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Yeah, I think we're live now. Super. And can we see your tendons or anything? People? Yep. There are. There are a few people with two people. Shooper. Should we give you a couple of more minutes or do you just want to? I think we just talked you to time constraints. Okay. No problem. There we go. Let's see the slides. Super so high there, everybody. I guess this is just the super cozy session on a quick revision guides for the spine anatomy. I'm getting car chocolate. I'm 1/4 year medical student, and I'm just going to be walking you through the very basics of the anatomy of the spine. And I'm going to try to make it easy to understand and easy to remember just the way I've, um um, try to memorize it whenever I was the first year student. So on the next slide, we've got the learning objectives for tonight, and we only have one simple learning objective to understand. And that's the key word. Um, the relevant anatomy of common joints and systems in the body and the joints and the system we're gonna be looking at today is gonna be, um the spine or the vertebral column on the next. Like these are the tiny concepts that we are gonna be quickly going over. Today. We're gonna be looking at the function of the spine, the structure of the vertebral column, the five regions that we, uh, five Hun atomical regions that the spine is divided into. Then we're gonna be looking a bit deeper at the anatomy and the particularities of the vertebras. And lastly, we'll be covering the joints and the ligaments of our vertebral column. Super and the way I've always memorized this, you know, and I always find it very helpful. If I'm explaining concepts to myself, this is a column, as you probably all know. And then on the next slide, we are going to have a vertebra. And this is something you probably have known since kindergarten. You know, we've got these sort of bony things that are sitting at the or back. If you curl down, you're gonna be looking a bit like a dinosaur because that's where they're coming from, You know, evolutionary speaking, Um, and all put together one on top of the other. They are gonna be forming a column and given that, um, it's a column made up of vertebras. It is gonna be called the vertebral column in anatomy. Um, and those are just two diagrams of the vertebral column. Seem from seen from the lateral side and also from the posterior side. And again, you can see how it's basically a column, a straight collection of of vertebras, all put on top of the other. And the main function, as you would expect, is gonna be the same as the columns were used for, um, back in ancient times to support something, and the something that will support is going to be the human body. Now you may wonder why we were referring to it as the spine. And again, that shouldn't be very hard to imagine. Because if you look at the posterior view, um, you can see how it looks. A bit spine is just like the spines on the next slide of mine. So again, you can see how those things those thorns on, um, the stem of the rose. They are also going to be known as spines. And hence, that's why we sometimes refer to, uh the vertebral. Call them as the spine now looking at a bit more, you know, medical school anatomy. The functions of the spine are very, very important. And usually the function of an organ or body system is seen whenever there's a problem with that, and my colleague is going to talk to you about, um, the things that can go wrong with the spine in the second part of our lecture. However, in terms of the function of the spine, one of the most important ones is gonna be protection. Your spine or your vertebral column will be in closing and protecting the spinal cord within the spinal canal, and we'll see how that form in the performed in due course. Now, the idea is that you've got the very important spinal cord, which is essential for your movement for your survival, basically, and that's going to be in close, you know, very very, um, of safe and secure environment, which is gonna be your bony vertical column. And secondly, as we were saying, just like the columns were used in construction, the spine is going to be used for support. It will be carrying the weight of the body about the pelvis and will form the central axis of the body. If there's a problem with your spinal cord, your body will be in loads of trouble, trying to support um, its own weight, then looking at movement. The spine is really, really important in the movement of your body, especially the Super A pelvic movements. It is going to be involved in both posture, helping us sit upright. And it's also going to be involved in different movements extension flexion, lateral rotation and so on and so forth now, quickly recapping the regions of the spine because I know how important they are. And I know how they are assessed in osteo because you always need to seem professional and say, Oh, the patient has something in the cervical region of the spine or the thoracic or lumbar or a bit rarely, um, in the sacral or coccygeal area of the spine. So we've got our seven cervical vertebra sour 12 drastic vertebras, our five number vertebras and then the sacrum and the Coxes, which are, um, seen as, um, individual bone structure's. Each of them will have their own particularities, and we'll be looking at