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Dermatomes – Physiopedia

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A dermatome is an area of skin that is mainly supplied by a single spinal nerve. There are 8 cervical nerves (note C1 has with no dermatome), 12 thoracic nerves, 5 lumbar nerves and 5 sacral nerves. Each of these spinal nerves relay sensation from a particular region of the skin to the brain.[1]

[2]

The nerves from the

  • C2 to C4 supply the skin of the neck.
  • C5 to T1 nerves supply the arms. 
  • T2 to L2 nerves supply the chest and abdomen. 
  • L3 to S1 nerves supply the skin of the legs. 
  • S1 to S4 nerves go to the groin.
Nerve Roots Dermatomes[3]
Nerve Root Dermatomes
Cervical
C2 Temple, forehead, occiput
C3 Entire neck, posterior cheek, temporal area, prolongation forward under mandible
C4 Shoulder area, clavicular area, upper scapular area
C5 Deltoid area, anterior aspect of entire arm to base of thumb
C6 Anterior arm, radial side of hand to thumb and index finger
C7 Lateral arm and forearm to index, long, and ring fingers
C8 Medial arm and forearm to long, ring, and little fingers
Thoracic
T1 Medial side of forearm to base of little finger
T2 Medial side of upper arm to medial elbow, pectoral and midscapular areas
T3-T12 T3–T6, upper thorax;

T5–T7, costal margin;

T8–T12, abdomen and lumbar region

Lumbar
L1 Back, over trochanter and groin
L2 Back, front of thigh to knee
L3 Back, upper buttock, anterior thigh and knee, medial lower leg
L4 Medial buttock, latera thigh, medial leg, dorsum of foot, big toe
L5 Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes
Sacral
S1 Buttock, thigh, and leg posterior
S2 Same as S1
S3 Groin, medial thigh to knee
S4 Perineum, genitals, lower sacrum

Testing of dermatomes is part of the neurological examination looking for radiculopathy as sensation changes within a specific dermatome may help in determining the pathological disc level.

Dermatome Testing is done ideally with a pin and cotton wool. Ask the patient to close their eyes and give the therapist feedback regarding the various stimuli. Testing should be done on specific dermatomes and should be compared to bilaterally.

  • Pinprick test (pain sensation) – Gently touches the skin with the pin ask the patient whether it feels sharp or blunt
  • Light touch test (light touch sensation) – Dab a piece of cotton wool on an area of skin [4]

During the review of systems, asking the patient to carefully describe the pattern or distribution of sensory symptoms (e.g., tingling, numbness, diminished, or absent sensation) provides the therapist with preliminary information to help guide the examination and to assist in identifying the dermatome(s) and nerve(s) involved.[5]

Peripheral nerve injuries generally present sensory impairments that parallel the distribution of the involved nerve and correspond to its pattern of innervation.For example, if a patient presents with complaints of numbness on the ulnar half of the ring finger, the little finger, and the ulnar side of the hand, the therapist would be alerted to carefully address ulnar nerve (C8 and T1) integrity during the sensory examination. Complaints of sensory disturbances on the palmar surface of the thumb and the palmar and distal dorsal aspects of the index, middle, and the radial half of the ring finger would be indicative of median nerve (C6–8 and T1) involvement.[5]

There exist some discrepancies among published dermatome maps based on the methodologies used to identify skin segment innervation. In a clinical commentary, Downs and Laporte discuss the history of dermatome mapping, including the variations in methodologies employed, and the inconsistencies in the dermatome maps used in education and practice.[5][[Laporte C. Conflicting dermatome maps: educational and clinical implications. journal of orthopaedic & sports physical therapy. 2011 Jun;41(6):42[6]7-34.]]

Anatomy, Skin, Dermatomes – StatPearls

Introduction

The skin is divided anatomically into distinct patterns based on the specific distribution of sensory nerve fibers arising from a single spinal nerve. These patterns were mapped and discussed most prominently in 1933 by O. Foerster in a publication entitled “The Dermatomes in Man” in the journal Brain, which some consider the founding basis on which dermatomal theory rests.[1] After Foerster, J. Keegan and F. Garrett discussed the distribution of spinal nerves in 1948 in their publication “The Segmental Distribution of the Cutaneous Nerves in the Limbs of Man” in the journal The Anatomical Record.[2] Most recently, in 2008, M. Lee, R. McPhee, and M. Stringer published an article in Clinical Anatomy entitled “An Evidence-Based Approach to Human Dermatomes,” in which they contested some of the classic presentations of dermatome maps and put forth an evidence-based method for determining a more accurate map of human dermatomes.[3][4]

Structure and Function

Spinal nerves form from the dorsal nerve roots and the ventral nerve roots which branch from the dorsal and ventral horn of the spinal cord, respectively. The spinal nerves exit through the intervertebral foramina or neuroforamina and travel along their respective dermatomal distributions from posterior to anterior, creating the specific, observable dermatomal patterns.[5]In total, there are 31 distinct spinal segments and thus 31 distinct spinal nerves bilaterally. These 31 spinal nerves are composed of 8 pairs of cervical nerves, 12 pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerve.[5]

The cervical nerves C1-C7 exit through the intervertebral foramina above their respective vertebrae. Cervical nerve C8 exits between the C7 vertebra and the T1 vertebra. The remaining spinal nerves all exit below their respective vertebrae.[5]

 The dermatomes on the trunk are layered horizontally, one on top of the other. This horizontal pattern contrasts with the pattern on the extremities, where it is typically more longitudinal. This pattern is fairly standard although some variations can exist from person to person because spinal nerves overlap in the areas of the body they supply.

Embryology

During embryological development, spinal nerves develop from neural crest tissue allowing for the formation of dermatomal, myotomal, and scleratomal patterns. The spinal cord begins development during the third week of the embryonic period with the formation of the neural plate and the elevation of the neural folds. Early in the fourth week of development, the neural folds begin to fuse. Late in the fourth week, neuroblasts form and move into the intermediate zone of the early neural tube, and this process continues throughout embryological development. During the sixth week, spinal nerves begin to form and progressively travel from dorsal to ventral.[6]

Blood Supply and Lymphatics

The spinal cord and the spinal nerves receive their vascular supply predominantly via the anterior spinal artery and two posterior spinal arteries. The anterior spinal artery supplies the bulk of the spinal cord, the anterior two-thirds, while the two posterior spinal arteries supply the dorsal columns. These spinal arteries branch off the vertebral arteries in the skull and proceed out of the skull and course inferiorly along the spinal cord.[7]

Nerves

Several anatomic landmarks help easily identify or estimate different dermatomal levels.

  • C6 – Thumb

  • C7 – Middle finger

  • C8 – Little finger

  • T1 – Anteromedial forearm and arm

  • T2 – Medial forearm and arm to the axilla

  • T4 – Nipple

  • T6 – Xyphoid process

  • T10 – Umbilicus

  • L3 – Medial knee

  • L4 – Anterior knee and medial malleolus

  • L5 – Dorsal surface of the foot and first, second, and third toes

  • S1 – Lateral malleolus

Clinical Significance

Neurological evaluation of dermatomes helps to assess radiculopathy or neurologic deficits as radicular patterns can suggest specific spinal nerve involvement. For example, sciatica, a common condition with a lifetime prevalence reported as high as 84%, will often present along the dermatome of the involved spinal nerve.[8] Sciatica-associated pain will commonly follow a path from the posterior hip down the back of the thigh to the knee involving the S1 or S2 dermatome. Neurological assessment of dermatomes helps to assess the level of spinal cord injury.[9]

Herpes zoster infections, colloquially known as chickenpox and shingles, are caused by varicella zoster virus or human herpesvirus 3 (HHV-3). In the primary varicella infection, the distribution is widespread and diffuse, progressing in a cephalocaudal manner with classic lesions often described as “dew drops on a rose petal.” With the resolution of the primary infection, the virus retreats into the dorsal root ganglia awaiting reactivation. Viral reactivation can frequently be due to a triggering event while in an immunocompromised state, but immunosuppression is not requisite for reactivation of the virus and presentation of the secondary disease.[10]

Once reactivated, the viral symptoms typically present in 3 different phases. The pre-eruptive, or prodromal, phase exhibits symptoms associated with sensory phenomena presenting along the affected dermatome. These sensory symptoms may present as pain, burning, itching, or paresthesias. After the pre-eruptive phase follows the eruptive phase during which the affected dermatome erupts in a grouped vesicular rash (herpetiform) on an erythematous base. The vesicular lesions will most commonly present along a truncal dermatome, with facial onvolvement the second most prevalent. The lesions progress through a pattern of vesicles, pustules, crusting, and resolution.[11]

Disseminated herpes zoster is significantly rare and almost exclusively associated with severely immunocompromised states (i.e., AIDS, malignancy, long-term immunosuppressive therapy use, etc.). Affected patients are also at risk of life-threatening conditions including encephalitis or pneumonitis.

Of particular concern for herpes zoster infections is the involvement of the cranial nerves, particularly the trigeminal nerves (CN V). Herpes zoster ophthalmicus presents similarly to herpes zoster infections affecting the trunk, beginning with the prodromal phase of burning or itching on the skin, and can sometimes be clinically confused with trigeminal neuralgia while still in the pre-eruptive stage. The concern with herpes zoster ophthalmicus is that with the eruptive phase, lesions distribute along the face, and if involving the optic nerve, the oculomotor nerve, or the trigeminal nerve, blindness can result. Hutchinson’s sign, herpetic lesions along the lateral nose tip, indicates the involvement of the nasociliary branch of the first trigeminal nerve and is ominous of potential ocular involvement.[12]

Upon resolution of the lesions, pain can remain and continue to affect patients along the affected dermatome as postherpetic neuralgia.[11]

Dermatomes | DermNet NZ

Authors: Claire Jordan Wiggins, Riyad N.H. Seervai, Medical Students, Baylor College of Medicine, Houston, TX, USA. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. June 2020.


What is a dermatome?

A dermatome is an area of skin that is primarily supplied by a single nerve root: communicating sensation from this skin region to the brain. Somatosensation includes feedback from mechanoreceptors, thermoreceptors, proprioceptors, pain receptors, and chemoreceptors. Dermatomes are different from Blaschko lines.

Maps of dermatomes are not consistent, and variation will be noted between different sources.

Dermatomes

Credit: https://www.grepmed.com/images/2963/dermatomal-dermatomes-diagnosis-cutaneous-anatomy-nerves-roots

Where are dermatomes located?

Dermatomes form a stack of horizontal layers on the trunk and run lengthwise in the extremities.

  • There are eight cervical nerves (although C1 does not have its own dermatome), 12 thoracic nerves, 5 lumbar nerves, and 5 sacral nerves.
  • The 5th cranial nerve is divided into three divisions; V1, V2, and V3, which are responsible for sensation in the face.
  • Contiguous dermatomes overlap, and each individual’s exact dermatomal pattern is unique.

What is the clinical relevance of dermatomes?

Knowledge of dermatomes can aid in the diagnosis of disease.

