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

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

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The lecture has been given on May 4th, 2011 by Dr. Hamid.

The lecture has been given on May 4th, 2011 by Dr. Hamid.

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

    • Anatomy of the Cervical Spine
    • Cervical Spine Anatomy
      • Primary function
        • Mobility, support, and protection of spinal canal and neural structures
    • Cervical Spine Anatomy
      • Vertebrae (7)
      • Intervertebral discs (6)
      • Pairs of exiting nerve roots (8)
      • Cervical lordosis Occ-C7 averages 40°
        • Most of the lordosis occurs at the C1-C2 segment
      1 2 3 4 5 6 7
    • Cervical Spine Anatomy
      • Approximately 50% of flexion-extension motion occurs at occiput-C1
      • Approximately 50% of rotation occurs at C1-C2
      • Lesser amounts of flexion-extension, rotation, and lateral bending occur segmentally between C2-C7
    • Cervical Spine Anatomy
    • Cervical Spine Anatomy
      • Atypical vertebral
      • structure C1 (atlas)
      • Vertebral canal/foramen
      • Anterior arch
      • Anterior tubercle
      • Transverse process
      • Posterior arch
      • Transverse foramen
      • Lateral mass
      Superior Inferior Occipital condyles Foramen magnum
    • Cervical Spine Anatomy
      • Atypical cervical
      • vertebra C2 (axis)
      • Odontoid process or dens
      • Vertebral canal/foramen
      • Facet joints
      • Transverse process
      • Transverse foramen
      • Bifid spinous process
      • Lamina
      anterior view posterior view
    • Cervical Spine Anatomy
      • The odontoid process of the axis (C2) extends cranially to form the axis of rotation with atlas (C1)
    • Cervical Spine Anatomy
      • Ligaments
        • The cervical spine also features a complex arrangement of ligaments to supplement its structure and mobility
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Ligaments
        • Anterior longitudinal ligament
        • Posterior longitudinal ligament
        • Ligamentum flavum
        • Intertransverse ligaments
        • Interspinous ligaments
        • Ligamentum nuchae
    • Cervical Spine Anatomy
      • Neural elements
        • 8 pair of cervical nerves
        • Exit the spinal canal superior to the vertebrae for which they are numbered
          • C1 nerves exit the canal between Occ & C1
          • C2 nerves exit the canal between C1 & C2
          • C8 nerves exit the canal between C7 & T1
    • Cervical Spine Anatomy
      • Arteries
        • Carotid arteries
          • Located anterior and bilateral to the spine
        • Vertebral arteries
          • Enter the transverse foramen at C6 and continue through C1
    • Cervical Spine Anatomy
      • Veins
        • Jugular veins
          • Located bilateral and anterior to the spine.
        • Vertebral veins
          • Located within the transverse foramen of C1-C7
    • Cervical Spine Anatomy Neural and Circulatory Elements
    • Torticollis
    •  
    •  
    •  
      • Infantile –congenital –
      • Cause and discription
      • Clinical feature
    • DDX X-ray Treatment
      • Secondary torticollis
    •  
    •  
    •  
    •  
    • Prolapsed Intervertebral Discs
    • Introduction
      • Male predominance
      • 30 – 50 yrs
      • Smokers
      • Sudden flexion& Twisting
      • FUNCTION OF SPINE
      • – Combination of stability and
      • mobility due to 2 types of joints.
      • 􀂄 Facet Joints
      • 􀂄 Intervertebral disc
      • TYPES OF JOINTS
      • A- Facet joint- Typical (Diathrodial)
      • 􀂄 Lined with synovial membrane
      • 􀂄 Minimal resistance to movemetns
      • B- IVD.
      • lining
      • 􀂄 Disc- Bears load associated with erect
      • postur
      • 􀂄 Allows movements between ….. Bodies
      • ANATOMY OF
      • INTERVERTEBRAL DISC
      • 1- Annulus- concentric laminae of collagen
      • fibrils.
      • – Outermost – Sharpey fibers attached to bone .
      • Tough - type I collagen
      • – Inner – less tough – type II collagen
      • 2- Nucleus pulposus
      • only type II collagen
    •  
    • Nerve root
      • Medial & inferior to the pedicle at
      • each level
      • More susceptiple for mechanical
      • deformation
      • --lack an epineurium
      • --reduced collagen content
      • --more parallel orientation of n.fibres
    • fig
    • Pathology
      • Normal aging
      • -disc degeneration-displacement of facet joint
      • -acute disc herneation-pain
      • -2ndary effect-aquired SS
      • ---Effects of pressure on the nerve root
    • Pathophysiology
      • Effects of pressure on the nerve root
      • -Compressive
      • -Deformation-str,& fun,changes
    • Classification
      • A-Site;5-6,6-7
      • B-Direction; posterolat
      • C-Amount
      • ---Bulge
      • --Herniation
      • 1-Protrusion
      • 2-extrusion
      • 3- sequestration
      • Effects of prolapse
    •  
    • Clinical picture
      • Pressure on Dura
      • Pressure on root
      • Pressure on cord
      • Mixed
    • Imaging
      • X-ray
      • MRI
      • CT scans with or without myelography
      • -intolerant to MRI
      • -Unsuitable for MRI
      • 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
      • Acute muscular&ST strain
      • Neuralgic amyatrophy
      • Infection
      • Tumor
      • Rotator cuff syndrome
    • Treatment
      • usually have a good prognosis
      • . In up to four-fifths of patients, symptoms
      • will resolve spontaneously within a 12-week
      • period.
      • However, if pain persists beyond this time
      • there is a slow resolution of pain in the
      • majority of patients.
      • By approximately 4 years there is no difference in the incidence of pain in
      • patients treated non-operatively or surgically.
      • Surgical results will deteriorate after
      • symptoms have been present for 1
      • year.
    • Non-operative treatment
      • ANALGESICS&ANTIINFLAMATORY
      • REST-collar
      • Reduce-traction
    • Indications for diskectomy
      • Strong indications for surgical intervention
      • -Acute mylopathy or myloradiculopathy
      • -Progressive Neurological deficit
      • Relative indications
      • Failure of conservative treatment-refractory
      • Significant motor deficit
      • 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 related
      • 2--mechanical intraop;
      • 3-early postop , wound infections , Discitis
      • Haematoma-Airway obs
      • 4-late postop-Non-union-Instability-deformity
    •  
    •  
    • THANK YOU THANK YOU