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Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
Orthopedics 5th year, 1st lecture (Dr. Hamid)
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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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  • 1. Anatomy of the Cervical Spine
  • 2. Cervical Spine Anatomy <ul><li>Primary function </li></ul><ul><ul><li>Mobility, support, and protection of spinal canal and neural structures </li></ul></ul>
  • 3. Cervical Spine Anatomy <ul><li>Vertebrae (7) </li></ul><ul><li>Intervertebral discs (6) </li></ul><ul><li>Pairs of exiting nerve roots (8) </li></ul><ul><li>Cervical lordosis Occ-C7 averages 40° </li></ul><ul><ul><li>Most of the lordosis occurs at the C1-C2 segment </li></ul></ul>1 2 3 4 5 6 7
  • 4. Cervical Spine Anatomy <ul><li>Approximately 50% of flexion-extension motion occurs at occiput-C1 </li></ul><ul><li>Approximately 50% of rotation occurs at C1-C2 </li></ul><ul><li>Lesser amounts of flexion-extension, rotation, and lateral bending occur segmentally between C2-C7 </li></ul>
  • 5. Cervical Spine Anatomy
  • 6. Cervical Spine Anatomy <ul><li>Atypical vertebral </li></ul><ul><li>structure C1 (atlas) </li></ul><ul><li>Vertebral canal/foramen </li></ul><ul><li>Anterior arch </li></ul><ul><li>Anterior tubercle </li></ul><ul><li>Transverse process </li></ul><ul><li>Posterior arch </li></ul><ul><li>Transverse foramen </li></ul><ul><li>Lateral mass </li></ul>Superior Inferior Occipital condyles Foramen magnum
  • 7. Cervical Spine Anatomy <ul><li>Atypical cervical </li></ul><ul><li>vertebra C2 (axis) </li></ul><ul><li>Odontoid process or dens </li></ul><ul><li>Vertebral canal/foramen </li></ul><ul><li>Facet joints </li></ul><ul><li>Transverse process </li></ul><ul><li>Transverse foramen </li></ul><ul><li>Bifid spinous process </li></ul><ul><li>Lamina </li></ul>anterior view posterior view
  • 8. Cervical Spine Anatomy <ul><li>The odontoid process of the axis (C2) extends cranially to form the axis of rotation with atlas (C1) </li></ul>
  • 9. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>The cervical spine also features a complex arrangement of ligaments to supplement its structure and mobility </li></ul></ul>
  • 10. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 11. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 12. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 13. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 14. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 15. Cervical Spine Anatomy <ul><li>Ligaments </li></ul><ul><ul><li>Anterior longitudinal ligament </li></ul></ul><ul><ul><li>Posterior longitudinal ligament </li></ul></ul><ul><ul><li>Ligamentum flavum </li></ul></ul><ul><ul><li>Intertransverse ligaments </li></ul></ul><ul><ul><li>Interspinous ligaments </li></ul></ul><ul><ul><li>Ligamentum nuchae </li></ul></ul>
  • 16. Cervical Spine Anatomy <ul><li>Neural elements </li></ul><ul><ul><li>8 pair of cervical nerves </li></ul></ul><ul><ul><li>Exit the spinal canal superior to the vertebrae for which they are numbered </li></ul></ul><ul><ul><ul><li>C1 nerves exit the canal between Occ & C1 </li></ul></ul></ul><ul><ul><ul><li>C2 nerves exit the canal between C1 & C2 </li></ul></ul></ul><ul><ul><ul><li>C8 nerves exit the canal between C7 & T1 </li></ul></ul></ul>
  • 17. Cervical Spine Anatomy <ul><li>Arteries </li></ul><ul><ul><li>Carotid arteries </li></ul></ul><ul><ul><ul><li>Located anterior and bilateral to the spine </li></ul></ul></ul><ul><ul><li>Vertebral arteries </li></ul></ul><ul><ul><ul><li>Enter the transverse foramen at C6 and continue through C1 </li></ul></ul></ul>
  • 18. Cervical Spine Anatomy <ul><li>Veins </li></ul><ul><ul><li>Jugular veins </li></ul></ul><ul><ul><ul><li>Located bilateral and anterior to the spine. </li></ul></ul></ul><ul><ul><li>Vertebral veins </li></ul></ul><ul><ul><ul><li>Located within the transverse foramen of C1-C7 </li></ul></ul></ul>
  • 19. Cervical Spine Anatomy Neural and Circulatory Elements
  • 20. Torticollis
  • 21.  
  • 22.  
  • 23.  
  • 24. <ul><li>Infantile –congenital – </li></ul><ul><li>Cause and discription </li></ul><ul><li>Clinical feature </li></ul>
  • 25. DDX X-ray Treatment <ul><li>Secondary torticollis </li></ul>
  • 26.  
  • 27.  
  • 28.  
  • 29.  
