THE SPINE

Ngwazi DR. KIRSTEEN .O. AWORI

MBChB, MMed(Surg.), Dip.(SICOT), FCS(Orth.)ECSA
Consultant Spine & Pelvic Reconstruction Surgeon.
OBJECTIVES
OBJECTIVES
 Of SOMITESS Here
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Migration

Segmentation TO FORM VERTEBRAL COLUMN

Differentiation

BETWEEN 3RD & 8TH WEEK OF

DEVELOPMENTere
Sclerotome organizes into dense & loose zones
STAGE OF VERTEBRAL FORMATION

MESENCHYMAL CHONDRIFICATION OSSIFICATION OSSIFICATION

STAGE STAGE (PRIMARY) (SECONDARY)

 Congenital
anomalies

CONGENITAL ISTHMIC
SPINA BIFIDA SCOLIOSIS
HEMIVERTEBRA
SPONDYLOLISTHESIS
 CONGENITAL ANOMALIES

Fusion bars A cause of scoliosis

• Idiopathic/hemivertebra Missing chondrification centre
• Infantile/juvenile/adolescent

• Aperta
Failure of union at the pars
• Cystica interarticularis.
 Meningocele
 Myelomeningocele
 Myeloschisis
 Rachischisis
 Congenital
kyphosis

The result is
Osseous diminished vertebral
Osseous body longitudinal
transformation of growth in the
metaplasia of the presence of normal
the annulus is
anterior annulus or near normal
also called non- neural arch
fibrosus development
segmentation
 The animation
automatically begins.

PAEDIATRIC
SPINE
The concept of spinal cord
injury without radiographic
abnormality (SCIWORA) was
introduced by Pang and
Wilberger in 1982.
Features of the pediatric spine make it more susceptible to
SCIWORA than the adult spine:

• Increased horizontal orientation of the facets, joints - allows

increased translational motion in an anteroposterior plane.

• The relatively large mass of an infant's head lacks protection due to

undeveloped neck musculature

• Anterior wedging of the superior aspects of the vertebral bodies.

• More "elastic" ligaments and joint capsules.

SCIWORA IN ADULTS
3 By disk protrusion.

2 Cord pinching between

pre-existing osteophytes

Inward bulging of the

interlaminar ligaments
1
Why spine?
• The spine is the third most common site for skeletal metastases
following the lung and liver, respectively.

• Spinal injuries are debilitating

• Degenerative Disc Disease

 33
VERTEBRAE
FRANCIS DENIS 3-COLUMNAR MODEL
Posterior
column Posterior elements +
ligaments.
Middle
Posterior half of the body,
column
disc & PLL

Anterior half of body, disc &

Anterior and ALL
column
INSTABILITY
At least two columns must fail
• Subluxation at disc

• Facet dislocation (unlocked)

• Burst fracture

• Compression fracture (height > 50% of body)

POSTERIOR LIGAMENTS
• The paired sets of ligamentum flava

• Intertransverse ligaments

• Interspinous ligaments

• The supraspinous ligament

Longitudinal ligaments

• ALL resists hyperextension & distraction

• PLL resists hyperflexion & distraction

PLL
• The superficial layer of the PLL crosses the vertebral body as a
narrow band of fibers.

• At each disc, a deeper layer of oblique fibers fans out above and
below the annulus.

• It has been shown that the PLL is smaller and less well-developed in
the lower lumbar spine
DISC
• Structure & function

• Microanatomy

• Degenerative disc disease

DISC
Pressures
• Lumbar intradiscal pressure is lowest in recumbent posture

• higher in standing posture

• highest in unsupported sitting

• A backrest, inclined to 110° with a lumbar support, can significantly

reduce disc pressure during sitting
THORACIC SPINE
Pedicles
• The thoracic pedicles project posterior to the upper portion of the
vertebral body

• Have a greater superoinferior diameter and smaller mediolateral

diameter.

• Are oriented from posterolateral to anteromedial direction.

• The medial inclination of the pedicle decreases from T1 to T12.

THORACIC SPINE
TH
4 COLUMN?

The sternum in conjunction with the ribs may function as the fourth
column of the spine in stabilization of the thoracic region.
SPINE IMAGING
• Plain radiography

• CT scan + myelography

• MRI

• Bone scan (Tc99 bisphosphonate)

PLAIN RADIOGRAPHY
• Fractures/subluxation

• Infections

• Degenerative conditions:
spondylosis
 Osteophytes
 Loss of disc height
CT SCAN
• Bone differentiation

• Complex fractures

• Myelography when cant do MRI

 MRI T2

T1

BLACK DISC
Lateral mass screws
(Magerl & Roy Camille techniques)
Anterior cervical discectomy
and fusion (ACDF)
ENTRY PORTAL OF PEDICLE SCREW

THORACIC LUMBAR
Transforaminal (TLIF), Anterior (ALIF), Posterior (PLIF) &
Extreme lateral (XLIF)
Interbody fusion techniques
PLIF TLIF
ANY QUESTION ?
SUMMARY
SPINE Embryological basis of kyphotic & scoliotic
DEVELOPMENT deformities, hemivertebra, spina bifida & listhesis

Basis for higher frequency of C-spine injuries in

PAEDIATRIC SPINE young children, & of SCIWORA

Based on 3-columnar model of Denis and

SPINE STABILITY
examples of unstable injuries

TECHNIQUES OF Techniques of anterior & posterior

SPINE STABILIZATION instrumentation of the spine
& SAFETY OF
Paediatric
spine