The spinal cord extends from the brainstem down to the lumbar region and is protected by meninges. It conducts motor and sensory signals and coordinates reflexes. Spinal cord injuries can damage the cord or vertebrae and cause changes in motor and sensory function that are temporary or permanent. The most common causes are motor vehicle accidents. Injuries can be complete or incomplete. The cervical and thoracolumbar regions are most vulnerable. Complications include paralysis, respiratory issues, and bladder/bowel dysfunction. Treatment involves stabilization, monitoring for secondary injuries, and rehabilitation.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
PNI with Relevant Anatomy, Etiology, Mechanism of Degenration and Regenration, Saddon's and Sunderland Classifications, Clinical symptoms and Examination (Tests) of Brachial Plexus, Radial & Median Nerve.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
3. • The spinal cord extends from the foramen magnum where it is continuous with
the medulla olbangata in brainstem and continues through to the conus
medullaris near the second lumbar vertebra, terminating in a fibrous extension
known as the filum terminale.
• The spinal cord is 40 to 50 cm long ( varies between male & female as in male it
is longer ) and 1 cm to 1.5 cm in diameter.
• It made with the brain the Central Nervous System ..
• Function of spinal cord :
1- as a conduit for motor information
2- as a conduit for sensory information
3-coordination of reflexes
• It is divided into five regions:
1-cervical (C) ….. C1-C8
2-thoracic (T) ….T1-12
3-lumbar (L) ……L1-L5
4-Sacral (S) ……S1-S5
5- Coccygeal ( Co )…..Co1
4. • The Spinal Cord is enlarged in the cervical and lumbar
regions :
1- The cervical enlargement : located from C3 to T2 spinal
segments, is where sensory input comes from and motor output
goes to the arms
2- The lumbar enlargement : located between L1 and S3 spinal
segments, handles sensory input and motor output coming from
and going to the legs.
5. • The spinal cord(and brain) are protected by three layers of tissue or
membranes called meninges, that surround the canal :
1- The dura mater is the outermost layer, and it forms a tough protective
coating( Between the dura mater and the surrounding bone of the
vertebrae is a space called the epidural space. )The epidural space is filled
with adipose tissue, and it contains a network of blood vessels.
2-The arachnoid mater is the middle protective layer.
3-Pia mater and the space between the arachnoid and the underlying pia
mater is called the subarachnoid space. The subarachnoid space
contains cerebrospinal fluid (CSF)
6. • Two consecutive rows of nerve roots emerge on each of its
sides. These nerve roots join distally to form 31 pairs
of spinal nerves as they contain motor and sensory nerve
fibers to and from all parts of the body.. The spinal cord is a
cylindrical structure of nervous tissue composed of white
and gray matter.
9. • SCI :Insult to spine resulting in a change in the normal motor, sensory or
autonomic function.
**This change is either temporary or permanent .
• injury to :
- vertebral column
- spinal cord
- Nerves roots
Epidemiology :
• Incidence 2-5/100,000 .
• Adolescent and young adults are the most commonly affected .
• Most common cause of SC injury : RTA
• Although the majority of spinal injuries do not affect the cord or spinal roots ,
about 10% will result in quadriplegia or paraplegia .
10. • Secondary Injury versus Primary Injury:
A-Primary Injury
–Spinal Injury that occurred at time of trauma
B-Secondary Injury
–Spinal Injury that occurs after the trauma
–possibly secondary to mishandling of unstable
fractures , swelling and Ischemia .
11. Cervical region
• most vulnerable
• C5/6 is the most common site
Thoracic region
• protected by the immobility provided by the ribs
Thoracolumbar junction
• the less mobile thoracic vertebra joins the more mobile lumbar
vertebra making it more susceptible to injury
Lumbosacral region
• the area in which the spinal cords ends and the quada equina
begins
** most commonly vertebrae affected are :C5_C7 & T12 &L1
12. Causes of injury :
1-force
2-Ischemia due to vascular injury
3-Secondary hemorrhage in and around the cord.
** Stability
• Stable : If the ligamentous and bony component of the spine are preserved .
• Unstable: If the ligamentous and bony component of the spine are not preserved .
