1. REVIEW OF ANATOMY OF SPINE UNDERLYING INTERVERTEBRAL DISC REPAIR

2. NOSE CERVICAL SPINE IS LOCATED IN CENTER OF NECK SURROUNDED BY
CERVICAL SPINE IS LOCATED IN CENTER OF NECK SURROUNDED BY MANY STRUCTURES THAT ARE ESSENTIAL, SMALL AND READILY DAMAGED
THESE SLIDES REVIEW THE ANATOMY OF VERTEBRAE, STRUCTURE OF THE NECK AND SPINAL CORD TO APPRECIATE THE TECHNIQUE OF CERVICAL DISC REPAIR
CERVICAL SPINE
IS LOCATED IN
CENTER OF NECK
SURROUNDED BY
MANY STRUCTURES
THAT ARE ESSENTIAL,
SMALL AND FRAGILE
NOSE
BODY OF
CERVICALVERTEBRA
INTERVERTEBRAL
DISC

3. { ANATOMY OF TYPICAL VERTEBRA BODY VERTEBRAL ARCH
1. BODY – anterior, solid transmits weight
2. VERTEBRAL ARCH – posterior, surrounds vertebral canal, spinal cord; consists of a) PEDICLES – project from body
b) LAMINAE – unite to form arch posteriorly
anterior
NOSE
BODY
TRANSVERSE PROCESS-LATERAL {
PEDICLE
VERTEBRAL ARCH
LAMINA
SPINOUS PROCESS -
POSTERIOR
3. TRANSVERSE AND SPINOUS PROCESSES - projections from arch for muscle, ligament attach

4. LATERAL VIEW OF VERTEBRA
NOSE
JOINTS BETWEEN VERTEBRAE PERMIT MOVEMENTS
HOWEVER, CAN POTENTIALLY DAMAGE SPINAL NERVES
Sup. Vertebral Notch
Inf. Vertebral Notch
2. Spinal nerves leave vertebral canal via INTERVERTEBRAL FORAMINA - between vertebrae;
bordered by – Superior and Inferior Vertebral Notches
1. Location of
Intervertebral
Discs between
bodies

5. VERTEBRA IN DIFFERENT REGIONS ARE SPECIALIZED
Cervical (neck) - 7 vertebrae (C1-C7)
Thoracic (chest) - 12 vertebrae (T1-T12)
Lumbar (lower back) - 5 vertebrae (L1-L5)
Sacral (pelvis) - 5 fused vertebrae (S1-S5)
Coccygeal (tail) vertebrae (Co1-Co3)
Vertebral column functions like structural
support column
Most weight is supported at base of column (lumbar and sacral vertebrae are large)
Cervical vertebrae are relatively small

6. CERVICAL VERTEBRA - small and highly mobile
NOSE
– body is small
Foramen Transversarium - in transverse process (C1-C7) for Vertebral artery & veins
ant.
BODY
TRANSVERSE PROCESS
post.
SPINOUS PROCESS – bifid (divided) for Ligamentum nuchae
ARTICULAR FACETS - angled superiorly & medially - PERMIT CONSIDERABLE MOVEMENT
lat.
view

7. VERTEBRAE ARE STABILIZE BY BEING LINKED BY LIGAMENTS,
INTERVERTEBRAL DISCS
1. ANTERIOR LONGITUDINAL LIGAMENT -Strong band joins bodies on anterior side
Adjacent vertebrae held tightly together (protect spinal cord)
Anterior view

8. VIEW FROM INSIDE VERTEBRAL COLUMN
On post. Side of bodies
LOOK
ANTERIOR
LOOK
POSTERIOR
2. POSTERIOR LONGITUDINAL LIGAMENT- weaker, narrower band on posterior side of bodies
3. LIGAMENTA FLAVA - yellow elastic bands connecting laminae

9. FUNCTION OF INTERVERTEBRAL DISC
STRUCTURE/
FUNCTION OF INTERVERTEBRAL DISC
Intervertebral discs function as shock absorbers; there are strong but undergo degeneration with age (begins at about age 20)
a) Nucleus pulposus-inner gelatinous core
b) Anulus fibrosus - collagen fibers & fibrocartilage

10. MRI OF 'SLIPPED DISK' FROM SNELL'S TEXTBOOK
POSTERIOR
ANTERIOR
HERNIATION OF
NUCLEUS
PULPOSUS

11. DAMAGE TO INTERVERTEBRAL DISCS
Postero-lateral
POSTERIOR
LONGITUDINAL
LIGAMENT
post
lateral
ANTERIOR
LONGITUDINAL LIGAMENT
Typically in Postero-Lateral Direction, lateral to Posterior Longitudinal Ligament (Anterior Longitudinal Ligament is broad and strong)
Disc herniation can lead to nerve compression at intervertebral foramen

