You will be placed in a kneeling position. Your skin will be cleaned. An incision will be made in the middle of the back. The overlying muscles will be moved to the sides. Your surgeon will confirm the correct vertebrae for the procedure by using xray imaging. The ligamentum flavum is separated from the lamina and then removed. The spinous process and lamina are removed at each level needing to be decompressed. Next the tracks for the pedicle screws are prepared. The hard bone surface is removed. A guide track is inserted under Xray guidance.
Its depth and position are checked. Then a thread is tapped into the bone, and the pedicle screw is placed. The vertebrae are prepared for the other pedicle screws, and the transverse processes and facet joints are prepared for the bone graft. Next the bone graft and the remaining pedicle screws are placed. Then the brackets and rods are installed. Xrays are used to check the position of the screws and rods. A lateral xray will look like this. A posterior xray will look like this. The muscles are replaced, and the wound is closed.
4 Exercise Tools for Under $20
Jessica Matthews Today we’re going to show you four great pieces of equipment, each for under $20, that you can incorporate into your workout to enhance what you’re already doing. Balance pod. This portable piece of equipment is great for not only improving your balance, but also enhancing core activation in a variety of exercises you may already be doing, such as squats and lunges. Now, for a pair of these, go for about 15 bucks, and you can use it two ways. For a little more stability, flat surface down, or, for more of a challenge, flip it with the spikes touching the ground.
Yoga block. This helpful prop costs about $10 and is a great way to enhance your yoga practice. You can use this tool to focus on alignment, provide stability, enabling you to move deeper into postures and improve the integrity of your overall practice. Small, weighted balls. Now, these durable pieces of equipment filled with sand cost about $15 each and they’re a great resistance training tool to add some variety to some exercises you may already be doing. Reaction ball. This fun piece of equipment is a great way to train a critical component of fitness reactivity.
Dissection Vertebral Column, Spinal CordCoverings
Welcome to the University of Michigan Dentistry Podcast Series promoting oral health care worldwide. In order to visualize the structures within the spinal canal, the entire posterior aspect of the vertebrae need to be removed. As we see in this illustration all of the deep back muscles have been removed from the ribs and the posterior aspect of the vertebral column and the vertebral column has been opened already. Removing all of the spines of the vertebrae all the way from the back of the sacrum and including the posterior aspect of the sacrum.
And all of the way up and down the line of attachment to the base of the skull we can now visualize some of the content of the vertebral canal. Before we do however, we should look at the spinous processes in this segment that have been removed. Here we have four spinous processes extending downward and they are interconnected with one another and they are interconnected through a long continuous ligament that extends completely across the top of each and every one of the vertebrae all the way from the back of the skull to the coccyx.
Region. This is a supraspinous ligament. Between the spines in this area at each and every spinal level are interspinous ligaments and these allow the movement of the spine as well as permit freedom of movement and also limitation of movement because it is dependent upon the laxity of these ligamental fibers to determine the amount of movement that one has. When we turn this section then over and look at the vertebral column side, we can see with great clarity the individual ligaments spanning from one vertebral segment up to the next,.
Interconnecting the lamina are these the ligamentum flavum. There are other ligaments, of course, the disks between the vertebrae, the anterior and posterior longitundal ligaments that are found on the anterior and posterior aspects of the body of the vertebrae. In order to clear up this area so that you can see vertebral contents we have removed a significant amount of fat and venous plexuses. This is the epidural venous plexus, a venous network without valves in it and depending on pressure gradients within the abdomen, or within the thoracic cavity, the blood can move in and out of this venous plexus laterally as well as be forced.
Upward or downward through the interconnections. This is an extremely important venous network. It’s very, very small. Hairnetlike in nature and its importance is that metastasis as well as infections of other sorts can be spread from the pelvic area due to abdominal pressure such in tightening abdominal wall musculature during defecation and can cause this infectious material to pass upward for example into the thoracic region where there are interconnections with the intercostal veins or even all the way up into the venous plexus around the brain. So this is a very important yet hardly ever stressed venous network, the vertebral venous.
Plexus. Surrounding the spinal cord are three protective membranes the meninges, and these meninge cannot be seen all three at once but rather we must look at the exterior one first and this is the very, tough outer coating the dura matter. This is what we are looking at here. It is a long, continuous sac that completely surrounds the spinal cord and is continuous with the dura matter in the cranial cavity. In order for us to visualize the other structures, what we need to do is open this dural sac in order to get deep within to be able to.
