THE BACK & SPINAL CORD

Presented by: Dr. Deepesh Khanna

 Learning Objectives
• Describe the makeup of a spinal nerve and the course and function of dorsal rami of spinal
nerves that serve the back
• Identify the names, attachments, extent, nerve supply, blood supply and actions of the
superficial and deep back muscles
• Describe the parts of the vertebrae
• Identify the joints, ligaments, curvatures and movements of the vertebral column
• Describe the spinal meninges, gross features and extent of the spinal cord and the formation
and course of spinal nerve primary branches
• Describe the arrangement of the structures comprising the back from superficial to deep
• Identify structures of the back on radiographs (x-rays) and scans
• Discuss the possible consequences of intervertebral disc herniations, narrowing of
intervertebral foramina and spinal meningitis
THE BACK
• A skin dimple associated
with the PSIS found on
either side of the posterior
aspect of the iliac crest
(common site for bone
marrow bx).
• Posterior medial furrow.
Erector spinae muscles.
Area of the sacrum.
• The back region extends
from the base of the skull
to the posterior aspect of
the sacrococcygeal column.
• Back pain is very common,
especially in the cervical and
lumbar areas because these
regions are highly moveable.
Surface Anatomy of the Back, Palpable Structures

(
Extemal occip"al protuberance

Greatertubercle
of humel'\.ls

Spinous processes - - - - - - --.-- h ' 7 .....,'C

ofvertebrae in
vertebral furrow

Posterior superior iliac spine

Copyright@ 2 0 0 8 Wolters Kluwer Health 1 Lippincott Williams & Wilkins

 Muscles of back are arranged in 4 layers.
• 1st. Layer :
1- Trapezius.
2- Latissimus Dorsi.
• 2nd Layer:

1- Levator Scapulae.
2- Rhomboideus minor.
3- Rhomboideus major.
• Also the 2nd layer contains 2 other muscles:
4- Serratus posterior superior.
5- Serratus posterior inferior
• 3rd Layer : Erector spinae (Sacrospinalis) & Semispinalis.
• 4th Layer : Number of small muscles called multivators, rotators, interspinalis,
intertransverses & muscles forming the suboccipital triangle.
 Infraspinatus
Teres minor
Teres major
Latissim us dorsi

……………•- External oblique

; … … … … . . --- Gluteus med us
Flexor carpi ulnaris
Extensor carpi ulnaris
a ' t -- l u,:a_ Tensor fasciae
latae
- . . . . : . . -.._ Gluteus max mus
_ ,...,.rn:_.- Vastus lateralis
Gracilis
Adductor magnus
Semitendinosus
Bic eps femoris
Iliotibial tract
Semimembranosus
Po pliteal fossa
Sartorius

Flexo r digitorum - - -t-- 1 Flexor hallucis longus

longus Extensor digitorum longus
Calcaneal
(Achilles) tendon

(b) Posterior view

Okn>Wioy &Son o . . . .
 Trapezius
• Origin: From Medial 1/3 of superior nuchal, external
occipital protuberance, Ligamentum nuchae, spines of all
cervical & all thoracic vertebrae and supraspinous ligament
• Insertion : posterior border of lateral 1/3 of the clavicle,
medial margin of acromion upper lip of the crest of the
spine of the clavicle.
• Nerve supply: Spinal part of the accessory cranial nerve &
C 3,4
• Actions:
• upper fibers: elevate the shoulder
• Lower fibers: depress the shoulder.
• Middle fibers: brace back (retraction) of shoulder
• It also, helps in raising the arm above 90° with (serratus
anterior).
 Latissimus Dorsi
• Origin:
1- Lower 6 thoracic spine.
2- Thoracolumbar fascia.
3- Iliac crest.
4- Lower 3 or 4 ribs.
5- Back of the inferior angle of the
scapula.
• Insertion: floor of the bicipital groove.
• Nerve supply: Nerve to Latissimus
dorsi (thoracodorsal nerve).
• Action: adduction, medial rotation.
• It also helps in extension and climbing.
• 1st layer:
• Trapezius
• Latissimus dorsi
• 2nd layer:
• Levator scapulae
• Rhomboid minor
• Rhomboid major.
 • Levator scapulae
• Origin: Transverse processes of upper 4 cervical vertebrae.
• Insertion: Medial border of scapula.
• Nerve supply: C3,4 & 5
• Action: Elevate the medial border of the scapula.
• Rhomboid minor
• Origin: Ligamentum nuchae & spines of C 7& T1
• Insertion: Medial border of the scapula.
• Nerve supply: C4& 5
• Action: Raises the medial border of scapula upward & medially.
• Rhomboid Major
• Origin: Spines of T2,T3,T4 & T5.
• Insertion: Medial border of scapula.
• Nerve supply: C4 & 5.
• Action: Raises the medial border of the scapula upward and medially.
 TRAPEZIUS