**Type of neurological impairment
• Complete : no preservation of neurologic function distal to the level of injury
{flaccid paralysis + total loss of sensory & motor functions}
• Incomplete: preservation of any sensorimotor function below the level of injury
constitutes an incomplete injury {mixed loss
- Anterior sc syndrome
- Posterior sc syndrome
- Central cord syndrome
- Brown sequard’s syndrome
- Cauda equina syndrome }
14. • Motor level = the last level with at least 3/5
(against gravity) function
• Sensory level = the last level with preserved
sensation
• Dermatome: patch of skin innervated by a
given spinal cord level
• Myotome : Spinal nerve roots which
innervates muscles groups. Most muscles are
innervated by more than one root.
18. • Mechanisms and Associated Injuries ( directional force )
1. Hyperextension
– Cervical & Lumbar Spine
– Disk disruption
– Compression of ligaments
2. Hyperflexion
– Cervical & Lumbar Spine
– Stretching of ligaments
– Compression Injury of cord
– Disk disruption with potential vertebrae dislocation
3. Rotational
– Most commonly Cervical Spine but potentially in Lumbar Spine
– Stretching and tearing of ligaments
– Rotational subluxation and dislocation
4. Compression
– Most likely between T12 and L2
– Ruptured disk
5. Distraction
Most common in
upper Cervical Spine
Stretching of cord
without damage to
spinal column.
6. Penetrating
Forces directly to
spinal column
Disruption of ligaments
Direct damage to cord
19. • Cervical Spine Fractures and Dislocations
• classified on the basis of:
• mechanism
– Flexion
– Extension
– Compression
– Rotation
– a combination of these
• Location
• stability
20. Upper cervical spine ( skull to C2 )
1) Craniocervical Dislocation (anterior , posterior or vertical )
including atlanto- axial and atlanto-occipital dislocation
• Cause : high energy trauma
• Usually fatal , but Early diagnosis and spinal stabilization protected
against worsening spinal cord injury
• Careful occipitocervical fusion is required in survivals
• Halo brace should be applied before surgery to prevent intraoperative
dislocation
2) Atlantoaxial instability
The most common is rotatory subluxation in children
• usually spontaneous ( bone or ligament abnormality) but can be
traumatic
• child presents with cock-robin appearance ( head tilt toward the
affected site with contralateral chin rotation )
• halter traction results in realignment in the majority of cases .
21.
22. 3) Jefferson’s fracture ( C1 ring )
Results from fracture through C1 arches
• Associated with axial loading of cervical
spine .
• Can be : stable or unstable
• Transverse ligament rupture may occur
• unstable jefferson’s fracture should be
treated in a halo jacket for 3 months ,followed
by flexion-extension stress radiography
23. 4) Odontoid fracture
• * It results from hyperflexion injury
1. At the tip (type I) - stable
2. Through the base of the dens (type II) (the
most common) - unstable
3. Through C2 vertebral body (type III) -
generally unstable
24. • 5) Hangman’s fracture
• Fracture through the pedicles of C2
• It occurs due to hyperextension
• Usually stable
• Majority can be treated non-operatively: halo jackets or brace
• Those with significant displacement or associated facet
dislocation requires surgery .
25. • 6) Occipital condyle fracture
• Uncommon injury , usually associated with head
injury
• Identified on CT
• Can be treated in hard collar for 8 weeks .
26. • Subaxial cervical spine (C3-C7)
1) Flexion rotation injury :
Most common cervical injury
• Mainly at C5/C6
• Unstable
• Extensive damage to posterior ligaments
• It may sustain both direct damage and
vascular impairment
• It leads to 2 types of fractures:
• A)wedge fractures B)tear drop
fractures
27. A) Wedge fracture :
mostly stable
treatment : brace or halo for 3 months
B) Tear drop fratcure :
• Results in an anteroinferior vertebral body fracture & is more common
in lower cervical vertebrae , C5
• Note : Hyperextension tear drop fracture is more common in upper
cervical vertebrae
28. 2) compression (axial
loading) :
• Mainly at C5/C6
• Vertebral body is decreased in height
• Usually stable (no damage to posterior
Bony structures or longitudinal
ligaments)
Resulting injury:50% complete
50% incomplete (anterior cord
syndrome)
***anterior cord syndrome : involvment of
anterior two thirds of spinal cord which
include the spinothalamic and
corticospinal tracts
• May result in burst fractures : in which
bone fragments may explode into the
cord
29.
