SPINE

GENERAL
INFORMATION
33 Vertebrae:

7 Cervical (lordosis)

12 Thoracic (kyphosis)

5 Lumbar (lordosis)

5 Sacral fused (kyphosis)

4 Coccygeal (fused)

GENERAL
INFORMATION (2)
Root exit spinal column via
intervertebral foramen

C1-7 : exit above their vertebra

C8-L5 : exit below their vertebra (C7 exit
above C7 vertebra and C8 exit below
C7 vertebra)
Medula spinalis end at L1 (Conus
Medullaris)
Lumbar and sacral nerve form cauda
equina in spinal canal before exit

DEVIDED INTO 3 COLUMN

(DENIS THEORY)

Anterior : 2/3 of
vertebral body
Middle : 1/3 of
vertebral body
Posterior :
Pedicles, lamina,
spinous process,
and ligament

CERVICAL VERTEBRA (1)

CERVICAL VERTEBRA (2)

THORACAL VERTEBRA (1)

THORACAL VERTEBRA (2)

LUMBAL VERTEBRA

SACRUM AND COXIGEAL

VERTEBRA

CORESPONDING STRUCTURE
OF VERTEBRA

SPINE
RADIOLOGY

CERVICAL RADIOLOGY (1)

CERVICAL RADIOLOGY (2)

SWIMMERS VIEW
SENTRASI DAN ARAH SINAR

SWIMMERS VIEW
the patient is placed
prone on the table with
the left arm abducted
180 and the right arm
by the side, as if
swimming the crawl.
The central beam is
directed horizontally
toward the left axilla.
The radiographic
cassette is against the
right side of the neck, as
for the standard crosstable lateral view

To demonstrate : Fractures of C-7, T-1, and T-2

THORACIC RADIOLOGY (1)

For the anteroposterior view of the thoracic
spine, the patient is supine on the table, with the
knees flexed to correct the normal thoracic
kyphosis. The central beam is directed vertically
about 3 cm above the xiphoid process.

THORACIC SPINE
(AP VIEW)
1 = pedicle
2 = Paravertebral line
3 = Border of
descending aorta
4 = Intervertebral disk
5 = Superior endplate
6 = Inferior endplate

THORACIC RADIOLOGY (2)

For the lateral view of the thoracic spine, the
patient is erect with the arms elevated. To
eliminate structures that would obscure the bony
elements of the thoracic spine, the patient is
instructed to breathe shallowly during the
exposure. The central beam is directed
horizontally to the level of the T-6 vertebra with
about 10 cephalad angulation. The film in this
projection demonstrates a lateral image of the
vertebral bodies and intervertebral disk spaces.

LATERAL
THORACIC
SPINE

CLAVICAL

PEDICLE
DISC SPACE
VERTEBRAL BODY

RIB

SPINOUS PROCESS

LUMBAL RADIOLOGY (1)

LUMBAL RADIOLOGY (2)

SPINE
INJURY

CERVICOCRANIUM INJURY
ADI : Atlantodens
Interval
SAC : Space
Available for the
Cord

Measurements for evaluating basilar invagination.

ATLAS AND ODONTOID FRACTURE

Odontoid Fracture :
Above the base of adontoid (type 1)
At the base (type 2)
Extends into the vertebral body (type
3).

AXIS FRACTURE

Posterior element fracture of C2 the Hangmans

fracture

SUBAXIAL CERVICAL FRACTURE

Compression
Fracture

Involve anterior half of

vetebral body
Treatment :Collar
neck

Anterior compression of C5, wit a

fracture of te anterior inferior
aspect.

SUBAXIAL CERVICAL FRACTURE

CERVICAL BURST FRACTURE

Burst Fracture

Involve whole vetebral

body & have
retropulsion into
spinal canal
Treatment: ACDF
(anterior corpectomy,
diskectomy, and
fusion ant.plate) VS
decompression/post.
fusion

Instability (White and Panjabi)

> 3.5 mm of translation

11 degree of kyphotic angulation

(+) strech test

Neuro (cord or root) injury

Anterior elements destroyed

Posterior elements destroyed

Narrow spinal canal

Disc space narrowing

CERVICAL SUBLUXATION AND

DISLOCATION

LUMBAL BURST FRACTURE

Burst Fracture

Involve whole vetebral

body & have
retropulsion into
spinal canal
Treatment: ACDF
(anterior corpectomy,
diskectomy, and
fusion ant.plate) VS
decompression/post.
fusion

LUMBAL
CHANCE FRACTURE

Distraction result in complete

transverse fracture through
entire vetebra.
Note higher effect if anterior
longitudinal ligament

SPINAL CORD INJURY

SPINAL CORD INJURY

ANAMNESIS

Paraparese/paraplegi

Mekanisme trauma

PEMERIKSAAN FISIS
Defisit neurologis atau tidak Spinal shock (+/-) jika
Spinal shock (+) Th/ Metilprednisolon (30 mg/KgBB
pada jam pertama dilanjutkan 5,4 mg/KgBB/jam
selama 23 jam berikutnya)

SPINAL INJURY ALOGARITM

SCI
A Thorough neurological
examination : sensory and
motory

SPINAL
SHOCK (+)

Th/ with
metilprednisolon

BCR (-)

SPINAL
SHOCK (-)

Level of SCI

BCR (+)

SPINAL CORD INJURY

Young males most

common
High associaton with
C-spine fracture

Classification:
1. Complete : no function
below the injury level
(spinal shock must be
resolved to diagnose)
2. Incomplete

Central
II. Anterior
III. Brown-Sequard
IV. Posterior
I.