them. Um, in a couple of minutes, Um and each of them will have crucial functions. And as you can see, the spine also has some specific curvatures. And that's just to protect. Um, and that's just to, um, age with, um, the positioning of your body. And it's also due to, um, development and how we have evolved now, quickly looking at the structure of a vertebra fous again, we said the spine or the vertebral column is made up of multiple vertebras, all put on top of each other. We've got the vertebral body over there, depicted in the dark blue, which is gonna be, as you would expect, the weight bearing component which is gonna be forming the anterior part of each vertebra. So the vertebral body, the way I think about it, usually sits towards the front of your body. It's the one that you're not going to be able to feel whenever you palpate uh, the person's back. The part that you're actually able to feel whenever you palpate your back is actually gonna be the spine ist process. The bodies are put more towards the inside of your body more towards the anterior aspect of your body. Secondly, we've got the vertebral arch over there in light blue, which is gonna be forming the lateral and posterior aspect, serving as attachments for muscles and ligaments. That's where the muscles that your vertebral that your vertebra are gonna be, um, serving as attachment 0.4 are going to go and bind to. And lastly, and certainly not least we've got the center part, which is gonna be your intervertebral frame on it is gonna be the enclosed gap between the arch and the body housing the spinal cord in your spinal canal. That's where the spinal cord will be very well enclosed by the very, very bulky vertebral body and nicely surrounded by your vertebral arch. Being very, very well protected from any kind of danger, any kind of damage. Now moving on to, um, again the main, um, the main function of your spinal cord, which is going to be weight bearing, and the component that's going to be doing the weight bearing part is gonna be the vertebral bodies. They are going to be the main weight bearers of your spine. And again, it's not going to be hard for you to memorize that, because if you have a look at them. They are the chunky part. And you may have noticed that they are going to be covered with, uh, you may have noticed that they are not coming in direct contact, what to the other one to the other. But they are gonna be separate, separated by your intervertebral discs. And that's going to further facilitate the weight bearing, uh, function of your, um, uh of your spine. And it's also gonna be protecting them from continuous friction whenever you move, they're also going to be covered with highland cartilage again just to protect the bone itself. Now, having a look at the second component of your vertebra, which is the vertebral arch, we were saying that it is gonna be, um, the attachment part for muscles and ligaments. And as you can see, it is, it does have a couple of particular components. It is gonna have seven processes which are gonna be your, um uh uh out of each four will be articular, so they will be participating in your joints. Your superior articular process is you've got two of them over there in sort of the cocky green, and you also have your inferior articular process is You're also gonna have a lamina. You are going to have the spinous process. The thing that I was saying you can palpate and you can actually feel the thing that gives your vertebral column the name spine and you are going to have your laminas as well. Then you also have the pedicles and the transverse processes which lies somehow towards the slide, the side of the vertebras. To me, they look a bit more like the wings of the vertebra. That's what I'm imagining it. If you put two eyes on the vertebral body, you are going to see a tiny bird with to transverse process wings and with a very, very long spine ist tale. Now, having a look at, um, each individual vertebra and turn, we've got the subvert a bright, and I was saying that there's seven cervical vertebrae in the human body. A bit later in the session, we will be looking at the first two at your access and atlas, which are very, very special vertebras. However, overall there's gonna be a couple of special features which are gonna be characteristic of your cervical vertebra, and they love asking these questions and exams. Now, luckily, there's only three types of vertebra that they are going to be interested in in exam questions your cervical, thoracic and lumbar and each of their structures will be 100% associated to their function. Now, if we look at the spine is processes of your survive cervical vertebra, right, They are gonna be benefit. And what, Biff, it means, you know, it start to buy. That means it refers to two. So as you can see, they are going to be separated into, um two. And the exceptions to this rule are gonna be your C one vertebra, which doesn't have any spinous process at all. And, um, C seven and sometimes, um, the the C, the C seven spinous process may not bifurcate. Then we've got our transverse transverse phenomena, which are gonna be tiny holes in your transverse processes which are gonna be transmitting your vertebral arteries that are gonna be traveling up to your brain. There are particular for your cervical vertebra again. And lastly, the vertebral frame