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spine spine Presentation Transcript

  • „SelectedChaptersfromtheCross-SectionalAnatomyof the Human Body”SpineanatomyAndrás Jakab MD, Levente István Lánczi MD
  • The SpinalCord
    Cervical (7)
    C1-C7
    C1: atlas
    C2: axis
    Thoracic (12)
    T1-T12
    Lumbar (5)
    L1-L5
    Sacral(5)
    S1-S5, synosthosis
    Coccyx
    Coc3-5
    View slide
  • Spinalcord – macroscopicanatomy
    =medullaspinalis
    conusmedullaris (termianlis)
    cervical and lumbarenlargement
    filumterminale
    anteriormedianfissura
    posteriormediansulcus
    dorsalroot(sensory) et ventralroot(motor)
    spinalnerves
    View slide
  • Spinalcord – structure
    Segments – functions
    8 cervical
    Segment+nerve: level of intervertebralforamen
    C1 nerve: exitsbetweenoccipitalbone and atlas
    Remember!C8exitsonintervertebralforamenbetween C7-Th1!
    Spinalcordsegmentsareshorterthanvertebraeheight!Nerveexitsspinalcordupperthanintervertebralforamen.
    12 thoracic
    5 lumbal (nervesdescend almost vertical!)
    5 sacral
    1 coccyx
    Altogether: 31 pairs of spinalnerves
  • Spinalcord vs. spinalcolumn (C7)
    Spinousprocess
    Vertebralarch
    arachnoidea mater
    Periosteum
    Epiduralspace
    Spinaldura mater
    Subarachnoidspace
    Pia mater
    Posteriorroot
    Anteriorroot
    Spinalganglion
    n. spinalis; r. posterior
    Transverseprocess
    n. spinalis; r. anterior
  • Spinalcord
    • vessels
    • sheaths: pia, arachnoid, dura
  • Vertebralcolumn – demonstratingon IMAIOS
  • Vertebralcolumn – demonstratingon IMAIOS
    Specificvertebraeoneverylevel
    • Cervicalvertebrae (atlas!, axis!)
    • Thoracicvertebrae
    • Lumbalvertebrae
    • Sacrum
    • Coccyx
  • Crosssectionalstructureof thespinalcord
  • Crosssectionalstructureof thespinalcord
    Centralcanal
    White matter
    commisura alba
    funiculi
    Posteriorfuniculus
    Lateralisfuniculus
    Anteriorfuniculus
    Grey matter
    PEG (periaqueductalgreymatter)
    Anteriorroot
    Posteriorroot
    …Rexed laminae…
  • Spinalcord – tracts
    Ascendingtracts
    Fasciculus gracilis, Goll(skin)
    Fasciculuscuneatus, Burdach
    Spinothalamictract (pain)
    Ant. & post. spinocerebellartract
    Descendingtracts
    Corticospinaltract
    Rubrospinaltract
    Reticulo-vestibulo-tectospinaltract
    Fasciculuslongitudinalismedialis
    Descendingvegetativetracts
  • Epiduralfat
    T11
    Intervertebralface
    lumbarenlargement
    T12
    Intervertebraldisc
    Anulusfibrosus
    Nucleuspulposus
    L1
    conusterminalis
    L2
    filum terminale (cauda equina)
    L3
    Spinalcanal
    Spinousprocess
    L4
    Interspinal ligament
    L5
    promontory
    Sacralcanal
    S1
    S2
  • Intervertebralforamen
    Vertebralarch, pediculus
    Articularprocess
    Spinousprocess
  • Vertebral body
    Level: lowerthoracic,T2 weighted MRI
    Ant. & post. longitudinalligament
    Transverseprocess
    Ventralroot
    Dorsalroot
    Spinalmedulla
    Ligamenta flava
    Spinousprocess
  • Vertebral body
    Level: Lumbar,T2 weighted MRI
    Ant. longitudinal ligament
    Transverseprocess
    Spinalganglion
    caudaequina
    ligamenta flava
    Spinousprocess
  • Spinalnerves
  • Rootsymptoms
    C- headache, dizziness
    T- upperlimbweakness, no skinsensationorpain
    L- lowerlimbweakness, no skinsensationorpain
    S- buttocks, toes; incontinence, erectiledysfunction
  • Neck – C2, C3
    Upperlimb: C6, C8, T1
    Hand: C6-C8
    Level of nipples: Th4
    Level of umbilice: Th10
    Genitalorgans: S2-S3
    Gluteus: S1-S4
    Smalltoe: S1
    Big toe: L4-5
  • Spinal reflex – an example (patella-reflex)
    Receptor -> afferent-> center -> efferent -> effector
  • Cranialnerves
    12 pairs
    Motory, sensory and parasymphateticnerves
    Eyemovements
    Specialsensorynerves – sensoryorgans
    N. vagus (X)
  • Vegetativenervoussystem
    Center inbrain: hypothalamus
    Parasympathetic („rest&digest”)
    Heartrate, bloodpressuredecreases, pupilnarrows
    N.
    Sympathetic(„fightorflight”)
    Stress: respiration+, heartrate+, bloodpressure+, pupilbroadens, hair
    Truncussympaticus
  • Parasymphateticnerves
  • Symphateticnerves
  • Symphateticnerves
  • Sensoryorgansdemonstratedon IMAIOS
  • Clinicalcase
    68 year old female
    4-hour history of pain in the back and epigastrium with paraesthesia and weakness of the lower limbs.
    Warfarintherapy (earlier: PE)
    Sensoryloss below the umbilicus
    http://www.eurorad.org/case.php?id=2954
  • Clinicalcase
    56 year old female
    3 yearshistory of dizzinessand heaviness of the neck, withoutneurologicsigns
    Plain radiographsof the cervical spine in the lateral view, in an erect position; CT scan
    http://www.eurorad.org/case.php?id=978
  • Othercases
    Cervicalspineepiduralmass http://www.eurorad.org/case.php?id=4361
    Spinalarachniodcysthttp://www.eurorad.org/case.php?id=2550
    Traumaticmeningocelehttp://www.eurorad.org/case.php?id=2403