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Spinal Column

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Anatomy Of The Spine

Spinal Column

The spine is a flexible column, composed of a stack of individual bones. Each bone is called a vertebra. There are seven vertebrae in the neck (cervical vertebrae) twelve in the thoracic region (thoracic vertebrae) and five in the lumbar region (lumbar vertebrae). At the top, the skull rests on the atlas vertebra (the first cervical vertebra). This is called the occipito-cervical junction. At the bottom, the fifth lumbar vertebra rests on the sacrum (a large triangular bone) which consists of five fused vertebral elements. The sacrum forms part of the pelvis. Below the sacrum, there is a small string of bones, the residual tail, called the coccyx. This is composed of up to six or seven segments.

The vertebrae are separated from each other by joints. At the front, there is a large fibro-cartilaginous joint, called a disc. At the back, there are facet joints. The bones are bound together by ligaments. The most important of these are the anterior longitudinal ligament, the posterior longitudinal ligament and the ligamentum flavum (see diagrams).

Down the centre of the spine there is a canal – the vertebral or spinal canal. In this canal, we find the spinal cord and spinal nerves.

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Back Pain Explained (By Area)

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Back pain can be separated into four different areas neck, upper back, lower back and tailbone pain.

Spinal column

Neck Pain

Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Neck pain, although felt in the neck, can be caused by numerous other spinal issues. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back.

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Overview of surgical techniques

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Strange as it may seem, the objectives that a spinal surgeon wants to achieve in the treatment of spinal disorders are surprisingly few and very simple. There are only four - and in fact these are the only objectives that can be achieved.

1. Freedom From Pain

First, the surgeon wants to achieve freedom from spinal pain. This is the commonest cause of trouble within the spine and is most commonly due to mechanical problems.

2. Freedom From Neurological Compromise

Second, the surgeon wants to achieve freedom from neurological impairment or compromise, both immediately and also in the future.

3. Stability

Third, the surgeon wants to achieve stability of the spine.

4. Make a Pathological Diagnosis

Fourth, when needed, the surgeon wants to make a pathological diagnosis - is the problem mechanical, or is it for example an infection or a tumour? Treatment of the spinal disorder will then clearly involve treatment of that underlying condition as well.

However, where as the objectives of surgical treatment - and its limitations - are simple, the means whereby we achieve these objectives are exceedingly complex. This is in fact the bulk of the subject matter of learned text books, which I will not attempt to reproduce here. However, it pays all - patients, even clinicians - to remember these four very simple principles.

 Usually, freedom from neurological compromise, spinal stability and the treatment of the underlying pathological process will result in freedom from pain.

Surgical Technique

All surgery has to be carried out with meticulous surgical technique, and this is particularly true in neurosurgery. The consequences of minor lapses in technique may be tolerated in other surgical fields. In neurosurgery, they can be disastrous.

Carrying out a surgical procedure falls into a number of phases:
First, we obtain an informed consent. This means that the patient understands the nature of the procedure, the indications, risks, complications and the post operative care. Above all, the patient must understand that surgical procedures do not relieve all symptoms, and this must be discussed before hand.

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