30. hyperextension :
- Most common in the elderly patients. With
degenerative spinal canal stenosis
- Usually no bone injury, only damage to ant.
Long. Ligament
- Results in incomplete injury
- Mostly stable
- The most common neurological impairment is
Central Cervical Cord syndrome
31. 4) facet subluxation / dislocation
Either unifacet or bifacet
-Unifacet:
-Result from flexion and rotation
-Posterior ligament is ruptured
-stable, because the vertebra are locked in place
-Bifacet:
-it’s unstable
-high incidence of cord damage
32. Cervical Injury leads to:
• Quadriplegia or quadriparesis
• Bowel/bladder retention (spastic)
• Various degrees of breathing difficulties
• Neurogenic and/or spinal shock
• *quadriplagia: it refers to impairment or loss of motor
and sensory function in the cervical segments it
results in impairment in the function of arms, trunk,
legs and pelvic organs (it does not include the
brachial plexus)
• *quadriparesis:it describes incomplete lesions
imprecisely, the ASIA scale provide a more precise
approach.
33. • Thoracic spine injuries T2-L1:
- Causes paraplegia or paraparesis
- Upper Motor Neuron symptoms
(weakness,decreased motor control,altered
muscle tone,exagerated deep tendon reflexes
spasticity and clonus)
1) flexion, flexion-rotation :
Mostly at level of T12/L1
Unstable
Disruption of post. longitudinal ligament and post.
Bony structures
Anterosuperior wedge fractures are seen
Complete neurological damage (of spinal cord, conus
medullaris, cauda equina)
34.
35. 2) Compression : give an example???? 3
Very common
Stable, rarely cause neurological damage
Decrease in height of vertebral body
36. 3) hyperextension :
• Uncommon
• Leads to :
- damage to ant. Longitudinal
ligament
- rupture of intervertebral disc
- fracture of ant. Part of the
involved vertebral body
• Unstable, causes severe neurological
damage
4) Open injury :
• Results from stab or gunshot wounds
• Injury is due to :
- blast injury
37. • 5- Chance fracture is a flexion injury of the
spine,[ It consists of a compression injury to the
anterior portion of the vertebral body and a
transverse fracture through the posterior
elements of the vertebra and the posterior
portion of the vertebral body. It is caused by
violent forward flexion, causing distraction injury
to the posterior elements.
• The most common site at which Chance
fractures occur is the thoracolumbar junction
(T12-L1)
38.
39. • Lumbar spine injuries L1 and below
• Mainly affect cauda equina
• Leads to paraparesis or paraplegia
• Lower Motor Neuron symptoms(flaccid
paralysis, muscle wasting, fibrillation,
fasiculation, hypotonia~atonia,hyporeflexia)
40. • Radiologic investigation:
1) plain X-ray
2) Dynamic X-ray(named dynamic flexion-
extension x-ray)
3) CT (for bone injury, DO NOT give contrast)
4) MRI (for cord, soft tissues and ligament
damage, an emergency only in cauda
equina syndrome)
42. 1. To relieve any reversible neural compression.
1. To preserve neurological function.
2. To restore alignment of the spine.
3. To stabilize the spine.
4. To rehabilitate the patient.
-Indications for urgent surgical
stabilization:
1. Unstable fracture with progressive neurological
deficit,
2. An unstable fracture in a pt with multiple injuries.
44. - This disc degeneration results from the aging process
and wear and tear that occurs to the bone and soft
tissues of the spine.
- It is one of the most common causes of low back and
neck pain and a major cause of chronic disability in the
adult working population and a common reason for
referral to MRI.
45. >>Degenerative Disc Disease is a Misnomer ! WHY ?
- First , For most people the
term degenerative understandably implies that the
symptoms will get worse with age. However, the term does
not apply to the symptoms, but rather describes the process
of the disc degenerating over time.
- Another source of confusion is probably created by the
term disease, because degenerative disc disease is not
really a disease at all, but rather a degenerative condition
that at times can produce pain from a damaged disc
50. • Prolapse of an intervertebral disc in
the cervical region
• It is less common than disc prolapse
in the lumbar area.
• The disc herniation occurs most frequently at the C6/C7 (70%) level and slightly
less commonly at the C5/6 level (20%) due to the force exerted at these levels .
