Anatomy, Physical Examination and Imaging of Thoracic and Lumbosacral Spine .NGUYỄN THÀNH NHÂN

Anatomy, Physical Examination and Imaging of Thoracic and Lumbosacral Spine NGUYỄN THÀNH NHÂN... LEARNING OBJECTIVES Understand: * Basic anatomy of the spine * Thoracic and Lumbar spine

Anatomy, Physical Examination

and Imaging of Thoracic and Lumbosacral Spine

NGUYỄN THÀNH NHÂN

LEARNING OBJECTIVES

 Understand:

* Basic anatomy of the spine

* Thoracic and Lumbar spine anatomy

 Understand basic imaging of X ray, CT Scan and MRI

 Identify and assess functions of the structures in clinical aspect:

* Identify structures: inspection, palpation

* Assess: Thoracic - Lumbar spine movements

 Understand: dermatomes, * SLR test, Bragard’s test, Neri’s test, …

 Basic anatomy of the spine

 Thoracic - Lumbosacral spine anatomy

 Imaging of Thoracic - Lumbar spine

 Physical examination of Thoracic and Lumbar spine

Basic anatomy of the spine

- The vertebral column consists of 33 vertebrae,

- 5 segments: cervical, thoracic,

lumbar, sacral, and coccygeal

- There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4

Basic anatomy of the spine

[1]

Basic anatomy of the spine

[1]

Basic anatomy of the spine

- The spinal cord

- Conus medullaris: L1 - L2

- There are 8 cervical, 12 thoracic, 5

lumbar, and 5 sacral pairs, and 1

coccygeal pair of spinal nerves

- The sacral spinal nerves

make up the cauda equina

The neural anatomy is such that the spinal cord resides within the bony canal between C1 and L1 and/or L2 The filum

terminale extends from the conus and attaches to the coccyx.[1]

+ Afferent sensory neuron axons

+ 4 funiculi: L lateral, R lateral, ventral,

dorsal

Cross section of the spinal cord delineating

white and gray matter and four funiculi [1]

+ Within the white matter are tracts

of ascending and descending axons

segregated into pathways of function

[1]

+ The lateral spinothalamic tract: pain

and temperature sensation (crosses)

+ The dorsal column pathway:

vibration sensation, two-point touch,

conscious proprioception

+ The lateral corticospinal tract:

Lumbosacral Spine

Lumbar vertebrae are characterized by massive bodies and robust spinous and transverse processes Their articular facets are oriented somewhat parasagittally, which is thought to contribute the large range of anteroposterior bending possible between lumbar vertebrae Lumbar vertebrae also contain small mammillary and accessory processes on their bodies These bony protuberances are sites of attachment of deep lumbosacral muscles.

Lumbar Spine Anatomy

[2]

Drawing of 2 lumbar segments viewed from an oblique angle The outline of the facets and the pars interarticularis has the appearance of the "neck" of a Scottie dog.

Lumbar Spine Anatomy

[2]

IMAGING

AP VIEW LATERAL VIEW OBLIQUE VIEW

Adult Lumbar Spine - AP View [3]

Adult Lumbar Spine - Lateral View [3]

Adult Lumbar Spine - Lumbosacral L5S1 View [3]

Adult Lumbar Spine - Oblique View [3]

Spondylolisthesis L4-L5

EXTENSION VIEW FLEXION VIEW

CT Scan

Sagittal

CT: L4 compression fracture

T2W T1W STIR

T2W MRI

Thoracic Spine X-ray: AP projection 1, Left

ventricle 2, Gas in stomach 3, Right

hemidiaphragm 4, Posterior rib 5,Clavicle.

Thoracic Spine X-ray: AP projection 1, Gas in Colon (Splenic

flexure) 2, Gas in stomach 3, Left hemidiaphragm 4, Posterior rib 5, Pedicle 6, Spinous process 7, Transverse process.

THORACIC SPINE

Thoracic Spine X-ray: Lateral view 1, Right

hemidiaphragm 2, Left

hemidiaphragm 3, Vertebral body 4, Rib.

Thoracic Spine X-ray: Lateral view 1,Posterior

rib 2, Vertebral body 3, Intervertebral discal space.

THORACIC SPINE

Physical Examination Of Thoracic Spine

Visual Examination

Physical Examination Of Thoracic Spine

Visual Examination

Physical Examination Of Thoracic Spine

Palpation

Physical Examination Of Thoracic Spine

Percussion

Physical Examination Of Thoracic Spine

Movements

Active Movements

Physical Examination Of Thoracic Spine

Movements

Active Movements

Physical Examination Of Thoracic Spine

Movements

Active Movements

Physical Examination Of Thoracic Spine

Movements

Active Movements

Physical Examination Of Thoracic Spine

Neurologic Evaluation of the Thoracic Spine

Physical Examination Of Thoracic Spine

Inspection

When the patient enters the room

▪ He or she is distressed?

▪ Is the patient leaning to one side?

▪ Is the patient able to walk,

▪ Is the gait normal?

▪ The pelvis?

▪ The patient is limited in any motion,

▪ Note the extent of any pain

Physical Examination Of Lumbosacral Spine

[1]

Inspection

Once the patient is undressed,

▪ Look for signs of trauma, blisters, scars, discoloration,

redness, contusions, lumps, bumps, fat pads, and

other marks

▪ Hairy patches or café au lait spots

▪ Look for a lateral curvature, or scoliosis

Physical Examination Of Lumbosacral Spine

[1]

Palpation

Posterior Lumbar, Sacral, and Coccygeal Spine

▪ Sit on a stool behind the

standing patient Place

your thumbs on the

midline of the patient’s

back at the level of the

iliac crest This should be

the junction between L4

and L5.

Physical Examination Of Lumbosacral Spine

[1]

C7

D7 D12

L4-L5

Palpation

Posterior Lumbar, Sacral, and Coccygeal Spine

Physical Examination Of Lumbosacral Spine

[1]

Anterior Lumbar, Sacral, and Coccygeal Spine

Physical Examination Of Lumbosacral Spine

[1]

Tests

Physical Examination Of Lumbosacral Spine

Straight Leg Raise (Lasègue)

[1]

Tests

Physical Examination Of Lumbosacral Spine

Bragard’s Test – Neri’s Test

[1]

Tests

Physical Examination Of Lumbosacral Spine

Neurologic Evaluation of the Lumbar Spine

[1]

Tests

Physical Examination Of Lumbosacral Spine

Neurologic Evaluation of the Lumbar Spine

[1]

KEY MUSCLES - MYOTOME

1 Todd J.Albert, Alexander R Vaccaro Physical Examinatiom of the

Spine 2th edition Thieme Medical Publishers, 2017

2 Stephen Kishner, Maxim Moradian, Jan K Morello Lumbar Spine

Anatomy Update: Aug 12 2015 emedicine.Medscape.com

3 Wiki – Radiography.net