TRIANGLE OF
AUSCULTATION
Superior border of latissimus dorsi =
inferior border
Lateral border of trapezius = medial border
Medial border of scapula = lateral border
LATISSIMUS
Floor = rhomboid major, ICS6 DORSI
LUMBAR TRIANGLE THORACOLUMBAR
(of Petit) FASCIA
Iliac crest = inferior border
Lateral border of latissimus dorsi = (lumbodorsal fascia)
medial border *Invests the deep muscles of the back
Posterior border of external abdominal *Provides origins for the latissimus dorsi,
oblique = lateral border internal abdominal
Floor = internal abdominal oblique oblique, and transversus abdominis muscles
*It may be a site for abdominal hernias.
 LEVATOR
RHOMBOID
SCAPULAE
MINOR

RHOMBOID
MAJOR
 SERRATUS
POSTERIOR
SUPERIOR
 SERRATUS
POSTERIOR
INFERIOR
 Intrinsic Muscles of the Back
• These are three parallel groups or columns called SACROSPINALIS OR ERECTOR
SPINAE MUSCLE.
• Supplied by the dorsal rami of the spinal nerves and named depending on location.

LATERAL COLUMN:
• ILIOCOSTALIS MUSCLE:
• Lumborum
• Thoracis
• Cervicis

INTERMEDIATE COLUMN:
• LONGISSIMUS MUSCLE:
• Thoracis
• Cervicis
• Capitis

MEDIAL COLUMN:
• SPINALIS MUSCLE:
• Thoracis
• Cervicis
• Capitis
DEEP MUSCLES OF THE BACK
 Intrinsic Muscles of the Back
• Deep to the sacrospinalis muscle we find the
TRANSVERSO-SPINALIS MUSCLES:
• Multifidus muscle (most robust in the lumbar region) at
the lumbosacral curvature
• Interspinalis muscle
• Intertransversarii muscle (between the transverse
processes)
• Rotators
• Short (brevis)
• Long (longus)
• Semispinalis muscle (in the neck region)
 - - - Transverse process of
second lumbar vertebra

INTERTRANSVERSARII

ROTATORE
INTERSPINALES

Spinous process - - - - - - +
of fourth lumbar
vertebra

(b) Posterolateral view

OJ c m IWoy & Sono.lnc.
DEEP MUSCLES
OF THE BACK Levatore
Costorum
muscles
4.25A C. Deep

Semispinalis

tnuwsplnaleS -c:::._·
l.imborum
lft1ettransversari <' );>
kJmbotum

(C)
 x
x
x
DERMATOMES OF THE TRUNK: yellow=cervical, pink=thoracic, blue=lumbar, green=sacral

T4

T10

T12
 SUBOCCIPITAL TRIANGLE
• Paired triangular-
shaped space
• Formed by the
configuration of
three paired
muscles in the
posterior neck
between the
occipital bone, C1
and C2
 SUBOCCIPITAL TRIANGLE

