of pedicle laminae, thereare 2 structures:

Transverse processes

Pars Inter-articularis : This is a mass ofbone which is oriented vetrically. It bearsthe superior articular facet in upperhalf,superior to alaminae and the inferiorarticular facet in the lower half


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Of muscles, which extends from pelvis to skull the

sacrospinallis

supplied by dorsal rami of the segmental spinal nerves.


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It is divided into :

Anterior column : Consist of anterior longitudinal

ligament,anterior half of the vertbral body and

anterior half of intervertebral disc. Middle Column: Consists of posterior longitudinal

ligament.Posterior half of vetebral body and

posterior half of intervertebral disc.

Posterior Column: Consists of posterior bonyarch, consists of pedicles facets and laminae of

both sides. And the supraspinous ligament, inter

spinous ligament and facet joint capsule.


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Normally 23 in number starting from second or third

cervical intervertebral space to lumbo sacral

intervertebral space

Develops from mesoderm (Annulus fibrosis &cartilagenous plate) & Nucleus pulposus from endoderm.

All together discs occupy 1/5 th of total length of spinal

column

The discs are practically avascular by the age of about

18 yrs and derives it nutrition by diffusion of adjacentcancellous bones.


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Arteries of Spinal Cord:

Mainly supplied by vertebral arteries and its branches.

Anterior Spinal Artery - Supplies anterior 2/3 rd of spinal

cord

Two Posterior Spinal Arteries Supply posterior part of

posterior horn & Column

Reinforcements : Spinal branches of vertebral, inferior

thyroid, inter coastal, illiolumbar, sacral enter through

intervertebral foramina. Largest of the radicular arteries

is Great Spinal Artery of Adamkiewcz which originatesfrom left intercostal or lumbar artery between the 4th

thoracic and 4th lumbar vertebrae.

Verterbra supplied by ascending cervical, intercostal and

lumbar segmental arteries. Consequently on each side,

upper half of the vertebra below and lower half of thevertebra above with inter veinin disc receive arterial


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Veinous Supply :

It is principally organised in external and internal plexuscalled

Batsons Plexus.

External Veinous is divided into anterior plexes andposterior plexes

Internal verterbral plexes lies between dura matter and

verterbra, receiving tributaries from bone and cord. Veins of Spinal Cord :

These are situated in pia matter and form a plexesconsisting of :

Two medial longitudinal veins

Two anterolateral and Two posterolateral longitudinal veins which communicates

with internal verterbral venous plexus & intervertebralveins.


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Movements occuring at different regions of spine

Movement Cervical DorsalLumbar

Flexion/extension Present;free in Present but Present& Free

atlanto-occipital restricted

joint

Lateral Flexion Present;free in Present but Free

atlanto-occipital restricted

joint

Rotation Free in atlantoaxial Present Absent

joint;minimum in

remainder of cervical

spine


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Types Mechanism

1. Compression Flexion

Anterior Anterior Flexion

Lateral Lateral Flexion

2. Burst

A Axial Load

B Axial Load plus flexionC Axial Load rotation

D Axial Load plus lateral

Contd


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flexion

E Axial Load pluslateral flexion

3. Seat Belt Flexion -

distraction

4. Fracture dislocation

Flexion rotation Flexion rotation

Shear Shear(antero

posterior)Flexion distraction Flexion

distraction


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There is loss of > 50 % of vertebral body ht.

Angulation of T L junction > 20 degree.

Failure of atleast 2 of Denis 3 columns

> 50% canal compromise

Based on clinical data, it is concluded that it

was integrity of the posterior column that

determines the stability of fracture, and

hence suitability of non operative treatment.


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Grays Anatomy

Rothman Simeone Fifth Edition

Orthopaedic Clinics Spine Sudhir K Kapoor

Cambels Operative Orthopaedics


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THANK YOU

Seminar on Anatomy of Spine

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