mint will be triangular in shape, and it's gonna be quite wide. It's gonna certainly be wider than the vertebral body and the reason behind. That is because the cervical vertebra only has only have to support, um, your your head, which is not as heavy as your whole body. Now, looking at the thoracic vertebra, their special thing about them from the get go is gonna be the fact that they will be articulating with, um, your ribs. They are gonna be healthy, are gonna be binding to your ribs to form your enclosed to formula enclosed, Um um, thoracic cavity and oh, sorry, Thoracic cage ribcage. So the special features of, um, the thoracic vertebra will be the fact that the body will be, um, shaped like the heart. And we'll have to Demi facets at its side, a superior Demi facet and then inferior Demi facets, And they will be serving as articular process is for the heads of the two different ribs. Your ribs will be putting their heads into the Demi articular facets, and they will be articulating very, very strongly with, um, the bodies of your vertebra, hence creating the nice skeletal outline of your thoracic cavity supported very well by your, um 36 spine at the back. The transverse processes will also have a particular itty about them. And that is gonna be the fact that it has a facet for the rib typical of the same number. So your ribs will have a tubercle, which will be attaching to the transverse process of your vertebra and their respective tubercle. For example, the tubercle of re one will be articulating with the transverse process of rib one of, uh, sorry for the thoracic vertebra one and so on and so forth. Then, in terms of the spine, it will be long pointed and direct, directed downward and backward. And you are gonna clearly see that in any kind of anatomical specimen, and the vertebral foramen will become smaller and more circular. Um, and it's not gonna be as wide as the cervical one because of the fact that your thoracic vertebra will be much more involved in weight bearing stand or, um, cervical spine was. Now, um, it's also important to notice that your T 11 and T 12 will have no costal facets. And you probably already know the reason behind that because your, um, last two ribs are going to be floating or free ribs and um, t 10 and T 12 will only have a single articular facet again. You're sort of points that you memorize before the exam. You probably will forget afterwards, but they are points that they asked about in exams. Looking at the lumbar vertebra, we are gonna have five lumbar vertebra in the human body. They're super special features Will have will be the fact that they are the largest in the body and, you know, it's only five of them. However, they are going to be there to support the whole weight of what's about them. That means that they will have a thick, stout vertebral body again. And it's all for the weight bearing purposes. And they will have a very, very blunt spine is process. Um, and again, that's going to be very visible. If you get three anatomical, um, specimens, you are gonna clearly be able to identify which one is the lumbar vertebra because they are going to be massive. They are going to be very thick, and you could clearly see that they were so designed in order to wait birth. And then we've got, um, a triangular framing as well. But if you remember the pictures, I was showing you of your cervical vertebra the frame, and it's gonna be much, much smaller again, highlighting the fact that now we are not no, no longer, um, we can no longer afford a wide framing because we need to Weight bear. Now, looking at your sacrum, this is This is a very special bone which forms part of your pelvic bones as well. And it is going to be made by the fusion of five vertebra from s one to s five. It is again gonna be weight bearing it is. It's gonna be sort of the posterior part of your pelvic hurdle, and it is going to be crucial in walking, standing and sitting. If somebody gets any kind of damage to their cycle bones or if they have, for example, secret a genesis whenever they are, um, in utero, that's going to be causing severe problems whenever it comes to walking, standing or sitting. And lastly, we've got the coccygeal part of your, um, spine of your spine of your vertebral column. And what I always found fascinating is the fact that the Kochs is is actually thought to be a remnant from the tail of our ancestors, and it does look like a tale. If you look at it, it does look like the posterior aspect of the tail of any primate that we see at the zoo. It's made by the fusion of 3 to 5 small bones. Now that depends from one person to the other. How many bones you've got in your boxes and the special features are gonna be the fact that it's present under the sacrum. It's weight bearing while you're sitting, but as you can see, it's quite a tiny bones, so it's not going to be extremely extremely, um, important. But again, um, if you lean back while sitting, um, for example, if you're sitting in a chair at the moment, if you leak back, if you lean back, the pressure on your Kocsis will actually be increasing. And that's when you're going to feel the presence of these small bones very, very down your back. Now, quickly having a look at the vertebral joints we are going to have. You know your vertebral column will be very, very mobile, and your mobile vertebra will be