D5.5 Spine Clinical Anatomy and Pathologies_NR.pptx

SPINAL CORD & NERVE CLINICAL ANATOMY & L3 PATHOLOGY L3 Objectives: L4 Understand the difference between disc herniation and L4 ve...

SPINAL CORD & NERVE CLINICAL ANATOMY & L3 PATHOLOGY L3 Objectives: L4 Understand the difference between disc herniation and L4 vertebral stenosis and be able to assess what spinal nerve L5 would be affected. Understand general information about other pathologies presented. H E AT H E R G A R V I N , P H D , D - A B FA Disc Herniation C1 Despite the fact that C1-C7 nerves C2 are numbered above the vertebrae, C3 and all others below… C4 C5 C5 RULE: A herniated disc effects the C6 C6 spinal level of the vertebra below it! C7 C7 C8 L3 L3 Nucleus L4 pulposis Herniated disc Annulus fibrosis L4 L5 Typically, herniate posterolaterally. Disc Herniation: Cervical 31 pairs of spinal nn C1-C7 exit superior C1 C1 C2 to their vertebra # C8 exits inferior to C C7 C7 C7 T1 C8 6 T2 T1 All others exit inferior to their vertebra # https://www.spine-health.com/conditions/spine-anatomy/all-about-c5-c6-spinal- segment Even those in T12 T1 cauda equina L1 2L1 L5 S1 L5 S1 http:// manjahh.cwebdesigns.us/ icd-9-code-for- S5 Co  Disc Herniation: Lumbar Thoracic herniated discs are extremely rare Lumbar herniated disc. Sagittal view shows (~1/1,000,000), and when disc material impinging on neighboring they do occur, typically occur neural structures (arrow). in the lower thoracic region. (Thus, do not worry about What spinal nerve will likely be affected? thoracic herniated discs for Where might you expect pain? this exam). L4 L5 This is where your dermatome & myotome maps come https://www.aafp.org/afp/2002/0601/p2299.html in handy! Impinges on L5 roots / spinal nerve L5  The Rule only applies to Disc Herniation Narrowed intervertebral foramen would likely affect what nerve? The one exiting there (stenosis is more lateral), in this case L4 spinal nerve L3 L3 L4 L4 L4 L5 L5 L5 https://www.aafp.org/afp/2002/0601/p2299.html  Stenosis of the cervical intervertebral foramina… What spinal nerve level would be affected? https://www.spine-health.com/conditions/spine-anatomy/all-about- c5-c6-spinal-segment It’s still going to be C6… same as it was for the cervical disc herniation. http://manjahh.cwebdesigns.us/icd-9-code-for-degenerative-disc- disease-cervical-spine/  White Matter Gray Matter Myelinated axons & Collection of cell bodies & dendrites (neuronal cell unmyelinated neuronal processes) processes Dorsal Horn Ventral Horn Lateral Horn (T1-L2 only) Can you tell what side is Dorsal vs Ventral? Dermatomes & Myotomes Dermatomes-strip of skin innervated by single spinal level Myotomes- Certain spinal levels responsible for certain actions (muscles masses by spinal nn) Shingles dermatom es C4 T4 T10 L1 C6 C8 S2 Herpes zoster infection causes S1 S1 shingles, an infection of the L4 L4 dorsal root ganglion area of skin supplied by a single spinal nerve or spinal cord segment presents as burning pain dermatomes overlap substantially but can be and rash in the dermatome of used to determine the neurologic level of a the infected ganglion lesion Spina Bifida Spina Bifida What structures may be involved? Spina bifida occulta: the vertebral laminae fail to fuse (usually lumbar). Usually covered by skin and frequently diagnosed by presence of a tuft of hair over the site. Meningocele (meninges) or myelomeningocele (spinal cord & meninges) protrude Paralysis Questions? [email protected]