The document provides an overview of spinal anatomy including:
1) It describes the coronal, sagittal, and axial planes used to view the spine on imaging and their anatomical divisions.
2) The basic structures and functions of vertebrae are outlined including protection of the spinal cord, flexibility, and load distribution.
3) Ligaments, joints, vasculature and innervation of the spine are summarized at different regions from cervical to lumbar.
Evidence-based Interventional Pain Medicine
according to Clinical Diagnoses
13. Sacroiliac Joint Pain
Pascal Vanelderen, MD, FIPP*,†; Karolina Szadek, MD‡; Steven P. Cohen, MD§;
Jan De Witte, MD¶; Arno Lataster, MSc**; Jacob Patijn, MD, PHD††;
Nagy Mekhail, MD PhD, FIPP‡‡; Maarten van Kleef, MD, PhD, FIPP††;
Jan Van Zundert, MD, PhD, FIPP*,††
Evidence-based Interventional Pain Medicine
according to Clinical Diagnoses
13. Sacroiliac Joint Pain
Pascal Vanelderen, MD, FIPP*,†; Karolina Szadek, MD‡; Steven P. Cohen, MD§;
Jan De Witte, MD¶; Arno Lataster, MSc**; Jacob Patijn, MD, PHD††;
Nagy Mekhail, MD PhD, FIPP‡‡; Maarten van Kleef, MD, PhD, FIPP††;
Jan Van Zundert, MD, PhD, FIPP*,††
Bones of Trunk (Human Anatomy)
by DR RAI M. AMMAR
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1.INTRODUCTION
Shoulder joint is formed by scapula and clavicle (which is also called as shoulder girdle)and proximal humerus.
2.BONES OF SHOULDER JOINT
3.Joints of the Shoulder Complex
Glenohumeral
Acromioclavicular
Sternoclavicular
Scapulothoracic
4.Muscles of the Shoulder
5.Gateways to the Posterior Scapular Region
6. Movements
this is a presentation on atlanto-axial and atlanto-occipital joints. after reading this, most of you will know about atlas and axis, joint type, anatomy of joint, movements allowed by joint and its clinical considerations.
Anattomy of back with Dr. Ameera A. Al-Humidi .pptxAmeera Al-Humidi
this lecture describes the anatomy of bach and details of anatomical variations of vertebrae with related disorders.
the vertebral column consists of seven cervical vertebrae, tweleve thoracic vertebrae, five lumbar vertebrae, sacral vertebrae, and five fused coccygeal vertebrae.
Minimally Invasive Spine and Pain Interventions (MIPSI) are going to be game changers in healthcare Industry.
Dr (Maj) Pankaj N Surange MD, FIPP, FIAPM
Director, IPSC India
Hon Secretary, Indian Society for the study of Pain, National
Introduction
The need of a specialty arises as the burden of the disease increases. Pain medicine is one such new paradigm of medicine that require specialists who are trained to understand the distinctive needs of patients who suffer from chronic and complex pain.
Pain medicine is a discipline of medicine which deals with subacute, chronic and intractable and resistant painful conditions principally with minimally invasive interventional techniques. Acute pain for various conditions is managed by the specialist of that field and perioperative pain is managed mainly by Anesthesiologists.
Interventional techniques are minimally invasive, non-surgical procedures including percutaneous precision needle placement, with placement of drugs in targeted areas or ablation of targeted nerves; and some surgical techniques for the diagnosis and management of chronic, persistent, or intractable pain such as laser or endoscopic discectomy and spine procedures, Vertebroplasty, intrathecal infusion pumps, and spinal cord stimulators. (1)
There is overwhelming evidence showing an association of chronic pain with significant economic, societal, and health outcomes. (2,3) With increasing geriatric population and even more alarming, the young population getting affected with chronic pain. A study from across 42 countries identified that self-reported chronic pain amongst adolescent populations was common: 20.6% of young people experienced pain in at least two sites of headache, stomach, and backache. Chronic pain affects up to 30% of those aged 18–39 yr. (4)
A survey conducted by Indian Society for the study of pain showed 43% of patient with chronic pain consulting pain physicians belong to young age group between 25-45 years of age. Further, along with enormous costs and disability associated with reduced functioning, overuse of opioids and related fatalities have been well described. (5,6,7) Severe and chronic pain can impair mobility and function as well as reduce general quality of life, thereby posing barriers to human flourishing and productivity.
Prevalence of Chronic pain worldwide.