  • Herpes zoster (shingles), a viral infection caused by varicella-zoster virus. The virus can lie dormant in the spinal nerve ganglia, producing a rash and pain along the corresponding dermatome.
  • Lumbar radiculopathy, a radiating back pain extending down a dermatome is due to compression of a spinal nerve root (sciatica).
  • Referred pain from a visceral organ can be perceived at a location other than the site of the stimulus or origin in a nearby dermatome.

Dermatomes – Development – Maps

A dermatome is defined as ‘a strip of skin that is innervated by a single spinal nerve‘. They are of great diagnostic importance, as they allow the clinician to determine whether there is damage to the spinal cord, and to estimate the extent of a spinal injury if there is one present.

In this article, we shall look at the embryonic origins of dermatomes, and explore their clinical uses.


Origins of Dermatomes

Fig 1 – Somites adjacent to the neural tube.

We can trace back the origins of dermatomes to the 3rd week of embryogenesis. At around day 20, the tri-laminar disc has been established and the middle layer (mesoderm) has differentiated into its different types. The portion that is directly adjacent to the neural tube is called paraxial mesoderm.

From day 20 onwards the paraxial mesoderm differentiates into segments called somites. 44 pairs of somites are formed, but 13 of these break down leaving 31 somites. This corresponds to the 31 sets of spinal nerves in the body.

The somites themselves are comprised of a ventral and a dorsal portion. The ventral portion consists of sclerotome, the precursor to the ribs and vertebral column.

The dorsal portion consists of dermomyotome. Over time, the myotome proliferates and the dermatome disperses to form dermis. As the limbs grow, the dermis associated with the precursor of the limbs is stretched and moved down the limb, creating the segmental innervation that is associated with the Keegan and Garrett dermatome map of 1948.


Dermatome Maps

There are two main maps that are accepted by the medical profession. The first is the Keegan and Garret map of 1948. This depicts dermatomes in a way that correlates with the segmental progression of limb development. The second is the Foerster map of 1933 which depicts the medial part of the upper limb as being innervated by T1-T3 which follows the distribution of pain from angina or an MI. This is the most commonly used map, and features in the ASIA scale of assessing spinal injury.

Both maps depict progression of limb growth around an axial line. Across this line there is no overlap between dermatomes, but often those adjacent each other have a slight overlap.

Fig 2 – The Keegan and Garrett dermatomal distribution.

[start-clinical]

Clinical Relevance: Assessing Spinal Cord Lesions

Following a traumatic injury that may involve the spinal cord, the clinician can test dermatomes to determine the presence and the extent of a spinal cord lesion.

Firstly, the clinician uses cotton wool to test for light touch sensation along the limbs and torso, touching areas which correspond to the different dermatomes. Secondly the clinician uses a small pin to test for responsiveness to pain. The patient is instructed to close their eyes and say when they feel contact with their skin (Light touch and pain are tested separately as their fibres travel in different parts of the spinal cord – see here).

By using their knowledge of dermatomal and peripheral cutaneous innervation, and noting any regions of paresthesia, the clinician is able to ascertain whether there is any nerve involvement. Also, they can determine whether this is at the spinal root or peripheral nerve level.

Fig 3 – The ASIA scale. It used to assess patients with a potential spinal nerve lesion.

[end-clinical]

 

 

 

What is a Dermatome? – Definition & Distribution – Video & Lesson Transcript

Mapping the Spinal Cord

These dermatomes provide a rough map, useful for healthcare professionals and researchers. The dermatomes, like the spinal nerves, are divided into four sections: cervical, thoracic, lumbar, and sacral. Each dermatome is labeled according to the spinal nerve which innervates it. So, the dermatome innervated by the seventh cervical nerve would be dermatome C7. Remember the bony lump you felt at the back of your neck? Running through that vertebra is spinal nerve C7, which reaches out to innervate the skin of the shoulder, upper arm, lower arm, index and ring fingers!

There are four major categories of dermatomes:

  • The cervical dermatomes cover skin on the back of the head, neck, shoulders, arms and hands
  • The thoracic dermatomes cover skin on the inner arm, chest, abdomen, and mid-back
  • The lumbar dermatomes cover skin on the lower back, fronts of the legs, outer thighs and outer calves, and tops and bottoms of the feet
  • The sacral dermatomes cover skin on the genital and anal regions; back of the legs, central back of the thighs and calves; and the outer edge of the feet

These dermatomes have been discovered mainly through clinical observations over the years, though it’s important to realize they are just a guideline. Every human is wired slightly differently, and variations in the exact dermatome borders is expected.

Examples of Conditions

Dermatomes help in the diagnosis and treatment of several conditions. These conditions include:

  1. Viral illnesses
  2. Radiculopathy
  3. Spinal cord injuries

Viral Illnesses

Certain viral illnesses, such as shingles, present in specific dermatomes. The herpes zoster virus lies dormant in the spinal cord, then when awakened, moves along the spinal nerve causing a painful rash in the area of skin associated with that nerve.

Radiculopathy

Radiculopathy is pain, numbness, or tingling experienced in a certain dermatome which originates from an affected spinal nerve. So, knowing which dermatome is experiencing symptoms helps the healthcare provider know which vertebra to examine further.

Spinal cord injuries

Dermatomes are a useful tool in diagnosing the level of spinal cord injury. The healthcare provider starts in the skin region where sensation is lacking and moves upward until the patient can feel the assessment tool.

Lesson Summary

In summary, a dermatome is a specific zone of skin innervated by a single spinal nerve.

There are four major categories of dermatomes:

  • The cervical dermatomes cover skin on the back of the head, neck, shoulders, arms and hands
  • The thoracic dermatomes cover skin on the inner arm, chest, abdomen, and mid-back
  • The lumbar dermatomes cover skin on the lower back, fronts of the legs, outer thighs and outer calves, and tops and bottoms of the feet
  • The sacral dermatomes cover skin on the genital and anal regions; back of the legs, central back of the thighs and calves; and the outer edge of the feet

Dermatomes are helpful in assessing certain health conditions such as shingles, radiculopathy, and spinal cord injuries. So the next time you burn your index finger and the pain shoots up to your brain, you can thank dermatome C7 for relaying the message so quickly.

Skin Dermatomes – Ravi Ramachandran, M.D.

by Ravi Ramachandran, M.D.

A dermatome refers to a portion of skin in the body that gets its sensation from a single spinal nerve. When I examine people in the office, I will test a dermatome for sensation.  I saw a patient last week who had hip osteoarthritis.

He had pain over his right thigh.  When I examined him, he had a hypersensitivity over the L2,3 distribution.  As it turns out, he has a herniated disc at that level in his lumbar spine that is the source of his pain.  Here are 4 things to take away about  a dermatome and what to know about your body’s innervation pattern.

  1. Spinal cord segments.  The spinal cord, as you can imagine, is highly specialized. It is divided into segments.  Spinal nerve roots arise from the spinal cord in pairs of nerves.  These nerves are numbered based upon where they exit.  For instance, there are 8 cervical, 12 thoracic, 5 lumbar and 5 sacral segments.  Each of these nerve pairs will give motor, sensation and in some cases reflexes to the body.  It is in understanding this wiring that we can identify where a particular problem lies in the spine.
  2. Dermatome and myotome.  Just as a dermatome will give information about a segment of skin, a myotome is a map of motor power for a group of muscles.  In addition to testing your skin at various levels, a motor examination will help confirm if a particular nerve root or nerve roots are affected.  For instance, with a C5 radiculopathy, I will specifically test the deltoid muscle of the shoulder, and the skin over the outside or lateral aspect of the arm.  In addition, I will test the biceps reflex which is a predominately supplied by the C5 nerve root.
  3. A dermatome can explain referred pain.  Because a dermatome is a roadmap of nerves it can also explain referred pain.  Referred pain is a phenomenon where structures in the body can confuse nerve perception.  An example is when someone has an inflamed gall bladder orcholecystitis.  The gall bladder can inflame the diaphragm which is innervated by C3,4 and C5.  The C3,4 dermatome innervate above the shoulder.  Rarely, a patient will come to the office with right shoulder pain but the pain is coming from cholecystitis.
  4. Virus can express themselves in a dermatome distribution.  Viruses can hibernate in the sensory cell bodies.  An example is varicella zoster virus.  Patients can present with severe pain in the back or trunk and this can be a manifestation of a zoster attack. Diagnosis can be confusing because it can be misinterpreted as back or flank pain and not the beginning of shingles.

In medicine you often have to play detective.  The dermatome map is one clue to a diagnosis and hopefully a cure.  I have included a dermatome map here for you to look at further. 

Ravi Ramachandran M.D. Sacramento Spine Surgeon

Sacral Spine (S1 – S5) Injuries, Sacral Sparing

Injuries to the Sacral Spine 

While there is no spinal cord in the sacral spine region, the sacral nerves actually originate in the lumbar spine. Damage done to the nerve roots in the lower lumbar spine and into the sacrum may have similar symptoms as spinal cord damage.

Patients with sacral nerve injuries may have symptoms on one or both sides of the body. Injuries to the sacral spine may leave the patient with some degree of function loss in the hips and/or legs. The patient will most likely be able to walk, and drive a car. An injury to the sacral spinal cord may leave the patient with little or no bladder or bowel control, however, the patient will be completely autonomous and have the ability to perform their own self-care. 

The sacral region is home to the control center for pelvic organs such as the bladder, bowel, and sex organs. Sexual function is a concern, especially in men who experience sacral spinal nerve injuries. Men’s fertility may be affected with lumbar and/or sacral nerve injuries while a woman’s fertility is typically not affected.

Symptoms

Patients with injuries to the sacral nerve roots may experience:

  • Lack of control of bowels or bladder
  • Lower back pain
  • Leg pain, which may radiate down the back of the leg(s)
  • Sensory issues in the groin and buttocks area 

Causes

The most common causes of spinal cord injuries to the sacrum are:

  • Motor vehicle accidents
  • Trauma
  • Falls
  • Birth defects
  • Degeneration
  • Osteoporosis 

Treatment

Current treatments available for spinal cord patients with sacrum injuries are:

  • Drugs: Non-steroidal anti-inflammatory (NSAID) drugs are used in treating spinal cord and nerve root injuries. The quicker these drugs are initiated after injury, the better the result for the patient by reducing inflammation around the spinal cord.
  • Surgery: Surgical decompression of the nerves and fusion of the vertebrae are done to reduce pressure around the spinal nerves, and fixate the spinal column around the spinal cord injury.
  • Therapy: Physical therapy is done to encourage strength in the areas that are affected by spinal cord damage, as well as to maintain function in the non-affected area. Occupational therapy helps patients to learn to function after spinal cord damage. 

Additional Information

Damaging either the S1, S2, S3, S4, or S5 vertebrae should leave the patient fairly functional with some issues controlling bowel and bladder function. Patients with injuries to the sacrum typically live very normal lives. Some assistance may be needed for these patients, but most do well on their own.  

Anatomy and physiology of the spine

Anatomy and physiology of the spine

The human spine is a very complex mechanism, the correct operation of which affects the functioning of all other mechanisms of the body.