• Disc herniation above these levels and at the C7/T1 level is much less common
51. Because the nerves pass directly laterally from the
cervical cord to their neural foramen, so that the
herniation compresses the nerve at that level
52. Causes of
cervical disc
prolapse :
Repetitive cervical stress
Trauma
Heavy lifting
Prolonged sedentary position
Whiplash accidents
Frequent acceleration/deceleration
53. Clinical presentation
1. Neck pain
2. Arm pain
3. Hand and fingers pain
4. Part of the shoulder
>> These neurological deficits are determined
by the location of the herniated disc
The pain usually begins in the
cervical region but then it radiates
into the periscapular area, the
occiput, shoulder and down to the
arm.
54. Radiologic Imaging
Investigations
High-quality MRI is now the investigation of
choice and has almost completely replaced
both myelography and CT scans .
Although myelography is an invasive test , it is
more sensitive even to subtle nerve root
compression
55.
56.
57. Management
Conservative(non-surgical) treatment
Patients may find relief by
• using medications to control pain and
inflammation (NSAIDs)
• Use of a cervical collar, cervical pillows
or neck traction may also be
recommended to stabilize the neck and
improve neck alignment.
• exercising the neck and shoulder areas
(alone or with the help of a professional
familiar with neck conditions) to relieve
stiffness and maintain flexibility
58. Lumbar disc prolapse
About 75% of total spinal movement & of lumbar flexion–
extension occurs at the lumbosacral junction ( L5/S1 ),
20% at ( L4/L5 ) level, 5% at upper lumbar levels.
>> Consequently, about 90% of lumbar disc prolapses
occur at the lower two lumbar levels;
The most frequently affected disc is at L5/S1 level
59.
60.
61. Directions of prolapse
Posterolateral (most common)
Lateral
Central (compresses cauda equina)
>> Posterolateral prolapsed disc : causes compression of the nerve
which runs along the posterior aspect of the disc and down in the
neural foramen under the pedicle of the vertebra below
>> Lateral disc prolapse : will cause compression of the nerve root
passing below the pedicle of the vertebra above the disc prolapse.
e.g. :
L3/L4 posterolateral disc prolapse : L4 nerve root compression
Lateral : L3 compression
62.
63. Investigations
• ( 1 ) Lumbar myelography
Involves injection of a water-soluble
contrast material into
the subarachnoid space
that demonstrate the spinal canal.
• Risk of:
• Headache
• epileptic seizures
• In the past the use of oil-based material
was associated with a risk of arachnoiditis
66. Management
• 1.Conservative
• 2. Surgery
Most patients improve by conservative
treatment while Less than 20% require surgery.
• According to the pathology of the disc prolapse:
• A‘bulging’ disc is likely to settle with simple conservative
management,
• If the nucleus pulposus has herniated out of the disc space and
‘sequestrated’ outside the annulus, it will need surgery for
satisfactory relief of symptoms
67. Conservative treatment
1- Bed rest, usually for a period of about 7–10
days
2- Analgesic agents
3- NSAID’s
• Conservative treatment help in:
1.Resorption of the prolapsed disc material
2.Decreasing nerve edema
3.Possible adaptation of the pain fibers to
pressure
68. Indication for surgery
1- Pain if persists after 7-10 days of bed rest OR
reccurent
episodes of pain when mobilizing.
2- Neurological deficit :
A significant weakness or increasing amount of
weakness.
3- Central disc prolapse :
In cases of bilateral sciatica or other features indicating
a central disc prolapse, such as sphincter disturbance
and diminished perineal sensation.
As it cause irreversible cauda equina compression.
4- Tumor
69. scoliosis
• Scoliosis is an (sideways)
of the spine.
• ‘apparent ‘ because although lateral curvature
does occur , the commonest form of scoliosis
is actually a deformity with ,
and
components .
• Two broad types of deformity are defined :
and
70.
71. kyphosis
Rather confusingly , the term ‘kyphosis’ is used to
describe both the (the gentle rounding of the
thoracic spine)and the (excessive thoracic
curvature or straightening out of the cervical or lumber
lordotic curves) .
thoracic curvature might be better describe as
’
, or , is a sharp posterior angulation due to
localized collapse or wedging of one or more vertebrae
This may be the result of a defect , a
(sometimes pathological ) or spinal
72.
73.
74.
75. Myotome
Spinal nerve roots which innervates
muscles groups. Most muscles are
innervated by more than one root