overview on anatomy of spine for anaesthesia and autonomic nervous system.

1. ANATOMY OF THE SPINE
Joey Erll Hulleza RN
October 20, 2014

2. Overview
The spine is made of 33 individual bones stacked one on the top of the other.
Ligaments and muscles connect bones together and keep them aligned
The spinal column provides the main support for your body allowing you to stand
Upright, bend, and twist
Protected inside the bones, the spinal cord connects your body to the brain
Allowing movement of your arms and legs
Strong muscles and bones, flexible tendons and ligaments and sensitive nerves
Contribute to a healthy spine

3. Spinal
Anatomy

4. Spinal curves
The neck (cervical) and low back (lumbar) regions have a slight
Concave curve.
The thoracic and sacral regions have a gentle convex curve
The curves work like a coiled spring to absorb shock and
Maintain balance, and allow range of motion throughout
The spinal column.

5. Spinal curves
An abnormal curve of the Thoracic spine is KYPHOSIS, also called hunchback
An abnormal curve of the lumbar spine is LORDOSIS, also called sway back.
An abnormal curve from side-to-side is called SCOLIOSIS

6. Vertebrae

7. Vertebrae: numbered and divided into regions
1 • Cervical region (7)
2 • Thoracic region (12)
3 • Lumbar region (5)
4 • Sacral region (5)
5 • Coccyx region

8. Cervical (neck)
The main function of cervical spine is to support the
Weight of the head (about 10lbs)
C1- is the ring- shaped ATLAS that connects directly to the
Skull; this joint allows for the nodding or “yes” motion of
The head
C2 is the peg shaped AXIS, this joint
allows for the side-to-side or “no” motion of the head.

9. Thoracic (Mid Back)
The main function of the thoracic spine is to:
hold the rib cage and protect the heart and lungs.

10. Lumbar (low back)
The main function of the lumbar spine is
to bear the weight of the body

11. Sacrum
The main function of the sacrum is
to connect the spine to the hip bones (iliac)
Together with the iliac bones, they form a ring called
Pelvic Girdle

12. Coccyx
The four fused bones of the coccyx or tail bone provide
Attachment for ligaments and muscles of the pelvic floor.

13. Vertebral Unique regional
features:
A drum- shaped body designed to bear weight and
Withstand compression
An arch-shaped bone the creates a hollow tube for the spinal cord
and nerves.
Star- shaped processes designed as outriggers for the
Muscle attachment.

14. Intervertebral Discs
Annulus – the outer ring, criss-crossing fibrous bands much
Like tire thread; inside the disc is a gel-filled center called the
Nucleus, much like a tire tube; these bands attach between
the bodies of each vertebra
With age, our disc incraesingly lose the ability to reabsorb fluid and
Become brittle and flatter.
• We became shorter as we grow older
• Osteoporosis
• Osteoarthritis
• Injury and strain can cause isc to herniate, a condition is which
the nucleus is pushed out through the annulus to compress
The nerve roots—causing back pain.

15. Vertebral Arch and Spinal Canal
Vertebral arch is made of 2 supporting pedicles and 2 laminae
The hollow spinal canal contains the spinal cord, fat, ligaments, and
Blood vessels.
Under each pedicle a pair of spinal nerves exits the spinal cord
And pass through the intervertebral foramen to the branch of
The body.
Seven processes arise fro the vertebral arch:
spinous process; 2 transverse process;2 superior facets
and 2 inferior facets.

17. Facet joints
The facet joints allows back motion.
Each vertebra has 4 facet joints
2 superior facets
2 inferior facets
Ligaments
The three major ligaments:
Ligamentum flavum
Anterior longitudinal ligament
Posterior longetudinal ligament

18. Spinal Cord
• 18 inches long and is thickness of your thumb
• Runs within the spinal canal from brain stem to L1
• At the end of the cord, the cord fibers separate into
CAUDA EQUINA and continue down trough the spinal
canal to tailbone before branching off to your legs
• Serves as information highway, relaying messages
between the brain and the body.
• Brain to body via SC-allows movement/ reaction
• Limbs/body to brain/limbs via SC- allows interpretation
• Nerve cells that make up spinal cord are called UPPER
MOTOR NEURONS, the nerves that braches off are called
LOWER MOTOR NEURONS

19. Spinal Nerves
• 31 pairs of spinal nerves
• Act as telephone line- carrying messages back and
forth
• 2 roots
• Ventral (front) – carries motor impulses
• Dorsal (back) – carries sensory impulses
Smaller branch is called POSETRIOR PRIMARY RAMUS
Supply the skin and muscles of the back of the body.
Larger branch is called ANTERIOR PRIMARY RAMUS
Supply the skin and muscles of the front of the body
And form most of the major nerves.