articulating with each other by the joints between their bodies and also by their articular facets. you're gonna have your superior articular facets which are gonna be present on your on your vertebral arch. Um, and the left and right superior facets will be articulating with the vertebra above. Those are going to be called facet joints, and they are gonna be synovial joints. Whatever your connective tissue will be PSA creating synovial fluid in order to nourish and lab req eight your joint, the joint surfaces will be coated with cartilage, allowing the movement of those joints. So they are actually mobile joints in terms of the inferior facets. Um, there's gonna be a left and the right inferior facet will be articulating with, and they will be articulating with the vertebra below again. These joints are gonna be synovial joints, and they will be allowing flexion whenever you bend forward extension whenever you are gonna be bending backwards and also lateral rotation so twisting motions, certain movements are gonna be restricted. And there's only a certain extent to which we can either hyperflex or hyper extent, and we'll see what the limiting factors of those movements are in a couple of slides. Then we've got our vertebral bodies, which are gonna be indirectly articulating with each other via the intervertebral discs that I was mentioning at the beginning of the talk. Those are gonna be cartilaginous joints. Um, the articular surfaces of those cartilaginous intervertebral joints will be covered by highland cartilage and also will be connected by an intervertebral disc. So these are the facet joints in motion on the very next slide. So again they will be allowing flexion. Whenever the anti of your intervertebral, the anterior part of your intervertebral, this will be compressing, and the inferior articular processes will move upward. Then we've got extension whenever we could go backwards and lateral rotation Now moving on to the ligaments, which are promoting supporting and also making sure that you're not going to go above your limits. These are gonna be your longitudinal ligaments. They are gonna be the two ligaments that will strengthen the vertebral body joints. The interior one will be a very strong and will be preventing hyper extension of the vertebral column. The way I think about it is it's gonna be sitting anteriorly so again more towards the front of your body. Hence, whenever you're trying to go backwards, it is gonna be hyper stretched and it's gonna be preventing your hyper extension. Your posterior one will be a bit weaker. It will be present, as you can see in the diagram right in your vertebral canal. And it is gonna be, um, weaker than the anterior. You're one preventing hyperflexion. The reason why it's weaker is because you can only hyperflex to some extent, and that's just gonna be did you to the normal body anatomy. And we also have a good number of facet joint ligaments. We are going to have the ligamentum the ligamentum flavum, which is gonna be, um, extending between the laminas. And it's called Flavum because it is gonna be yellow. Then we've got interspinous and super spinous. And as you would expect, they will be joining the spinous processes either in between or above. And we also have the inter transverse ligaments. And that's what I love about anatomy. The keys in the name they are gonna be linking the transverse ligaments of your, um, vertebras. Then we've got a couple of anatomical landmarks that are very, very important for you to know, and that's gonna be the C seven spinous process, the one that you can pulpit on almost anybody's packs. And once you identify that, you will know that once below is gonna be t one t two and so on and so forth. And if you follow somebody's spine is ligaments outline, you may be able to feel the supraspinatus ligament. You may be actually able to, you know, feel the sort of, um, jelly like material z not jelly like, but more like, um, something quite rigid. Okay. And then, lastly, I have promised I would be introducing you to your atlas and taxes. Your atlas will be that quite interesting vertebra that you see sitting above in your, um in your in that that picture it is going to be your first cervical vertebra and it will be supporting the weight of the scalp. The access will be that vertebra. That's quite interesting, because it's gonna very, very interesting process. The odontoid process, which is gonna be forming the private sort of the body of your atlas, will be formed by the odontoid process of your access, and it will be forming the private around which the atlas will be rotating. Then, if we look at the mobility of this joint, which is sort of the first joint between your head and your spinal cord in your spinal column. Um, the Atlanto axial joint is the most mobile joint in our vertebral column, allowing the rotation of the head and neck to even, you know, very, very high expense. And then this joint will be a three in one joint. It is gonna be composed of three synovial joints with the medium joints being a private joint again, the one that you can clearly see. And you can probably imagine the rotation and the two others are gonna be playing joints, which are simply going to be supporting the stability of your private joint. And I think that's gonna be, um, me. I'm gonna pass you over to injuries of the