Back Clinical Anatomy

Spondylitis

(ankylosing or rheumatoid spondylitis): involves inflammation of the joints between the vertebrae and sacroiliac joints. Ankylosing spondylitis is a form of chronic inflammatory arthritis, the most common of which is rheumatoid arthritis, and causes pain, stiffness, swelling, and limited motion in the (lower) back. It causes the affected vertebrae to fuse or grow together, resulting in a rigid spine (bamboo spine), poor posture, and deformities. Pain and stiffness may progress up to the hip, shoulder, knee, and hand joints.

kyphosis

(hunchback or humpback) an abnormally increased thoracic curvature resulting from osteoporosis

lordosis

(swayback or saddle back)—an abnormally increased lumbar curvature resulting from trunk muscular weakness or osteomalacia

myeloschisis (rachischisis)

a cleft spinal cord due to failure of neural folds to close

scoliosis

a condition of lateral deviation resulting from unequal growth of the vertebral column, pathologic erosion of vertebral bodies, or asymmetric paralysis or weakness of vertebral muscles.

Spinal cord ischemia:

can easily occur because the blood supply to the spinal cord is surprisingly meager. The anterior and posterior spinal arteries are of small and variable diameter, and the reinforcing segmental arteries vary in number and in size. Ischemia may be caused by aortic disease and surgery, regional anesthesia, or pain block procedures.

Tethered cord syndrome

is a congenital anomaly resulting from defective closure of the neural tube. It is characterized by the abnormally low conus medullaris, which is tethered by a short thickened filum terminale, leading to such conditions as progressive neurologic defects in the legs and feet and scoliosis.

Arnold-Chiari (or Chiari) deformity:

is a congenital cerebellomedullary malformation in which the cerebellum and medulla oblongata protrude down into the vertebral canal through the foramen magnum

Klippel-Feil syndrome

is a congenital defect manifested as a short, stiff neck resulting from reduction in the number of cervical vertebrae or extensive fusion of the cervical vertebrae, which causes low hairline and limited motion of the neck.

Lumbar spondylosis

is a degenerative joint disease affecting the lumbar vertebrae and intervertebral disks that causes pain and stiffness, sometimes with sciatic radiation resulting from nerve root pressure by associated protruding disks or osteophytes (bony outgrowths).

Spina bifida

is a developmental anomaly characterized by defective closure of the verte bral arch associated with maternal folic acid deficiency and is classified as follows

Spondylolisthesis:

is a forward displacement of a vertebra on the one below, usually of the fifth lumbar over the body of the sacrum; it is usually due to a developmental defect in the pedicle of the migrating vertebra. In this case, the spinal nerve roots may be pressed on, causing low backache, sciatica, or a shortened trunk.

Hangman's fracture

is a fracture of the pedicles of the axis (C2), which may occur as a result of judicial hanging or automobile accidents. In this fracture, the cruciform ligament is torn and the spinal cord is crushed, causing death.

Multiple sclerosis (MS)

is a lifelong chronic disease diagnosed primarily in young adults but affects three times more women than men. It is a progressive disease that causes destruction of myelin in the spinal cord and brain, leading to sensory disorders and muscle weakness. Common signs and symptoms include numbness or pain on the skin, blurred or double vision, cognitive impairments, muscle weakness in the extremities, difficulty with coordination and balance, slurred speech, bladder incontinence, fatigue, and depression. MS may be caused by an autoimmune disease in which the immune system attacks the myelin around axons in the CNS, thereby interfering with the conduction of signals along the axons. The most important immune cells are lymphocytes, which break down the myelin, and then macrophages phagocytize the remains.

A herniated (slipped) disk

is a protrusion of the nucleus pulposus through the annulus fibrosus of the intervertebral disk into the intervertebral foramen or into the vertebral canal, compressing the spinal nerve root. It commonly occurs posterolaterally where the annulus fibrosus is not reinforced by the posterior longitudinal ligament and frequently affects the lumbar region.

Herpes zoster (shingles)

is an infectious disease caused by the varicella zoster virus that remains latent in the dorsal root ganglia of spinal nerves and the sensory ganglia of cranial nerves. It results from activation of the virus, which travels down the sensory nerve to produce severe neuralgic pain, an eruption of groups of vesicles, or a rash in the dermatome of the nerve. Herpes zoster is frequently associated with spina bifida and results in such conditions as a short neck and obstructive hydrocephalus.

