Spine

facet joints

• found on superior and inferior end of each vertebral body
• contained within rim of cortical bone
• contains 2 layers cartilagionous external, bony internal
• functions as growthplate

it prevents subsidence of device into soft cancellous bone

ring of cortical bone that surronds the vertebral body beneath portions of endplate

• formed by pedicles
• opening through which spinal nerve roots leave spinal cord

L5 fuses to S1

S1 remains separate from S2

large concave articulating surfaces of cervical vertebrae

dens

subaxial cervical spine upward projections on lateral margins

• joints of luschka
• articulating vertebral bodies of cervical spine C3-C7

sulcus

longer larger spinous process at C7

T2-T9

• area of sacrum surrounding the foramina
• made from fused transverse processes of formal sacral vertebrae

• anchor for spinal cord and cauda equina
• contains the filum terminale

nucleus pulposus

outer collagenous part of disc

diffusion through endplate

• two adjacent vertebrae
• the disc between them
• connecting capsular facet joints
• ligamentous structures

• occipitocervical joint or
• alantooccipital joint

atlantoaxial joint

mainly flexion and extensino

motion in transverse plane for rotation

allow for flexion-extension, side bending, rotational movements

• between C0 and C1
• anterior occipitoatlantal ligament
• posterior ociipitoatlantal ligament
• lateral occipitaoatlantal ligaments

• ligaments betweem C1 and C2
• anterior atlantoaxial ligament
• posterior atlantoaxial ligament
• lateral ligaments

• occipital ligament
• alar ligaments x2
• apical ligament

• extends from
• axis posterior body (spinal canal) to anterior foramen magnum
• (continuation of posterior longitudinal ligament)

• aka check ligaments
• extend laterally from superior tip of odontoid process to occipital condyles

extends from tip of odontoid process in C2 to anterior foramen magnum

• transverse ligament
• superior and inferior longitudinal fascicles

helps stabilize atlantoaxial complex

• extends from anterior axis to sacrum.
• attaches at endplates

extend from inferior surface of entire length of transverse process to superior surface of adjacent transverse process

connect heads of ribs to vertebrae

• weaker than ALL
• run from axis to sacrum caudally
• may help to contain herniated discs

connect adjacent spinous process

• aka the yellow ligament
• extends from anterio inferior surface of lamina above and below

extends from spinous process to spinous process

extend from TP of L4, L5 to iliac crest

extends from aterior inferior aspect of TP L5 to lateral surface of sacrum

extend from sacrum to iliac bone

at L1 it terminates as the conus medullaris

• fatty tissue
• veins and arteries

shock absorber

membrane covering spinal nerves

small space between dura and arachnoid layer

• layer between arachnoid and pia mater
• contains CSF

• to protect by acting as a shock absorber
• to nourish containnig electrolytes, proteins, and glucose

• closely adherent to spinal cord
• highly vascular suppling blood to neurological structures

• cervical 8
• thoracic 12
• lumbar 5
• sacral 5
• coccygeal 1
• total 31 pairs

in anterior spinal cord

ventral roots

within spinal cord

loss of musculoskeletal function

posteror spinal cord

dorsal root

jointing of dorsal and ventral root

basilar artery

circle of willis

common illiac arteries

internal and external illiac artery

femoral artery

common iliac veins

SVC

L4

• vertebral arteries C1-C6
• Carotid arteries
• juglar veins
• pharynx C1-C2
• larynx C5
• recurrent laryngeal nerves
• thyroid gland
• esophagus
• trachea

T4-T7

• great vessels
• kidneys
• ureteres
• urinary bladder
• middle sacral artery

anterior subluxation of one vertebra on another

posterior slippage of one vertebra on another

slippage to one side or the other

degenerative changes in vertebrae at articulation points

defect in the vertebrae, usually the pars interarticularis

spondylolisthesis in which the entire L5 vertebral body has fallen bellow the horizontal line across the top of the sacrum

• Type I - Dysplastic
• Type II - Isthmic
• Type IIA - Lytic or Stress
• Type IIB
• Type IIC
• Type III degenerative
• Type IV traumatic
• Type V pathologic
• Type VI iatrogenic

• usually at L5-S1
• congenital defect in sacral articulating processes or posterior elements of L5
• intact posterior elements may compress dura as subluxation increases

• defect or fx of pars interarticularis of lamina
• L5-S1 most common site
• Contains three subtypes

• recurrent microfractures in pars interarticularii from hyperextension cause complete separation of posterior elements - stress fx of the pars
• most common type
• L5-S1 most likely location
• more common in males: wt lifters, football linemen, gymnasts

microfractures in pars which remains intact but stretches as fxs fill with new bone causing pars to enlongate and the body to sublux forward

• acute fx of pars
• difficult to distinguish from Type IIA

• results from degenerative changes in facet joints causing hyper mobility of motion segment
• L5 nerve root is often compressed
• most common at L4-L5
• more common in females

fracture of vertebra in area other than pars: pedicles, lamina, or facets

tumor or metabolic type

excessive surgical decompression of posterior elements

• LBP
• mild backache that may be exertion related
• posterior thigh radiculopathy
• forward center of gravity
• lordodic curve with possibly a horizontal sacrum
• knees and hips partially flexed
• shuffling gate
• sciatica
• claudication - from decreased vascular circulation

• Napoleon's hat
• Scotty Dog Sign

• Normal - no slip
• Grade I - 25% slip
• Grade II - 45-49% slip
• Grade III - 50 - 74% slip
• Grade IV - 75-99% slip
• Grade V - body completely off level below

angle made from top of posterior body of level below slip and inferior endplate of slipped vertebra

angle of sacrum to a line drawn perpendicular to floor

measure with one line against posterior sacrum the other the anterior body of the subluxed vertebrae

amount of roll the L5 has along sacral endplate - degree of slip and amount of tilt measuring the horizontal and vertical position

• cessation of precipitating activities
• bed rest
• traction
• bracing
• back exercises
• medications

surgery in cases of intractable pain or with neurological symptoms

loss of normal tissue sturcture and function due to aging process

inflammation of bones and cartilage due to degenerative process

symptomatic, degenerative changes of osteoarthritis

• DDD
• spinal stenosis

• 90%
• 70%

• anterior longitudinal ligament
• posterior longitudinal ligament
• ligamentum flavum
• face capsular lifagment
• intertransverse ligament
• interspinous ligament
• supraspinous ligament

lifamentous damage that has led to reduced or excessive ROM of the the motion segment which causes spurs and osteophytes leading to spinal stenosis.

• increased bone formation in subchondral bone adjacent to endplate
• decreases blood flow to cartilaginous endplate into disc causing degeneration
• stiffens endplate making it less able to absorb loads.