The SpineMACAIRE GROBE, KATHERINE CALLAHAN, SOPHIA POWELL, BIN CHEN, AND THEO DIPAULI

Evolution of the Human SpineThe structure of the spine has changed significantly over the course of millions of years of evolution. Notochords in the first vertebraeThe development of the spinal cordTransition for humans to walk upright

http://factsanddetails.com/world/cat56/sub360/item1492.html

Walking Upright Bone and Joint Adaptions:

◦ Ability to lock our legs◦ Inward thigh bones◦ Arched foot◦ Gluteal Abductor

Spine Adaptions: ◦ Curved structure of the spine◦ Foramen Magnum

http://humanorigins.si.edu/human-characteristics/walking

Embryonic Development

Spine starts to form during 4th week of embryonic development

http://phys.org/news/2011-02-fetal-surgery-kids-spine-defect.html

5

Mesenchymal cells from the sclerotome of the somites start to form in three main areas: notochord, neural tube, and body wall

In the 6th week, chondrification occurs

Embryonic Development

http://imueos.wordpress.com/2010/09/26/development-of-musculoskeletal-system/

Curvature of the Spine

http://www.emory.edu/ANATOMY/AnatomyManual/back.html

http://blog.intellidance.ca/blog/2-15-2011/c-s-how-nurture-your-babys-spine-development

Biomechanics of Spinal InjuriesThe spine shares a similar structure to a flexible segmented column.Offers strong supportProne to various kinds of injuries

Fractures of the spine can be classified by:Causal MovementLocationShape Severity

http://www.bluechipspine.com/first-visit

Classifications of Fractures:

Three Column Concept Major and Minor Fractures

Classifications of Fractures:

Specific Fracture TypesStable vs. Unstable

Spinal Cord Injury: What is spinal cord injury?

◦ A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection.

Why is it significant?◦ The spinal cord is incapable of healing itself.◦ Complete spinal cord injury: cannot send

signals below the level of injury. ◦ Incomplete spinal cord injury: some

movement and sensation below the injury.

Spinal Cord Injury: Causes:

◦ The most common cause of spinal cord injury is trauma.◦ Types of trauma include: falls from heights,

violence (stabbing or gunshot wounds to the spine), or sporting injuries (diving, football, rugby, equestrian, etc.)

◦ Spinal cord injury can also be caused by compression of the cord by a tumor, infection, or inflammation. ◦ Spinal stenosis

Conditions that affect the spinal cord:

• Tumors

• Infections such as meningitis and polio

• Inflammatory diseases

• Autoimmune diseases

• Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy

Diseases of the Spinal Cord: MeningitisPolioAmyotrophic lateral sclerosis (ALS) Spinal muscular atrophy (SMA)

Spine Treatment

Level 1: Mobilization and Physical Therapy

Level 2: Immobilization, Braces

Level 3: Spinal Surgery; Fusion, Disk Implants

Level 1: Mobilization and Physical Therapy Two components:

1. Passive physical therapy (heat/ice packs, ultrasound)2. Active Exercises (stretching)

Manual physical therapy:◦ Restore mobility ◦ Reduce muscle tension

Level 2: Immobilization, Braces Spinal bracing used for

treatment of: low back pain trauma infections muscle weakness neck conditions osteoporosis

Cervical Braces Soft and hard collars Philadelphia collar Sterno-occipital-mandibular

immobilization device (SOMI) Halo

Back Braces Two types of back braces commonly used:

1. Rigid braces2. Corset (elastic braces)

Level 3: Spinal Surgery; Fusion, Disk Implants Spinal FusionArtificial Disk Replacement (ADR)

Fusion Involves forming direct

connection between vertebrae surrounding the painful disc(s)

Pain relief occurs by stopping the motion of the painful disc(s).

Fusion

http://www.spine-health.com/video/interbody-spine-fusion-surgery-video

Artificial Disk Replacement (ADR)

Alternative to spinal fusion

replaces damaged or worn out spinal disc with an artificial disc

The Charité artificial disc is made of two metallic endplates and a plastic center

Artificial Disk Replacement (ADR)

http://www.spine-health.com/video/total-disc-replacement-back-surgery-video

Christopher Reeve

In 1995, famous actor Christopher Reeve broke his neck in a horseback riding incident.

Paralyzed from neck down and unable to breathe

Background on the injurySecond vertebrate (C2) causes instant death if displaced laterally by 5mmFracture in any cervical vertebrate causes quadriplegiaSpinal cord injuries breaks nerve fibers Destroys possible muscle movement in

distal direction

• Survived instant death• Survived 60-70% chance mortality rate over the following week• No recovery within 48 hours usually means no recovery

Spinal Cord Concussion Cervical Cord neurapraxia (CNN)

◦ Nerrowing of the spinal canal (stenosis)◦ Torg or Pavlov ratios:

◦ Ratio of canal diamter to vertebral body◦ 0.8< indicates significant for athletic

◦ Instantaneous loss of function of limbs but followed with complet recovery◦ Most commonly occurs at the cervical vertabrates

Torg. J. et al, 1997

Both techniques share the same level of reoccurrence

Torg. J. et al, 1997

How does it happen?Hyperextension, hyperflexion, axial load mechanisms on neckSpear tackleOccur in 7 out of 10,000 players per year

(1.8 million people) and rising

http://www.youtube.com/watch?v=UpdrHe31J-8

Why the rise? Helmets are too safe!

Long term effectsSymptoms subside usually after 24 hours

56% chance of reoccurrence

Repeat episode is directly proportional to diameter of player’s cervical spine canal

If neurologic symptoms persist surgery

Second episode termination of sport

Torg. J. et al, 1997

Case Study Example20 year old college defensive back

5 minutes of transient paralysis

C-3, 5 narrowing of 0.66

C-4 narrowing of 0.62

Minimal anterior subluxation

Returned to play after recovery

Minimal Flexion

… Fourteen months later

Contact is made with head

Classic spear tackle

Axial load

Fracture in the C4-C6 vertebrate

*Unilateral facet dislocation at C4-5 (C4 displaced anteriorly 25%) in sagittal plane

*Oblique fracture

*Three-part-two-plane fracture with small anterior fracture fragment

*Non-displaced sagittal fracture through the vertebral body and partial fracture of the right lamina

Help efforts Christopher and Dana Reeve

Paralysis Resource Center◦ Located in New Jersey◦ Funds for research, treatments/cures, for CNS disorders◦ Advocate improvement of quality of life post-injury◦ 22M to neuroscientist research◦ http://www.reevebigidea.org

References

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