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The Back and Spine

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  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

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

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

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

  7. 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

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

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

  10. 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)

  11. Spinal Curvature

  12. 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.

  13. Kyphosis

  14. 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.

  15. Lordosis

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

  17. 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

  18. Scoliosis

  19. Scoliosis

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

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

  22. 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

  23. 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)

  24. Back Fractures Burst Compression Torsion Compression

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

  26. 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

  27. Herniated Disc

  28. 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

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