ANATOMY OF THE SPINE
The human spine is formed by individual vertebrae and connective tissue discs in between. The vertebrae form the spinal canal. There are seven cervical, twelve thoracic, and five lumbar vertebrae. The intervertebral discs are the link between the individual vertebral bodies.
Normal anatomy of the spine. Longitudinal section and cross sections through the cervical, thoracic and lumbar spine.
The little joints that link the vertebrae together are known as facet joints. They help to stabilize the spine and, together with the intervertebral discs, allow a certain degree of mobility of the spinal cord. The spinal canal should be wide enough to allow nerve roots to float freely in cerebrospinal fluid.
The front border of the spinal canal is built by the vertebral bodies and intervertebral discs, the side by the intervertebral joints (facets) and back by the ligamentum flavum (yellow band) and vertebral arches. Discs consist of an outer fibrous ring (annulus fibrosus), which surrounds an inner gel-like center (nucleus pulposus).
The spinal cord and nerve roots lie within the spinal canal. The spinal cord extends downwards approx. to the 1st lumbar vertebra. Below, only nerve roots are present in the spinal canal. At the level of the intervertebral disc the nerve roots pass through the neural root foramina to exit the spinal canal. The spinal cord and nerve roots conduct electric-like signals from the skin and joints to the brain, and process of movement is initiated from the brain to the muscles.
M. Scheuermann's, disease (aka juvenile kyphosis) is a thoracolumbar spinal deformity. It occurs in pediatric patients and presents with increased kyphosis, back pain and radiologic changes in the vertebrae. The diagnostic critera are: kyphosis greater than 40°, irregular upper and lower vertebral endplates, loss of disk space height and wedging of 5° or more in three consecutive vertebrae.
CAUSE OF SYMPTOMS
Gradually progressing inflammation and degeneration in the intervertebral joints
SYMPTOMS AND SIGNS
Pain and stiffness along the spine
THE DIAGNOSIS IS BASED ON Medical history Clinical exam Radiographs
Treatment is usually non-surgical.
Non-surgical treatment may include
Treatment is non-surgical
Stretching Manual therapy Physiotherapy
Surgery is usually considered as a last resort
WHEN SHOULD AN OPERATION BE PERFORMED?
Nonsurgical therapy fails to improve symptoms
Patient's health is in imminent danger
WHAT IS THE GOAL OF SURGERY?
To release the compressed nerve roots and/or spinal cord
HOW IS SURGERY PERFORMED?
Posterior instrumentation ± Smith-Petersen osteotomy
WHICH OTHER DISEASES SHOULD BE EXCLUDED (DIFFERENTIAL DIAGNOSIS)? Ankylosing spondylitis (Bechterew's disease)
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