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MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD. SPINE. USC. = speaker notes. GOALS VERTEBRAL BODY BONY ANATOMY DISC / NEURAL AND LIGAMENT ANATOMY CERVICAL vs THORACIC vs LUMBAR DIFFERENTIATION DISCO-VERTEBRAL JUNCTION FORAMEN- FACET RELATIONSHIP
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MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD SPINE USC = speaker notes
GOALS • VERTEBRAL BODY BONY ANATOMY • DISC / NEURAL AND LIGAMENT ANATOMY • CERVICAL vs THORACIC vs LUMBAR DIFFERENTIATION • DISCO-VERTEBRAL JUNCTION • FORAMEN- FACET RELATIONSHIP • NERVE ROOT - CENTRAL CANAL • ANATOMIC PATHOLOGY CORRELATES
VERTEBRAE 33 VERTEBRAE ARRANGED IN 5 REGIONS AP VIEW PA VIEW LATERAL VIEW VERTEBRAL BODY VERTEBRAL DISC SPINOUS PROCESS KYPHOTIC CURVE LORDOTIC CURVE
ANTERIOR POSTERIOR
COMPARE THE X-RAY IMAGE TO THE MODEL. ANTERIOR AND POSTERIOR STRUCTURES ARE SUPERIMPOSED ON X-RAY. anterior posterior
MAG VIEW THE IMAGE SHOWS: A- Spina bifida B- Spondylolysis C- Metastatic lesion D- Osteomyelitis
MAG VIEW THE IMAGE SHOWS: A- Spina bifida B- Spondylolysis C- Metastatic lesion D- Osteomyelitis
AP angled AP T-4 CERVICAL VERTEBRAE(7) RIB ANTERIOR THORACIC VERTEBRAE(12) LUMBAR VERTEBRAE(5) RIB POSTERIOR DISC COSTAL CARTILAGE T-12 L-1 L-5
POSTERIOR VIEW ANTERIOR RIBS SPINOUS PROCESS POSTERIOR RIBS TRANSVERSE PROCESS
AP AP CERVICAL VERTEBRAE(7) RIB Anterior RIB Posterior DISC T-12 L-1
THE IMAGE SHOWS: A- Spondylolisthesis B- Facet hypertrophy C- Degenerative disc D- Osteoporotic fracture
THE IMAGE SHOWS: A- Spondylolisthesis B- Facet hypertrophy C- Degenerative disc D- Osteoporotic fracture
INDIVIDUAL VERTEBRA AXIAL OR TRANSVERSE ANTERIOR LATERAL VIEW POSTERIOR ANTERIOR POSTERIOR
LATERAL VIEW OF VERTEBRAL BODY lateral
LATERAL PROJECTION FORAMEN FORAMEN NERVE ROOT DISC DISC SPACE SPINOUS PROCESS SPINOUS PROCESS
INDIVIDUAL VERTEBRA ANTERIOR POSTERIOR
AXIAL LUMBAR CT SCAN LAMINA SPINOUS PROCESS FACET JOINT PEDICLE
DISC FACET JOINTS LAMINA MR – LUMBAR SPINE AXIAL VIEW
VERTEBRAL BODYMID LINE SAGITTAL SECTION COMPACT BONE SPONGY BONE FORAMEN / CANAL FOR BASIVENTEBRAL VEIN SUPERIOR VERTEBRAL “END PLATE” INFERIOR VERTEBRAL “END PLATE” VERTEBRAL BODIES VERTEBRAL ARCHES MR SECTION
