Clinical Aspect of

Spine Disorders

dr. Yoyos Dias Ismiarto, SpOT (K), M.Kes, CCD, FICS

Dept. of Orthopaedic & Traumatology

Medical School of Padjadjaran University
Hasan Sadikin General Hospital
Bandung
The Spine
Important structure
Composed of 33
vertebrae
Act to support the trunk
and transfer muscular
load
Regional Characteristics of Vertebrae
Cervical
Body
Small, wide side to side
Spinous process
Short, bifid, projects posteriorly
Vertebral foramina
Triangular
Transverse processes
Contain foramina
Superior & inferior articulating
processes
Superior facets directed
superoposteriorly
Inferior facets directed inferoanteriorly
Movement allowed
Flexion, extension, lateral flexion,
rotation
Regional Characteristics of Vertebrae
Thoracic
Body
Larger than cervical,heart
shaped,bears two costal demifacets
Spinous process
Long, sharp, projects inferiorly
Vertebral foramen
Circular
Transverse processes
Bear facets for ribs (Except T11&T12)
Superior & inferior articulating
processes
Superior facets directed posteriorly
Inferior facets directed anteriorly
Movement allowed
Rotation, lateral flexion possible but
limited by ribs, flexion & extension
prevented
Regional Characteristics of Vertebrae
Lumbar
Body
Massive, kidney shaped
Spinous process
Short, blunt, projects posteriorly
Vertebral foramen
Triangular
Transverse processes
Thin & tapered
Superior & inferior articulating
processes
Superior facets directed
posteromedially (or medially)
Inferior facets directed anterolaterally
(or laterally)
Movement allowed
Flexion & extension ; some lateral
flexion, rotation prevented
Regional Characteristics of Vertebrae
Sacrum
Composed of five fused
sacral vertebrae
Provide strength &
stability to the pelvis
Sacral canal contains
nerve root of the cauda
equina
Regional characteristics of Vertebrae
Coccyx
Formed by four
rudimentary vertebrae
Remnant of the sceleton
of the tail
Pelvic surface is concave
& smooth
Dorsal surface is convex
& rough
Joints of the Spine
Atlanto-occipital joints
Atlantoaxial joints
Costovertebral joints
Joints of the vertebral
bodies
Joints of the vertebral
arches (zygapophysial
joints/facet joints)
Sacroiliac joints
Intervertebral Disc
Intervertebral disc - comprised
of three parts :
nucleus pulposus
annulus fibrosus
hyaline cartilage end plates

Acts as a thick-walled cylinder

to distribute load
A pair of vertebral bodies with
the intervening disc is called
Motion segmen
Functional unit
Symptoms
Pain
Stiffness
Deformity
Neurological disturbance
Numbness
Paraesthesia
Weakness
Urinary/Faecal retention or incontinence
 Examination
Look :
Scars, pigmentation, abnormal tufts of hair
Shape and posture
Symmetry
Normal curvature
Mass
 Examination
Feel
Palpate the spinous processes
Prominence? Step offs?
Tenderness
Bone
Intervertebral tissues
Paravertebral muscles
 Examination
Move
 Examination
Move
 Examination
Special tests
Straight Leg test
Bowstring test
Sensory Examination

Cervical Thoracic Lumbosacral

C-5 Deltoid T-4 Nipple L-4 Medial Leg
C-6 Thumb T-8 Xiphoid L-5 1st/2nd toes
C-7 Middle T-10 Umbilicus S-1 Lateral foot
finger T-12 S-4 Perianal
C-8 Little finger Symphysis
Motor Examination

Cervical / Thoracic Lumbosacral

C-5 Shoulder abduction L-2 Hip flexion
C-6 Wrist Extension L-3 Knee extension
C-7 Elbow extension L-4 Ankle dorsiflexion
C-8 Middle finger flexion L-5 Big toe extension
T-1 Little finger S-1 Big toe / ankle
abduction plantar flexion
 Imaging
Plain Radiographs
Computed Tomography
Magnetic Resonance Imaging
Radioisotope scanning
Discography/Arthrography
 Etiology Spine Disorders
Congenital
Infection
Neoplastic
Trauma
Others
Degenerative Spine Disease
Autoimmune disorders
Spina Bifida
Klippel-Feil Syndrome
Cervical Fracture
Cervical Fracture
Cervical Fracture
Intervertebral Disc Disorders
Open Discectomy & Stabilization
Spondylolisthesis
Senile Kyphosis
Spine Tuberculosis
Case preview
Mr. R, 52 y.o. Spondilitis TB T-11. Frankle A
Case preview
Post op X Ray
Case preview
Mr. H, 44 y.o. Spondilitis TB T12-L1, Frankle C
Case preview
Post op X Ray
Scoliosis
Instrumentation for Scoliosis
THANK YOU