According to a study published by the National Centre for Biotechnology Information (NCBI) in 2015, around 19.6% of the individuals aged between 20 to 60 years were suffering from low back pain worldwide. (8)
According to a study published by the Centres for Disease Control and Prevention (CDC) in 2012, around 20.3% of the population in the U.S. suffer from lower back pain. As per the report of the American Academy of Pain Medicine (AAPM) 2012, over 100 million people suffer from chronic pain.
Traditional nonsurgical Osteoarthritis therapies have limited utility and the treatment effect on
the disease is very low. Most of the therapies are aimed at controlling the symptoms but have
minimal or no effect on disease progression or repair. On the other hand, surgeries such as Total
knee replacement and partial knee replacement are unwarranted until the disease progresses to
moderate or end-stage.
Stem cell therapy by the Interventional Pain specialist has shown some promising results and has
shown disease modification to prevent knee joint destruction. Stem cell therapy for knee arthritis
has shown a reduction of pain and stiffness, improvement in physical function, and
maintains cartilage quality with minimal side effects. The cost of the procedure and affordability
are a matter of concern and may not be suitable for the masses.
With the DGCI approval of stem cell treatment for Knee osteoarthritis, IPSC is introducing stem
cells into clinical practice. The success of any new treatment depends on strict adherence to
the clinical protocols and research recommendations. In view of the above, IPSC is introducing
its treatment protocol for stem cell therapy.
IPSC INDIA
INTERVENTIONAL PAIN AND SPINE CENTER INDIA
IPSC India is a state-of-the-art Center of Excellence offering the highest standard of quality care with the most technologically advanced treatments by implementing practice guidelines derived from “evidence based medicine.”
We have best of the Equipments that includes ALNITEC Ozone Generator imported from Italy, COSMAN Radiofrequency generator, GE Fluoroscopy Machine for precise placement, GE LOGIC P-5 for ultrasound guided Interventions, STRYKER Disc decompressors, STRYKER Vertebroplasty,Endoleak Scope from Germany for Endoscopic Discectomy.
Interventions are the minimally invasive techniques to control chronic knee and joint pains. Some procedures are even offered to patients who are not fit to undergo surgery.
Located at Sector-7 Dwarka,New delhi with Diagnostic and Imaging facilities by Dr Maj Harshita Surange and Consultation and treatment by Dr Maj Pankaj N Surange, Interventional Pain and Spine Specialist.
Trigger points are commonly seen in patients with myofascial pain which is responsible for localized
pain in the affected muscles as well as referred pain patterns. Correct needle placement in a
myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point
injection to help reduce or relieve myofascial pain
Office based ultrasound-guided injection techniques for musculoskeletal
disorders have been described in the literature with regard to tendon, bursa, cystic, and
joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically
and practically, including observation of needle placement in real-time, ability to perform
dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation
exposure, reduced overall cost, and portability of equipment within the office setting.
Percutaneous discectomy is a minimally invasive surgical procedure that treats contained, herniated discs. Specific procedures within the class include: manual percutaneous lumbar discectomy, Automated percutaneous lumbar discectomy (APLD) laser discectomy and nucleoplasty percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil.
International conference on Interventional Pain Management and FIPP Review course with Cadaveric Workshop at All India Institute of Medical Sciences AIIMS, New Delhi
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Why invest into infodemic management in health emergenciesTina Purnat
A lecture discussing the challenge of health misinformation and information ecosystem in public health, how this impacts demand promotion in health, and how this then relates to responding to misinformation and infodemics in health emergencies. Appended with lots of tools, guidance and resources for people who want to do more reading.
US E-cigarette Summit: Taming the nicotine industrial complexClive Bates
I look back to 1997 and simpler time in tobacco control, then look at changes in trade, communications, technology and conclude the market is becoming ungovernable
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn...kevinkariuki227
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
TEST BANK For Wong’s Essentials of Pediatric Nursing, 11th Edition by Marilyn Hockenberry, Cheryl Rodgers, Verified Chapters 1 - 31, Complete Newest Version.pdf
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Scientificity and feasibility study of non-invasive central arterial pressure...
Anatomy of spine
1. ANATOMY OF SPINE Dr Pankaj N Surange MBBS, MD, FIPP Interventional Pain and Spine specialist
2. Anatomical Planes A-P X-ray of a scoliotic spine in the coronal plane. The CORONAL PLANE , also called the FRONTAL PLANE , is a vertical cut that divides the body into front and back sections. Physicians look at the coronal plane when they view an A-P (anterior-posterior) x-ray of the spine to evaluate scoliosis.