The spine (from the Latin “columna vertebralis”, synonym – the vertebral column) consists of 32 – 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, connected to the sacrum, and 3 – 4 coccygeal), between which are located 23 intervertebral discs.

Ligamentous-muscular apparatus, intervertebral discs, joints connect the vertebrae to each other. They keep him upright and provide the necessary freedom of movement. When walking, running and jumping, the elastic properties of the intervertebral discs significantly soften shocks and shocks transmitted to the spine, spinal cord and brain.

Physiological curves of the body create additional elasticity for the spine and help to relieve stress on the spinal column.

The spine is the main supporting structure of our body. Without a spine, a person would not be able to walk or even stand. Another important function of the spine is to protect the spinal cord. The high frequency of diseases of the spine in a modern person is mainly due to his “upright posture”, as well as a high level of traumatism.

Sections of the spine : The cervical, thoracic, lumbar, sacrum and coccyx are distinguished in the spine. In the process of growth and development of the spine, cervical and lumbar lordosis, thoracic and sacrococcygeal kyphosis are formed, which turn the spine into a “springy system” that resists vertical loads.In medical terminology, for brevity, the Latin letter “C” – C1 – C7 is used to designate the cervical vertebrae, “Th” – Th2 – Th22 to designate the thoracic vertebrae, and the lumbar vertebrae are designated by the letter “L” – L1 – L5.

Cervical spine. This is the uppermost part of the spinal column. It is particularly mobile, which provides such a variety and freedom of movement of the head. The two upper cervical vertebrae with the beautiful names atlas and axis have an anatomical structure that is different from the structure of all other vertebrae.Thanks to the presence of these vertebrae, a person can make turns and tilts of the head.

Chest. 12 pairs of ribs are attached to this section. The thoracic spine is involved in the formation of the posterior chest wall, which is the seat of vital organs. In this regard, the thoracic spine is inactive.

Lumbar region. This section consists of the most massive vertebrae, since they bear the greatest load.Some people have the sixth lumbar vertebra. Doctors call this phenomenon lumbarization. But in most cases, such an anomaly has no clinical significance. 8-10 vertebrae grow together to form the sacrum and coccyx.

The vertebra consists of a body, arch, two legs, spinous, two transverse and four articular processes. Between the arch, the body and the legs of the vertebrae there are vertebral foramen, from which the spinal canal is formed.

Between the bodies of two adjacent vertebrae there is an intervertebral disc, consisting of the fibrous ring and the nucleus pulposus and performing 3 functions: amortization, retention of adjacent vertebrae, ensuring the mobility of the vertebral bodies. Around the nucleus is a multilayer annulus fibrosus, which holds the nucleus in the center and prevents the vertebrae from shifting to the side relative to each other.

The annulus fibrosus has many layers and fibers that intersect in three planes.In a normal state, the annulus fibrosus is formed by very strong fibers. However, as a result of degenerative disc disease (osteochondrosis), the fibers of the annulus fibrosus are replaced by scar tissue. The fibers of the scar tissue do not have the same strength and elasticity as the fibers of the annulus fibrosus. This leads to a weakening of the intervertebral disc and, with an increase in intradiscal pressure, can lead to rupture of the annulus fibrosus.

A significant increase in pressure inside the intervertebral discs can lead to rupture of the annulus fibrosus and the exit of a part of the nucleus pulposus beyond the disc.This is how a herniated disc is formed, which can lead to compression of nerve structures, which, in turn, causes the appearance of pain and neurological disorders.

The ligamentous apparatus is represented by the anterior and posterior longitudinal, supra – and interspinous ligaments, yellow, intertransverse ligaments and the capsule of the intervertebral joints. Two vertebrae with an intervertebral disc and a ligamentous apparatus represent the vertebral segment.

When the intervertebral discs and joints are destroyed, the ligaments tend to compensate for the increased pathological mobility of the vertebrae (instability), resulting in hypertrophy of the ligaments. This process leads to a decrease in the lumen of the spinal canal, in which case even small hernias or bone growths (osteophytes) can compress the spinal brain and roots.

This condition is called spinal stenosis. To expand the spinal canal, an operation is performed to decompress the nerve structures.

The spinal cord and the cauda equina roots are located in the vertebral canal. The spinal cord starts from the brain and ends at the level of the gap between the first and second lumbar vertebrae with a conical point. Further from the spinal cord in the canal are spinal nerve roots, which form the so-called “cauda equina”.
The spinal cord is surrounded by hard, arachnoid and soft membranes and is fixed in the spinal canal by roots and tissue.The dura forms an airtight connective tissue sac (dural sac) that contains the spinal cord and a few centimeters of nerve roots. The spinal cord in the dural sac washes with cerebrospinal fluid (CSF).

31 pairs of nerve roots depart from the spinal cord. From the spinal canal, nerve roots exit through the intervertebral (foraminar) openings, which are formed by the legs and articular processes of adjacent vertebrae.

In humans, as well as in other vertebrates, the segmental innervation of the body is preserved.This means that each segment of the spinal cord innervates a specific area of ​​the body.

For example, the segments of the cervical spinal cord innervate the neck and arms, the thoracic region – the chest and abdomen, the lumbar and sacral – the legs, perineum and pelvic organs (bladder, rectum).

Through peripheral nerves, nerve impulses are sent from the spinal cord to all organs of our body to regulate their function.Information from organs and tissues enters the central nervous system through sensitive nerve fibers.

Most of the nerves in our body are composed of sensory, motor and autonomic fibers.
The spinal cord has two thickenings: the cervical and the lumbar. Therefore, intervertebral hernias of the cervical spine are more dangerous than lumbar hernias.

The doctor, determining in which area of ​​the body, there were disorders of sensitivity or motor function, can assume at what level the spinal cord was damaged.

Human spine – anatomy, vertebrae, bends and sections

1 March 2019 98517

The human spine is the basis of the musculoskeletal system. At the same time, it not only performs a supporting function and provides the ability to walk upright, but also represents a rather flexible axis of the body, which is achieved due to the mobility of the overwhelming majority of its individual parts. In this case, the anterior part of the spine is involved in the formation of the walls of the chest and abdominal cavities.But one of its most important functions is to ensure the safety of the spinal cord, which runs inside it.

Features of the structure of the spine

The human spine is formed by 31-34 vertebrae lying on top of each other, between the bodies of which there are peculiar cartilaginous formations – intervertebral discs. In addition, adjacent vertebrae are connected by joints and ligaments. In general, 122 joints of various sizes and structures, 365 ligaments and 26 cartilaginous joints can be distinguished in the spine, but there are only 52 true joints.

Most of the vertebrae have a similar structure. They have:

  • body – the main part of the vertebra, which is a cancellous bone close to a cylindrical shape;
  • arch – a bony structure of a semicircular shape located at the back of the vertebral body and attached to it by two legs;
  • articular, transverse and spinous processes – have different lengths and depart from the arch of the vertebra, forming together with the body and arch of the vertebral canal, and the articular processes of adjacent vertebrae form true joints, called facet or facet.

The cancellous bone is a special type of bone tissue that is highly durable. Inside, it has a system of bone crossbars diverging in different directions, which ensures its increased resistance to multidirectional loads.

Formed by the back of the vertebral bodies, arcs and processes, the vertebral foramen clearly coincide with each other and create a single spinal canal, where the spinal cord is located, conventionally divided into segments.On average, in an adult, its cross-sectional area is about 2.2-3.2 cm 2 , but in the cervical and lumbar regions it has a triangular shape, while in the chest it is round.

At the level of each vertebra, the spinal roots branch off in pairs from the corresponding segments of the spinal cord. They pass in natural openings formed by the processes of the vertebrae. There are also blood vessels that provide nutrition to the spinal cord.

Changing the position of the spine is carried out with the help of muscles attached to the vertebral bodies.It is thanks to their reduction that the body bends, and relaxation leads to the restoration of the normal position of the vertebrae.

Sections of the spine and structural features of the vertebrae

There are 5 sections in the spine: cervical, thoracic, lumbar, sacral and coccygeal. At the same time, oddly enough, but in fact, in different people, the spine can be formed by a different number of vertebrae. These are:

  • 7 cervical vertebrae – C1-C7;
  • 12 chest – T1-T12;
  • 5 lumbar – L1-L5;
  • 5 sacral – S1-S5;
  • 2-5 coccygeal.

The sacral and coccygeal vertebrae are connected motionlessly.

The cervical spine has the greatest mobility. It has 2 vertebrae, the structure of which is very different from the rest, since they must ensure the connection of the spinal column with the bony structures of the head, and also create the possibility for turning and tilting the head. The thoracic region is the least mobile. It has direct connections with the ribs, which provokes the appearance of the corresponding anatomical features of the vertebrae of this department.Overall, it provides organ protection and body support. The lumbar spine is distinguished by massive vertebrae, which bear the bulk of the body’s weight. The sacrum, formed by the 5 fused vertebrae, helps maintain an upright body position and takes part in the distribution of the load. The last part of the spine, the tailbone, serves as a place of attachment of ligaments and other anatomical structures.

There are also developmental abnormalities in which there is a change in the number of vertebrae.Normally, during embryonic development, the 25th vertebra should fuse with the sacrum. But sometimes this does not happen, which leads to the formation of the 6th lumbar vertebra. In such cases, they speak of the presence of lumbarization. There are also opposite cases, when not only 25, but also 24 vertebrae grow together with the sacrum. As a result, 4 vertebrae remain in the lumbar spine, while the 6th is formed in the sacrum. This is called sacralization.

The vertebrae of different parts of the spinal column have different sizes and shapes, but all of them from the front, back and lateral sides are covered with a thin layer of dense tissue, perforated by vascular canals.The cervical vertebrae have the smallest sizes, while the first of them, the atlas, does not have a body at all. As the serial number increases, the size of the vertebral bodies increases and reaches a maximum in the lumbar region. The fused sacral vertebrae carry the entire weight of the upper body and connect the spine to the pelvic bones and lower limbs. The coccygeal vertebrae are the remnant of a vestigial tail and are small bony formations that have extremely poorly developed bodies and are completely devoid of arcs.

Normally, the height of the vertebral bodies is the same over the entire area, with the exception of the 5th lumbar vertebra ( L5), whose body is wedge-shaped.

The spinous processes, which are present in almost all vertebrae, tiling each other, branch off from them at different angles in different parts of the spine. So, in the cervical and lumbar regions, they are located almost horizontally, and at the mid-thoracic level, which corresponds to 5-9 thoracic vertebrae, they are located at rather sharp angles.At the same time, the processes of the upper and lower thoracic vertebrae occupy an intermediate position.

The spinous processes, as well as the transverse ones, are the base to which the ligaments and muscles are attached, which set the vertebrae in motion. The articular processes of adjacent vertebrae form the facet joints. They create the ability to flex the spine back and forth.

