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MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD

MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD. SPINE. USC. = speaker notes. GOALS VERTEBRAL BODY BONY ANATOMY DISC / NEURAL AND LIGAMENT ANATOMY CERVICAL vs THORACIC vs LUMBAR DIFFERENTIATION DISCO-VERTEBRAL JUNCTION FORAMEN- FACET RELATIONSHIP

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MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD

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  1. MEDICAL HUMAN EMBRYOLOGY AND GROSS ANATOMY Dr. Francis Neuffer, MD SPINE USC = speaker notes

  2. GOALS • VERTEBRAL BODY BONY ANATOMY • DISC / NEURAL AND LIGAMENT ANATOMY • CERVICAL vs THORACIC vs LUMBAR DIFFERENTIATION • DISCO-VERTEBRAL JUNCTION • FORAMEN- FACET RELATIONSHIP • NERVE ROOT - CENTRAL CANAL • ANATOMIC PATHOLOGY CORRELATES

  3. VERTEBRAE 33 VERTEBRAE ARRANGED IN 5 REGIONS AP VIEW PA VIEW LATERAL VIEW VERTEBRAL BODY VERTEBRAL DISC SPINOUS PROCESS KYPHOTIC CURVE LORDOTIC CURVE

  4. ANTERIOR POSTERIOR

  5. COMPARE THE X-RAY IMAGE TO THE MODEL. ANTERIOR AND POSTERIOR STRUCTURES ARE SUPERIMPOSED ON X-RAY. anterior posterior

  6. MAG VIEW THE IMAGE SHOWS: A- Spina bifida B- Spondylolysis C- Metastatic lesion D- Osteomyelitis

  7. MAG VIEW THE IMAGE SHOWS: A- Spina bifida B- Spondylolysis C- Metastatic lesion D- Osteomyelitis

  8. AP angled AP T-4 CERVICAL VERTEBRAE(7) RIB ANTERIOR THORACIC VERTEBRAE(12) LUMBAR VERTEBRAE(5) RIB POSTERIOR DISC COSTAL CARTILAGE T-12 L-1 L-5

  9. POSTERIOR VIEW ANTERIOR RIBS SPINOUS PROCESS POSTERIOR RIBS TRANSVERSE PROCESS

  10. AP AP CERVICAL VERTEBRAE(7) RIB Anterior RIB Posterior DISC T-12 L-1

  11. LATERAL LUMBAR SPINE

  12. THE IMAGE SHOWS: A- Spondylolisthesis B- Facet hypertrophy C- Degenerative disc D- Osteoporotic fracture

  13. THE IMAGE SHOWS: A- Spondylolisthesis B- Facet hypertrophy C- Degenerative disc D- Osteoporotic fracture

  14. INDIVIDUAL VERTEBRA AXIAL OR TRANSVERSE ANTERIOR LATERAL VIEW POSTERIOR ANTERIOR POSTERIOR

  15. LATERAL VIEW OF VERTEBRAL BODY lateral

  16. LATERAL PROJECTION FORAMEN FORAMEN NERVE ROOT DISC DISC SPACE SPINOUS PROCESS SPINOUS PROCESS

  17. INDIVIDUAL VERTEBRA ANTERIOR POSTERIOR

  18. TRANSVERSE OR AXIAL PROJECTION 20

  19. MRIAXIALSECTION

  20. AXIAL LUMBAR CT SCAN LAMINA SPINOUS PROCESS FACET JOINT PEDICLE

  21. DISC FACET JOINTS LAMINA MR – LUMBAR SPINE AXIAL VIEW

  22. NOW TO LOOK AT SECTIONSIN A SAGITTAL PLANE

  23. VERTEBRAL BODYMID LINE SAGITTAL SECTION COMPACT BONE SPONGY BONE FORAMEN / CANAL FOR BASIVENTEBRAL VEIN SUPERIOR VERTEBRAL “END PLATE” INFERIOR VERTEBRAL “END PLATE” VERTEBRAL BODIES VERTEBRAL ARCHES MR SECTION

  24. INTERVERTEBRAL DISC • MADE OF TWO PARTS: • ANNULUS FIBROSIS • FORMED BY CONCENTRIC RINGS OF FIBROCARTILAGE • THINNER POSTERIORLY • NUCLEUS PULPOSUS • 88% WATER AT BIRTH, • WATER CONTENT DECREASES WITH AGE • SERVES AS SHOCK ABSORBER