20. Spinal nerves
8 cervival nerve from C1-C8
12 Thoracic nerve from T1-T12
5 lumbar nerve from L1-L5
5 Sacral nerve from S1-S5
1 coccygeal nerve

22. Coverings and Spaces
The SC is covered with the same three membranes as the brain called
MENINGES
PIA- inner membrane
ARACHNOID- mid membrane
DURA- outer membrane
Subarachmoid space- surrounds the CSF;
Accessed during lumbar puncture,
Myelogram to inject dye
Epidural space (between dura and the
bone.; for epidural anestesia

24. AUTONOMIC
NERVOUS SYSTEM
Joey Erll Hulleza RN
October 20, 2014

25. Nervous System
Central Nervous System
• brain & spinal cord
Peripheral Nervous System
• Cranial and peripheral nerves
1. Somatic nervous system
(voluntary movement)
1. Autonomic

26. Central nervous
system
Peripheral
Nervous system
Somatic Nervous
system
Autonomic
nervous system
Parasympathetic
nervous system
Sympathetic
nervous system
Alpha receptors Beta receptors

27. Autonomic Nervous System
Responsible for control of involuntary or visceral
bodily functions visceral functions:
Central nervous
• Cardiovascular
• Respiratory
• Digestive
• Urinary
• Reproduction functions
• Key role in the bodies response to stress
system
Peripheral
Nervous system
Somatic Nervous
system
Autonomic
nervous system
Parasympathetic
nervous system
Sympathetic
nervous system
Alpha receptors Beta receptors

28. Autonomic Nervous System
• Sympathetic nervous System
– Allow body to function under stress
– Fight or flight
Parasympathetic Nervous system
– Controls vegetative functions
• Feed or breed or restand repose
• Constant opposition to sympathetic system
Central nervous
system
Peripheral
Nervous system
Somatic Nervous
system
Autonomic
nervous system
Parasympathetic
nervous system
Sympathetic
nervous system
Alpha receptors Beta receptors

30. Major Components
• Neuron
– Sensory- afferent
– Motor neurons- efferent
• Neurotransmitter
– Chemical substance which travels across a
synaptic junction to act on a target cell
• Effect Organs
– Specific tissues stimulated by the autonomic
nervous system

31. Neurotransmitters
• Norepinephrine
– Post ganglionic neurotransmitter for the
sympathetic nervous system
• Acetylcholine
– Pre- ganglionic neurotransmitter for both system
– Post-ganglionic neurotransmitter for the
parasympathetic nervous system

32. Synapse
• Junction of pre and post synaptic neurons
– Neurotransmitter produced in presynaptic
membrane
– Moves across synaptic space
– Binds with receptor on post synaptic membrane
– Causes impulse potential

33. Synapse
Pre ganglionic
neuron
post ganglionic
neuron
Norepi

34. SYMPATHETIC PARASYMPATHETIC
• Thoracolumbar
• Conduction takes place along
very short neurons, effecting
on gland or muscle
• Vagus Nerve
• Main regulator of automatic
functions
• Neuron pathways are much
longer, making this a slower
system

35. Reflex Arc
• Craniosacral
– Brain to effector organ
– Parasympathetic nervous system
• Thoracolumbar
– Ganglia are located near the spine
– Makes for a quicker response
– Sympathetic nervous system

36. Sympathetic Nervous System
• Stimulates sweat glands
• Constrict peripheral vessels
• Increase blood to skeletal muscles
• Increase chronotropic and inotropic
effect
• Bronchodilation
• Stimulation of NRG production
• Reduce blood flow to abdomen
• Decrease digestive activity
• Relax smooth muscle in wall
bladder
• Release glucose stores from liver

37. Adrenal Medulla
• This area of the nervous system is also
stimulated by the release of norepinephrine
– This releases
• Noradrenaline and adrenaline
– These are releases into the body to also react
with the receptors and prolong the effect of
sympathetic stimulation

38. Sympathetic receptors
• As norepineprhine is released, it travels
across the synaptic cleft and interact with
adreneric receptors
– Epinephrine will also stimulate these receptors
• Two types of sympathetic receptors
– Adrenergic
– dopaminergic

39. Adrenergic receptors
• Alpha 1
– Peripheral vasoconstriction
– Positive inotropic effect
– Negative chronotropic effect
• Alpha 2
– Peripheral vasodilation
• Limits release of norepinephrine
– Stimulates by excessive amounts of
norepineprhine in the synaptic cleft

40. Adrenergic Receptors
• Beta 1
– Positive inotropic effect on heart
• Increase contractility
– Positive chronotropic effect on heart
• Increase heart rate
– Positive dromotropic effect on heart
• automaticity

41. Adrenergic receptors
• Beta 2
– Peripheral vasodilation
– Bronchodilation
– Uterine smooth muscle relaxation
– GI smooth muscle reaxation

42. • Sympathomimetics
– meds that stimulates the sympathetic nervous
system
• Sympatholytics
– Inhibits the sympathetic system
• Alpha or betagonist
– Stimulate alpha sites
• Alpha or beta antagonist
– Block effects of beta stimulation

43. Parasympathetic Nervous System
• Pulillary constriction
• Secretion by digestive
glands
• Increase smooth muscle
activity along GI tract
• Brochoconstriction
• Reduced HR and negative
Inotropic effects

44. • Parasympathomimetics
– Stimulates parasympathetic nervous system
– Physostigmine
• Parasympatholytics
– Block action of parasympathetic system
– Atropine sulfate

45. THANK YOU 