腰椎间盘突出症2.ppt

1、 LOWER BACK PAIN ANDHERNIA OF INTERVERTEBRAL DISC腰痛和腰椎间盘突出症Structural support and balance for upright postureFunctions of the Spine Protection Spinal cord and nerve rootsFunctions of the Spine Internal organs Flexibility of motion in six degrees of freedomFunctions of the SpineLeft and RightSide Ben

2、dingFlexion and ExtensionLeft and Right Rotation Cranial-the head or towards the head Caudal-the tail or towards the tail Anterior-the front section or towards the front Posterior-the back section or towards the back Ventral-the front or anterior surface Dorsal-the back or posterior surfaceBasic Ter

3、minologyCranialCaudalAnteriorPosteriorDorsal VentralVertebral Structures Pedicle notchesSlight NotchDeep NotchIntervertebral Foramen Intervertebral foramen Nerve roots exitVertebral StructuresBodyPedicleLaminaSuperior Articular ProcessSpinousProcessTransverse ProcessVertebral Foramen Anterior Arch V

4、ertebral body Anterior 1/3 pediclesVertebral Arches Posterior Arch Posterior 2/3 pedicles and posterior elements Arches form the vertebral foramenVertebral Structures Articular processesSuperior Articular Process Pars interarticularisInferior Articular ProcessZygapophyseal Joint(Facet Joint)ParsLumb

5、ar Vertebrae Body-L1 to L5 progressive increase in mass Pedicles-longer and wider than thoracic;oval shaped Spinous processes-horizontal,square shaped Transverse processes-smaller than in thoracic region Spinal foramen-large to allow for cauda equina and nerve roots Intervertebral foramen-large,but

6、with increased incidence of nerve root compression Intervertebral DiscVertebral Structures End Plate Apophyseal Ring Cartilaginous Bony The FUNCTIONAL UNIT of the spine Comprised of:Two adjacent vertebrae Intervertebral disc Connecting ligaments Two facet joints and capsulesThe Motion Segment Fibroc

7、artilaginous joint of the motion segment Makes up the length of the spinal column Present at levels C2-C3 to L5-S1 Allows compressive,tensile,and rotational motion Largest avascular structures in the bodyIntervertebral Disc Intervertebral Disc Annulus Fibrosus Outer portion of the discLamellae Great

8、 tensile strength Made up of lamellaeAnnulus Fibrosus Layers of collagen fibers Arranged obliquely 30 Reversed contiguous layersIntervertebral Disc Nucleus PulposusNucleus Pulposus Inner structure Gelatinous High water content Resists axial forcesIntervertebral Disc Largest avascular structure Blood

9、 supply by diffusion through end plates Damage to the blood supply leads to degradation of the discAnatomy and Degenerative ChangeThe Vertebral Body(VB)Key Roles Carry 80%of the axial loads through VB and disc Endplates enable nutrition to diffuse to discIntervertebral DiscThe Intervertebral DiscHas

10、 two roles Shock absorber of axial forces Pivot point in motion segmentIntervertebral DiscLigamentsLigamentum flavumPosterior longitudinal ligamentAnterior longitudinal ligamentSpinal Ligaments Bands or sheets of tough,fibrous tissue that connect bones,cartilage,or other structures Become active whe

11、n stressed to maximum range of motion Protect the joints from being hyperflexedThe Intervertebral Disc and Degenerative ChangeTwo major components of IVD Annulus fibrosis:thick,fibrous“radial tire”Lamellae Nucleus pulposus:ball-like gelThe Intervertebral Disc(IVD)and Degenerative ChangeBy age 50,95%

12、of people show lumbar disc degeneration Not all have symptoms Significant changes to IVD are:Water and proteoglycan content decreasesCollagen fibers of AF become distortedTears may occur in the lamellae Results in:Disc loses height and volumeLoses resistance to loading forces No longer acts as a sho

13、ck absorberOverview-cont.The motion segment is the functional unit of the spine and consists of Muscle(activators)Ligaments(passive restraints)Adjacent vertebral bodies A 3-joint complex of two facet joints and a disc(pivots)Degeneration can begin in one or more of these joints,but ultimately all th

14、ree will be affectedDegenerative ConditionsProvide an overview of degenerative conditions Degenerative Disease Spinal Stenosis Herniated DiscDegenerative Disease-Overview Loss of normal tissue structure and function due to aging process Changes are usually gradual,trauma sometimes accelerates Degene

15、rative changes do not always lead to clinical symptoms When changes cause symptoms(often pain),the process is referred to as osteoarthritis Spondylosis is degenerative changes in the spineAnatomy and Degenerative ChangeThe Vertebral Body(VB)Degenerative Changes Sclerosis:Increased bone formation adj

16、acent to endplates Reduces nutrition diffusing to disc Stiffens endplate,and reduces ability to absorb loads Osteophytes:Formation of small bony spurs Can project into neuro structuresFacet Joints and Degenerative ChangeKey Roles Carry 20%of compressive loads Help stabilize spine Degenerative Changes Cartilage lining loses water content Cartilage wears away Facets override each other Leads to abnormal function of motion segmentAnatomy and Degenerative ChangeLigaments and Muscles Ligaments attach