spine
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„Selected Chapters from the Cross-Sectional Anatomy of the Human Body” Spine anatomy András Jakab MD, Levente István Lánczi MD
Transcript of spine
„Selected Chapters from theCross-Sectional Anatomy
of the Human Body”
Spine anatomyAndrás Jakab MD, Levente István Lánczi MD
The Spinal Cord Cervical (7)
C1-C7 C1: atlas C2: axis
Thoracic (12) T1-T12
Lumbar (5) L1-L5
Sacral (5) S1-S5, synosthosis
Coccyx Coc3-5
Spinal cord – macroscopic anatomy
=medulla spinalis conus medullaris (termianlis) cervical and lumbar enlargement filum terminale anterior median fissura posterior median sulcus dorsal root (sensory) et ventral root (motor)
spinal nerves
Spinal cord – structure
Segments – functions 8 cervical
Segment+nerve: level of intervertebral foramen C1 nerve: exits between occipital bone and atlas Remember!
C8 exits on intervertebral foramen between C7-Th1! Spinal cord segments are shorter than vertebrae height!
Nerve exits spinal cord upper than intervertebral foramen. 12 thoracic 5 lumbal (nerves descend almost vertical!) 5 sacral 1 coccyx Altogether: 31 pairs of spinal nerves
Spinal cord vs. spinal column (C7)
Spinous process
Vertebral arch
Transverse process
Periosteum
Epidural space
Spinal dura mater
Subarachnoid space
arachnoidea mater
Pia mater
Posterior root
Anterior rootSpinal ganglion
n. spinalis; r. posterior
n. spinalis; r. anterior
Spinal cord• vessels• sheaths: pia, arachnoid, dura
Vertebral column – demonstrating on IMAIOS
Vertebral column – demonstrating on IMAIOS
Specific vertebrae on every level
Cervical vertebrae (atlas!, axis!) Thoracic vertebrae Lumbal vertebrae Sacrum Coccyx
Cross sectional structureof the spinal cord
Cross sectional structureof the spinal cord
Central canal White matter
commisura alba funiculi
Posterior funiculus Lateralis funiculus Anterior funiculus
Grey matter PEG (periaqueductal grey
matter) Anterior root Posterior root …Rexed laminae…
Spinal cord – tracts
Ascending tracts Fasciculus gracilis, Goll (skin) Fasciculus cuneatus, Burdach Spinothalamic tract (pain) Ant. & post. spinocerebellar tract
Descending tracts Corticospinal tract Rubrospinal tract Reticulo- vestibulo- tectospinal tract Fasciculus longitudinalis medialis Descending vegetative tracts
S1
S2
L5
L4
L3
L2
L1
T12
T11
Intervertebral disc1. Anulus fibrosus
2. Nucleus pulposus
conus terminalis
filum terminale (cauda equina)
lumbar enlargement
promontory
Spinal canal
Intervertebral face
Spinous process
Interspinal ligament
Sacral canal
Epidural fat
Intervertebral foramen
Vertebral arch, pediculus
Spinous process
Articular process
Vertebral body
Ventral root
Dorsal root
Spinal medulla
Ligamenta flava
Transverse process
Spinous process
Level: lower thoracic,T2 weighted MRI
Ant. & post. longitudinal ligament
Vertebral body
cauda equina
ligamenta flava
Transverse process
Spinous process
Level: Lumbar,T2 weighted MRI
Ant. longitudinal ligament
Spinal ganglion
Spinal nerves
Root symptoms
C- headache, dizziness
T- upper limb weakness, no skin sensation or pain
L- lower limb weakness, no skin sensation or pain
S- buttocks, toes; incontinence, erectile dysfunction
Neck – C2, C3
Upper limb: C6, C8, T1
Hand: C6-C8
Level of nipples: Th4
Level of umbilice: Th10
Genital organs: S2-S3
Gluteus: S1-S4
Small toe: S1
Big toe: L4-5
Spinal reflex – an example (patella-reflex) Receptor -> afferent -> center -> efferent -> effector
Cranial nerves
12 pairs Motory, sensory
and parasymphatetic nerves
Eye movements Special sensory
nerves – sensory organs
N. vagus (X)
Vegetative nervous system
Center in brain: hypothalamus Parasympathetic („rest&digest”)
Heart rate, blood pressure decreases, pupil narrows
N. Sympathetic („fight or flight”)
Stress: respiration+, heart rate+, blood pressure+, pupil broadens, hair
Truncus sympaticus
Parasymphatetic nerves
Symphatetic nerves
Symphatetic nerves
Sensory organs demonstrated on IMAIOS
Clinical case
68 year old female 4-hour history of pain in the back and
epigastrium with paraesthesia and weakness of the lower limbs.
Warfarin therapy (earlier: PE) Sensory loss below the umbilicus
http://www.eurorad.org/case.php?id=2954
Clinical case
56 year old female 3 years history of dizziness and heaviness of
the neck, without neurologic signs Plain radiographs of the cervical spine in the
lateral view, in an erect position; CT scan
http://www.eurorad.org/case.php?id=978
Other cases
Cervical spine epidural mass http://www.eurorad.org/case.php?id=4361
Spinal arachniod cysthttp://www.eurorad.org/case.php?id=2550
Traumatic meningocelehttp://www.eurorad.org/case.php?id=2403
