MEDICAL HUMAN EMBRYOLOGY
AND
GROSS ANATOMY
Dr. Francis Neuffer, MD
SPINE
1
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
ANTERIOR
POSTERIOR
COMPARE THE X-RAY IMAGE TO THE MODEL.
ANTERIOR AND POSTERIOR STRUCTURES
ARE SUPERIMPOSED ON X-RAY.
anterior
posterior
AP
AP
CERVICAL
VERTEBRAE(7)
RIB
Anterior
T-12
L-1
RIB
Posterior
DISC
LATERAL VIEW
FORAMEN
FORAMEN
NERVE ROOT
DISC
DISC
SPACE
SPINOUS
PROCESS
SPINOUS
PROCESS
OSTEOPOROSIS
COMPARED WITH NORMAL X-RAY
OSTEOPOROTIC COMPRESSION FRACTURE
The 68 yr. old female patient fell at home.
The vertebral body has further collapsed ---a compression fracture due to the
patient falling plus the underlying problem of osteoporosis in post menopausal
females.
DISC
LAMINA
CT Scans-LUMBAR SPINE
AXIAL VIEW
NOW TO LOOK AT SECTIONS
IN A SAGITTAL PLANE
SAGITTAL PLANE
Axial
3-D reconstruction
of CT scan
LUMBAR VERTEBRAE
 LARGEST
 TRIANGULAR VERTEBRAL
FORAMEN
 LAMINECTOMY TO ACCESS
SPINAL CANAL
 SHORT SPINOUS
PROCESS
 SPINAL CORD ENDS AT L2
LEVEL
LUMBAR SPINE
AP VIEW
T-12
RIB
L-1
TRANSVERSE
PROCESS
LAMINA
DISC
SPACE
SPINOUS
PROCESS
SACRUM
ANTERIOR
POSTERIOR
LAMINECTOMY
MID LINE SAGITTAL MR SCAN
LONGITUDINAL
LIGAMENTS
LIGAMENTUM
FLAVUM
ANTERIOR
FOUR LINES FOR ALIGNMENT
C2 FRACTURE
A forced flexion injury usually causes this.
HYPER FLEXION INJURY
INJURY TO INTERSPINOUS AND
SUPRASPINOUS LIGAMENTS
C5
normal
COMPLEX FRACTURE DISLOCATION
OF CERVICAL SPINE
CT scan
Reformatted CT sections in a sagittal plane better show position of complex fractures
22
CERVICAL SPINE
C-1
C-7
C-1
C-7
C1 - ATLAS
 ANTERIOR ARCH
 NO VERTEBRAL BODY
 POSTERIOR ARCH
 LATERAL MASS
 LARGEST OF
CERVICAL VERTEBRAE
C1 AND C2 ARE DIFFERENT FROM
LOWER SEGMENTS
C2
C1
C1(Atlas) and C2 ( Axis)
RELATIONSHIP WITH THE SKULL
JEFFERSON BURST FRACTURE C1
C1 AND C2 ARE DIFFERENT FROM
LOWER SEGMENTS
C2
C1
C1 and C2
LATERAL VIEW
ANTERIOR
ARCH OF C1
POSTERIOR
ARCH OF C1
C2
C2
NO FORMAL
INTERVERTEBRAL DISC
AT C1-2
ODONTOID FRACTURE
C1 - ATLAS
 ANTERIOR ARCH
 NO VERTEBRAL BODY
 POSTERIOR ARCH
 LATERAL MASS
 LARGEST OF
CERVICAL VERTEBRAE
RHEUMATOID SUBLUXATION
normal
LATERAL VIEW
FORAMEN
FORAMEN
NERVE ROOT
DISC
DISC
SPACE
SPINOUS
PROCESS
SPINOUS
PROCESS
SAGITTAL
MR
SCANS
L-5
L-5
L-5
AXIAL OR TRANSVERSE
ANTERIOR
POSTERIOR
NORMAL
CENTRAL CANAL STENOSIS
LUMBAR SPINE
FORAMEN
FORAMEN
DISC
DISC
SPACE
NERVE ROOT
FACET JOINT OF
L-3 – L-4
SPINOUS
PROCESS
L-5
SPINOUS
PROCESS
DEGENERATIVE DISEASE
1
COMPARE THE X-RAY IMAGE TO THE MODEL.
ANTERIOR AND POSTERIOR STRUCTURES
ARE SUPERIMPOSED ON X-RAY.
anterior
posterior
CERVICAL RIB
SACRUM
5 segments
CHILD
SEGMENTED
ADULT
FUSED
SACRUM - ANTERIOR VIEW
MAG VIEW
SPINAL BIFIDA
SPINA BIFIDA-NEURAL
tube defect
Meningomyelocele
MIDLINE SAGITTAL MR SCAN
ANTERIOR
DISC
NUCLEUS
PULPOSUS
ANNULUS
FIBROSIS
MID LINE SAGITTAL AND AXIAL MR SCANS
ANTERIOR
POSTERIOR
LONGITUDINAL
LIGAMENT
Longitudinal
ligament
ANTERIOR
LONGITUDINAL
LIGAMENT
LIGAMENTUM
FLAVUM
ANTERIOR
THE ANNULUS THINNING THAT CONTRIBUTES
TO DISC HERNIATION IS:
A- anteriorly
B- posteriorly
C- medially
D- laterally.
20 YEAR OLD MALE WITH BACK PAIN---SPONDYLOLYSIS
FRACTURE OF BONY RING ON A NON ACUTE BASIS
SPONDYLOLYSIS
SPONDYLOLITHESIS
VERTEBRAE
33 VERTEBRAE ARRANGED IN 5 REGIONS
AP VIEW
PA VIEW
LATERAL VIEW
VERTEBRAL BODY
KYPHOTIC CURVE
VERTEBRAL DISC
SPINOUS PROCESS
LORDOTIC CURVE
SCOLIOSIS
THE ELDERLY FEMALE OSTEOPOROTIC PATIENT
COMPENSATES HER KYPHOSIS BY:
A- Extending the neck
B- Straightening the sacrum
C- Flexing the thoracic spine
D- Moving chin to chest
THE PATIENT COMPENSATES THE KYPHOSIS BY:
A- Extending the neck
B- Straightening the sacrum
C- Flexing the thoracic spine
D- Moving chin to chest
ANATOMIC KEYS
DISCO VERTERBRAL JUNCTION
FORAMEN- FACET JOINT ALIGMENT
CENTRAL CANAL- FORAMEN INTEGRITY
ANATOMIC KEYS
DISCO VERTERBRAL JUNCTION
FORAMEN- FACET JOINT ALIGMENT
CENTRAL CANAL- FORAMEN INTEGRITY
END END…