Thus, the vertebral bodies are connected by intervertebral discs, and the arches – by intervertebral joints and ligaments. Formed by the intervertebral disc, two adjacent intervertebral joints and ligaments, the anatomical complex is called the spinal motion segment.In each individual segment, the mobility of the spine is small, but the simultaneous movement of many segments provides a sufficient level of flexibility and mobility of the spine in different directions.

Normally, the spine has 4 physiological bends, which provide the weakening of shocks and shocks of the spine during movement. Due to this, they do not reach the skull and ensure the safety of the brain. Distinguish:

  • cervical lordosis;
  • thoracic kyphosis;
  • lumbar lordosis;
  • Sacrococcygeal kyphosis.

Lordosis is called the curvature of the spine, which is convex towards the front of the body, and kyphosis, respectively, in the opposite direction.

Due to the presence of physiological curves, the human spine is S-shaped. But normally they should be smooth and not exceed the permissible values. The presence of pronounced angles or the location of the spinous processes at different distances from each other is a sign of a pathological increase in kyphosis or lordosis.In the lateral or frontal plane, any bends, slopes should normally be absent.

At the same time, the degree of physiological bends is not a constant value even for an absolutely healthy person. The fact is that the angle of inclination depends on the age of the person. So, a child is born, already having physiological curves of the spine, but they are much less pronounced. The degree of their manifestation directly depends on the age of the child.

In the horizontal position of the body, the physiological curves are slightly straightened, and in the vertical position they are more pronounced.Therefore, in the morning after sleep, the length of the spine increases slightly, the bends are less pronounced, and by the evening the situation changes. At the same time, during an increase in the load, the magnitude of the bends increases in proportion to the incident load.

All vertebrae are of different sizes. Moreover, their width and height progressively increase with distance from the head. The dimensions of the intervertebral discs correspond to the vertebral bodies and are present in almost all of them. There is no such cartilaginous layer, which acts as a shock absorber and provides mobility of the spine, only between the 1st and 2nd cervical vertebrae, i.e.e. atlas and axis, as well as in the sacrum and coccyx.

In total, there are 23 intervertebral discs in the body of an adult. Each of them has a nucleus pulposus, called pulposus, and a solid fibrous sheath surrounding it, called an annulus fibrosus. The intervertebral disc passes into a rather thin plate of hyaline cartilage, which covers the bony surface.

Ligamentous apparatus

The spine is equipped with a powerful ligamentous apparatus formed by a large number of different ligaments.The main ones are:

  • Anterior longitudinal ligament – formed by fibers and bundles of different lengths, which are firmly attached to the vertebral bodies and much more loosely to the corresponding intervertebral discs. It runs along the anterior and lateral surfaces of the vertebral bodies. This ligament originates from the occipital bone and runs through the entire spinal canal up to the 1st sacral vertebra.
  • Posterior longitudinal ligament – also originates from the occipital bone, covers the posterior surface of the vertebral bodies up to the lower part of the sacral canal.Its thickness is greater than that of the anterior similar ligament, and at the same time it is more elastic due to the presence of a greater number of elastic fibers. Unlike the anterior one, it tightly fuses with the intervertebral discs, but is more loosely attached to the bony bodies of the vertebrae. Therefore, in the places of contact with the cartilaginous plates, it is thicker in cross section, and in the place of attachment to the vertebrae, it takes the form of a narrow strip. The lateral parts of the posterior longitudinal ligament form a thin membrane that delimits the venous plexus of the vertebral bodies from the hard spinal cord, thereby protecting the spinal cord from compression.
  • Ligamentum yellow – located between the arches of the vertebrae, closing the lumen and forming the spinal canal. They are formed from elastic fibers, but with age they tend to thicken, that is, ossify. Ligaments of yellow resist excessive forward flexion and extension of the spine.

There are also interspinous, intertransverse and supraspinous ligaments connecting the corresponding processes. But the legs of the arches are not connected by ligaments, due to which the intervertebral foramen are obtained through which the spinal roots and blood vessels come out.

Connection of the spine to the skull

The vertebral column is connected to the skull by means of:

  • paired atlantooccipital joints;
  • median atlantoaxial joints;
  • lateral atlantoaxial joints.

Atlantooccipital joints are formed at the point of contact of the protruding parts (condyles) of the occipital bone with the superior glenoid fossa of the 1st vertebra of the cervical spine, called the atlas. Both atlantooccipital joints are surrounded by wide articular capsules and are strengthened by 2 membranes: anterior and posterior.These joints have physiological limitations of mobility: flexion up to 20 °, extension not exceeding 30 °, head tilt to the side within 15-20 °.

By the way, it is through the posterior atlantooccipital membranes, which are more wide, that the vertebral arteries pass, which are responsible for the blood supply to the vertebrobasilar basin of the brain.

The median atlanto-axial joint has a cylindrical shape and includes 2 separate joints, which are formed by the posterior and anterior articular surfaces of the tooth of the 2nd cervical vertebra, a fossa on the posterior side of the arch of the 1st cervical vertebra, a fossa on the anterior surface of the transverse ligament.Both joints of the tooth have separate articular cavities and capsules. The vertebral tooth is connected to the foramen magnum by a corresponding ligament, while at the same time it has 2 strong pterygoid ligaments that begin on its lateral surfaces and attach to the occipital condyle, thereby preventing excessive rotation of the head. Therefore, rotations in the joint are possible only by 30-40 ° in each direction.

The lateral atlantoaxial joint is a paired combined polyaxial sedentary joint, in the formation of which the lower articular fossa of the C1 vertebra and the upper articular surfaces of the axial vertebra take part.Each joint has a separate capsule and is additionally reinforced with the atlas cruciate ligament. It originates from the apex of the tooth and ends at the front of the foramen magnum.

Spinal cord

The spinal cord is one of the parts of the central nervous system. It is a long, delicate cylindrical cord, slightly flattened from front to back, from which nerve roots branch off. It is the spinal cord that is responsible for the transmission of bioelectric impulses from the brain to each organ and muscle and vice versa.It is responsible for the functioning of the sensory organs, contraction during filling of the bladder, relaxation of the sphincters of the rectum and urethra, regulation of the work of the heart muscle, lungs, etc.

The spinal cord is located inside the spinal canal, and its length in an adult is 45 cm in men and 41-42 cm in women. Moreover, the weight of an anatomical structure so important for the human body does not exceed 34-38 g. Thus, the length of the spinal cord is less than the length of the spinal canal.It starts from the medulla oblongata, which is the lower part of the brain, and becomes thinner at level 1 of the lumbar vertebra (L1), forming a cerebral cone. From it the so-called terminal thread departs, the lower part of which consists of the spinal membranes and ultimately attaches to the 2nd coccygeal vertebra.

In men, the apex of the conical cusp of the spinal cord is localized on the border of the lower edge of L1, and in women – in the middle of L2. From this moment on, the spinal canal is occupied by the lumbosacral roots extending from the last segments of the spinal cord, which forms a large neural formation – the cauda equina.Its constituent nerve roots emerge at an angle of 45 ° from the corresponding intervertebral foramen.

In newborns, the spinal cord ends at L3, but by the age of 3 years its cone is already at the same level as in adults.

The spinal cord is divided by longitudinal grooves into two halves: anterior and posterior. Its central part is formed by gray matter, and the outer layers are white matter. In the central part of the spinal cord, there is a channel in which the cerebrospinal fluid is located.It communicates with the IV ventricle of the brain. In adults, this canal is clogged in some parts or throughout the entire length of the spinal cord. The gray matter is formed by the bodies of neurons, that is, nerve cells, and in cross section resembles a butterfly in shape. As a result, it contains:

  • Anterior horns – they contain motor neurons, also called motoneurons. Like any other neurons, they have long processes (axons) and short branching ones (dendrites). The axons of motor neurons transmit an impulse to the skeletal muscles of the arms, legs and trunk, provoking their contraction.
  • Dorsal horns – the bodies of intercalary neurons are located here, which connect sensory neurons with motor neurons, and also take part in the transmission of information to other parts of the central nervous system.
  • Lateral horns – they are localized neurons that create the centers of the sympathetic nervous system.

The average diameter of the spinal cord is 10 mm, but it increases in the cervical and lumbar spine. In these places, the so-called thickening of the spinal cord is formed, which is explained by the influence of the functions of the arms and legs.Therefore, in the cervical spine, its transverse size is 10-14 mm, in the thoracic – 10-11 mm, and in the lumbar – 12-15 mm.

The spinal cord is washed by CSF or cerebrospinal fluid. It is designed to play the role of a shock absorber and protect it from various damages. In this case, the cerebrospinal fluid is the most filtered blood, devoid of red blood cells, but saturated with proteins and electrolytes, the overwhelming majority of which is sodium and chlorine. Thanks to this, it is completely transparent.CSF is formed in the ventricles of the brain approximately 0.5 liters per day, although on average its volume in the canal does not exceed 130-150 ml. Therefore, even with significant losses of cerebrospinal fluid, its losses are quickly compensated by the body. A small part of the cerebrospinal fluid is absorbed by the blood and lymphatic vessels of the spinal cord.

Spinal cord membranes

The spinal cord is surrounded by 3 membranes: the hard outer membrane, the arachnoid, separated from the first by the subdural space, and the inner one, called the soft spinal membrane.The latter is adjacent directly to the spinal cord and is separated from the mid-position of the membrane by the subarachnoid space. Each of the spinal membranes has its own structural features and performs certain functions.

Thus, the hard shell is a kind of connective tissue case for this sensitive and most important nervous structure, densely braided with blood vessels and nerves. It consists of collagen fibers and has 2 layers, the outer one tightly adheres to the bone structures of the spine and, in fact, forms the periosteum, and the inner one forms the dural sac of the spinal cord.The hard shell is additionally reinforced with multiple bundles of connective tissue, which connect it to the posterior longitudinal ligament, and in the lower parts of the spine form a terminal thread (the terminal thread of the spinal cord), which is ultimately fixed on the coccyx periosteum. The hard shell has a different thickness in different areas, which ranges from 0.5 to 2 mm. It reliably protects the spinal cord from most external influences and extends from the foramen magnum to 2-3 sacral vertebrae, i.That is, it covers the entire length of the delicate spinal cord.

In addition, this shell has conical protrusions. They are designed to form a protective layer for the nerve roots extending at the level of all vertebrae, therefore, they exit with them into the intervertebral foramen.

The hard shell is delimited from the wall of the spinal canal by the epidural space. It contains fatty tissue, spinal nerves and numerous blood vessels responsible for the blood supply to the vertebrae and spinal cord.

The above-mentioned subdural space separates the hard and arachnoid membranes of the spinal cord. In fact, this is a narrow slit, saturated with thin bundles of connective tissue fibers. In this case, the subdural space dullly ends at the S2 level, but has free communication with a similar space inside the cranium.

The arachnoid is a delicate, transparent anatomical structure formed by multiple trabeculae (cords), which does not have a rigid fixation system with a hard spinal cord.They are connected to each other only at the intervertebral foramen.

The arachnoid membrane is separated from the soft by the subarachnoid (subarachnoid) space, in which the cerebrospinal fluid circulates, and connective tissue cords pass, uniting these membranes with each other. The subarachnoid space communicates with the IV ventricle of the brain, which ensures the continuity of the circulation of the cerebrospinal fluid.