spine. Thank you. Thank you, Ana. So moving on to the injuries that we can expect in, uh, the spine, firstly, just providing a summary What I'm of what I'm going to cover. It's going to start with the history. Uh, as in what? Aspects of the history are important. When you're assessing a patient with possible spinal injury, then what clinical examination that we need to do different imaging strategies and then finally, how to manage these patient's starting off with the history. I think the main thing that we need to know is the mechanism of injury, as different patterns can be identified just purely based on the mechanism. For example, if it's a person in your a traffic accident wearing a seatbelt, they are highly likely that they're going to get a chance fracture. Also, generally speaking there, there's a high risk of spinal injury in all, high energy trauma and therefore, spinal protect protection is requiring all trauma patient's until a fracture is excluded. You should also have a high clinical suspicion. Suspicion of the spinal cord, spinal spinal injury in elderly and osteoporotic patient's as low energy trauma may also result in spinal fractures such as wedge fractures. For instance, when you're examining a patient with possible spinal injury, it is always important to ensure that whole spine immobilization is carried out in the first instance. Uh, most commonly, you're gonna encounter patient's who have been in a polytrauma or multiple trauma case, and therefore it is always important to immobilize their whole spine. And how would you do this? You would use the semi rigid cervical collar with side head support, using sandbags or just blocks and strapping across the head as well, and this will immobilize the cervical spine. You would then use a long spine board to immobilize the Seroquel number, uh, spine as well. When you're moving such patient's, it is always important to use a log roll technique as this prevents any movement off the spine and does prevent any further deterioration of that patient. As I said, spinal immobilization is a priority in multiple trauma. About the spinal clearance is not so. What this means is that in patient's that have been in a trauma, and in polytrauma you have you you have to immobilize their spine. However, assessing their spine can take place when appropriate. Most of these patient's are gonna have life threatening conditions such as hemorrhage for instants and controlling the hemorrhage. And performing other such lifesaving procedures is gonna take precedence over imaging the spine and assessing the spine as well. So when we come to assessing the spine, there are two main things that we need to know. First is assessing the spine, the vertebrae themselves, and then is doing an assessment of the, uh, neuro vascular system associated with it as well. So when we are assessing the vertebrae, we need to look at five main things and first as tenderness, edema, bruising in that area, any gap or step deformity and a spasm of the associated muscles included, as well, then, the next thing that we do is a neurovascular examination. Um, it is always important to differentiate between, uh, an upper motor neuron lesion and low lower motor neuron lesion. And this can be done by conducting your motor examination, including your tone and power, your sensory examination, which follows a dermatomal distribution and your reflexes as well. And this allows you to see whether the lesion or the injury is present in the spinal cord or in the exiting nerve roots. This is an Asia chart and is used to a document your motor and sensory findings and allows you to identify um, where exactly the lesion is and what, where exactly the injury is and what needs to be done next. So the next obvious logical step would be imaging to see exactly where the injury is in. Water injury has occurred, so obviously not every patient that comes in through the door would require an imaging of their spine. So we need to see. So we need to see those patient's with neck pain, midline neck or back tenderness, neurological signs and symptoms in their paraphrase or anywhere else. If they have mental status that is less than alert or if they're intoxicated or if they have a distracting injury, for example, in Polytrauma, where they have a painful limb elsewhere due to limb fractures. All of these patient's would require imaging, uh, of the spine in terms of what investigations need to be done or imaging that needs to be done. As with every musculoskeletal problem, we start off with an X ray, and this allows you to visualize, uh, bones easily and identify any fractures that are present as well. Again, as with any any other musculoskeletal condition, we need to take two views. And and for the spine, it would be an A P uh, anterior posterior review and lateral view of the relevant part of the spine or the whole spine for the C spine. You would also do something called a peg view, which looks down, uh, and gives you a clear, uh, visualization of this uh, of the C one and C two water pill as well, If you you see that there's no fracture, uh, present in these views, you can also do something called in flexion and extension view, but in patients that have persistent pain and these check for signs of ligament is insufficiency, which and I had previously mentioned as well. However, in most polytrauma cases, patient's