3. Anatomical Planes Lateral X-ray of a kyphotic spine in the sagittal plane. The SAGITTAL or MEDIAN PLANE is a vertical cut that divides the body into left and right sections. The sagittal view is seen by surgeons on a lateral x-ray of the spine.
4. Anatomical Planes CT Scan of a thoracic vertebra in the axial plane. The AXIAL or TRANSVERSE PLANE is a horizontal cut that divides the body into upper and lower sections. To best view the axial plane of the spine, surgeons will often obtain a CT scan with axial cuts.
20. The Atlas (C1) Transverse Process Transverse Foramen Anterior Tubercle Articular Facet for Dens Lateral Mass Lamina Posterior Tubercle Superior Articular Facet Superior View
21. The Axis (C2) Odontoid Process (Dens) Body Transverse Process Inferior Articular Facet Superior Articular Facet Anterior View Posterior View Lateral Mass Spinous Process
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23. Lower Cervical Vertebrae C3 - C7 Transverse Process Body Sulcus for Spinal Nerve Lateral Mass Lamina Pedicle Superior Articular Facet Vertebral Foramen Bifid Spinous Process Transverse Foramen Axial View
24. Lower Cervical Vertebrae C3 - C7 Sulcus for Spinal Nerve Uncinate Process Uncovertebral Joint (Joint of Luschka) Anterior View The vertebral bodies of the subaxial cervical spine have upward projections on the lateral margins called UNCINATE PROCESSES . These processes articulate with the level above to form the UNCOVERTEBRAL JOINT . These are also called JOINTS OF LUSCHKA .
25. Vertebra Prominens (C7) Spinous Process Axial View C7 is referred to as the VERTEBRA PROMINENS because it has a longer and larger spinous process than the other cervical vertebrae. This spinous process is not usually bifid.
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30. The Sacrum Sacral Horns Sacral Ala Pedicles Dorsal Foramina Sacral Hiatus Coccyx Posterior View Inverted triangle shape
37. Occipitocervical Joint Occipital Condyles Foramen Magnum articulate with C1 superior facets
38. Atlantoaxial Joint C1 C2 Dens Zygapophyseal joints JOINT between the atlas (C1) and the axis (C2); has a range of motion in the transverse plane for rotation. The DENS of C2 acts as a pivot point for the rotation of C1. The articulating surfaces of the two vertebrae form ZYGAPOPHYSEAL (FACET) JOINTS that allow flexion-extension, side bending, and rotational movements.
39. The Facet Joints Also called ZYGAPOPHYSEAL JOINTS . The facet joints are formed by the articular processes of adjacent vertebrae. The inferior articular process of a vertebra articulates with the superior articular process of the vertebra below. These are synovial gliding joints Facet joints are oriented in different planes depending on their anatomic location.
40. Uncovertebral Joints Uncovertebral Joint The bony elevations on the superior lateral margins of the cervical vertebrae are called UNCINATE PROCESSES . The uncovertebral joints are not true joints These joints articulate with the inferior, lateral aspect of the vertebra above to form the UNCOVERTEBRAL JOINTS , also known as the JOINTS OF LUSCHKA . These are fibrous joints Uncinate Process
41. Costovertebral Joints The T2-T9 thoracic vertebra have facets superiorly and inferiorly at the posterior aspect of the vertebral body that form the COSTOVERTEBRAL joints. Costovertebral joints Rib Costotransverse joints Axial View In the thoracic spine, the RIBS articulate with the vertebrae at both the body and the transverse processes. At all thoracic levels there is a facet where the rib articulates with the transverse process. These are called the COSTOTRANSVERSE joints. The T1 and T10-T12 vertebral bodies have only one costal facet. Rib
43. Sacroiliac Joint Sacroiliac Ligaments Sacrum Ilium The superior lateral surface on either side of the sacrum articulates with the inner aspects of the pelvis. This area forms the capsular, synovial SACROILIAC JOINT . In some cases the sacroiliac joint is a hidden source of back pain .
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47. Lower Cervical, Thoracic, and Lumbar Ligaments Intertransverse ligaments Costal ligaments The INTERTRANSVERSE LIGAMENTS extend from the inferior surface of the entire length of the transverse process to the superior surface of the adjacent transverse process. The COSTAL LIGAMENTS connect the heads of the ribs to the vertebrae.
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49. Lower Cervical, Thoracic, and Lumbar Ligaments Interspinous ligament Ligamentum nuchae The INTERSPINOUS LIGAMENT connects each adjacent spinous process. In the cervical spine the interspinous ligament becomes part of the LIGAMENTUM NUCHAE , that extends cranially to insert into the occiput.
