The Back and Spine

1. The Back and Spine

2. Anatomy of the Back and Spine Cervical Vertebrae (7) Thoracic Vertebrae (12) Lumbar Vertebrae (5) Sacrum (1)

3. Anatomy of the Vertebral Disc • Inter-articular disc sit between the bodies of the vertebrae to act as shock absorbers. • All of these discs are fibrocartilegenous • Outer portion is fibrocartilage • Inner portion is fluid filled made of protein and water

5. Ligaments • Anterior Longitudinal Ligaments (body to body) • Posterior Longitudinal Ligaments (inside vertebral canal)

6. Muscles of the back and Spine • Abdominal Muscles • Iliopsoas Group • Lumbosacral Muscles • Erector Spinae

7. Spinal Cord • The spinal cord runs from the brain to the thoracic vertebrae and branches out when it reaches the lumbar area.

8. Lumbosacral Plexus • One of the major branches is Sciatic Nerve • Multiple branches go off this major branch • When L3 and L4 are in involved pain is noted in the low back and posterior pain across the back of the thigh and over the patella • L4 and L5 are side specific and cause pain through the buttock, could not be able to extend big toe, and foot drop is possible

9. Structural Abnormalities • Genetic • Traumatic • Curvature • Kyphosis • Lordosis • Lateral Deviation • Scoliosis

10. Structural Abnormalities • Genetic is a congenital structural deformity • Traumatic is a deformity that usually occurs from an accident (most often a fall)

11. Spine Curvature • At birth the spine is straight and then gradually takes on different curves. • Normal • Cervical (anterior curve) • Thoracic (posterior curve) • Lumbar (anterior curve) • Sacrum (slight posterior curve)

12. Spinal Curvature

13. Kyphosis • Excessive thoracic posterior curvature (hump back) • This is usually a degenerative condition that may be caused by over development of the anterior musculature. • When this occurs it results in excess anterior cervical curvature in order to hold the head up.

14. Kyphosis

15. Lordosis • Excessive anterior curvature of the lumbar spine (bubble butt) which causes a sway back. • Condition can be caused by weak abdominal muscles, obesity, over development of iliopsoas muscle , or pregnancy.

16. Lordosis

17. Lateral Deviation • Spine should be straight with just slight deviation to the dominant side.

18. Scoliosis • This is a genetic condition with either a genetic S curve or traumatic C curve that is greater than 10-15 degrees off center

19. Scoliosis

20. Scoliosis

21. Lumbar Abnormalities • Spondylolysis • Spondylolisthesis • Back Fractures • Sicatica • “Slipped Disc” • Ruptured Disc • Sprain

22. Spondylolysis • Occurs with Lordosis, excessive force on L5 can cause nerve impingement

23. Spondylolisthesis • L5 excessive lordosis causes anterior slippage and L5 moves forward onto S1 and impinges on the nerves. • Could be a congenital defect • Correct with rest, abdominal strengthening, lumbosacral vest, or spinal fusion

24. Back Fractures • Can be caused by a compressive force • Could be several different types: • Spinous process • Transverse process • Foramen ( This type can cause serious implications because of the proximity to the spinal cord)

25. Back Fractures Burst Compression Torsion Compression

26. Sciatica • Sciatica nerve inflammation is the usual cause of this condition.

27. Slipped Disc • A sprain occurs to the ligament that causes herniation of the disc. • The disc bulges out on the nerve root at that level • Treatment • Rest, Modalities, Traction, Strengthening, Medication

28. Herniated Disc

29. Ruptured Disc • Can be caused by high impact forces • Generally will not heal on it’s own • Laminectomy ( removal of disc and fusion) • Live with it or have surgery

30. Sprain • Usually occurs at the Sacro-illac joint • Causes sciatic pain with hip flexion • Treatment is modalities and medications