would often get pants can or a whole body CT, as in, because this allows you to visualize the spine not only the spine but other injuries that the patient may have, and most patients would have internal bleeding as well. And Defoe would require a CT and the less if you do establish any new neurological deficits during your examination. And MRI is also indicated to look for where, exactly? Um, the spinal cord or the nerve roots are injured, moving on to the management. And again, I can't highlight this enough, but it is dictated by the level of stability. And how would you? How would you assess, um, signs of instability or whether uh, stable is using these few criteria clinically, if you find a deformity in our examination, if you find a neurological damage present. And if if there is extreme pain that is uncontrolled and simple analgesia, we would consider this unstable. If you look radiologically more than if more than one column is damaged, this can be either due to a fracture or ligament Is terror. This would be considered unstable, unstable if less than 50% of the anterior heights of the water browse maintained if multiple levels are fractured. If we can, uh, see nerve or spinal cord damage? And if there's progressive loss of position over time and a fracture that appears otherwise stable, we would consider this, uh, particular fractures unstable and would require urgent management. So if you take this X ray, for example, we can see that there's an obvious deformity. There's an obvious fracture over here in the T 12 vertebra. And how could we check for signs of instability? Would start off by checking the, uh, anterior height, and we can see that it's less than less than 50% of it is actually maintained or preserved, and therefore, this would point towards, uh, instability. The other thing that we do is look at the columns and as you can see if we hear the anterior middle and posterior columns have been disrupted and therefore again pointing towards instability. And this patient, which required to be managed as soon as possible in terms of how we manage these patient's stable fractures would not require reduction as the bone is auditing the anatomical position. And we would just have to maintain this Indiana anatomical position so that, uh, they can heal themselves through primary bone healing. And this can be done. But providing adequate analgesia as these can be very painful and a supporting place as well. However, in unstable fractures, what you would need to do is, um, perform an open reduction as in, uh, manually reduce the fracture, place it in the anatomical position and maintain it in the anatomical position, either using spinal stabilization, uh, internal fixation using spinal stabilization and also decompression of the nerves or the spinal cord if any neurological, uh, deformities present as well. This is a C tlso brace, which can be used if there's multiple levels of stable fractures in the C spine or the thoracolumbar spine as well, where there's immobilization of the cervical spine and the thoracic lumbar spine again there's there's different variants of, uh, this particular, uh, brace that is used for just solely to Rachael numbers, uh, spinal injuries or just cervical spinal injuries as well, Moving on to specific fractures. Now, if you look at the cervical spine, uh, we start off with the Jefferson fracture, which is which is a fracture of the C one vertebral body. What happens is there's a compression compression of the bony ring of see one, which causes a splitting of the lateral masters and causes causes a transfers ligament tear. The primary imaging that we use over here is an odontoid or a peg view that looks up through the mouth into the cervical. Uh, as we can see from Figure A. Over here, we can clearly see the body of C one and C two along with the dense, and there's a fracture observed to the right of the dense on the C one body indicated by the dotted line. However, when you see this, it is quite difficult to identify this fracture, and therefore there is a low threshold for a CT scan and figures B and C. We can clearly see the, uh, fracture of the fracture lines and how this would be unstable and would require immediate treatment. The next thing that we can see is in a daunted fracture, which is a fracture of the sea to UM, which is a fracture of the C two vertebrae. And there are three types dictated by where exactly the fracture is. So if there's an avulsion of the tip of the ligament, which is the top of the dense, Uh, this would be, um, a Type one fracture, as indicated by this diagram over here, and it's usually stable, and it's usually treated with an orthotic brace Type. Two factors, however, are at the junction of the denser, the peg or the don't hurt process with the sea to body, and it's mostly unstable and would require treatment with either surgery or a halo brace. And if they're unsuitable for surgery or they're unfit for surgery, then our sources can be used. However, because this is unstable, most patient's would require surgery. Type three. A type three fracture would be would mean that there's a fracture in the body of the CT, which is a cancellous bone and is again usually stable and treated using an orthotic brace. Another type of fracture in the C two vertebral body can be a hangman fracture, and it's caused you to as traumatic