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51. Lower Cervical, Thoracic, and Lumbar Ligaments Ligamentum flavum LIGAMENTUM FLAVUM Also called the YELLOW LIGAMENT Consists of elastic fibers oriented vertically that extend from the anterior inferior surface of the lamina above to the superior posterior surface of the lamina below. The ligamentum flavum tends to thicken as it progresses down the spine, beginning at the axis (C2) and extending to the sacrum.
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53. Lumbosacral Ligaments Anterior View Lumbosacral ligaments The LUMBOSACRAL LIGAMENT is a thick, fibrous band that extends from the anterior, inferior aspect of the transverse process of L5 to the lateral surface of the sacrum.
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58. Arteries of the Cranial and Cervical Region Foramen lacerum Vertebral artery Carotid artery Two VERTEBRAL ARTERIES , one located on each side the cervical vertebrae. These arteries are branches of the right and left subclavian vs. that exit from aorta. They ascend through the transverse foramen of C6 through C1,entering the skull through the foramen magnum where they join together to form the BASILAR ARTERY. Anterior to the cervical vertebrae are the CAROTID ARTERIES , which ascend through the FORAMEN LACERUM and join with the vertebral arteries to form the CIRCLE OF WILLIS .
59. Arteries of the Cranial and Cervical Region Vertebral arteries Basilar artery Circle of Willis Internal carotid arteries
60. Arteries of the Thoracic and Lumbosacral Regions Vertebral artery Aortic arch Ascending aorta Descending aorta Thoracic segmental arteries Abdominal aorta Bifurcation of the aorta Lumbar segmental arteries External iliac artery (left & right) Internal iliac artery (left & right) Femoral artery (left & right)
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62. Veins of the Cervical and Thoracic Region The most important venous structures in the cervical spine are the internal and external JUGULAR VEINS . The internal jugular veins follow a path similar to the carotid arteries. They should always be considered during any anterior cervical spine procedure. External jugular Anterior jugular Internal jugular
63. Veins of the Thoracic and Lumbar Region Internal jugular Superior vena cava Azygos vein Thoracic segmental veins Hemiazygos vein Lumbar segmental veins Inferior vena cava Common iliac veins
64. Batson’s Plexus The AZYGOS SYSTEM is a large network of veins draining blood from the intestines and other abdominal organs back to the heart. The segmental veins drain into the azygos vein located on the right side of the abdomen, or into the hemiazygos vein located on the left side. The azygos system also communicates with a valveless venous network known as BATSON’S PLEXUS . When the vena cava is partially or totally occluded, Batson’s plexus provides an alternate route for blood return to the heart. The vessels of Batson’s plexus may be referred to as epidural veins Batson’s plexus
65. Batson’s Plexus Because of the azygos system, patient positioning is very important in posterior lumbar spine surgery. The patient’s abdomen should always hang free and without abdominal pressure. An increase in pressure will diminish flow through the azygos system and the vena cava. This results in an increase of venous flow into Batson’s plexus with a corresponding increase of blood loss . Batson’s plexus
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67. Meninges Dura mater Subdural space Arachnoid layer Subarachnoid space: filled with CSF Pia mater Within the spinal canal, the spinal cord is surrounded by the EPIDURAL SPACE, filled with fatty tissue, veins, and arteries. The fatty tissue acts as a shock absorber. The spinal cord is covered by MENINGES which has three layers.
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69. Spinal Nerves Spinal cord Epidural space Dura mater and Arachnoid layers Subarachnoid space Dorsal root Ventral root Dorsal root ganglion Peripheral nerve
70. Autonomic Nervous System Independent of voluntary control. Controls glandular and cardiac function and smooth muscle such as that found in the digestive tract. There are two components: sympathetic parasympathetic The control centers of both systems are located outside the spinal cord in structures called GANGLIA .
71. Autonomic Nervous System The SYMPATHETIC NERVOUS SYSTEM consists of a series of ganglia extending from the skull to the coccyx, lying on each side of the vertebral bodies. These aligned ganglia look like a chain at each side of the spine and are often referred to as the sympathetic nerve chain. Injury to the sympathetic nerve chain in the lumbar spine may result in genitourinary problems for the patient . Each sympathetic ganglion has fibers that join to the adjacent spinal nerve. The PARASYMPATHETIC NERVOUS SYSTEM has ganglia located close to the organs they control.