Lumbar Spine
Physicians use a code to number each of the 24 vertebrae in the
spine. The low back officially begins with the lumbar region of
the spine directly below the cervical and thoracic regions and directly
above the sacrum. The lumbar vertebrae, L1-L5, are most frequently
involved in back pain because these vertebrae carry the most amount
of body weight and are subject to the largest forces and stresses
along the spine.
The true spinal cord ends at approximately the L1 level, where
it divides into many different nerve roots that travel to the
lower body and legs. This collection of nerve roots is called
the "cauda equina," which means horse's tail and describes
the continuation of the nerve roots at the end of the spinal cord.
Vertebrae
The vertebral body is a thin ring of dense cortical bone. The
vertebral body is shaped like an hourglass, thinner in the center
with thicker ends. Outer cortical bone extends above and below
the superior and inferior ends of the vertebrae to form rims.
The superior and inferior endplates are contained within these
rims of bone.
Pedicles
The pedicles are two short rounded processes that extend posteriorly
from the lateral margin of the dorsal surface of the vertebral
body. They are made of thick cortical bone.
Laminae
The laminae are two flattened plates of bone extending medially
from the pedicles to form the posterior wall of the vertebral
foramen. The Pars Interarticularis is a special region of the
lamina between the superior and inferior articular processes.
A fracture or congenital anomaly of the pars may result in a spondylolisthesis.
Intervertebral Discs
Intervertebral discs are found between each vertebra. The discs
are flat, round structures about a quarter to three quarters of
an inch thick with tough outer rings of tissue called the annulus
fibrosis that contain 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.
Facet Joints
Joints between the bones in our spine are what allow us to bend
backward and forward and twist and turn. The facet joints are
a particular joint between each vertebral body that help with
twisting motions and rotation of the spine. The face joints are
part of the posterior elements of each vertebra. * Each vertebra
has facet joints that connect it with the vertebrae above and
the vertebrae below in the spinal column. The surfaces of the
facet joints are covered with smooth cartilage that help these
parts of the vertebral bodies glide smoothly on each other.
Ligamentum Flavum
The ligamentum flavum is a strong ligament that connects the laminae
of the vertebrae. The term "flavum" is used to describe
the yellow appearance of this ligament in its natural state. The
ligamentum flavum serves to protect the neural elements and the
spinal cord and stabilize the spine so that excessive motion between
the vertebral bodies does not occur. It is the strongest of the
spinal ligaments and often has a thinner middle section. Together
with the laminae, it forms the posterior wall of the spinal canal.
Spinal Cord
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).
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.
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