The third sheath of the spinal cord is located in the immediate vicinity of it and has many blood vessels that supply blood to the spinal cord.It is connected to the arachnoid membrane by a significant number of connective tissue bundles.

Spinal roots

As already mentioned, the entire spinal cord is divided into segments. Moreover, it is shorter than the spinal canal, therefore, there is a discrepancy between the ordinal number of its segments and the positions of the vertebrae. Thus, the upper cervical segments fully correspond to the position of the vertebral bodies. The displacement of the numbering is observed already in the lower cervical and thoracic segments. They are located one vertebra higher than the corresponding vertebrae.In the central part of the thoracic spine, this difference increases by two vertebrae, and in the lower one – by 3. Therefore, it turns out that the lumbar segments of the spinal cord are at the level of the bodies of the 10th and 11th thoracic vertebrae, and the sacral and coccygeal vertebrae correspond to 12 thoracic and 1 lumbar vertebrae. But the spinal roots always exit through the intervertebral foramen at the level of the discs corresponding to the numbering.

From each spinal segment there is a pair of nerve roots: anterior and posterior.There are 31 couples in total. They originate from the lateral surface of the spinal cord and penetrate the dural sac, which forms a protective sheath for them. When leaving it, the spinal roots pass through the hard shell, which has special protrusions in the form of funnel-shaped pockets, designed specifically for them. As a result, the spinal roots can bend in a physiological manner, but there is no risk of wrinkling or stretching.

Each dural funnel-shaped pocket has 2 holes through which the anterior and posterior nerve roots pass.Moreover, they are delimited by parts of the hard and arachnoid shells. They are firmly adhered to the roots, so the leakage of cerebrospinal fluid outside the subarachnoid space is excluded.

The anterior and posterior roots are combined at the level of the intervertebral foramen, forming the spinal nerves. But the posterior one in the area of ​​the intervertebral foramen thickens, forming the so-called ganglion. The anterior and posterior roots join together immediately after the ganglion to form the spinal nerve.Each has several branches:

  • The back is responsible for the innervation of the deep muscles, the skin of the back and the back of the head.
  • Anterior – takes part in the formation of the cervical, brachial, lumbar and sacral plexuses. In this case, the anterior branches of the pectoral nerves form the intercostal nerves.
  • Meningeal – provides the transmission of bioelectric impulses to the dura mater of the spinal cord, as it returns to the spinal canal through the vertebral foramen.

Blood vessels

The blood supply to the spine is realized through sufficiently large arteries that pass either in the immediate vicinity of the vertebral bodies or along them. The arteries of the vertebral bodies of the cervical spine originate from the subclavian artery, the thoracic vertebrae are fed from the intercostal arteries, and the lumbar vertebrae from the lumbar. As a result, the spine is actively supplied with blood at all levels, and the pressure in the vessels is at rather high levels.But if the bone structures have a direct blood supply, then the intervertebral discs are deprived of this. Their nutrition is carried out through the diffusion of substances during the compression / straightening of the disc during physical activity.

The lumbar and intercostal arteries are located along the anterolateral surfaces of the vertebral bodies. In the area of ​​the natural intervertebral openings, the posterior branches branch off from them, which are responsible for feeding the soft tissues of the back and dorsal vertebrae. In turn, spinal branches depart from them, which go deeper into the spinal canal, where the blood vessels are again divided into 2 branches: anterior and posterior.The anterior branch is larger in size and is located transversely with respect to the anterior part of the vertebral body, and on the posterior surface it is combined with a similar vessel on the opposite side of the body. The posterior branch extends along the posterolateral surface of the spinal canal and connects to a similar artery on the opposite side.

Thus, the spinal arteries form an anastomotic network that covers the entire spinal canal and has transverse and longitudinal branches.Numerous vessels responsible for nutrition of the vertebral bodies and spinal cord are diverted from it. Arteries penetrate into the vertebral bodies near the midline, but they do not pass into the intervertebral discs.

The spinal cord has 3 blood supply basins:

  • Cervico-thoracic, where the first 4 segments are fed from the anterior spinal artery formed by the fusion of 2 vertebral arteries, the next 5 segments have absolutely independent nutrition, and the blood supply is realized by 2-4 large radicular-spinal arteries branching from the vertebral, ascending and deep cervical arteries.
  • The intermediate (middle) thoracic basin, including the T3-T8 segments, is fed exclusively from one single artery located at the 5th or 6th level of the thoracic root. Due to these features of the anatomy in this part of the spinal cord, there is a high risk of developing severe ischemic lesions.
  • Lower Thoracic and Lumbosacral Basin — Blood supply is provided by one large anterior radicular artery.

As for the venous system, the spine has 4 venous plexuses: 2 external, localized on the anterior surface of the vertebral bodies behind the arches, and 2 internal.The largest venous plexus is the anterior intravertebral plexus. Its large vertical trunks are interconnected by transverse branches. It is firmly fixed to the periosteum along the posterior surface of the vertebrae by a large number of bridges. The posterior venous intravertebral plexus can easily move, since it does not have strong connections with the vertebral bodies. But at the same time, all 4 venous plexuses of the spine are closely interconnected by numerous vessels that penetrate the vertebral bodies, as well as the yellow ligaments.In general, they form a single whole and extend from the base of the skull to the coccyx itself.

Venous blood is withdrawn through the system of the superior and inferior vena cava, into which it enters from the vertebral, intercostal, lumbar and sacral veins. All intervertebral veins exit through the corresponding openings of the spine. Moreover, they are firmly attached to the periosteum of the bony edges of the holes.

The spinal cord itself has 2 systems for the outflow of venous blood: anterior and posterior. In this case, the veins of the surface of the organ are united by a large anastomotic network.Therefore, if it is necessary to ligate one or more veins, the likelihood of developing spinal disorders is close to zero.

Age and gender characteristics of the spine

The length of the spinal column in newborns does not exceed 40% of the total height. But during the first 2 years of life, its length almost doubles. All this time, all parts of the spine are growing at high speed, but mainly in width. From 1.5 to 3 years, the growth rate decreases, especially in the cervical and upper thoracic regions.At about 3 years old, active growth of the lumbar and lower thoracic spine begins. From 5 to 10 years, a phase of smooth, uniform growth in all parameters begins, followed by a phase of active growth, lasting from 10 to 17 years. After this, the growth of the cervical and thoracic regions slows down, but the growth of the lumbar region accelerates. The whole process of development of the spinal column ends at 23-25 ​​years.

Thus, the average length of the spine in an adult man is 60-75 cm, while in a woman it is 60-65 cm.Over the years, degenerative changes occur in the intervertebral discs, they flatten and cease to fully cope with their functions, and the physiological bends increase. As a result, not only do various diseases arise, but also there is a decrease in the length of the spinal column in old age by about 5 cm or more.

Thoracic kyphosis and lumbar lordosis are more pronounced in women than in men.

Thus, the human spine has a complex structure, a dense network of nerves and blood vessels.This explains in many ways the complexity of surgical interventions on it and the possible risks. Therefore, today all efforts are aimed at finding the least invasive surgical techniques that involve minimal tissue trauma, which sharply reduces the likelihood of complications of varying severity.

What you need to know about the spine

The vertebrae are divided into divisions according to their structural and functional characteristics.

Spine:

In medical terminology, for brevity, the Latin letter “C” – C1 – C7 is used to designate the cervical vertebrae, “Th” – Th2 – Th22 to designate the thoracic vertebrae, the lumbar vertebrae are designated by the letter “L” – L1 – L5.

  • Cervical (7 vertebrae) This is the uppermost part of the spinal column. It is particularly mobile, which provides such a variety and freedom of movement of the head. The two upper cervical vertebrae with the beautiful names atlas and axis have an anatomical structure that is different from the structure of all other vertebrae. Thanks to the presence of these vertebrae, a person can make turns and tilts of the head. By the way, all mammals have 7 cervical vertebrae, even a giraffe.
  • Thoracic region (12 vertebrae) 12 pairs of ribs are attached to this region.The thoracic spine is involved in the formation of the posterior chest wall, which is the seat of vital organs. In this regard, the thoracic spine is inactive.
  • Lumbar region (5 vertebrae) This region consists of the most massive vertebrae, since they bear the greatest load. Some people have the sixth lumbar vertebra. Doctors call this phenomenon lumbarization. But in most cases, such an anomaly has no clinical significance.8-10 vertebrae grow together to form the sacrum and coccyx.
  • Sacrum (5 vertebrae)
  • Coccyx (4-5 vertebrae)

Osteochondrosis and disc herniation

More than half of the adult population suffers from back pain, often simply unbearable! There are many reasons for this: age problems, poor posture, injuries, etc. Separately, it is necessary to highlight osteochondrosis of the spine and herniated intervertebral discs. For those who have faced these problems, many questions arise: What to do? Do you need an operation? Where to go? Below we will try to answer them.

Osteochondrosis?

Synonyms – sciatica, salt deposition.
Between the bodies of two adjacent vertebrae there is an intervertebral disc that performs 3 functions: amortization, retention of adjacent vertebrae, and ensuring the mobility of the vertebral bodies. With osteochondrosis, the intervertebral disc loses its elasticity, becomes less durable, and therefore cannot perform its functions. Salts are deposited at the junction of the vertebrae, bone growths occur, which, together with the discs, can shift and squeeze the nerve roots.It causes pain.

The manifestations of osteochondrosis are herniated intervertebral discs . A hernia of the lumbar spine causes pain in the back, buttocks, sacrum, and can spread to the legs. If you have any of these symptoms, you need to have an examination that includes not only X-rays, but also magnetic resonance imaging (MRI). In determining the tactics of treatment, we rely on MRI data. If an MRI reveals a disc herniation, the patient is most often frightened by this “terrible” diagnosis – just not an operation! It must be said that good reasons are needed for lumbar disc herniation surgery.The patient makes the final decision after consulting a neurosurgeon – vertebrologist.

A herniated disc causes severe pain, even with light exertion, which interferes with living and working. If the patient wants to significantly improve the quality of his life, he will choose an operative treatment that will relieve him of this ailment forever.

Another question arises: Where to operate? What should you focus on when choosing a medical institution?

For a successful operation, in addition to the knowledge and skills of the surgeon, you need the appropriate equipment for the operating room (Electron-optical converter (EOP) – a special X-ray unit, a powerful operating microscope, a special set of microsurgical instruments).Operating rooms in our clinic meet all these requirements and are fully equipped with everything necessary for spinal surgery.

Question asked by people with active lifestyles: How many days will it take to stay in the hospital in case of surgery? Before surgery – 2 to 5 days. After surgery – up to two weeks. The patient gets up on the second day and is discharged after the removal of the stitches. He is offered a special rehabilitation program that will allow him to recover in the shortest possible time and return to an active lifestyle.

