Curs 3. Dezvoltarea Coloanei Vertebrale

7/26/2019 Curs 3. Dezvoltarea Coloanei Vertebrale

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Gr. T. Popa University of Medicine and Pharmacy Iai, RomaniaAnatomy Department

Dezvoltarea

coloanei

vertebrale


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Pan! c!rs!!i

1. Coloana vertebral generaliti

2. Dezvoltarea coloanei vertebrale

3. Dezvoltarea coastelor i sternului4. Curburile coloanei vertebrale

5. Conformaia extern a coloanei vertebrale

. !m"ortana funcional a coloanei vertebrale#. Corelaii clinice


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Introd!ction$ %&e vertebral column is com"ose' of alternating vertebrae an'

intervertebral 'iscs su""orte' b( robust s"inal ligaments an'muscles. )ll of t&ese elements* bon(* cartilaginous* ligamentous* an'

muscular* are essential to t&e structural integrit( of t&e s"ine.$ %&e s"ine serves t&ree vital functions+

"rotecting t&e s"inal cor' an' s"inal nerves* transmitting t&e ,eig&t of t&e bo'(* "rovi'ing a flexible axis for movements of t&e &ea' an' t&e torso.

$ %&e vertebral column is ca"able of extension* flexion* lateral flexion

-si'e to si'e* an' rotation. /o,ever* t&e 'egree to ,&ic& t&e s"ine isca"able of t&ese movements varies b( region. %&ese regions*inclu'ing t&e cervical* t&e t&oracic* t&e lumbar* an' t&esacrococc(geal s"ine* form four curvatures

$ %&e t&oracic an' t&e sacrococc(geal curvatures are establis&e'$ in fetal 'evelo"ment* ,&ile t&e cervical an' t&e t&oracic curvatures

'evelo" 'uring infanc(. %&e cervical curvature arises in res"onse to&ol'ing t&e &ea' u"rig&t* ,&ile t&e lumbar curvature 'evelo"s as aninfant begins to sit u"rig&t an' ,al0.


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Introd!ction

Dimensi!ni

$ "!n#imea n me'ie 'e #3 cm labrbat i 3 cm la femeie*re"rezentn' 4 'in lungimea

total a cor"ului.$ "$%imea ma&im$ la baza sacruluimsoar 11 cm.

$ Diametr! sa#ita ma&im lanivelul ultimelor vertebre lombare

atinge # cm.


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$ %&e origins of t&e vertebral column* s"inal musculature* an' associate'

ten'ons are t,o ro's of "araxial meso'erm t&at fill in t&e s"ace on eit&ersi'e of t&e neural tube at t&e time of gastrulation.$ 6eginning at 2 'a(s post coitus, paraxial mesoderm un'ergoes

segmentation in a rostral to cau'al 'irection to form 4244 "airs of somites*,&ic& can be sub'ivi'e' into 4 occi"ital* 7 cervical* 12 t&oracic* 5 lumbar* 5

sacral* an' 71 cocc(geal somites.

'ormarea cooanei verte(rae


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$ %&e first occi"ital an' t&e last 5# cocc(geal somites 'isa""ear 'uring embr(onic'evelo"ment. 8ac& somite ,ill 'ifferentiate into four cell lineages"ecific com"artments

t&at contribute to t&e vertebral column an' associate' musculature+ sclerotome -vertebraean' ribs* s(n'etome -ten'ons* m(otome -s0eletal muscle* an' 'ermom(otome -'ermisan' s0eletal muscle "rogenitor cells.

$ 9omite formation can best be 'escribe' as a continuous segmentation of mesenc&(malcells from t&e rostral en' of t&e "araxial meso'erm or t&e "resomitic meso'erm -:9;t&at la(s 'o,n t&e embr(onic cells t&at ,ill give rise to t&e axial s0eleton.