NORMAL SPINAL CORD

CENTRAL CORD SYNDROME

Central grey matter

Hyperextension mechanical, seen in elderly with cervical
spondylosis
Evaluation : Upper Extremity > Lower Extremity Motor Loss

ANTERIOR SPINAL ARTERY

SYNDROME
Worst prognosis
Evaluation : Lower Extremity > Upper Extremity motor and
sensoris, proprioseptor intact
Spinothalamic and corticospinal tracts out, posterior columns
spared

BROWN-SEQUARD SYNDROME

Best prognosis

Usually penetrating trauma, rare injury

Ipsilateral motor loss, contralateral pain/temp loss

Lateral half of spinal cord (hemisection)

POSTERIOR COLUMN
SYNDROME

NEUROVASCULAR
EXAMINATION

MOTORIC EXAMINATION

C1 : motor : Gniohyoid, Thyrohyoid, Rectus

Capitus

C2 : Motor : Longus colli/capitis

C3 : Motor : Diaphragm

C4 : Motor : Diaphragm

Note : C1-C4 are not included in examination

because of the difficulty of testing them

UPPER EXTREMITY (MOTORIC)

C5 Shoulder Abduction

C6 Wrist Extension

UPPER EXTREMITY (MOTORIC)

C7 Wrist flexion and finger extension

UPPER EXTREMITY (MOTORIC)

C8 Finger flexion

UPPER EXTREMITY (MOTORIC)

T1 Finger abduction, adduction

LOWER EXTREMITY (MOTORIC)

T12, L1, L2, L3 : Hip Flexion

LOWER EXTREMITY (MOTORIC)

L2, L3, L4 : Knee Extension & Hip Adduction

LOWER EXTREMITY (MOTORIC)

L4 Foot Inversion

LOWER EXTREMITY (MOTORIC)

L5 Toe Extension & Hip Abduction

LOWER EXTREMITY (MOTORIC)

S1 Foot Eversion & Hip Extension

SENSORIC EXAMINATION

SENSORIC EXAMINATION

C2 : Sensory : Parietal
scalp

C3 : Sensory : occipital
scalp

C4 : Sensory : Base of neck

UPPER EXTREMITY (SENSORIC)

C5 Lateral arm
C6 Lateral forearm,
thumb, and index
finger
C7 : Middle Finger
(variable)
C8 : Medial forearm,
ring, and small finger
T1 : Medial arm

LOWER EXTREMITY (SENSORIC)

T12 Lower
abdomen just
proximal to inguinal
ligament
L1 : Upper thigh just
distal to inguinal
ligament

L2 : mid thigh

L3 : Lower thigh

LOWER EXTREMITY (SENSORIC)

L4 - Medial leg,
medial side of foot
L5 Lateral leg,
dorsum of foot
S1 Lateral side
of foot

UPPER EXTREMITY (REFLEX)

C5 Biceps reflex

UPPER EXTREMITY (REFLEX)

C6 Brachioradialis reflex

C7 : Triceps reflex

LOWER EXTREMITY (REFLEX)

L4 Patellar reflex

LOWER EXTREMITY (REFLEX)

L5 Tibialis posterior (difficult to obtain)

LOWER EXTREMITY (REFLEX)

S1 Achilles tendon reflex

SPINAL
EXAMINATION

SPINAL EXAMINATION (1)

Inspection

Gait

Learning foward : spinal stenosis

Wide-based : Myelopathy

Alligment

Malaligment : dislocation, scoliosis, lordosis,

kyphosis

Posture

Head tilted : dislocation, spasm, spondylosis,

torticolis

Pelvis titled : loss of lordosis (spasm)

Skin (Disrobe patient)

cafe-au-lait spots, growth -->

neurofibromatosis

Port wine spots, soft masses --> spina bifida

SPINAL EXAMINATION (2)

Palpation

Bony structure (Spinous processes)

focal/point tenderness --> fracture

Step off -->

dislocation/spondylolithesis

Soft tissues

Cervical facet joints : tenderness -->

osteoarthritis, dislocation

Coccyx, via rectal exam :

tenderness --> fracture or contusion

Paraspinal muscle : difuse

tenderness --> sprain/muscle strain,
trigger point --> spasm

SPINAL EXAMINATION (3)

Range of motion

Cervical

Flexion : Chin to chest

Extension : Occiput back

Lateral flexion : Ear to shoulder

Rotation : stabilize shoulders -->

rotation

Lumbal

Flexion : Touch toes with legs

straight

Lateral flexion : bend to each side

Rotation : stabilize hip --> rotate

thank you