Spine injury

Spinal injuries are very common and extremely dangerous, as spinal injuries result in spinal cord injury, which can lead to paralysis. Injuries of the cervical spine are diverse: damage to the ligamentous apparatus, subluxation and dislocation of the vertebrae, their fractures. Many experts do not consider damage to the ligamentous apparatus serious, since they do not detect pathology on X-rays. The patient only has a sore neck.Therefore, they either put a soft collar on him, or let him go with parting words: in 2 weeks everything will pass! However, our experience shows that such damage must be taken seriously. Lack of treatment often leads to serious complications: pain increases significantly, and a herniated disc may occur.

Subluxation and dislocation of the vertebrae is a very serious problem. In this case, the spinal cord and its roots are affected to one degree or another. In this situation, active actions of the surgeon are required.The goal is to eliminate compression of the nerve structures (the spinal cord and its roots) and restore the correct anatomical relationship in the cervical spine between the bone and nerve structures (eliminate the dislocation). To restore the supporting function of the spine, during the operation, the dislocation is reduced, and then special plates are implanted to fix the unstable section.

Fractures of the cervical vertebrae

This is a common injury. Especially among athletes.In the event of a fracture of the cervical vertebrae, surgery is always required. You need to act as quickly as possible, since the spinal cord suffers, and this entails serious problems (loss of sensitivity and loss of motor function are possible).

Separately, it is necessary to highlight injuries of the upper cervical spine . These include damage to the first two vertebrae. They are different in structure from the rest and require a special approach to treatment. In order for the fragments to grow together correctly, a special device is used – the Halo apparatus, which allows the fragments to be fixed in the desired position.

Injury of the thoracic and lumbar spine

In contrast to the cervical region, in these regions, vertebral dislocations are not found in their pure form.

Fractures and dislocation fractures are distinguished.

Distinguish between stable and unstable fractures.

Bones and ligaments that provide mobility protect the spinal cord from injury. In the event that, due to a fracture, these structures no longer protect the spinal cord or nerve roots from damage or irritation under stress, the fracture is considered unstable.

Unstable fractures are subject to mandatory surgical treatment, while stable fractures can be treated conservatively.

Diagnostic methods

In our clinic, the diagnostic process includes the passage by the patient of modern examination methods – computed or magnetic resonance imaging. This allows you to identify pathology with high accuracy and determine the correct treatment tactics.

Treatment tactics

After all the necessary examinations, the treatment tactics are selected.

If conservative (non-surgical) treatment is possible, a corset is selected for the patient, primary rehabilitation is carried out (it is necessary to strengthen the muscles of the abdomen and back).

If a decision is made about an operation, the doctor determines the type of surgical treatment. You can read more about this in the section “For persons with medical education”.

Thanks to reliable and proven methods, the experience of surgeons, as well as modern technology, patients recover quickly.

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90,000 Cases from blogs related to the spine

This section describes the identification of diseases related to the spine. As practice shows, mri diagnostics of the spine in the early stages of the disease helps to significantly reduce the risk of developing diseases

08 JAN
MRI diagnosis of Schmorl’s cartilaginous nodes

Patient G., 24 years old, turned to a neurologist at the medical center with complaints of back pain between the shoulder blades.The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

MRI of the thoracic spine revealed: at the Th8-Th9 level in the adjacent endplates of the bodies of the same vertebrae, Schmorl’s cartilaginous nodes are determined.

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DEC 27
MRI diagnostics of posterior disc herniation C5-C6

Patient R. 40 years old applied to the medical center to a neurologist with complaints of pain in the cervical spine. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine revealed: At the C5-C6 level, under small postero-lateral marginal bone growths, a posterior herniated disc up to 3 mm in size is determined.

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26 NOV
MRI diagnostics of posterior disc protrusion L5-S1

Patient X. 25 years old applied to the medical center to a neurologist with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L5-S1 level with the presence of diffuse disc protrusion up to 2.5 mm in size at this level.

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23 NOV
MRI diagnostics of herniated disc

Patient E., 43 years old, turned to a neurologist at the medical center with complaints of pain in the neck with irradiation to the right arm. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine at the level of C5-C6 revealed a right-sided postero-lateral herniated disc, up to 3.5 mm in size. Also, at the level of C4-C5, diffuse protrusion of the intervertebral disc up to 2 mm in size is determined.

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14 NOV
MRI diagnostics of chronic cerebrovascular insufficiency

Patient X, 69 years old, consulted a neurologist at a medical center with complaints of headaches, periodic dizziness. In order to exclude focal brain lesions, the patient was referred for MRI.

MRI of the brain revealed that in the white matter of both hemispheres, subcoritical and periventricular, multiple foci of a vascular nature are determined.Diagnosis: chronic cerebral circulation insufficiency.

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07 NOV
MRI diagnostics of a tumor of the frontal lobe

We bring to your attention a clinical case of patient A., 66 years old, who, against the background of complete well-being, developed a generalized convulsive attack with loss of consciousness. The neurologist was referred for an MRI of the brain.

On MRI scans of the right frontal lobe, an extensive area of ​​edematous changes (tumor tissue?) Is determined, which extends to the knee of the corpus callosum, islet lobe, anteromedial parts of the right temporal lobe, and the area of ​​the basal nuclei.

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01 NOV
MRI diagnostics of right-sided postero-lateral herniated disc

Patient J., 40 years old, turned to a neurologist at the medical center with complaints of pain in the neck with irradiation to the right arm. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine at the level of C6-C7 revealed a right-sided posterior-lateral herniated disc, up to 3.5 mm in size.

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SEP 20
MRI diagnostics of the spine after a fall

Patient K.For 15 years, she turned to a neurologist at a medical center with complaints of pain in the thoracic spine after falling on her back. The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

MRI of the thoracic spine revealed that the structure and shape of the vertebral bodies were not changed. Zones of pathologically altered MR signal in the vertebral bodies were not identified.

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12 SEP
MRI diagnostics of posterior protrusion of the disc L4-L5

Patient N.At the age of 23 she turned to a neurologist at the medical center with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L4-L5 level with a diffuse protrusion of a 2.5 mm disc at this level.

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10 SEP
MRI diagnostics of posterior herniated discs

Patient R., 76 years old, turned to a neurologist at the medical center with complaints of pain in the neck, headaches.The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine revealed: widespread osteochondrosis at the C2-C7 level with a sharp decrease in the height of the intervertebral discs, the presence of anterior and posterior-lateral marginal bone growths of the vertebral bodies, as well as posterior hernias of intervertebral discs at the C3-C7 level up to 3, 5 mm.

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30 AUG
MRI diagnostics of asymmetry of the calibers of the vertebral arteries in a 43-year-old man

A 43-year-old man turned to a neurologist with complaints of recurrent headaches, and therefore was referred for an MRI angiography of the cerebral vessels.

On the obtained images of cerebral vessels in 3D-TOF mode, the asymmetry of the calibers of the vertebral arteries in the V4 segment is determined (the caliber of the PAP is less than the LA), which is most likely responsible for the clinical symptoms of the patient.

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17 AUG
MRI diagnostics of osteochondrosis

Patient N., 39 years old, turned to a neurologist at the medical center with complaints of back pain. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L3-L4, L4-L5 levels with a 3 mm posterior disc herniation at the L4-L5 level.

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10 AUG
MRI diagnostics of posterior disc herniation L5-S1

Patient R., 42 years old, turned to a neurologist at the medical center with complaints of lower back pain radiating to the left buttock. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the L4-L5, L5-S1 levels with a posterior (with slight lateralization to the left) disc herniation at the L4-L5 level, 3 mm in size.

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JUL 31
MRI diagnostics of posterior disc herniation L4 – L5

Patient Sh. 40 years old applied to the medical center to a neurologist with complaints of lower back pain radiating to the left buttock. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: MR signs of osteochondrosis at the level of L4-L5, L5-S1; posterior disc herniation at the level of L4-L5 up to 4 mm in size.

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July 17
MRI diagnostics of a hernia of the cervical spine at the level of C5-C6

Patient K., 28 years old, turned to a neurologist at the medical center with complaints of pain in the cervical spine, poor sleep. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine at the C5-C6 level revealed a posterior herniated disc.

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15 JUL
MRI diagnostics of a hernia of the cervical spine at the level of C6-C7

Patient T., 38 years old, turned to a neurologist at the medical center with complaints of pain in the neck region radiating to the right and left arms. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine at the C6-C7 level revealed a posterior herniated disc.

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11 JAN
MRI diagnostics of spondylolisthesis

We bring to your attention a clinical case of patient K., 38 years old, who, after an injury 8 months ago (pressed against the door in the metro), began to notice weakness in the legs, occasionally cases of urinary incontinence. At the same time, low-intensity pain in the lumbar spine does not often bother. I performed MRI of the lumbar spine on my own.

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20 DEC
MRI diagnostics of sequestered hernia of the lumbar spine

Patient M., 18 years after exercise and weight lifting, felt severe pain in the lumbar spine, spreading to the left leg. Referred by a neurologist for MRI of the lumbosacral region.

On MRI scans, sequestered left-sided posterolateral disc herniation L5-S1, spreading paramedianally, paraforamenally to the left up to 5 mm, caudally – up to 15 mm, compressing the left root is determined.

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07 DEC
MRI diagnosis of spinal syringomyelia

We bring to your attention a clinical case of patient M.30 years old, who for six months notes a decrease in strength and atrophy of the muscles of the right arm. The neuropathologist was referred for MRI of the cervical and thoracic spine.

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28 NOV
MRI diagnostics of a hernia of the cervical spine at the level of C4-C6

We bring to your attention a clinical case of patient D, 40 years old, who has been worried about pain in the cervical spine for several years. In addition, notes frequent headaches, dizziness and numbness of the fingers. Under the direction of a neurologist, she performed MRI of the cervical spine.

On MRI scans, the cervical lordosis is straightened with the formation of a small kyphotic deformity at the level of C4-C6 vertebrae.

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22 NOV
MRI diagnosis of stem stroke

We bring to your attention a clinical case of patient T., 57 years old, who suddenly developed staggering gait. A neurologist directed for an MRI of the brain. History of nephrectomy (removal of the kidney) for cancer.

MRI showed: against the background of signs of dyscirculatory encephalopathy in the anterior-basal parts of the left frontal lobe, a hematoma is determined, of a heterogeneous structure, surrounded by a small zone of edema.

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20 NOV
MRI diagnostics of hernia of the lumbar spine

We bring to your attention a clinical case of patient K, 45 years old, who has been suffering from pain in the lumbar region during physical exertion for 10 years. The pain radiates to the right leg. With the next exacerbation, she was treated at the place of residence for a month. Conservative treatment did not bring relief. For further examination and treatment, she was hospitalized in a hospital, where the patient underwent MRI of the lumbar spine.

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19 NOV
MRI diagnostics of sequestered herniated disc of the spine

We bring to your attention a clinical case of a 45-year-old patient E. Intense pain did not allow to straighten. The patient was admitted to a hospital where he underwent an MRI of the lumbar spine.