  • 30. Prolapsed Intervertebral Discs
  • 31. Introduction <ul><li>Male predominance </li></ul><ul><li>30 – 50 yrs </li></ul><ul><li>Smokers </li></ul><ul><li>Sudden flexion& Twisting </li></ul>
  • 32. <ul><li>FUNCTION OF SPINE </li></ul><ul><li>– Combination of stability and </li></ul><ul><li>mobility due to 2 types of joints. </li></ul><ul><li>􀂄 Facet Joints </li></ul><ul><li>􀂄 Intervertebral disc </li></ul>
  • 33. <ul><li>TYPES OF JOINTS </li></ul><ul><li>A- Facet joint- Typical (Diathrodial) </li></ul><ul><li>􀂄 Lined with synovial membrane </li></ul><ul><li>􀂄 Minimal resistance to movemetns </li></ul><ul><li>B- IVD. </li></ul><ul><li>lining </li></ul><ul><li>􀂄 Disc- Bears load associated with erect </li></ul><ul><li>postur </li></ul><ul><li>􀂄 Allows movements between ….. Bodies </li></ul>
  • 34. <ul><li>ANATOMY OF </li></ul><ul><li>INTERVERTEBRAL DISC </li></ul><ul><li>1- Annulus- concentric laminae of collagen </li></ul><ul><li>fibrils. </li></ul><ul><li>– Outermost – Sharpey fibers attached to bone . </li></ul><ul><li>Tough - type I collagen </li></ul><ul><li>– Inner – less tough – type II collagen </li></ul><ul><li>2- Nucleus pulposus </li></ul><ul><li>only type II collagen </li></ul>
  • 35.  
  • 36. Nerve root <ul><li>Medial & inferior to the pedicle at </li></ul><ul><li>each level </li></ul><ul><li>More susceptiple for mechanical </li></ul><ul><li>deformation </li></ul><ul><li>--lack an epineurium </li></ul><ul><li>--reduced collagen content </li></ul><ul><li>--more parallel orientation of n.fibres </li></ul>
  • 37. fig
  • 38. Pathology <ul><li>Normal aging </li></ul><ul><li>-disc degeneration-displacement of facet joint </li></ul><ul><li>-acute disc herneation-pain </li></ul><ul><li>-2ndary effect-aquired SS </li></ul><ul><li>---Effects of pressure on the nerve root </li></ul>
  • 39. Pathophysiology <ul><li>Effects of pressure on the nerve root </li></ul><ul><li>-Compressive </li></ul><ul><li>-Deformation-str,& fun,changes </li></ul>
  • 40. Classification <ul><li>A-Site;5-6,6-7 </li></ul><ul><li>B-Direction; posterolat </li></ul><ul><li>C-Amount </li></ul><ul><li>---Bulge </li></ul><ul><li>--Herniation </li></ul><ul><li>1-Protrusion </li></ul><ul><li>2-extrusion </li></ul><ul><li>3- sequestration </li></ul><ul><li>Effects of prolapse </li></ul>
  • 41.  
  • 42. Clinical picture
  • 43. <ul><li>Pressure on Dura </li></ul><ul><li>Pressure on root </li></ul><ul><li>Pressure on cord </li></ul><ul><li>Mixed </li></ul>
  • 44. Imaging <ul><li>X-ray </li></ul><ul><li>MRI </li></ul><ul><li>CT scans with or without myelography </li></ul><ul><li>-intolerant to MRI </li></ul><ul><li>-Unsuitable for MRI </li></ul><ul><li>gadolinium-enhanced MRI </li></ul><ul><li>This will help to delineate which part of the previous operation site is disc and which is epidural fibrosis (the latter enhancing). </li></ul>
  • 45. DDX <ul><li>Acute muscular&ST strain </li></ul><ul><li>Neuralgic amyatrophy </li></ul><ul><li>Infection </li></ul><ul><li>Tumor </li></ul><ul><li>Rotator cuff syndrome </li></ul>
  • 46. Treatment <ul><li>usually have a good prognosis </li></ul><ul><li>. In up to four-fifths of patients, symptoms </li></ul><ul><li>will resolve spontaneously within a 12-week </li></ul><ul><li>period. </li></ul><ul><li>However, if pain persists beyond this time </li></ul><ul><li>there is a slow resolution of pain in the </li></ul><ul><li>majority of patients. </li></ul>
  • 47. <ul><li>By approximately 4 years there is no difference in the incidence of pain in </li></ul><ul><li>patients treated non-operatively or surgically. </li></ul><ul><li>Surgical results will deteriorate after </li></ul><ul><li>symptoms have been present for 1 </li></ul><ul><li>year. </li></ul>
  • 48. Non-operative treatment <ul><li>ANALGESICS&ANTIINFLAMATORY </li></ul><ul><li>REST-collar </li></ul><ul><li>Reduce-traction </li></ul>
  • 49. Indications for diskectomy <ul><li>Strong indications for surgical intervention </li></ul><ul><li>-Acute mylopathy or myloradiculopathy </li></ul><ul><li>-Progressive Neurological deficit </li></ul><ul><li>Relative indications </li></ul><ul><li>Failure of conservative treatment-refractory </li></ul><ul><li>Significant motor deficit </li></ul><ul><li>Severe incapacitating pain - does not respond to any form of treatment </li></ul>
  • 50. surgical treatment <ul><li>--ANTERIOR OPEN APPROACH </li></ul><ul><li>--POSTERIOR OPEN APPROACH </li></ul><ul><li>--Microdisectomy </li></ul><ul><li>--Chemonucleolysis </li></ul><ul><li>--percutanious </li></ul>
  • 51. Complications <ul><li>1--Approach related </li></ul><ul><li>2--mechanical intraop; </li></ul><ul><li>3-early postop , wound infections , Discitis </li></ul><ul><li>Haematoma-Airway obs </li></ul><ul><li>4-late postop-Non-union-Instability-deformity </li></ul>
  • 52.  
  • 53.  
  • 54. THANK YOU THANK YOU

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