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spine

  1. 1. „SelectedChaptersfromtheCross-SectionalAnatomyof the Human Body”SpineanatomyAndrás Jakab MD, Levente István Lánczi MD<br />
  2. 2.
  3. 3. The SpinalCord<br />Cervical (7)<br />C1-C7<br />C1: atlas<br />C2: axis<br />Thoracic (12)<br />T1-T12<br />Lumbar (5)<br />L1-L5<br />Sacral(5)<br />S1-S5, synosthosis<br />Coccyx<br />Coc3-5<br />
  4. 4. Spinalcord – macroscopicanatomy<br />=medullaspinalis<br />conusmedullaris (termianlis)<br />cervical and lumbarenlargement<br />filumterminale<br />anteriormedianfissura<br />posteriormediansulcus<br />dorsalroot(sensory) et ventralroot(motor)<br />spinalnerves<br />
  5. 5. Spinalcord – structure<br />Segments – functions<br />8 cervical<br />Segment+nerve: level of intervertebralforamen<br />C1 nerve: exitsbetweenoccipitalbone and atlas<br />Remember!C8exitsonintervertebralforamenbetween C7-Th1!<br />Spinalcordsegmentsareshorterthanvertebraeheight!Nerveexitsspinalcordupperthanintervertebralforamen.<br />12 thoracic<br />5 lumbal (nervesdescend almost vertical!)<br />5 sacral<br />1 coccyx<br />Altogether: 31 pairs of spinalnerves<br />
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  7. 7.
  8. 8. Spinalcord vs. spinalcolumn (C7)<br />Spinousprocess<br />Vertebralarch<br />arachnoidea mater<br />Periosteum<br />Epiduralspace<br />Spinaldura mater<br />Subarachnoidspace<br />Pia mater<br />Posteriorroot<br />Anteriorroot<br />Spinalganglion<br />n. spinalis; r. posterior<br />Transverseprocess<br />n. spinalis; r. anterior<br />
  9. 9. Spinalcord<br /><ul><li>vessels
  10. 10. sheaths: pia, arachnoid, dura</li></li></ul><li>Vertebralcolumn – demonstratingon IMAIOS<br />
  11. 11. Vertebralcolumn – demonstratingon IMAIOS<br />Specificvertebraeoneverylevel<br /><ul><li>Cervicalvertebrae (atlas!, axis!)
  12. 12. Thoracicvertebrae
  13. 13. Lumbalvertebrae
  14. 14. Sacrum
  15. 15. Coccyx</li></li></ul><li>
  16. 16.
  17. 17. Crosssectionalstructureof thespinalcord<br />
  18. 18. Crosssectionalstructureof thespinalcord<br />Centralcanal<br />White matter<br />commisura alba<br />funiculi<br />Posteriorfuniculus<br />Lateralisfuniculus<br />Anteriorfuniculus<br />Grey matter<br />PEG (periaqueductalgreymatter)<br />Anteriorroot<br />Posteriorroot<br />…Rexed laminae…<br />
  19. 19.
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  21. 21.
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  23. 23.
  24. 24. Spinalcord – tracts<br />Ascendingtracts<br />Fasciculus gracilis, Goll(skin) <br />Fasciculuscuneatus, Burdach<br />Spinothalamictract (pain)<br />Ant. & post. spinocerebellartract<br />Descendingtracts<br />Corticospinaltract<br />Rubrospinaltract<br />Reticulo-vestibulo-tectospinaltract<br />Fasciculuslongitudinalismedialis<br />Descendingvegetativetracts<br />
  25. 25.
  26. 26.
  27. 27.
  28. 28. Epiduralfat<br />T11<br />Intervertebralface<br />lumbarenlargement<br />T12<br />Intervertebraldisc<br />Anulusfibrosus<br />Nucleuspulposus<br />L1<br />conusterminalis<br />L2<br />filum terminale (cauda equina)<br />L3<br />Spinalcanal<br />Spinousprocess<br />L4<br />Interspinal ligament<br />L5<br />promontory<br />Sacralcanal<br />S1<br />S2<br />
  29. 29. Intervertebralforamen<br />Vertebralarch, pediculus<br />Articularprocess<br />Spinousprocess<br />
  30. 30. Vertebral body<br />Level: lowerthoracic,T2 weighted MRI<br />Ant. & post. longitudinalligament <br />Transverseprocess<br />Ventralroot<br />Dorsalroot<br />Spinalmedulla<br />Ligamenta flava<br />Spinousprocess<br />
  31. 31. Vertebral body<br />Level: Lumbar,T2 weighted MRI<br />Ant. longitudinal ligament<br />Transverseprocess<br />Spinalganglion<br />caudaequina<br />ligamenta flava<br />Spinousprocess<br />
  32. 32.
  33. 33.
  34. 34. Spinalnerves<br />
  35. 35. Rootsymptoms<br />C- headache, dizziness<br />T- upperlimbweakness, no skinsensationorpain<br />L- lowerlimbweakness, no skinsensationorpain<br />S- buttocks, toes; incontinence, erectiledysfunction<br />
  36. 36. Neck – C2, C3<br />Upperlimb: C6, C8, T1<br />Hand: C6-C8<br />Level of nipples: Th4<br />Level of umbilice: Th10<br />Genitalorgans: S2-S3<br />Gluteus: S1-S4<br />Smalltoe: S1<br />Big toe: L4-5<br />
  37. 37.
  38. 38. Spinal reflex – an example (patella-reflex)<br />Receptor -> afferent-> center -> efferent -> effector<br />
  39. 39. Cranialnerves<br />12 pairs<br />Motory, sensory and parasymphateticnerves<br />Eyemovements<br />Specialsensorynerves – sensoryorgans<br />N. vagus (X) <br />
  40. 40. Vegetativenervoussystem<br />Center inbrain: hypothalamus<br />Parasympathetic („rest&digest”)<br />Heartrate, bloodpressuredecreases, pupilnarrows<br />N. <br />Sympathetic(„fightorflight”)<br />Stress: respiration+, heartrate+, bloodpressure+, pupilbroadens, hair<br />Truncussympaticus<br />
  41. 41. Parasymphateticnerves<br />
  42. 42. Symphateticnerves<br />
  43. 43. Symphateticnerves<br />
  44. 44. Sensoryorgansdemonstratedon IMAIOS<br />
  45. 45. Clinicalcase<br />68 year old female<br />4-hour history of pain in the back and epigastrium with paraesthesia and weakness of the lower limbs.<br />Warfarintherapy (earlier: PE)<br />Sensoryloss below the umbilicus<br />http://www.eurorad.org/case.php?id=2954<br />
  46. 46. Clinicalcase<br />56 year old female<br />3 yearshistory of dizzinessand heaviness of the neck, withoutneurologicsigns<br />Plain radiographsof the cervical spine in the lateral view, in an erect position; CT scan<br />http://www.eurorad.org/case.php?id=978<br />
  47. 47. Othercases<br />Cervicalspineepiduralmass http://www.eurorad.org/case.php?id=4361<br />Spinalarachniodcysthttp://www.eurorad.org/case.php?id=2550<br />Traumaticmeningocelehttp://www.eurorad.org/case.php?id=2403<br />

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