A Short Practice of Spinal Surgery by Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S.

By Henry Vernon Crock A.O., M.D., M.S., F.R.C.S., F.R.A.C.S. (auth.)

"... i'd suggest this e-book for an in-depth research of the lumbar backbone and its degenerative states ... super important for the resident early in trainings as she or he makes an attempt to correlate the advanced anatomy of the lumbosacral quarter with linked pathological states ...” magazine of Neurosurgery

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21). A narrow transverse bulging ridge formed by posterior fibres of the remaining annulus fibrosus and posterior longitudinalligament protrudes into the floor of the S 1 nerve root canal. Coupled with the movement upwards of the S 1 facet towards the pedicle of L5, the anterior and medial edges of the S 1 facet come to lie very close to this ridge and occasionally even to the postero-inferior surface of the fifth lumbar vertebral body. In consequence, mechanical obstruction of the S 1 nerve root develops.

The shape of the dural sac changes from a rounded tubular outline, tapering progressively from the level of L3 downwards. Contrasting with the upper two lumbar spinal nerves, the lower lumbar nerves are longer and come off at more acute angles from the sides of the dural sac. The concept of a nerve root canal is of greatest significance in relation to the two lower-most lumbar and first sacral nerves. In Fig. 16, the origin of the S 1 nerve from the dural sac is shown just below the level of the inferior margin of the fifth lumbar pedicle.

1, measurements of the height of the LS/S 1 intervertebral disc space in these SO patients are recorded. 1. Height of the L5/S 1 intervertebral disc (50 patients) Anterior height Posterior height >lOmm* 10-5mm <5mm >5mm <5mm Male Female 7 3 20 14 3 3 5 4 25 16 Totals 10 34 6 9 41 * In only one patient was the height more than 15 millimetres. e) Investigations Plain X-rays and magnetic resonance images together can provide comprehensive information on isolated disc resorption. i) Plain X-Rays Typical findings are: gross disc space narrowing, vertebral body sclerosis especially close to the vertebral end-plates, the Knuttson vacuum sign on the lateral extension film, minimal evidence of osteophyte formation and facet joint subluxation.

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