  25. MIDLINE SAGITTAL MR SCAN ANTERIOR DISC NUCLEUS PULPOSUS ANNULUS FIBROSIS

  26. FORAMENAL SECTIONLATERAL VIEW INTERVERTEBRAL FORAMEN PEDICLE LAMINA INFERIOR ARTICULAR PROCESS SUPERIOR ARTICULAR PROCESS FORMING ZYGAPOPHYSIAL (FACET) JOINT INTERVERTEBRAL DISC SPINOUS PROCESS

  27. INTERVERTEBRAL FORAMENLATERAL VIEW MR SCAN SAGITTAL SECTION PEDICLE LAMINA INFERIOR ARTICULAR PROCESS SUPERIOR ARTICULAR PROCESS

  28. LIGAMENTS OF THE VERTEBRAL COLUMN • ANTERIOR LONGITUDINAL LIGAMENT • ANTERIOR VERTEBRAL BODIES • LIMITS EXTENSION • POSTERIOR LONGITUDINAL LIGAMENT • POSTERIOR VERTEBRAL BODIES • LIMITS FLEXION • LIGAMENTUM FLAVUM • CONNECTS LAMINA

  29. MID LINE SAGITTAL AND AXIAL MR SCANS ANTERIOR POSTERIOR LONGITUDINAL LIGAMENT Longitudinal ligament ANTERIOR LONGITUDINAL LIGAMENT LIGAMENTUM FLAVUM LIGAMENTUM FLAVUM ANTERIOR

  30. HYPER FLEXION INJURY

  31. CERVICAL SPINE C-1 C-1 C-7 C-7

  32. CERVICAL VERTEBRAE CHARACTERISTICS • MOST VARIATION and MOVEMENT • THIN IV DISK and SMALL BODY • TWO FORAMENA • FORAMEN OF TRANSVERSE PROCESS (VERTEBRAL ARTERY) • OVAL VERTEBRAL FORAMEN (SPINAL CANAL) CT SCAN

  33. C1 AND C2 ARE DIFFERENT FROM LOWER SEGMENTS C2 C1

  34. C1(Atlas) and C2 ( Axis)RELATIONSHIP WITH THE SKULL

  35. C1 - ATLAS • ANTERIOR ARCH • NO VERTEBRAL BODY • POSTERIOR ARCH • LATERAL MASS • LARGEST OF CERVICAL VERTEBRAE

  36. C1 and C2 LATERAL VIEW ANTERIOR ARCH OF C1 POSTERIOR ARCH OF C1 C2 C2 NO FORMAL INTERVERTEBRAL DISC AT C1-2

  37. RHEUMATOID SUBLUXATION normal

  38. C2 – AXISPOSTERIOR VIEW • STRONGEST OF THE CERVICAL VERTEBRAE • DENS- (ODONTOID) • LARGE BIFID SPINOUS PROCESS • SMALL LATERAL MASS

  39. “OPEN MOUTH” VIEW OF THE CERVICAL SPINE IS USED TO VISUALIZE THE ODONTOID PROCESS (DENS) ODONTOID PROCESS C-2 ODONTOID PROCESS C - 2

  40. LATERAL CERVICAL SPINE ANTERIOR POSTERIOR ANTERIOR POSTERIOR

  41. CERVICAL SPINE C-1 C-1 C-5 C-5

  42. CERVICAL SPINE “AP” VIEW FACET JOINTS C-4 AIR IN TRACHEA decreased density SPINOUS PROCESS PEDICLES

  43. CERVICAL SPINE LATERAL VIEW DENS SPINOUS PROCESS C-4 DISC SPACE TRACHEA

  44. C3–C7 OBLIQUE • VERY SIMILAR IN CHARACTERISTICS • VERTEBRAL ARTERY LOCATED IN TRANSVERSE FORAMEN

  45. OBLIQUE VIEW CERVICAL ANTERIOR

  46. CERVICAL VERTEBRA ANTERIOR FORAMEN TRANSVERSARUM TRANSVERSE PROCESS PEDICLE SPINAL CANAL VERTEBRAL FORAMEN ARTICULAR FACET LAMINA SPINOUS PROCESS

  47. THORACIC SPINE AP VIEW CLAVICLE PEDICLE OF T-7 PEDICLE OF T-7 DISC SPACE SPINOUSPROCESS T-11 12 th RIB COSTOVERTEBRAL JOINT

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