$ !ntrinsic to t&is "rocess is -1 an oscillating cloc0 controlling t&e timing of somitogenesis* -2 t&e formation of intersomitic boun'aries* -3 mesenc&(mal to e"it&elial transition -;8%* -4 "ositional i'entit( -e.g.* rostral


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:uin tim" 'u" formarea lor* fiecaresomit$se m"arte n scerotom* miotomi

dermatom.An cursul 94* celulele sclerotoamelornconBoar m'uva s"inrii ct i notocor'ul"rin creterea 'ifereniat a structurilora'iacente i nu "rin migrare activ+

$por%i!nea ventra$ a sclerotoamelornconBoar notocor'ul i formeazprimordi! corp!!i verte(ra$por%i!nea dorsa$ a sclerotoamelornconBoar tubul neural i formeazprimordi! arc!!i verte(ra.

)mbele "rocese sunt controlate 'es!(stan%e ind!ctorii prod!se denotochord -con'roitin sulfat i res"ectiv*'e t!(! ne!ra.



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%&e sclerotome cells from t,o a'Bacent somites migrate to,ar' t&e 'evelo"ing s"inal cor'* surroun' it* an''ifferentiate into a vertebra. %&at "art of an embr(onic vertebra ventral to t&e s"inal cor' is calle' t&e centr!m.As each centr!m forms, it enveops and 'estro(s t&e notoc&or' -a meso'ermal ro' l(ing ventral to t&e neuraltube an' "la(ing an im"ortant role in its in'uction. 6et,een a'Bacent centra* notoc&or'al tissue "ersists as "artof t&e intervertebral 'isc.)ttac&e' to eac& vertebral centrum is an arc& of s0eletal tissue t&at surroun's t&e 'evelo"ing s"inal cor' an'its coverings. %&is is calle' t&e ne!ra arch, and the space occ!pied (y the spina cord is calle' t&e verte(raforamen. At (irth the centr!m and ne!ra arch are ar#ey ossified, (!t cartilage still "ersists bet,een t&ebase of t&e neural arc& an' t&e centrum on eac& si'e. !n earl( c&il'&oo' t&is socalle' ne!rocentrasynchondrosis is (rid#ed (y (one to form the osseo!s verte(ra.>&at ,e call t&e (ody of a verte(ra comprises its centr!m and the (ases of its ne!ra arch.

%&e remain'er of t&e neural arc& is calle' t&e verte(ra arch . Up to the time of p!(erty, t&e osseousvertebral bo'( is covere' on bot& its su"erior an' inferior surfaces b( a "late of cartilage.)fter "ubert(* t&e margin of eac& cartilaginous "late ossifies to form t&e ringli0e su"erior an' inferior e"i"&(sesof t&e vertebral bo'(. %&ese e"i"&(ses fuse ,it& t&e rest of t&e bo'( sometime in ones earl( t,enties.



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)chematic of somitedifferentiation


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:e "arcursul migrrii sclerotoamelor s"re notocor' i tubul neural* acestea se 'ivi' ntro

*!m$tate crania$i una ca!da$.

umtatea ca!da$ a fiecrui sclerotom fuzioneaz cu Bumtatea crania$ asclerotomului succesiv.

Eertebra rezultat se 'is"une interse#mentar-ntre nivelurile 'e emergen ale nervilor

s"inali* ce "rezint 'ezvoltare segmentar.

+orp! verte(ra


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8xist # vertebre cervicale 'erivate 'in 7somite cervicale 'eoarece+

$Bumtatea cranial a "rimuluisclerotom cervical fuzioneaz cu

Bumtatea cau'al a celui 'e al"atrulea sclerotom occi"ital icontribuie la formarea bazei craniului.$Bumtatea cau'al a "rimuluisclerotom cervical fuzioneaz cuBumtatea cranial a celui 'e al 'oileasclerotom cervical* formn' "rimavertebr cervical.

FFFFFFFFFF.$al o"tulea sclerotom contribuie laformarea celei 'e a a"tea vertebrecervicale -Bumtatea cranial i "rimeivertebre toracice -Bumtatea cau'al.$"rimul nerv s"inal "rsete canalulra&i'ian ntre baza craniului i "rimavertebr cervical* iar al o"tulea nervs"inal "rsete canalul ra&i'ian

'easu"ra "rimei vertebre toracice.