spondylolisthesis of see, too. I know this is a very complicated words. Let's break it down. What happens is there's a disruption of the joint, and the body of the C two is displaced anteriorly compared to the body of this, uh, compared to the, uh, the three vertebral body. And there's a fracture across, um uh, the vertebral body has seen over here and the right hand side. Um, and it's often caused you too hyper extension of the of the next and axial compression forces as well. That is from the top and bottom. And this is often seen in various, uh, road traffic accidents when there is a whiplash type of injury. And this is often treated using a halo vest or a caller if it's less than six millimeters. If the if the displacement is less than six millimeters, however, surgery would be indicated if it's more than that, moving on to the thoracolumbar fractures. Uh, the first thing is a wedge fracture or anterior compression fracture. This occurs as the name suggests, uh, this occurs in the front of the word vertebra or the anterior area of the bone, and it's compressed while the posterior aspect is unchanged. As you can see from this exit over here, the anterior aspect of the word bro is significantly compressed and takes the shape of a veg, and hence it's called a. Hence, it's called a veg fracture. This is often seen in older patients who have osteoporosis as well and is usually stable and can be treated by simple energies here and just a brace. The next thing is the burst fracture, where the vertebra, as the name suggest, breaks into multi make breaks, breaks in multiple directions and highly commuted. It is usually due to a significant trauma, such as a road traffic accident or a severe fall as well. So if you look at the X ray over here, this vertebra over here is significantly damaged in multiple planes. A CT would highlight this better, showing the different planes of vertebral damage and how unstable this can be and therefore would require urgent treatment in terms of surgery. The next thing is a chance fracture, which is a horizontal fracture that extends through the anterior posterior parts of the water pill body to the spine is process and the pedicles, and it's often caused due to reflection of the crackle number, uh, spine. And it's classically seen in a lap seatbelt injury, as mentioned earlier. So if you look at this CT over here, we can see that the fracture goes across the water Bill body into this finest processes as well. And that is what a trans fracture is. And if you look at this, uh, look at the mechanism of injury over here, let's take this as the, uh, seatbelt. And, uh, there is a and there's, uh, there's a There's a flex flexion force that is applied to the Caracul lumber spine and thus causes high energy. Uh, thus, uh, uses high energy across the vertical body. In the spine is processes causing horizontal fracture across all these points. Then the next thing that can happen if, uh, we, uh, if we encounter a spinal fracture is spinal cord injuries is this is this is one of the functions of the vertebral column, uh, which is protecting the spinal cord. So what do you mean by spinal cord injury, which is it is an insult to the spinal cord. The results in alter neuro neurological function and can either be motor sensory autonomic. It can either be temporary or permanent, and it can be either complete or incomplete. Uh, it can be only some sensory loss or some motor function, Um, and can be laws are preserved. The level of injury again dictates the symptoms. So if we can get tetraplegia from a P C spine, uh, fracture. However, it will just be paraplegia if you get it from a throughout the lumbar spine level. So the uh so your spinal injuries can then be divided into complete course syndrome and incomplete coat syndrome. So complete coat syndrome is the complete loss of motor and sensory function below the level of the traumatic traumatic traumatic lesion. And it's important to know the dermatomal distribution of the different nerve roots as this allows you to adequately examine the patient, identify where the lesion exactly is if the symptoms that, uh, if the symptoms last for more than 24 hours, they are considered to be permanent, and therefore early intervention is often required in patient's that have, uh, complete course syndrome. If you have a high C spine injury, you can get respiratory dysfunction as well, which is due to loss of intercostal function and the phrenic, uh, nerve as well, which is supplied by the C three to C five, uh, nerve rules. And therefore it would be very, um, sensible to intervene in such patient's as soon as possible to prevent any further damage. Now, when you come to incomplete court's syndromes, we have different, uh, types, depending on where the lesion is. Firstly, as the name suggests, we're going with a Central Corp syndrome, and it affects the center of the spinal cord. And it's the most common type and is usually associated with the C spine hyper extension injury. It causes motor weaknesses, and it the upper extremities are affected more than the lower. However, the sensory loss is variable next, which is one of the most important ones which will highly, which is highly likely to come up in exams as well as the Bronze Accord syndrome. It has caused you to a Hemi section of the heavy set. It has caused you to a Hemi section lesion of