• The suboccipital triangle is a region at the back of the neck bounded

by the suboccipital group of muscles muscles:

• Rectus Capitis Posterior Major muscle = forms the medial border

• Obliquus Capitis Superior muscle = forms the lateral border
• Obliquus Capitis Inferior muscle = forms the inferior border
• Semispinalis capitis and longissimus capitis muscles = form
the roof
• Posterior arch of the atlas and the posterior atlanto-occipital
membrane =form the floor
!.rectus capitis posterior
ajo
r 2.obliquus capitis superior
3.obliquus capitis inferior
 SUBOCCIPITAL TRIANGLE
MUSCLE ORIGIN INSERTION NERVE ACTION
Rectus capitis Spine of axis Inferior nuchal Suboccipital Extends, rotates,
posterior major line and flexes the
head laterally

Rectus capitis Posterior Nuchal line Suboccipital Extends and

posterior minor tubercle of atlas flexes the head
laterally

Obliquus capitis Transverse Nuchal line Suboccipital Extends, and

superior process of atlas flexes the head
laterally

Obliquus capitis Spine of the axis Transverse Suboccipital Rotates the head
inferior process of atlas laterally
Contents:
SUBOCCIPITAL TRIANGLE
• Vertebral artery
• Branch off the subclavian artery
• Travels through the transverse
foramina of the upper six cervical
vertebrae
• Gives off an anterior spinal and two
posterior spinal arteries
• Suboccipital nerve (C1) and vessels
• Derived from the dorsal ramus of C1
• Emerges between the vertebral artery above
and the posterior arch of the atlas below
• Supplies the muscles of the suboccipital
triangle
• Suboccipital venous plexus
 Greater occipital nerve
(dorsal ramus of C2)

Occipital artery

3rd occipita l nerve

(dorsal ramus of C3l

Semispinalis capitis
and splenius
muscles in posterior
(lateral) tr iangle of neck

Splenius capitis muscle

(cut and reflected)

Dorsal ram us of C3
Great auricular nerve
(cervical plexus C2, 3)

Longissimus capitis muscle

Lesser occipital nerve
(cervical plexus C2,

Semispinalis cervicis muscle

Sternocleidomastoid rn

Semispinalis capitis muscle (cut)

Splenius capitis muscle (cull

Medial cutaneous branches
of dorsal rami of C4, S, 6
 SUBOCCIPITAL TRIANGLE
• Atlantoaxial
• JOINTS:
• Atlanto-occipital joint
• = flexion, extension, and
lateral flexion of the
head
• Atlantoaxial joints =
rotation of the atlas and the
head as a unit on the axis
dislocation
(subluxation)
• May occur from trauma -
MVA (rupture of the
cruciform ligament) or,
from rheumatoid arthritis
• May injure spinal cord and
medulla
• Signs and symptoms may
include pain in the posterior
neck, and /or painful
restricted mobility
Components of the
Occipitoaxial
Ligament

1-Cruciform Ligament
a-Transverse lig
b-Longitudinal lig
2-Apical Ligament
3-Alar Ligament
4-Tectorial Membrane
 THE
VERTEBRAL
COLUMN
 Vertebral Column
• 33 bones in infants
• 26 bones in adults • Two sets of curvatures:
• Primary Curvatures:
• 5 sections: • They appear during fetal
• Cervical (7 bones) development and are
retained in the adult
• Thoracic (12 bones) • Thoracic
• Sacral
• Lumbar (5 bones) • Secondary Curvatures:
• Sacrum (5 fused bones) • They develop after birth
• Cervical
• Coccyx (4 fused bones) • Lumbar
Lumbar (20)

Sacral (10)
 12Thoracte

5 Lumbar

5 lumbor verlebrae

5 sacralvenebrae

• COCC)'VMI. . . . .,... Anterior VIew Left la1mal view

Curvatures of the Vertebral Column
ANATOMY OFA TYPICAL VERTEBRA
CERVICAL VERTEBRAE
4.36. Anteroposterl« CAP) rad ograph of the .superior part of the r v l c a l region of the vertebral column.