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$ Ca rezultat al resegmentrii sclerotomale*nervii s"inali segmentari "rsesc m'uva

s"inrii ntre vertebre.$ ervii rahidieni-s"inali "streaz "oziia

lor segmentar "rimar* formn'use lanivelul 'iscurilor intervertebraleG ieirea lor'in canalul ra&i'ian se face "rin gurile

intervertebrale sau inter"e'unculare.$ Du" sta'iul precartia#inos* ns"tmna a #a nce"e condrificarea"rin 'oi centri care a"ar n cor"ul vertebreii "rin cte unul n fiecare Bumtate aarcului vertebral* care se formeaz

nconBurn' tubul neural.$ Cei "atru centri alctuiesc verte(ra

cartia#inoas$* care n s"tmna a Hai nce"e osificarea.


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Discurile intervetebrale se formeaz ntre cor"ii

vertebrali* la nivelurile segmentare 'intre celulelemezenc&imale localizate ntre "rile cefalic i cau'alale segmentelor sclerotomale originale.

Dei notocor'ul regreseaz n regiunea cor"ilorvertebrali* "ersist i se lrgete n regiunea 'iscurilorintervetebrale* formn' n!ce! p!pos.

?ibrele circulare cu originea n celulele sclerotoaleformeaz ine! fi(ros.=ucleul "ul"os este -"robabil nlocuit 'e celulele 'e

origine sclerotomal.

Disc! interverte(ra


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De-votarea coasteor i a stern!!i

$ Coastele se 'ezvolt 'in "roceselecostale ae vertebrelor toracice* 'in"oriunea sclerotomial amezo'ermului "araaxial.

$ 9ternul se 'ezvolt in'e"en'ent* nmezo'ermul somatic al "ereteluiventral al cor"ului.

$ Cele 2 benzi sternale se 'ezvolt "e"rile laterale ale liniei me'iosagitale*

fuzioneaz ulterior "entru a formamanubriul sternal* sternebrele i"rocesul xifoi'.


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1 "artie fixe+ sacrum et cocc(x1 "artie mobile+

# cervicales 12 t&oraciIues

5 lombaires

3 courbures cervicale en lor'ose 'orsale en c("&ose lombaire en lor'ose

!ntJrKt+ augmentation 'e larJsistance L la com"ressionselon la loi 'e 8MN8OGle colonne est 'ix fois "lusrJsistante L la com"ressionIuPune colonne rectiligne


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+!r(!rie cooanei verte(raeColoana vertebral nu este rectilinie* ci "rezint 'ou feluri 'e curburi +$ n "lan sagital$ n "lan frontal. Curburile n plan sagital (antero-posterior) orientate fie cu convexitatea anterior* numite

lordoze,fie cu convexitatea "osterior* numite cifoze.Coloana vertebral "rezint 4 curburi +$ curbura cervica$cu convexitatea nainte-lor'oza$ curbura toraca$cu convexitatea na"oi-cifoza$ curbura om(ar$cu convexitatea nainte -lor'oza

$ curbura sacrococci#ian$cu convexitatea na"oi -cifozaAn tim"ul vieii intrauterine coloana vertebral "rezint o singur curbur cu convexitatea "osterior$ Na nou-nscut coloana vertebral "rezint un ung&i lombosacral ce se"ar cifoza

cervicotoracal 'e cea sacrococcigian.$ Nor'oza cervical a"are n lunile 35 i este rezultatul ri'icrii ca"ului 'e ctre sugar.$ Nor'oza lombar a"are n Burul vrstei 'e 2 ani i se 'atoreaz staiunii verticale i locomoiei.+!r(!rie sa#itae s!nt do(/ndite 0n c!rs! vie%ii.


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1. Curburile n plan frontal (transversal)

$ 9unt mai "uin "ronunate ca cele n "lansagital.

$ An mo' obinuit ntlnim+ curbura cervical cu convexitatea la

stngaG curbura toracalcu convexitatea la 'rea"ta curbura lombarcu convexitatea la stnga.

$ Curbura toracal este "rimar* fiin' 'eterminat'e traciunea muc&ilor mai 'ezvoltai la

membrul su"erior 're"tG celelalte 'ou curburisunt com"ensatorii* avn' sco"ul 'e a restabiliec&ilibrul cor"oral.

