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ABC of Spine
Structure and Function of Spine

In the present fast paced lifestyle, where physical activity is on the decline with irregular food habits causing higher incidence of obesity, problems relating to spine are on the rise. The understanding about spine and perception about spinal problems and there treatment have been changing over last 3-4 decades. Having said that , even today a lot of misconceptions exists in the minds of lay persons, which is experienced in the outdoor clinic when interacting with spine patients and their relatives. Hence it is appropriate to educate the reader at large about the structure and function of spine, diseases of spine, available treatment and preventive aspects.

ABC of spine is a series of write ups which will address the structure and function of spine, manifestations of the common spinal problems like slip disc, cervical spondylosis , its management and its preventive aspects. This series will also give an insight into the advances in investigations, surgical techniques and instrumentation in the field of spinal surgery. This in turn results in better predictability of outcome.

The Spinal Column

The spine is an intricate structure of bones (vertebra), muscles, and other tissues that form the posterior part of the body's trunk, from the skull to the pelvis. The centerpiece is the spinal column, which not only supports the upper body’s weight but houses and protects the spinal cord - the delicate nervous system structure that carries signals that control the body’s movements and convey its sensations to and from the brain.

The spinal column consists of 5 regions, made up of 33 bones called vertebrae.

Cervical Region:

The top seven vertebrae make up the cervical region (labeled C1–C7). The first 2 of these vertebrae supports the skull and are atypical vertebra , called atlas and axis.

Thoracic Region:

Each of these twelve vertebrae supports a pair of ribs (labeled T1–T12).

Lumbar Region:

These are the five largest and strongest vertebrae (labeled L1–L5). This area of the spine if involved, as well as its surrounding tissues, can cause "low back pain".

Sacral and Coccygeal Regions:

The sacrum is made up of five fused vertebrae. The coccyx is made up of four fused vertebrae.

The spine has the vertebrae stacked one on top of one another to form the spinal column, also known as the spine. The solid portion in front of each vertebra is known as body . From the body two prong like pedicles on either side enclose the space and join the lamina.

The laminae are two flattened plates of bone extending medially from the pedicles to form the posterior wall of the vertebral foramen and meet in midline to form spinous process. This Knob can be felt under the skin at the back like a line of beads.

On either side of spinous process are the facet joints which serve as hinges between the vertebra above and one below. Each of these bones contains a roundish hole that, when stacked in register with all the others, creates a channel (the "spinal canal") that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves ("roots") enter and emerge from the spinal cord through spaces between the vertebrae called "foramina".

The spinal cord is part of the central nervous system of the human body. It is a vital pathway that conducts electrical signals from the brain to the rest of the body through individual nerve fibers. The spinal cord is a very delicate structure that is derived from the ectodermal neural groove, which eventually closes to form a tube during fetal development. From this neural tube, the entire central nervous system, our brain and spinal cord, eventually develops. Up to the third month of fetal life, the spinal cord is about the same length as the canal. After the third month of development, the growth of the canal outpaces that of the cord. In an adult the lower end of the spinal cord usually ends at approximately the first lumbar vertebra, where it divides into many individual nerve roots (L1).

Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail.

The intervertebral Disc

The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the spine and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Intervertebral discs have a tough outer ring of tissue called the annulus fibrosis which contains a soft, white, jelly-like center called the nucleus pulposus. Flat, circular plates of cartilage connect to the vertebrae above and below each disc. Intervertebral discs separate the vertebrae, but they act as shock absorbers for the spine. They compress when weight is put on them and spring back when the weight is removed.

Intervertebral discs make up about one-third of the length of the spine and constitute the largest organ in the body without its own blood supply. The discs receive their blood supply through movement as they soak up nutrients. The discs expand while at rest allowing them to soak up nutrient rich fluid. When this process is inhibited through repetitive movement, injury or poor posture, the discs become thinner and more prone to injury. This may be a cause of the gradual degeneration of the structure and function of the disc over time.

The Spinal Canal

The spinal canal is the anatomic casing for the spinal cord. The bones and ligaments of the spinal column are aligned in such a way to create a canal that provides protection and support for the spinal cord. Several different membranes enclose and nourish the spinal cord and surround the spinal cord itself. The outermost layer is called the "dura mater," which is a Latin term that means "hard mother," indicating that early anatomists had at least a rudimentary sense of humor. The dura is a very tough membrane that encloses the brain and spinal cord and prevents cerebrospinal fluid from leaking out from the central nervous system. The space between the dura and the spinal canal is called the "epidural space". This space is filled with tissue, vessels and large veins. The epidural space is important in the treatment of low-back pain, because it is into this space that medications such as anesthetics and steroids are injected in order to alleviate pain and inflammation of the nerve roots.

Spinal Support

The back and abdominal muscles play an important role in maintaining posture and strength of the spine. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Functions of Spinal Segment

In short, spine has three functions

  • Gives flexibility to the spine-disc and facet joints
  • Gives stability to the spine-joints, ligaments and muscles
  • Protects the nervous system ,spinal cord
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