Sciatica:

is characterized by pain radiating from the back into the buttock and into the lower limb and is most commonly caused by herniation of a lower lumbar intervertebral disk.

Meningitis:

is inflammation of the meninges caused by viral or bacterial infection. Nonbacterial meningitis is referred to as aseptic meningitis, whereas bacterial meningitis is referred to as purulent meningitis. Viral meningitis is milder and occurs more often than bacterial meningitis. Bacterial meningitis is an extremely serious illness and may result in brain damage or death, even if treated. Meningitis is also caused by fungi, chemical irritation or drug allergies, and tumors. Its symptoms include fever, headache, stiff neck, brain swelling, shock, convulsions, nausea, and vomiting. Antibiotics are effective for bacterial meningitis but are ineffective in viral meningitis.

Whiplash injury of the neck:

is produced by a force that drives the trunk forward while the head lags behind, causing the head (with the upper part of the neck) to hyperextend and the lower part of the neck to hyperflex rapidly, as occurs in rear-end automobile collisions. This injury occurs frequently at the junction of vertebrae C4 and C5; thus, vertebrae C1 to C4 act as the lash, and vertebrae C5 to C7 act as the handle of the whip. It results in neck pain, stiff neck, and headache and can be treated by supporting the head and neck using a cervical collar that is higher in the back than in the front; the collar keeps the cervical vertebral column in a flexed position.

Saddle block

is the introduction of anesthesia into the dural sac in the region corresponding with the areas of the buttocks, perineum, and medial aspects of the thighs that impinge on the saddle in riding.

Lumbar puncture (spinal tap):

is the tapping of the subarachnoid space in the lumbar region, usually between the laminae of vertebrae L3 and L4 or vertebrae L4 and L5. It allows measurement of CSF pressure and withdrawal of a sample of the fluid for microbial or chemical analysis and also allows introduction of anesthesia, drugs, or radiopaque material into the subarachnoid space.

Pott's disease

is tuberculosis of the spine or vertebra that results from softening and collapse of the vertebrae, often causing kyphosis (hunchback). It is also called tuberculous spondylitis and is most commonly localized in the thoracic portion of the spine. Common symptoms are paravertebral swelling or abscess (causing spinal cord compression), paraplegia, back pain, fever, cough, sweats, anorexia, and weight loss.

Caudal (epidural) anesthesia

is used to block the spinal nerves in the epidural space by injection of local anesthetic agents via the sacral hiatus located between the sacral cornua. It is used for surgery on the rectum, anus, genitals, or urinary tract and for culdoscopy. Obstetricians use this method of nerve block to relieve the pains during labor and childbirth, and its advantage is that the anesthetic does not affect the infant.

meningocele

meningocele—protrusion of the meninges through the unfused arch of the vertebra (spina bifida cystica);

meningomyelocele

meningomyelocele—protrusion of the spinal cord and the meninges;

spina bifida occulta

occulta—failure of the vertebral arch to fuse (bony defect only with a small tuft of hair over the affected area of skin);

Atlantoaxial dislocation (subluxation):

occurs after rupture of the cruciform ligament caused by trauma or rheumatoid arthritis. It may result from a congenital absence of the dens, a fracture of the dens, or a direct trauma frequently caused by traffic accidents. This subluxation may injure the spinal cord and medulla, and its symptoms include pain in the cervical area and in the back of the neck or painful restriction of mobility.

Scheuermann's disease

or kyphosis (juvenile kyphosis or vertebral epiphysitis): is epiphysial osteochondrosis of vertebral bodies commonly in the thoracic vertebrae. It occurs when the front parts of the thoracic vertebrae do not grow as fast as the back parts and thus form a wedge shape, leading to kyphosis. Symptoms include thoracic kyphosis, intermittent back pain, and tight hamstrings.

syringomyelocele

protrusion of the meninges and a pathologic tubular cavity in the spinal cord or brain

lipomeningocele

protrusion of the meninges with an overlying lipoma (lipomatous mass) in spina bifida

myelocele

protrusion of the substance of the spinal cord in spina bifida.

A baby with spina bifida, should?

should be delivered by cesarean section because passage of the baby through the narrow birth canal is likely to compress the meningocele and damage the spinal cord.