INTERVERTEBRAL DISC • MADE OF TWO PARTS: • ANNULUS FIBROSIS • FORMED BY CONCENTRIC RINGS OF FIBROCARTILAGE • THINNER POSTERIORLY • NUCLEUS PULPOSUS • 88% WATER AT BIRTH, • WATER CONTENT DECREASES WITH AGE • SERVES AS SHOCK ABSORBER
MIDLINE SAGITTAL MR SCAN ANTERIOR DISC NUCLEUS PULPOSUS ANNULUS FIBROSIS
FORAMENAL SECTIONLATERAL VIEW INTERVERTEBRAL FORAMEN PEDICLE LAMINA INFERIOR ARTICULAR PROCESS SUPERIOR ARTICULAR PROCESS FORMING ZYGAPOPHYSIAL (FACET) JOINT INTERVERTEBRAL DISC SPINOUS PROCESS
INTERVERTEBRAL FORAMENLATERAL VIEW MR SCAN SAGITTAL SECTION PEDICLE LAMINA INFERIOR ARTICULAR PROCESS SUPERIOR ARTICULAR PROCESS
LIGAMENTS OF THE VERTEBRAL COLUMN • ANTERIOR LONGITUDINAL LIGAMENT • ANTERIOR VERTEBRAL BODIES • LIMITS EXTENSION • POSTERIOR LONGITUDINAL LIGAMENT • POSTERIOR VERTEBRAL BODIES • LIMITS FLEXION • LIGAMENTUM FLAVUM • CONNECTS LAMINA
MID LINE SAGITTAL AND AXIAL MR SCANS ANTERIOR POSTERIOR LONGITUDINAL LIGAMENT Longitudinal ligament ANTERIOR LONGITUDINAL LIGAMENT LIGAMENTUM FLAVUM LIGAMENTUM FLAVUM ANTERIOR
CERVICAL SPINE C-1 C-1 C-7 C-7
CERVICAL VERTEBRAE CHARACTERISTICS • MOST VARIATION and MOVEMENT • THIN IV DISK and SMALL BODY • TWO FORAMENA • FORAMEN OF TRANSVERSE PROCESS (VERTEBRAL ARTERY) • OVAL VERTEBRAL FORAMEN (SPINAL CANAL) CT SCAN
C1 - ATLAS • ANTERIOR ARCH • NO VERTEBRAL BODY • POSTERIOR ARCH • LATERAL MASS • LARGEST OF CERVICAL VERTEBRAE
C1 and C2 LATERAL VIEW ANTERIOR ARCH OF C1 POSTERIOR ARCH OF C1 C2 C2 NO FORMAL INTERVERTEBRAL DISC AT C1-2
RHEUMATOID SUBLUXATION normal
C2 – AXISPOSTERIOR VIEW • STRONGEST OF THE CERVICAL VERTEBRAE • DENS- (ODONTOID) • LARGE BIFID SPINOUS PROCESS • SMALL LATERAL MASS
“OPEN MOUTH” VIEW OF THE CERVICAL SPINE IS USED TO VISUALIZE THE ODONTOID PROCESS (DENS) ODONTOID PROCESS C-2 ODONTOID PROCESS C - 2
LATERAL CERVICAL SPINE ANTERIOR POSTERIOR ANTERIOR POSTERIOR
CERVICAL SPINE C-1 C-1 C-5 C-5
CERVICAL SPINE “AP” VIEW FACET JOINTS C-4 AIR IN TRACHEA decreased density SPINOUS PROCESS PEDICLES
CERVICAL SPINE LATERAL VIEW DENS SPINOUS PROCESS C-4 DISC SPACE TRACHEA
C3–C7 OBLIQUE • VERY SIMILAR IN CHARACTERISTICS • VERTEBRAL ARTERY LOCATED IN TRANSVERSE FORAMEN
OBLIQUE VIEW CERVICAL ANTERIOR
CERVICAL VERTEBRA ANTERIOR FORAMEN TRANSVERSARUM TRANSVERSE PROCESS PEDICLE SPINAL CANAL VERTEBRAL FORAMEN ARTICULAR FACET LAMINA SPINOUS PROCESS
THORACIC SPINE AP VIEW CLAVICLE PEDICLE OF T-7 PEDICLE OF T-7 DISC SPACE SPINOUSPROCESS T-11 12 th RIB COSTOVERTEBRAL JOINT