Visualize now the next layer which is the arachnoid. Arachnoid means spider weblike. Just at the tip of the scalpel you can see this very thin membrane, the second meningeal layer, the arachnoid. And as we continue this and open it up completely, you’ll be able to see then the spinal cord and its coverings. The dura matter has now been reflected and is held back into position so that we can look down on the spinal cord. Notice that the spinal cord extends through the vertebral canal, fills most of this canal down to the level of the disk between the lumbar one and.
The lumbar two vertebrae. From that point on the spinal cord does not exist but in order to supply innervations to the lower extremities and to the pelvis the nerves come off and continue down within the spinal canal and eventually feed off at their respective vertebral levels. There is a bit of a swelling at the end of the spinal cord called a conus medullaris and from the very tip of the conus medullaris, centrally located, is the terminal filament of the spinal cord called filum terminale and filum terminale continues down on the.
Midline, continuing all the way to the level of the second sacral vertebrae. Here the large sac, the dura matter, tightly encloses the filum terminale and together then they go through the sacral area into the very top of the coccyx as the coccygeal ligament. So again filum terminale from the end of the spinal cord level L1 to two going downward to sacral two level where it is then joined and surrounded by the dura to form the coccygeal ligament. All of these hairlike strands that you see in this area are the mid and lower.
Lumbar region are individual nerves both centrally and motor and together are called the cauda equina. Cauda equina when literally translated means the horse’s tail and that’s just what this looks like. When we look now a bit higher up we see that the dura has been reflected here also and we can see the spider weblike nature of the arachnoid membrane that fills this area and it is between the arachnoid and the deeper pia matter. And the pia matter is very difficult to demonstrate because it is that tissue that is directly adherent to the spinal cord and.
To pull off pia matter you literally must start ripping into the spinal cord itself. It is not as thick as the dura matter but it is completely adherent to the spinal cord whereas this anarchnoid is this loose spider weblike material. Between the arachnoid and the pia matter is a space called a subarachnoid space. And it is in this space that the cerebralspinal fluid is found. The cerebralspinal fluid is produced in the ventricles of the brain passes out to completely surround the brain in the fluid media and then passes down into the spinal canal area. Cerebralspinal fluid.
Has basically the components of blood plasma, no red blood cells within it. Now, if and when, one does a spinal tap either to take some of the cerebralspinal fluid out or to inject contrast material for a spinal cord type of examination or of the vertebral column itself from the interior. One would not stick needles in the vertebral area where the spinal cord is located because damage to the spinal cord can never be repaired. This is irreparable damage and so one would go into the lumbar area where we don’t have a spinal cord. Remember.
All these filaments of the cauda equina are floating in cerebralspinal fluid so that classically then it’s in the lumbar three area that a spinal tap would be made because when the needle passes between the vertebrae, between the spines of the vertebrae, and pierces the dura and because the dura is so tough you could actually feel that needle passing and perforating the dura the floating nerves then as the needle comes at them will move out of its way and the possibility of doing damage to these nerves is extremely minimal.
The pia matter, the closest membrane to the spinal cord, has a specialization at each and every vertebral level and these are called the denticulate ligaments and if we look here now in close up by moving some of these nerve filaments we can see these toothlike processes that denticulate ligaments, one at this level and now one above it and all the way up and down the chain these denticulate ligaments pin the arachnoid membrane against the dura matter. This gives stability to the spinal cord for lateral movement purposes. Also in.
This area all along each and every segment we can see nerves coming off that will be going out to each and every individual level. These are dorsal nerves, dorsal roots, and they are sensory fibers coming into the spinal cord. The motor root fibers now are seen deep within the vertebral canal and more or less coming from its underside. These are motor fibers that go out to each and every segment. In addition to this, you should follow up the spinal cord to the base of the neck and.
Here it can be well shown the method by which a plexus is formed. In the cervical region remember we did a great deal of work on the brachial plexus and the brachial plexus nerve roots now coming directly from the spinal cord, all of the lateral bone has been removed, and we can see the individual sections of the levels C5, C6, C7, and C8 and then finally thoracic one embedded deeply around the first rib level. The brachial plexus well shown not only this side but some of the fibers from the other side can also be seen.