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11 OCT
MRI diagnosis of hypoplasia of the left vertebral artery

A 54-year-old man consulted a neurologist complaining of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

On the obtained images of cerebral vessels in 3D-TOF mode, hypoplasia of the left vertebral artery in the V4 segment is determined, which most likely determines the patient’s clinical symptoms.

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03 OCT
MRI diagnosis of Arnold-Chiari I anomaly

We bring to your attention a clinical case of a patient K., 15 years old, who came to see a neurologist with complaints of hand numbness. In addition, he noted periodic headaches in the occiput, aggravated by coughing and bending down.To clarify the nature of the changes, an MRI scan of the cervical spine was performed.

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11 SEP
MRI diagnosis of pancreatic tumor

Patient H., 22 years old, consulted a gastroenterologist for recurrent dyspeptic disorders (nausea, belching). Ultrasound revealed a cystic formation of the pancreas. To clarify the nature of the changes and the prevalence of the process, it was directed to the MRI of the abdominal cavity

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29 AUG
MRI diagnostics of brainstem cavernoma

We bring to your attention a clinical case of a 60-year-old patient K.There was facial asymmetry, impaired swallowing and speech. An ambulance team took the patient to the hospital, where an emergency MRI scan was performed.

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20 AUG
MRI diagnostics of the asymmetry of the vertebral arteries

A 52-year-old man consulted a neurologist complaining of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

On the obtained images of cerebral vessels in 3D-TOF mode, the asymmetry of the calibers of the vertebral arteries in the V4 segment is determined (the caliber of the PAP is less than the LA), which is most likely responsible for the clinical symptoms of the patient.

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07 AUG
MRI diagnostics of a perineural cyst

Patient L., 42 years old, turned to a neurologist at the medical center with complaints of lower back pain radiating to the right and left legs. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: in the spinal canal at the S2-S3 level, a large perineural cyst measuring 3.4×29 cm is determined.

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03 AUG
MRI diagnostics of sequestered disc herniation L5-S1

Patient Sh.45 years old applied to the medical center to a neurologist with complaints of lower back pain radiating to the right leg. The patient was referred for MRI of the lumbosacral spine at the CMR in order to clarify the diagnosis.

MRI of the lumbosacral spine revealed: at the L5-S1 level under the postero-lateral marginal bone growths, a posterior sequestered herniated disc is determined. The dimensions of the sequestration are 1.8×0.6 cm.

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02 AUG
MRI diagnosis of hypoplasia of the left vertebral artery in a 54-year-old man

A 54-year-old man consulted a neurologist complaining of daily headaches in the afternoon, and therefore was referred for an MRI angiography of the cerebral vessels.

On the obtained images of cerebral vessels in 3D-TOF mode, hypoplasia of the left vertebral artery in the V4 segment is determined, which most likely determines the patient’s clinical symptoms.

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23 JUL
MRI diagnosis of Schmorl’s hernia in the thoracic spine

Patient Sh. 35 years old applied to the medical center to a neurologist with complaints of pain in the lower thoracic spine. The patient was referred for MRI of the thoracic spine at the CMR in order to clarify the diagnosis.

MRI of the thoracic spine revealed: multiple Schmorl’s cartilaginous nodes are determined in the adjacent endplates of the vertebral bodies in the Th9-Th22 vertebral bodies in the adjacent endplates of the vertebral bodies. The intensity of the MR signal from the vertebral bodies is not changed.

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14 JUL
MRI diagnosis of median hernia

Patient J., 30 years old, turned to a neurologist at the medical center with complaints of a feeling of stiffness in the cervical spine, as well as pain. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI examination of the cervical spine revealed: At the C4-C5 level, under the small postero-lateral marginal bone growths, a median herniated disc up to 3 mm in size is determined.

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03 JUL
MRI diagnostics of the thoracic spine after a fall

Patient I., 36 years old, turned to a traumatologist at the medical center with complaints of back pain. From the anamnesis it is known that 3 days before going to the doctor, the patient fell on her back while snowboarding.In order to exclude the presence of bone-traumatic changes, she was sent for MRI of the thoracic spine.

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28 JUN
MRI diagnostics of the lack of visualization of the right vertebral artery

Patient P, 62 years old, was admitted to the Federal State Budgetary Institution FTSSKE named after V.A. Almazov of the Ministry of Health and Social Development of the Russian Federation “for planned heart surgery. Before the operation, anesthesiologists recommended performing an MRI scan of the cerebral vessels in order to assess their condition before applying general anesthesia in order to avoid complications of ischemic origin.

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27 JUN
MRI diagnostics of cavernous hemangioma of the spinal cord

We present to your attention a clinical case of patient P., 23 years old, who, against the background of complete well-being, developed numbness of the lower extremities. Lower paraparesis (paralysis of the lower limbs) developed within two weeks. Hospitalized in a neurological clinic. To clarify the nature of pathological changes, MRI of the spine was performed.

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18 JUN
MRI diagnostics of metastatic bone lesions

A clinical case of patient K.75 years old who was diagnosed with prostate cancer (stage III). Two months ago, the patient began to worry about weakness in the legs, pain in the lumbar spine. Computed tomography of the lumbar spine was performed, signs of pronounced degenerative changes in the lumbar spine were revealed. With the diagnosis, osteochondrosis was treated by a neurologist at the place of residence, with little effect (lower back pain became less, but weakness in the legs remained). Two weeks ago, the weakness in the legs became significant, he stopped walking on his own.To clarify the diagnosis, an MRI scan of the lumbar spine was performed.

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10 JUNE
MRI diagnostics of a hernia of the cervical spine

Patient M., 36 years old, turned to a neurologist at the medical center with complaints of pain in the neck, poor sleep. The patient was referred for MRI of the cervical spine at the CMR in order to clarify the diagnosis.

MRI of the cervical spine at the level of C5-C6, C6-C7 revealed posterior herniated discs.

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23 MAY
MRI diagnosis of spinal cord arteriovenous malformation

A clinical case of patient B.40 years. A month ago, the patient began to complain of general weakness, chills, intense pain in the lower abdomen, complete immobility of the lower extremities. Symptoms of peritoneal irritation were added. For dynamic surgical observation, exclusion of acute paralytic intestinal obstruction, mesenteric thrombosis, according to urgent indications, he was hospitalized in a surgical hospital. To clarify the diagnosis, MRI of the lumbar spine was performed.

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23 MAY
MRI diagnosis of neuroma at the level of L4-L5 vertebrae

We present to your attention a clinical case of patient A.44 years old. For six months, the patient has been disturbed by recurrent pain in the lumbar spine, in the left thigh, in the knee and ankle joints, and increasing weakness in the left foot. In order to clarify the diagnosis, she was referred by a neurologist for an MRI of the lumbar spine.

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23 MAY
MRI diagnostics of the formation of the spinal canal at the level of 7-8 thoracic vertebrae

We present to your attention a clinical case of a patient T., 80 years old, who considers herself ill for seven years, when she began to notice pain and burning sensation in the lower extremities.She did not seek medical help. In recent months, there has been an increase in the described complaints, the appearance of pain in the lower thoracic spine, radiating to the left arm. I performed MRI on my own.

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06 MAY
MRI diagnostics of sacroiliitis

A 12-year-old child with complaints of back pain underwent X-ray and subsequent MRI of the sacroiliac joints. On postcontrast images in T1 mode with a fat suppression program, a hyperintense MR signal is detected in the left sacroiliac joint along the slit of the sacroiliac joint against the background of unossified cartilage of the articulating surfaces.In addition, there are areas of hyperintense MR signal in the area of ​​the iliac cartilage and a site of trabecular edema of the ilium with a normal X-ray picture.

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19 APR
MRI diagnostics of herniated intervertebral disc

Patient K. A 43-year-old man consulted an osteopath with complaints of back pain, sharply increasing with movement. Based on the results of the examination, the patient was diagnosed with a herniated disc at the L4-L5 level and surgical treatment was recommended.The patient decided to undergo another consultation with his district neurologist. The neurologist confirmed the diagnosis of a disc herniation, but recommended to undergo an MRI of the lumbosacral spine to resolve the issue of further treatment tactics.

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90,000 Spinal displacement – treatment of a displaced spine in the clinic on Paliha

Displacement of the vertebrae, or spondylolisthesis, is the displacement of one vertebra relative to another, more often l5 relative to s1 or l4 relative to L5.

POSSIBLE CAUSES

Decreased strength of the subchondral bone plate with progressive development of microfractures.

Degenerative changes in the ligaments and joints of the spine, muscle weakness and obesity.

There is a congenital anomaly of the lumbosacral spine, microtrauma, trauma (hyperextension), hereditary predisposition.

DISEASE MANIFESTATIONS

The clinical picture is manifested by pain in the lumbar and lumbosacral regions, which occur voluntarily.They can often get worse when the patient is sitting, standing or walking for a long time. The pain can radiate to the limb and manifest itself as lumboischialgia – with tension or compression of the roots of the spinal cord. These symptoms can be both unilateral and bilateral. The displacement of the cervical vertebrae is accompanied by pain, which is caused and intensified by turning the neck.

If there is a displacement of the vertebrae, treatment is necessary, since the pain will not go away by itself. In the clinical picture, the symptoms of root lesion due to excessive pressure predominate at first.Then signs of compression of the cauda equina are added, which is manifested by neurogenic intermittent claudication, i.e. when the patient walks, pain increases. In order for it to pass, the patient must stop and rest.

Also, pinching of the vertebrae and compression of the nerve roots is manifested by shooting pains that radiate to the legs. Muscle weakness, paralysis, decreased sensitivity, muscle wasting or atrophy, both in the lumbar region and in the extremities, may appear.Tendon reflexes decrease or fall out. Stretching symptoms are positive: Lassegh and Wasserman. The severity of neurological symptoms depends on the degree of displacement of the vertebrae in the patient.

DIAGNOSTICS OF SPONDYLOLYSTESIS

Examination for spondylolisthesis is performed using technical imaging equipment, since it is impossible to determine the displacement, as they say, “by eye”. An obligatory method is X-ray of the spine in frontal and lateral projections. Computed tomography visualizes the area of ​​displacement of the vertebrae and their structure more informatively.

IT IS ACCEPTED TO SEPARATE THE DEGREE OF LYSTESIS DEPENDING ON THE EXPRESSION OF SLIDING THE VERINE:

1 degree limited to 25% offset.

2nd degree – up to 50%.

3 degree – up to 75% (risk of surgery).

4th degree – 100% offset.

90,000 CT or MRI of the spine – which is more effective?

MRI is one of the most effective methods of radiation diagnostics, which is used to examine almost any organs and tissues.Depending on the objectives of the study, the patient has the opportunity to undergo not only an MRI of the spine in which the problem was identified, but also a complex MRI of several parts of the spine, including in conjunction with an MRI of the brain, vessels, and joints.

MRI of the cervical spine (SHOP)

MRI SHOP displays the state of seven cervical vertebrae, intervertebral discs, epidural cellular spaces, subarachnoid space, spinal cord, paravertebral soft tissues.