$ Na stngaci* curburile frontale sunt n're"tate nsens invers.

M t f th t (


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Movements of the verte(ra co!mn$ %&e series of vertebral bo'ies* intervertebral 'iscs* an' vertebral arc&es+

form a mobile ro' t&at also "rotects t&e s"inal cor'. s&oul' be able voluntaril( to "ro'uce motion of t&e column*

t&ere must be mec&anisms to restrict excessive movements of an( one vertebra u"on anot&er.$ 2o!ntary motion is ac&ieve' b( &aving muscles attac& to t&e vertebral arc& an' to leverli0e"rocesses t&at exten' from it.

$ Prevention of !ndesira(e interverte(ra motion is ac&ieve' "rimaril( b( t&e 'evelo"ment of articular"rocesses -z(ga"o"&(ses an' intervertebral ligaments. t&e 'evelo"ment of articular "rocesses bet,een a'Bacent vertebral arc&es t&e Qrt&o"ae'ists call

t&ese RfacetS Boints* "ronouncing t&e ,or' RfacetS ,it& t&e accent on t&e secon' s(llable.

t&e 'evelo"ment of ligaments bet,een a'Bacent vertebral bo'ies* vertebral arc&es* an' leverli0e"rocesses.

$ !n t&e t&oracic region of t&e vertebral column* t&ese mec&anisms are furt&er ai'e' b( overla""ing oft&e obliIuel( 'is"ose' s"inous "rocesses* ,&ic& limits extension* an' b( t&e "ronounce' 'evelo"mentof t&e costal "rocesses -i.e.* ribs* ,&ic& &ave a ver( restrictive effect on all movements. !n t&e sacralregion* t&e t,o general mec&anisms of movement restriction are su"erse'e' b( fusion of t&e vertebrae.

$ If it is necessary to identify the spine of a specific thoracic vertebra on a patient, the patient should beasked to bend the neck forward so that the examiner may count downward from the easily recognizablespine of C7. Counting upward to identify higher cervical spines is difficult, since the th cervical spine

may or may not be palpable, and the higher ones are not.


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+onforma%ia e&tern$ a cooanei verte(rae

Coloana vertebral consi'erat n totalitatea ei "rezint+

$ fa%a anterioar$$ fa%a posterioar$$ do!$ fe%e aterae. Faa anterioareste format 'e o coloan cilin'ric* rezultat 'in su"ra"unerea cor"urilor vertebrelor.1. Faa posterioar"rezint "e linia me'ian "rocesele s"inoase* care formeaz m"reun creasta spina$.

:rocesele s"inoase se "ot ex"lora cu mult uurin* mai ales n tim"ul flectrii trunc&iului. Na limita 'intrecoloana cervical i toracal se vizualizeaz foarte net "rocesul s"inos al vertebrei C#-vertebra "roeminensG

"ornin' 'e la acest "roces s"inos* se "oate numerota fiecare vertebr.$ An continuarea "roceselor s"inoase se ex"loreaz creasta sacral me'ian* iar n "lica interfesier se "ot

"al"a coarnele sacrale* coarnele coccigelui i &iatul sacral.$ De fiecare "arte a crestei s"inale se gsesc anuri "rofun'e* numite anuri vertebrale "entru muc&ii

s"inali.3. Feele laterale! vrful "roceselor transversare* "e'iculii vertebrali* gurile intervertebrale i "oriunile laterale

ale cor"ilor vertebrali.

$ Erful "rocesului transvers al atlasului "oate fi "al"at ime'iat sub "rocesul mastoi'ian.


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Articular rocesses (!"gapop#"ses) and $nterarticular(!"gapop#"seal% Facet) &oints

Eertebrae sen' s!perior artic!ar processes 3s!perior -y#apophyses4 !p5ard from their

vertebral arc&es an' inferior artic!ar processes 3inferior -y#apophyses4 do5n5ard fromtheir vertebral arc&es !n t&e sacral region* t&e articular "rocesses of a'Bacent vertebrae are fuse'* forming a series of

bum"s on t&e bac0 of t&e bone bet,een t&e me'ian sacral crest -s"ines an' t&e lateral sacralcrest -ti"s of transverse elements. %&is series of bum"s is sai' to constitute an intermediatesacra crest. The lo,er "ortions of t&e t,o interme'iate sacral crests form t&e bor'ers of t&esacral &iatus an' are calle' sacra corn!a.