Anterior arch
of atlas (1nfenor
margin)

X-ray
beam n

Bi11d s p nous
process o• axis
 CERVICAL SPINE: Odontoid View

ATLANTO-OCCIPITAL
JOINT
ODONTOID PROCESS OF C2

ATLAS C1
TRANSVERSE
PROCESS OF C1

TRANSVERSE
PROCESS OF C2

ATLANTO-
AXIAL JOINT

BODY OF C2
THORACIC VERTEBRAE
 Articulated Thoracic Vertebrae

A. Lateral view B. Posterior view

A.

Intervertebral foramina

Intervertebral discs

Copyright@ 2008 Wolters Kluwer Health 1 Lippincott Williams & Wilkins

 LUMBAR VERTEBRAE

SUPERIOR FACETS:
BUM (BM)
Lumbar spine AP (A) and lateral (B) radiographs
SACRUM AND COCCYX
INTERVERTEBRAL DISC
 Herniated Intervertebral Disc
• Herniated disc
(slipped), or,
Herniated nucleus
pulposus (HNP):
• Common between L4-
L5, L5-S1, and C6-C7
• The nerve affected is
always the one below.
E.g. a slipped disc
between L4-L5 will
affect spinal nerve L5
 Spinal cord segment Vertebra
Spinal cord segment Vertebra Fig. 39.22 Segmental
innervation and spinal
cord lesions
The spinal cord is divided
into four major regions: cer
vical, thoracic, lumbar, and
sacral. Spinal cord segments
are numbered by the exit
points of their associated spi
nal nerves. (Note: This does
not necessarily correlate

&
numerically with the nearest
skeletal element .)

Thoracic cord
lesion
T12
L1

Lumbar cord
lesion

ffl
Conus/cauda

equina lesion

A Spinal cord segments. 8 Dermatomes. Each spinal c Spinal cord lesions.

cord segment innervates
a particular skin area
(dermatome).

A Spinal cord segments.

L1

L2

L3
 Joint Classification
• FUNCTIONAL:
• STRUCTURAL:
• Based on degree of movement.
• Based on the presence or absence of a • SYNARTHROSIS: no movement
joint cavity and the type of C.T. binding – SUTURE: skull
the articulating bones. – GOMPHOSIS: cone-shaped
peg fits into a socket. E.g.
• FIBROUS JOINT: tooth
– No joint cavity, fibrous CT – SYNCHONDROSIS:
– Distal tibiofibular joint • Rib and sternum
• CARTILAGENOUS JOINT: • AMPHIARTHROSIS: slight
movement
– No joint cavity, cartilage holds
– SYNDESMOSIS: e.g.
bones together distal tibiofibular joint
– Pubis symphysis – SYMPHYSIS: e.g. pubis
• SYNOVIAL JOINT: • DIARTHROSIS: freely moveable
– There is a joint cavity with a synovial cavity, articular
– Bones united by articular cartilage and capsule
capsule and ligaments – Ball-and-Socket Joint
– Knee joint, hip joint (spheroid)
e.g. hip
– Ellipsoidal Joint (condyoid):
Pivot Joint (throchoid) e.g.
e.g.
CARTILAGENOUS JOINT
Synovial Joint
Pivot & Condyloid Joints
• Joints of the Vertebral Column
The joints of the vertebral column are held together by:

1. Intervertebral discs
2. Ligaments
1. Anterior Longitudinal Ligament: from the anterior tubercle of the atlas to the sacrum
2. Posterior Longitudinal Ligament: from the occipital bone to the sacrum. Lies within the vertebral canal
3. Ligamentum Flavum: between the laminae
4. Supraspinous Ligament: on top of the spine
5. Interspinous Ligament: between the spines
3. Vertebral arches
1. All synovial joints b/w the articular processes
2. Zygapophyseal Joints – as a pair, they guide and limit movement of the spinal segment
4. Atlanto-occipital joint

