2. Spinal Anatomy
• The Human spine is
formed of:
1. 7 cervical
vertebrae.
2. 12 thoracic
vertebrae.
3. 5 lumbar
vertebrae.
4. Fused sacral and
coccyx vertebrae.
3. Spinal Anatomy
• These bony structures
articulate through the
vertebral disc to
provide:
1. Protection of the
spinal cord and its
nerve roots.
2. Mobility of the
trunk.
5. Spinal Anatomy
• Mid-sagittal section through a healthy young
intervertebral disc. The white cartilage endplates, the
gel-like nucleus pulposus and the surrounding anulus
fibrosus can easily be distinguished.
8. Lumbar Disc Herniation
• Lumbar disc herniation is
most frequently found in the
3rd and 4th decades of life at
the level of L4/5 and L5/S1.
• The cardinal symptom of
lumbar disc herniation is
radicular leg pain with or
without a sensorimotor
deficit of the affected nerve
root.
9. Lumbar Disc Herniation
• The radiculopathy
is not only caused
by a mechanical
compression of
the nerve root but
also by an
inflammatory
process caused by
nucleus pulposus
tissue
11. Lumbar Disc Herniation
• In contrast to large disc extrusion and
sequestrations, disc protrusions are frequently
found in asymptomatic individuals
12. Lumbar Disc Herniation
• The best discriminator of symptomatic and
asymptomatic disc herniation is nerve root
compromise
13. Lumbar Disc Herniation
• Mild radiculopathy responds well to nonoperative treatment, but surgical treatment
results in better short-term results in selected
patients.
• Severe radiculopathy responds poorly to nonoperative treatment and should be treated
surgically.
• The surgical treatment of choice is an open
standard
interlaminar
discectomy
or
microsurgical discectomy.
15. Lumbar Disc Herniation
• Cauda Equina Syndrome caused by a central
disc herniation.
• Symptoms include bilateral leg pain, loss of
perianal sensation, paralysis of the
bladder, and weakness of the anal sphincter
• Cauda equina syndromes require an
emergency decompression and should be
treated by complete laminectomy and wide
decompression.
16. Spinal Stenosis
• Lumbar spinal stenosis can be defined as any
narrowing of the spinal canal, lateral recess or
intervertebral foramen.
18. Spinal Stenosis
• Spinal stenosis most frequently results from
degenerative alterations of the motion
segment.
• Lumbar spinal stenosis is a common condition
in elderly patients.
• Spinal stenosis is often associated with
degenerative spondylolisthesis.
• Degenerative
spondylolisthesis
most
frequently occurs at the L4/5 level in females
22. Spinal Stenosis
• The cardinal symptom of spinal stenosis is
neurogenic claudication.
• Neurologic examination of a patient often is
remarkably normal.
• The most important differential diagnosis is
intermittent ischemic claudication.
25. Spinal Stenosis
• Conservative treatment may only relieve
symptoms for a short time period.
• Conservative treatment does not affect the
natural history of spinal canal narrowing.
26. Spinal Stenosis
• Surgery is generally accepted when the quality of
life is substantially limited because of the
neurogenic claudication.
• Selective decompression (laminotomy) with
preservation of the lamina is the preferred
technique in the absence of segmental instability.
• Instrumented fusion as an adjunct to
laminectomy improves the long-term results in
degenerative spondylolisthesis with spinal
stenosis.
28. Lumbar Spondylo-Listhesis
• The term spondylolisthesis comes from the
Greek spondylo, meaning “vertebra,” and
olisthesis, meaning “movement or slipping.”
• Spondylolisthesis describes the pathologic
state of one vertebra slipping on another; this
can be forward (anterolisthesis) or backward
(retrolisthesis).
32. Lumbar Spondylo-Listhesis
• Mechanical LBP may result from abnormal load distribution.
• Discogenic, facet-joint and neurogenic, referred pain may
coexist in spondylolisthesis.
33. Lumbar Spondylo-Listhesis
• Physical findings:
– tight hamstrings
– sensorimotor deficits
– pain on backward bending and rotation (often
facet joint pain)
– pain on forward bending (often discogenic pain)
– pain on extension from the forward bent position
– limitation of walking distance