the court's from penetrating homos It has, uh, stab stab wound such as a stab wound or gunshot. It causes ipsilateral loss, which is the same side. Uh, loss of motor proprioception vibration and deep touch function, however, will cause contralateral laws, which is on the opposite side of the lesion of light, touch, pain and temperature. I still can't remember which, um, which sides are affected and what is affected in each side. Therefore, we just emphasize that you need to know this. Read this one day before the exam and go for the exam and hope for the best. Next thing is going to be an anterior cord syndrome. And as the name suggests, the anterior aspect of the spinal cord is affected, and it again cause you commonly caused you to reflection injuries as a burst fracture or a herniated disk. There is variable laws of motor function, pain, funked, pain and temperature. However, because the proprioception vibration in touch functions are located on the posterior aspect of the spinal cord, these are preserved completely opposite to that. We have the posterior cord syndrome, and this is a very rare condition that occurs due to a lesion. The posterior portion of the spinal cord and can be due to the posterior spinal artery disruption. And it's exactly the opposite of the previous one where you have lots of the pro proprioception vibration and touch, but preservation of motor pain and temperature. I think that's the end of the lecture. We have some questions, uh, for you, Um, but before that, if anyone has any questions, just put it in the chat box, and we'll try to answer them. Sorry, Anna, Are there any questions in the chat box? No, not none that I've seen. No, I've kept on it. All right. Okay. So I guess we'll just move on to the M. C. Q. Questions that we have. Uh, if everyone just wants to just put their answer in the chat box, we can see if it's right now. Now, if you just If you could just let me know if, uh what on Thursday putting. Thank you. So the first question is, you have an 88 year old lady that presents to the emergency department with an episode of sudden onset back pain as she was getting up from her armchair early that morning. The pain is localized to her lower back and described as a dull ache. There's no radiation to her legs and no changes to her bladder and bowel function. She mentions that she has experienced similar episodes a few times in the past. Her medical history consists of long standing COPD, which he take steroid tablets for she also takes calcium supplements. On examination, she has a B M I of 19 and find standing and walking possible but painful over the aid of her walking stick. She has a kyphotic posture, and it's tender over the level of the T 12 vertebrae. A plain spinal X ray was requested. So what would you What is the most likely finding on the X ray? And those are your options there, give you a couple of minutes. So we've got an A in the chat. Yeah. Um, so Yep, that's the correct answer. So this is going to be a veg fracture. Um, So there are different clues that have that have been given in the question. Firstly, this is an old, uh, woman who takes, uh, steroids and calcium supplements as well. So most likely she's going to be or osteoporotic, and the most common type of fracture that you can see with osteoporotic patient is going to be a veg fracture. Also, there is no history of high energy trauma or any form of trauma. Therefore, that rules out the other fractures, and it's going to be a wedge fracture moving on to the next question then. So we have a 42 year old male who's involved in a road traffic collision. Uh, an MRI reveals that he has He may have a Hemi section of the cord. Uh, which one of the following? Which one of the following is most likely to occur And those are your options there. Sorry. Do we have any answers? Give you a couple of more? A couple of more minutes? We've got to be in the chat, Be any other. Any other ones? Uh, all right. So the answer is gonna be see. Um so for this, this is again brown's the cord syndrome, uh, where you'd get contralateral loss of pain in touch, but ipsilateral loss of motor vibration and position sense. Um, therefore, that rules out a and be and it's gonna be see with Bronze Accord syndrome. You don't you do not get tetraplegia where you have loss of function in all four limbs and you do not get complete paralysis below the level of the lesion as well. And therefore those are ruled out as well. And therefore the answer is going to be seen just a quick dipper. These I remember I'll always remember. And that's how I've always remembered brown Seaport syndrome. It was Doctor Chandru who was always mentioning how the old ones are crossing. So you're very old, you know, pain and touch. Sort of, um, very old. Um, senses are the one's crossing. And that's why I always remember, because pain and that, you know, all of our ancestors were feeling that while vibration sense is something a bit more sophisticated that we've developed along the the years and those are not going to cross, that's why I always remember it. In case it's helpful for somebody that's actually really good. Um, I guess that's the end of the session. Thank you, everyone for joining. Do you have any questions? Put it down in the chat box and yeah, thanks very much, guys. Yep. Nothing more in the chat. All right. Thank you. Thank you.