A synovial joint b/w the occipital condyle and C1. Allows nodding and sideways movements
5. Atlanto-axial joint
1. Two lateral and one median joint
2. The lateral joints are plane and glidding joints, whereas the median joint is a pivot
6. Costo-vertebral joints

1. Synovial joints b/w heads of the ribs and vertebral bodies

7. Costo-transverse joints

1. B/w the tubercles of the ribs and transverse processes

 LIGAMENTUM FLAVUM

COSTOTRANSVERSE
LIGAMENT

INTESPINOUS
LIGAMENT
COSTOTRANSVERSE
LIGAMENT

ZYGAPOHYSEAL
LIGAMENT
 LIGAMENTUM
FLAVUM
POSTERIOR
LONGITUDINAL
LIGAMENT

INTERVERTEBRAL
FORAMEN
SUPRASPINOUS ANTERIOR
LIGAMENT LONGITUDINAL
LIGAMENT
INTERSPINOUS
LIGAMENT

ZYGAPOPHYSEAL JOINT
 lnterspinalligament ·

Ligamentum flavum
Supraspinal ligament
Articular process
Erector spinae
muscle Dura/ arachnoid

Epidural space
: !l;; o - ifW rL subaraehno id space
nn@n containing cauda
Body of L3 equina and
lumbar puncture
needles
 ANTERIOR
LONGITUDINAL
LIGAMENT
 POSTERIOR
LONGITUDINAL
LIGAMENT
• In the cervical region,
the joints are oriented
in the horizontal
plane.
• In the thoracic region,
they are oriented in
the frontal plane.
• In the lumbar
region, the joints are
oriented in the
sagittal plane.
 Due to the mechanical
nature of their function,
facet joints often undergo
degenerative changes – arthritis.
MOVEMENTS OF THE VERTEBRAL COLUMN
THE SPINAL CORD
 The Spinal Cord
• Gross anatomy
• 3 layers of meninges
• Epidural space (fat & vessels)
• CSF – subarachnoid space
• Terminates at L1/2 vertebral level
(conus medullaris)
• Dura extends to S2 vertebral level
• Connects via filum terminale &
denticulate ligaments (pia)
• 31 pairs of spinal nerves (mixed)
• cauda equina
• Cervical & lumbar enlargements
 Structures of the Spinal Cord

• Paired denticulate
ligaments:
• extend from pia mater to dura
mater
• stabilize side-to-side movement
• Blood vessels:
• along surface of spinal pia
mater
• within subarachnoid space
 The 3 Meningeal Layers
• Dura mater:
– outer layer of spinal cord
– subdural space:
• between arachnoid mater and
dura mater

• Arachnoid mater:
– middle meningeal layer
– subarachnoid space:
• between arachnoid mater and
pia mater
• filled with cerebrospinal fluid
(CSF)

• Pia mater:
– inner meningeal layer
 The Spinal Cord
• Found in the spinal canal and in continuation with the brain stem.
• Attached to the coccyx at 8 weeks in utero.
• In the newborn the spinal cord level is at L3.
• In the adult the spinal cord ends at L1-L2, but never below L2.
• The conus medullaris ends at L2.
• The spinal cord is made up of white and gray matter.

• The filum terminale is from L2-coccyx (coccygeal ligament)

 Spinal Cord Position
• In the embryo, the spinal cord extends the entire length of the vertebral column and the
spinal nerves pass through the intervertebral foramina at their levels of origin.

• The vertebral column and dura mater grow at a faster rate than the spinal cord,
therefore the caudal end of the spinal cord terminates at a higher level as
development continues.

• During the sixth month of gestation the caudal tip of the spinal cord lies at the level of
S1.
• At birth, it lies at the level of L3, while in the adults it ends at L1-L2.

• As a result of the different rates of growth, the spinal roots run obliquely from the cord
to their corresponding vertebral level.