12. Ventral rami of spinal nerves:
DAMAGE TO CERVICAL INTERVERTEBRAL DISCS CAN PRODUCE SYMPTOMS IN UPPER EXTREMITY
Ventral rami of spinal nerves: C5
LOWER CERVICAL SPINAL NERVES FORM
BRACHIAL PLEXUS C6 C7 C8 T1
DAMAGE TO SPINAL NERVES CAN PRODUCE SENSORY AND MOTOR LOSS

13. SENSORY LOSS - DERMATOME MAP
THUMB = C6
LITTLE FINGER
= C8
Dermatomes of upper extremity:
C6 - thumb
C7 - middle finger
C8 - little finger
Questions: What is the level of a herniated disc that would produce numbness of thumb? Little finger?

14. NUMBERING OF CERVICAL SPINAL NERVES
LEVELS
OF SPINAL
NERVES
Spinal nerves - arise from/project to spinal cord; there are 31 spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal).
Note: Cervical spinal nerves 1-7 (C1-C7) exit above corresponding vertebrae; Spinal nerve C8 exits below vertebra C7; All other spinal nerves exit below corresponding vertebrae.
CONVENTION FOR
NAMING LEVELS
Cervical
(C1-C8)
Thoracic
(T1-T12)
Spinal nerves C1-C7
above
vertebra
Lumbar
(L1-L5)
Sacral
(S1-S5) C8
and
all
others
below
vertebra
Coccygeal
(Co1)
SPINAL NERVE C6 ARISES ABOVE VERTEBRA C6

15. CLINICAL TESTING OF STRETCH REFLEX: TENDON TAP
TESTING OF SPINAL
NERVE DAMAGE -
STRETCH REFLEXES
Ia sensory
neuron
CLINICAL TESTING OF STRETCH
REFLEX: TENDON TAP
Alpha motor neuron
TENDON TAP
1- Tendon tap elicits twitch
because it excites almost all muscle
spindles simultaneously
2- Use stretch reflexes to test nerve
function at different spinal levels

16. REFLEXES USED FOR CLINICAL TESTS
Nerve compressions can produce reduced spinal reflexes; also
muscle weakness

17. NECK CONTAINS A NUMBER OF VITAL STRUCTURES
SPINAL CORD
TRACHEA
COMMON
CAROTID
ARTERY
ESOPHAGUS
INTERNAL JUGULAR
VEIN
INTERVERTEBRAL
DISC

18. ANT. LAT. POST. ANATOMY OF NECK: NECK IS COMPARTMENTALIZED
1. Posterior Compartment -Vertebrae and muscles which support and move head & neck
2. Anterior Compartment- Viscera and rostral continuation GI & Respiratory Systems
3. Lateral Compartment- Blood vessels & nerve
Plane of section
ANT.
LAT.
POST.
HORIZONTAL SECTION THROUGH NECK: NOTE VERTEBRAE ARE IN
CENTER OF NECK

19. LOCATION OF STRUCTURES IN NECK: COMPARTMENTALIZED BY FASCIA
NOSE
Pretracheal layer
Plane of section
Carotid Sheath
Prevertebral Layer- surrounds vert. column & muscles back of neck, prevertebral, lateral vertebral and suboccipital m.
Pretracheal Layer- surrounds trachea, esophag. & thyroid continues to mediastinum Carotid Sheath- surrounds common & int carotid, int jugular and X (not: Symp. Chain)
LOCATION OF INTERVERTEBRAL
DISC
Prevertebral layer

20. DISCS ARE POSTERIOR TO PREVERTEBRAL MUSCLES
ACT - FLEX NECK/HEAD
INN - CERVICAL VENTRAL RAMI
2. Longus capitis
O - Trans processes C3-C6
I - Occipital bone
1. Longus colli muscle -
O- Trans processes Lower
cervical vertebrae
I - Bodies upper cervical
vertebrae
Colli = neck in Latin
View of anterior side of Cervical Vertebrae
with structures of Anterior and Lateral Compartments removed

21. HOW IS DAMAGE TO CERVICAL INTERVERTEBRAL DISC REPAIRED? SEE DR.
LECLERCQ'S
LECTURE
INTERVERTEBRAL
DISC