%&e "resence of z(ga"o"&(seal Boints actuall( serves to restrict certain motions bet,eenvertebrae. 8xactl( ,&ic& motions are restricte' 'e"en's on t&e "lanes of t&e Boint surfaces.

$ntervertebral 'igaments bet,een a'Bacent vertebrae &ave t&e same effect onlimiting motion regar'less of t&e region of t&e column in ,&ic& t&e( occur.

%&ese ligaments can be grou"e' accor'ing to ,&et&er t&e( limit -$ excessive flexion*$ excessive extension*$ excessive lateral flexion.

$ "xcessive flexion of the vertebral column #particularly in the lumbar region$ isthe greatest danger to its integrity.


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)pina i#aments$ )!praspino!s i#aments$ Interspino!s i#aments$ ligamenta flava

$ posterior on#it!dina i#ament

%he ligaments that limit excessive flexion of the vertebral

column play a significant role when a person bends the

trunk forward while keeping the knees straight, as if to

touch the toes. Interestingly, at the end of such a

movement the muscles that extend the vertebral column

cease firing.

$ Qnl( one ligament "revents excessive extension of t&e

vertebral column* t&e "o,erful anterior on#it!dinai#ament t&at starts at t&e base of t&e s0ull an' runs 'o,nt&e front of t&e vertebral bo'ies* getting ,i'er as it'escen's.

$ !t is t&e anterior longitu'inal ligament t&at ,ill be inBure''uring &("erextension of t&e vertebral column cause' b(external forces. 9uc& inBuries are most common)in t&e

cervical region 'uring ,&at is calle' ,&i"las& of t&e nec0*

"ro'uce' b( a force t&at 'rives t&e trun0 for,ar' ,&ile t&e&ea' lags be&in'. Qnce t&e anterior longitu'inal ligamentin t&e cervical region &as been straine'* t&e clinician must

'evise a met&o' for "reventing furt&er stress on t&isstructure. 9uc& a met&o' is a nec0 collar t&at is &ig&er int&e bac0 t&an in t&e front* because a collar of t&is s&a"e,ill force t&e cervical vertebral column into flexion an'

0ee" it t&ere.


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+ana! verte(ra

$ "rin su"ra"unerea gurilor vertebrale.$ se continu n sus cu cavitatea

neurocraniului* iar n Bos se 'esc&i'e"rin &iatul sacral.$ Canalul vertebral urmrete toate

inflexiunile coloanei vertebrale.$ Diametrele canalului vertebral

variaz+

mai mari n regiunea cervical i lombar*n ra"ort cu mobilitatea mai mare acoloanei vertebrale n aceste regiuni.

n regiunea toracal* un'e mobilitateacoloanei vertebrale este mai re'us*'iametrele canalului vertebral sunt maimici.


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Coloana vertebrala "oate "rezenta i curburipatologice* ca urmare a exagerrii curburilor normale+$Cifoza patolologic& se caracterizeaz "rinaccentuarea convexitii "osterioare.$'ordoza patologic& se caracterizeaz "rin

accentuarea convexitii anterioare.$colioza const in exagerarea curburilor n "lanfrontal.Curburile "atologice ale coloanei vertebrale "ot fi+ereditaresau dobndite.Dezvoltarea i funcionarea unor viscere "ot fiinfluenate n sens negativ 'e ctre curburile "atologiceale coloanei vertebrale.Coloana vertebrala "oate "rezenta i curburi

patologice* ca urmare a exagerrii curburilor normale+

+6R7"A8II +"II+7


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Defectele vertebrale a"ar 'atorit in'ucieianormale a sclerotoamelor+

$scolioza$s"ina bifi'a

$anencefalia


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)coiosis

$ 9coliosis is an abnormal curvature oft&e s"ine. !f (our c&il' &as scoliosis*t&e vie, from be&in' ma( reveal oneor more abnormal curves.