• The roots below the caudal end of the cord form a bundle of nerve roots called the
cauda equina.
 Spinal Nerves
• Thirty-one pairs of mixed nerves arise from the spinal cord and
supply all parts of the body except the head
• They are named according to their point of issue
• 8 cervical (C1-C8) • Cn1 (suboccipital nerve) between skull and the atlas.

• 12 thoracic (T1-T12) • Cn1 has no dorsal root but it has a dorsal ramus.

•
• 5 lumbar (L1-L5)
Cn2-7 exit the vertebral column ABOVE their

corresponding vertebrae.

• 5 sacral (S1-S5) • Cn8 passes BELOW C7, between C7 and T1.

•
• 1 coccygeal (C0)
All thoracic nerves (Tn1-12) pass BELOW their

corresponding vertebral level.

• All lumbar nerves (Ln1-5) exit
BELOW their corresponding level.

• All sacral nerves and coccygeal nerve exit BELOW

their corresponding vertebral level.
 Spinal Nerve Innervation: Back, Anterolateral Thorax,
and Abdominal Wall

• The back is innervated by dorsal rami via several branches

• The thorax is innervated by ventral rami T1-T12 as intercostal
nerves
• Intercostal nerves supply muscles of the ribs, anterolateral
thorax, and abdominal wall
Spinal Nerve Innervation: Back, Anterolateral Thorax,
and Abdominal Wall

Figure 13.7b
Spinal Nerves

Figure 13.6
 and sp nal nerves.

CeMcal

(8 p o h)

Thoraclo
nerves
(12 pairs)

l.umbat
nerveo
(Spaira)

Terminal filum ---=======;S

S-l

;-5;
sacral nerves{---;:
(S pairs)

-------------} {---------

• CeMcolnetYeS and ganglll

• Thoracic neNes and gllftQIIi
• Lumbar nervos and gangMe
• Sacral and coccygeal
nerves and ganglia
 1 -- -- -- THORA((ICNERVES
(12 paiJs)

}- - - SACRALNERVES
(5 pairs)
NERVES
( 1 pair)
Filum terminate

Posterior view of entire spinal cord

and portions of spinal nerves
GROSS ANATOMY
OF THE
SPINAL CORD
 Layers of the Spinal Cord
1. Vertebral bodies (bone)
2. Epidural space
• Fat
• Vertebral venous plexus (of Batson)
• Spinal nerves
3. Dura mater
4. Subdural space
5. Arachnoid mater
6. Subarachnoid space
• Contains the CSF
7. Pia mater
8. Spinal cord
 lnterspinalligament ·

Ligamentum flavum
Supraspinal ligament
Articular process
Erector spinae
muscle Dura/ arachnoid

Epidural space
: !l;; o - ifW rL subaraehno id space
nn@n containing cauda
Body of L3 equina and
lumbar puncture
needles
 ANTERIOR
SPINAL PIA MATER
SUBARACHNOID
VESSELS SPACE

SUBDURAL SPACE
ARACHNOID
MATER

DURA MATER

EPIDURAL
SPACE

VERTEBRALVENOUS PLEXUS
 Blood & Nerve Supply of the Spinal Cord

ARTERIAL SUPPLY:
• Anterior Spinal artery (vertebral artery) in the anterior median sulcus
• Segmental arteries
• Two Posterior Spinal arteries (vertebral artery) lateral to the posterior medial sulcus

• Radicular arteries (intermediate neural artery)

VENOUS DRAINAGE:
• Into the intervertebral veins, and then into the segmental veins or vertebral venous
plexus