Often, problems with the cervical spine can be manifested not only by pain in the arm or shoulder joint, but also by impaired sensitivity, numbness of the fingers, weakness in the hand. In addition, with the most common disease of this department – cervical osteochondrosis – due to a transient violation of the arterial blood supply to the brain, headaches, dizziness, fainting, ringing and pulsation in the ears, hearing impairment, visual disturbances may appear.

MRI of the cervical spine is prescribed for osteochondrosis, trauma, rheumatoid arthritis, multiple sclerosis, suspected spinal cord tumor, inflammatory diseases, ALS syndrome (motor neuron disease), etc.d.

MRI of the thoracic spine (GOP)

MRI GOP is indicated for mechanical injuries (bruises, falls, fractures, etc.), multiple sclerosis, intervertebral hernias, intercostal neuralgia, pain in the heart, inflammatory diseases (spondylitis of various etiologies), ankylosing spondylitis.

MRI of the thoracic region is often performed for shingles or unilateral pain of varying intensity associated with movement, in which the muscles of the back are tense; less often there may be weakness in the legs, numbness of the lower extremities, impaired urination and defecation.

MR imaging with high accuracy reveals the causes of such versatile clinical manifestations, which ensures effective treatment in the future.

MRI of the lumbosacral spine (LSP)

This part of the spine is experiencing the greatest stress, and therefore it is primarily susceptible to degenerative-dystrophic diseases, the most common of which is osteochondrosis.

The main complaints of patients are a feeling of heaviness, discomfort and varying intensity of pain syndrome associated with movement (tilt, turn), physical activity, with irradiation along the back, outer surface of the thigh, less often the lower leg, numbness of the toes.It is necessary to identify the causes of such sensations in order to avoid serious complications in the future.

In this regard, MRI of the lumbosacral region is recommended to be performed regularly, especially for people over 30 years of age. This is primarily true for those who are engaged in manual labor or are overweight.

This type of diagnosis allows assessing the condition of five lumbar and two sacral vertebrae, distal spinal cord and its roots, intervertebral discs, dural sac, epidural space and paravertebral soft tissues.MRI detects displacement of the vertebrae, wear of intervertebral discs, intervertebral hernias, stenosis of the spinal canal, inflammatory diseases and other diseases. MRI is especially important in the diagnosis of tumors of the spinal canal, vertebral bodies and paravertebral soft tissues, even at the earliest stage of the disease.

MRI coccyx

This method allows visualizing the bone marrow of the bodies of the sacral and all coccygeal vertebrae and revealing pathological changes in it.On MRI tomograms of the coccyx, the sacral canal, presacral tissue and paravertebral soft tissues are clearly visible.

MRI of the coccyx is prescribed for suspected fracture, tumor, epithelial coccygeal cyst.

The ability to detect pathological changes in the area under study at the earliest stages is one of the main advantages of MRI of the spine, which is why it is so important to undergo an examination in a timely manner.

Read also “CT or MRI of the spine: which is more effective?”

90,000 Treatment of spondyloarthrosis of the lumbosacral spine in Moscow at the Dikul clinic: prices, appointments

Spondyloarthrosis (osteoarthritis) is a common pathology of the lumbar spine.Spondyloarthrosis of the lumbosacral spine is more common in older people, but it can also develop in people doing hard physical work, who are obese, or anyone who has had a previous spinal injury.

Osteoarthritis of the lumbar spine develops in the joints that connect the segments of the spine. Each vertebra is connected to another vertebra at three locations. In front of the spinal cord, the vertebrae are separated by a spinal disc.Behind the spinal cord, the vertebrae are connected by two small joints called facet joints. These joints, together with the intervertebral disc, allow the spine to move and perform movements such as tilting and extending or rotating the back.

Treatment of spondyloarthrosis of the lumbosacral spine can be both conservative and operative, and the choice of treatment tactics depends mainly on the clinical picture.

Reasons

Common causes of osteoarthritis of the facet joints of the lumbar spine are as follows:

  • Degenerative changes in the joints and wear and tear of the joints over time.
  • Degeneration of the disc can lead to a decrease in the distance between the vertebrae, which will increase the stress on the facet joints, accelerating the wear of these joints.
  • Backward movements of the trunk (extensions) can place pressure on the facet joints, which can lead to degenerative changes.
  • A sudden fall or injury, such as a car accident, can damage the facet joints, increasing and accelerating wear and tear on the joints.
  • Genetic factors may influence the likelihood of developing degenerative joint disease.
  • Repetitive stress injuries, such as lifting or carrying heavy objects, can irritate joints and develop degeneration.

Symptoms

Symptoms of spondyloarthrosis of the lumbar spine will depend on which motor segment is most damaged and the degree of impact on nearby nerve structures.

Symptoms can range from mild to severe and can mimic those of disc pathology:

  • Back pain or radicular pain radiating to the buttock, leg and extending down behind the knee, less often to the front of the leg or foot.
  • Pain and tenderness are localized at the level of the facet joint involved in the pathological process.
  • Muscle spasm and forced changes in posture.
  • Loss of movement, such as inability to extend, bend the trunk to the side, or maintain an upright position for extended periods of time.
  • There may be violations of walking and standing with a pronounced pathological process
  • Sitting is generally more comfortable.
  • Change in normal lumbar curvature or lordosis.
  • Development of stenosis-like symptoms.
  • Joint stiffness after a period of rest.
  • Pain after overactivity and pain relief after rest.
  • There may be some swelling at the level of abnormal facet joints.
  • Muscle weakness in the lower extremities or symptoms of cauda equina syndrome with the development of spinal stenosis

Diagnostics

A patient who has had back pain or stiffness for more than two weeks should see a doctor for a physical examination.

Case history

The physician should evaluate the patient’s medical history, examine the symptoms, pain characteristics and joint function, how and when symptoms began, and how they have changed over time.

The doctor also needs to find out the presence of comorbidity, previous treatment, family history and bad habits (for example, alcohol consumption, smoking, etc.),

Physical examination. The physician will need to perform a physical exam to assess the patient’s general health, muscle and bone health, nerve conduction, reflexes, and joint mobility in the spine.

The clinician also needs information on muscle strength, flexibility, and the patient’s ability to perform daily activities such as walking, bending and standing up.

The patient may need to perform some movements before the clinician can understand the range of motion and determine which movements are aggravating the symptoms.

Instrumental diagnostic methods

X-ray – The doctor may order an X-ray to see if there is an injury to the joints of the spine and how extensive it is.X-rays can show cartilage loss, bone changes, and the location of possible bone growths (osteophytes).

Additional diagnostic methods that may be required to rule out other causes of pain or confirm the presence of spondyloarthrosis:

PET. A bone scan is used to check for inflammation, cancer, infection, or a small fracture.

CT scan can be performed to more accurately measure the degree of narrowing of the spinal canal and morphological changes in the surrounding structures.

MRI. Magnetic resonance imaging is a method that can give a very detailed morphological picture of the spinal cord, nerve roots, intervertebral discs, ligaments and surrounding tissues.

Treatment

Treatment of spondyloarthrosis of the lumbosacral spine is aimed at both reducing symptoms and stopping the progression of pathological processes in the joints or bones.

Most doctors take a conservative approach at the initial stage of treatment, and only then invasive options are considered, but only if the symptoms do not respond to conservative therapy or serious neurological signs appear.

Some of the most common treatments for spondyloarthrosis of the lumbar spine:

  • Physical therapy (exercise therapy) is used to strengthen the muscles of the lumbar spine. Stronger muscles support the spine better and thus less stress on the facet joints.
  • Weight loss improves symptoms simply by reducing stress on the lumbar spine. While weight loss can be difficult for some patients, low-impact exercise (such as swimming) combined with a low-calorie diet often produces the results needed to relieve pain.
  • Drug treatment . Anti-inflammatory drugs can reduce swelling and inflammation in the facet joint area. While over-the-counter medications such as Aleve (naproxen) or Advil (ibuprofen) can often provide sufficient symptom relief, sometimes stronger prescription medications such as Voltaren (diclofenac) and Arthrotec (diclofenac / misoprostol) are required.
  • Cold and heat applications may also be effective in relieving pain in the lumbar spine.Heat can help “loosen” the spine before physical activity, while ice is best used after activity to reduce inflammation.
  • Manual therapy . Manipulation is widely used to treat diseases of the spine. Although manual therapy does not allow to restore the full range of motion in the motor segments of the spine and restore the structure of the spine, nevertheless, manipulations can reduce pain manifestations and improve mobility.
  • Epidural injections include: injection of a steroid (cortisone or analogs) into the area of ​​the pinched nerve. Cortisone can act on the immune system, thereby reducing localized inflammation and radicular pain.

Additional treatments include acupuncture , massage, magnetic therapy , naturopathic remedies and other direct or indirect forms of posterior ones. While the scientific evidence to support these alternative therapies is largely lacking, most have few side effects and are reasonable options when used in conjunction with standard medical treatments.

Complications of spondyloarthrosis of the lumbosacral spine

Osteoarthritis rarely causes severe neurological dysfunction due to compression of neural structures.

However, over time, degenerative changes can cause spinal stenosis, which means that narrowing of the spinal canal can cause compression of the spinal cord and nerve roots.

Spinal stenosis can be a complication of spondyloarthrosis.

Cauda equina syndrome, a disorder caused by compression of nerves in the lower spinal cord by tissue overgrowth or intervertebral discs, is a rare complication of osteoarthritis that can cause serious neurological problems.

Surgical treatment

In the case of severe spondyloarthrosis that cannot be treated conservatively, surgery may be indicated.

Typically, surgery is considered if the patient experiences any of the following symptoms:

  • Increased radicular pain
  • Increased pain or irritation of nerves
  • Associated damage to discs
  • If degenerative changes in the facet joints lead to compression of the nerve roots, then radicular syndrome occurs.This causes radicular pain, weakness, and stenosis-like symptoms. In this case, surgery may be indicated to release the nerve root and remove excess degenerative tissue growth that puts pressure on the root. One such procedure is called a foraminotomy. In addition, an operation such as fusion of the vertebrae (fusion) is used
  • Vertebral fusion is a surgical procedure used to eliminate movement between adjacent vertebrae.When all other treatments fail to provide relief, spinal fusion may be a viable option for treating severe spondyloarthrosis.

Self-Help

  • Self-medication is important for pain caused by spondyloarthrosis because pain may increase or decrease over several days.
  • Experts have found that, even when pain is present, prolonged bedding is undesirable. Therefore, it is recommended to continue with normal physical activity.
  • However, anything that could aggravate the condition should be avoided, such as lifting heavy loads.
  • Some people benefit from applying heat or ice to treat back pain.
  • Sleeping with a pillow between your legs may be helpful for lower back pain. An orthopedic mattress can also provide good support.

Forecast

  • The prognosis for most cases of lumbar spondyloarthrosis is good.
  • Many people with spondyloarthrosis do not have any symptoms.
  • Most cases respond well to conservative treatment within a couple of weeks.
  • However, symptoms may recur later.
  • In about 1 in 10 people, a person may develop persistent chronic pain.