$ 9coliosis runs in families* but 'octorsoften 'ont 0no, t&e cause. ;ore girls

t&an bo(s &ave severe scoliosis.$ )'ult scoliosis ma( be a ,orsening of

a con'ition t&at began in c&il'&oo'* but,asnt 'iagnose' or treate'.

$ !n ot&er cases* scoliosis ma( resultfrom a 'egenerative Boint con'ition int&e s"ine.


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h i


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Kyphosis

With kyphosis, your spine may look normal or

you may develop a hump. Kyphosis can occuras a result of developmental problems;

degenerative diseases, such as arthritis ofthe spine; osteoporosis with compression

fractures of the vertebrae; or trauma to thespine.

It can aect children, adolescents and adults.


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L d i


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Lordosis

normal spine,when viewed frombehind appearsstraight. !owever,a spine aected bylordosis showsevidence of acurvature of theback bones"vertebrae# in thelower back area,

giving the child a$swayback$appearance.


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%uberculosis of the &pine' (ott)s disease

s a form of e*trapulmonarytuberculosis that impacts the spine,(ott)s disease has an eect that issometimes described as being a sortof arthritis for the vertebrae thatmake up the spinal column. +oreproperly known as tuberculosis

spondylitis, (ott)s disease is named

after r. (ercivall (ott, an eighteenthcentury surgeon who was consideredan authority in issues related to theback and spine.

(ott-s disease is often e*perienced asa local phenomenon that begins inthe thoracic section of the spinalcolumn. arly signs of the presence

of (ott)s disease generally begin withback pain that may seem to be dueto simple muscle strain. !owever, inshort order, the symptoms will beginto multiply.
http://www.wisegeek.com/what-is-tuberculosis.htmhttp://www.wisegeek.com/what-is-arthritis.htmhttp://www.wisegeek.com/what-is-arthritis.htmhttp://www.wisegeek.com/what-is-tuberculosis.htm


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+inica considerations )pina In*!ries$ ?irst* in or'er to "re'ict t&e neurologic conseIuences of "enetrating ,oun's to t&e bac0* one must 0no, ,&ere t&e 'ifferent s"inal cor'

segments lie in relation to t&e vertebral column. %&ere is a relativel( sim"le gui'e to t&is informationonl( t&e 'igit 1 nee' be memorize'+ %&e to" of s"inal cor' segment + ies opposite top of verte(ra +. %&e to" of s"inal cor' segment T ies opposite top of verte(ra T.

%&e to" of s"inal cor' segment " ies opposite top of verte(ra T. %&e to" of s"inal cor' segment ) ies opposite top of verte(ra ".

$ !t is obvious t&at t&e cervical cor' is virtuall( uns&ortene' relative to t&e vertebral column. %&e t&oracic cor' is s&ortene' slig&tl(. %&elumbar segments of t&e cor' run from t&e to" of %11 to t&e to" of N1 an' are t&us s&ortene' consi'erabl(. %&e 5 sacral an' 1 cocc(gealsegments of t&e cor' -com"rising t&e conus me'ullaris s"an onl( t&e 'istance occu"ie' b( t&e bo'( of N1.

$ )n inBur( to t&e s"inal cor' not onl( lea's to "aral(sis of t&e muscles su""lie' b( t&e 'amage' region* it also lea's to loss of cerebralcontrol over muscles innervate' b( all t&e intact cor' segments belo, t&e inBur(* an'* of course* it "revents sensor( information t&at enterssuc& intact segments from reac&ing consciousness. !ntras"inal reflexes belo, t&e inBur( are unaffecte' or* in t&e case of t&e stretc& reflexof striate' muscles* even accentuate'.