• Vertebral Venous Plexus of Batson

• Found in the epidural space
• It has no valves
• Drains into the Superior Sagittal Sinus of the brain
NERVE SUPPLY:
• Meningeal branches from the spinal nerves
ANTERIOR POSTERIOR
 Clinical Considerations
• Herniated disc.
• Lumbar puncture:
• Patient in lateral decubitus position
• Locate L4-L5
• Midspinal tap:
Skin
Supraspinous ligament
Interspinous ligament
Ligamentum flavum
Interspinalis muscle
Epidural space
Dura
Subdural space ("virtual")
Arachnoid mater
Subarachnoid space (lumbar cistern)
• Epidural anesthesia:
• By injecting between the lumbar laminae or the sacral hiatus
 Clinical Considerations
• Vertebral fractures:
• "Hangman" Fracture = caused by sudden
distraction of the cervical part of the vertebral
column, as occurs in hanging. It is a bilateral
fracture of the pedicles or laminae of C2.
• Jefferson Fracture = a burst fracture of the atlas
(C1) the arch may be broken at several points.
They result from axial loading of the cervical part
of the vertebral column.
• Fractures of the axis (C2) usually involve the
dens (type I, II, III)
HERNIATED DISC
CAUDAL EPIDURALANESTHESIA
HANGMAN' S F RACTURE: CT axial
 Jefferson Fracture
It’s a fracture of the
anterior and posterior
arches of C1
E.g. axial load on the back
of the head or hyperextension –
diving
 Clinical Considerations
• Kyphosis
• Round shoulder deformity "humpback".
• Exaggeration of the thoracic curvature in the sagittal plane
• Lordosis
• Exaggeration of the lumbar curvature in the sagittal
plane,"sway back"
• Scoliosis
• Exaggeration of the curvatures in the coronal plane
• May be functional, e.g. limb-length discrepancy
435: Structure and
!unction ol vertebrae

I <J,
Nonnal Kyphosis Lordosis Nonnal Scoliosis Nonnal Scoliosis
(A) (B) (C) (0) (E)
 Intervertebral Foramen
• Also called neural foramen
• Foramen between two spinal vertebrae
• Cervical, thoracic, and lumbar vertebrae all have intervertebral
foramina
• The foramina, or openings, are present between every pair of
vertebrae in these areas.
• Spinal nerve roots branch off the spinal cord and exit the column
via intervertebral foramina.
• Herniation of the disc, arthritis of the facet joints as well as bony
irregularities in the pedicle or vertebral body can narrow the
intervertebral foramen and cause nerve root compression.
Narrowing of Intervertebral Foramen

• Foraminal stenosis is the narrowing or tightening of the

openings between the bones in the spine
• Foraminal stenosis is a specific type of spinal stenosis
leads to nerve compression
• A pinched nerve can lead to radiculopathy — or pain,
numbness, and weakness in the part of the body the
nerve serves
• Staying physically active and maintaining a healthy weight
can help reduce the risk of developing stenosis
 Spinal Stenosis

• Spinal Stenosis: narrowing of the spinal canal occurs as the

patient ages (generally about the fourth decade).
• Osteoarthritis with osteophyte formation, and degenerative
changes in the intervertebral discs can lead to narrowing of
the spinal canal and intervertebral foramina. Symptoms may
vary from mild to severe pain, inability to walk…
• With aging, the vertebral column decreases in length due to
degeneration of the intervertebral discs.
• Reduction in mobility and flexibility also occurs.
The scotty dog sign refers to the normal
appearance of the lumbar spine when seen obliquely. On
oblique views, the posterior elements form the figure of
a Scotty dog with:
• the transverse process being the nose
• the pedicle forming the eye
• the inferior articular facet being the front leg
• the superior articular facet representing the ear
• the pars interarticularis (the portion of the lamina
that lies between the facets) equivalent to the neck of
the dog.
 Fracture - - - .
dlslocadon
of ve"oorae

(B) Hypere>Ctenslon (whiplash) injury

MYELOGRAM
 Spinal
Meningitis
Infection of the fluid in the
spinal cord and the fluid that
surrounds the brain
Viral or Bacterial
Etiology is important because of
the seriousness of the illness and
the treatment needed
 Acknowledgement

• Dr. Nicholas Lutfi

Thank
you