$ )n inBur( to t&e s"inal cor' above t&e N1 vertebra ,ill remove 'escen'ing inf luences on t&e sacral cor' neurons controlling striate' musclest&at regulate urination an' 'efecation. /o,ever* suc& an inBur( ,ill not affect t&e intras"inal "aras(m"at&etic reflexes initiating t&esebe&aviors. %&us* t&e bla''er contracts ,&en it is full* generating &ig& intravesical "ressure. /o,ever* t&e striate' muscle t&at normall( isres"onsible for t&e voluntar( control of urination* being 'e"rive' of 'escen'ing neural influences* becomes s"astic an' cannot "ro"erl(relax. Mrination is incom"lete an' a suite of com"lications results. !t ma( be necessar( to cut t&e striate' muscle* or its nerve* to enablecom"lete em"t(ing of t&e bla''er. ! 'o not 0no, if a similar "roblem c&aracterizes 'efecation or if it sim"l( occurs automaticall( ,&envisceral sensor( neurons 'etect a full rectum.

$ ) man ,&o &as suffere' a s"inal cor' inBur( above t&e sacral levels of t&e cor' can reflexl( ac&ieve an erection -a result of "aras(m"at&etic'isc&arge from 93 an' 94 u"on sensor( stimulation of t&e "enis but cannot ac&ieve erection ,&en s&o,n erotic "ictures.

$ !t s&oul' be obvious t&at inBuries to t&e vertebral column belo, t&e N1


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)pina Tap and )pina Anesthesia

$ t&e subarac&noi' s"ace bet,een t&e N1


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"!m(ar 7pid!ra Anesthesia$ 9"inal anest&esia is no longer t&e "referre' met&o' for ab'omino"elvic "roce'ures in

,&ic& general anest&esia is to be avoi'e'. !nstea'* anest&etic is inBecte' into t&elumbar e"i'ural s"ace. %&is entails essentiall( no ris0 of un'esire' s"rea' of anest&eticto t&e &ig&er regions -as can occur if anest&etic is inBecte' into t&e C9?* an' it iscom"atible ,it& insertion of a cat&eter t&at allo,s continuous a'ministration ofanest&etic. %&e use of lumbar e"i'ural anest&esia &as become ver( ,i'es"rea' inobstetrics.

$ %&e tec&niIue of lumbar e"i'ural anest&esia is similar to t&at of lumbar "uncture* ,it&some im"ortant 'istinctions. ) nee'le is inserte' bet,een t&e N3&en (ou are su"erficial to t&e ligamentum flavum* an( attem"tto inBect t&e air ,ill meet ,it& resistance an' t&e "lunger of t&e nee'le ,ill reboun'.

>&en (ou &ave entere' t&e e"i'ural s"ace* t&ere is a negative "ressure an' t&e air ,illbe suc0e' in. Tou t&en exc&ange t&e airfille' s(ringe for one ,it& anest&etic* or "ass acat&eter t&roug& t&e nee'le. De"en'ing on t&e volume of anest&etic inBecte'* or t&e'irection of t&e cat&eter* one can control &o, man( s"inal nerves are anest&etize'.


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)acra 7pid!ra Anesthesia 3sadde (oc:4

$ %&is is a met&o' of anest&etizing sacral s"inal nerves. !t ta0esa'vantage of t&e fact t&at t&e s"inal arac&noi'


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Proapsed or ;erniated Interverte(ra Disc3)ipped Disc4

$ 8xtrusion of t&e nucleus "ul"osus* ,&et&er it is covere' b( a t&in la(er of stretc&e'anulus fibrosus -"rola"se of t&e 'isc or ru"tures t&roug& t&e anulus -&erniation oft&e 'isc* occurs most commonl( in t&e lo, lumbar region. U&e secon' mostfreIuent site is in t&e nec0* usuall( as a conseIuence of some trauma. ) &erniate'nucleus "ul"osus ,ill generall( "resent to eit&er t&e rig&t or left of t&e "osteriorlongitu'inal ligament. !f &erniation occurs in t&e nec0* t&e s"inal cor' ma( besubBecte' to "ressure. /o,ever* in t&e more common case of a lo, lumbar sli""e''isc* t&e s"inal cor' &as en'e' above t&e site of nuclear "rotrusion an' onl( s"inalnerve roots are in 'anger of com"ression.

$ /erniations of cervical 'iscs affect t&e s"inal nerve t&at exits at t&e corres"on'ingintervertebral foramen. %&us* &erniation of t&e C5


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Curs 3. Dezvoltarea Coloanei Vertebrale

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