Modern Concepts
E-Book, Englisch, 507 Seiten, eBook
ISBN: 978-3-030-20925-4
Verlag: Springer International Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
Since 1989, Jean Marc Vital has been an Intern and University Professor of orthopedic and traumatology surgery at the University of Medicine of Bordeaux, as well as Head of the Department of Spinal Diseases and Director of the Anatomy Laboratory at the Paul Broca faculty. Upon completing his residency in Bordeaux in 1980, he received the Gold Medal Award of Surgery. Moreover, he earned an MD in human biology in the field of anatomy. In 1981 he was appointed Instructor of Anatomy and Organogenesis as well as Intern in Orthopedic Surgery and Traumatology. In the same year, he became Senior Registrar of the Department run by Prof. Jacques Senegas. He also earned the national specialized Diploma in Sports Medicine (CES). As a spine surgeon, Dr. Vital has a special interest in spinal deformities (with particular emphasis on sagittal balance) and in cervical spine surgery (cervical prostheses and myelopathy). He has been a member of several outstanding societies such as the French Medical College of Anatomy since 1989, and the European Cervical Spine Research Society since 2003. He also serves on the editorial boards of the European Spine Journal, The Spine, and The French Journal of Orthopedic and Traumatology Surgery.
Dr. Derek Thomas Cawley is a Spinal Fellow at Bordeaux University Hospital. Having completed his training as an orthopedic surgeon in the Republic of Ireland, he is the author of several publications on orthopedic and spinal research topics. He has received numerous international awards as an orthopedic trainee including an RCSI/Ethicon bursary, BOA/Zimmer Biomet travelling fellowship, SOFCOT/ARMO foreign graduate award and the Mark Paterson/EFORT travelling fellowship.
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Weitere Infos & Material
1;Foreword;5
2;Preface;6
3;Contents;7
4;Part I: Phylogenesis and Ontogenesis;9
4.1;Comparative Anatomy of the Axial Skeleton of Vertebrates;10
4.1.1;Introduction;10
4.1.2;The Organization Plan for the Vertebrates;10
4.1.3;Adaptive Constraints of the Living Environment;11
4.1.3.1;Constraints of the Aquatic Environment;11
4.1.3.2;Constraints of the Terrestrial Air Environment;11
4.1.4;Fish;11
4.1.5;Terrestrial Vertebrates;12
4.1.5.1;Amphibians (About 7000 Species);13
4.1.5.2;Reptiles (Approximately 8950 Species);14
4.1.5.3;The Cervical Spine;15
4.1.5.4;Birds (Approximately 10,000 Species);16
4.1.5.5;Mammals (About 5500 Species);16
4.1.5.6;The Cervical Spine;17
4.1.5.7;Structure;17
4.1.5.8;Movements;18
4.1.5.9;The Craniovertebral Musculature;19
4.1.5.10;Postures;20
4.1.5.11;Thoracic Spine and Lumbosacral;21
4.1.5.12;Structures;21
4.1.5.13;Musculature;22
4.1.5.14;Postures;22
4.1.6;References;25
4.2;Embryology of the Vertebral Column;26
4.2.1;Genetic and Biochemical Considerations;26
4.2.2;Embryology of the Vertebromedullary Axis;27
4.2.2.1;Early Development;27
4.2.2.2;Trilaminar Embryo;28
4.2.2.3;The Notochord;29
4.2.2.4;Primary Neurulation;29
4.2.2.5;Secondary Neurulation;29
4.2.2.6;Formation and Differentiation of Somites;29
4.2.3;References;30
4.3;The Growing Spine;32
4.3.1;A Mosaic of Growth Cartilage;32
4.3.2;Vertebral Growth Is Growth by Endochondral Ossification;32
4.3.3;Embryology Holds First Truths;32
4.3.4;The Fetal Period: The Strongest of All Growth Is the Intra-Uterine Period;33
4.3.5;Vertebral Curves Are Not Primitive But Acquired;34
4.3.6;At Birth, 30% of the Spine Is Ossified;34
4.3.7;The First Five Years of Life Are Decisive: Living Growth;34
4.3.8;Growth Between 5 Years and the Beginning of the Puberty;37
4.3.9;Puberty, a Decisive Turn: New Acceleration;37
4.3.10;Each Level of the Spine: A Different Growth;37
4.3.11;The Cervical Spine;37
4.3.11.1;Central Spinal Canal at the End of Growth;37
4.3.11.2;Cervical Spine Height;38
4.3.11.3;The Superior Cervical Spine;38
4.3.11.4;The Growth of the Atlas (Figs. 27, 28, and 29);38
4.3.11.5;The Growth of the Axis Is Even More Complex;40
4.3.11.6;The Lower Cervical Spine;40
4.3.11.7;The T1-S1 Segment (Figs. 31a, b, 32, and 33);41
4.3.11.8;The Thoracic Spine T1-T12 (Figs. 34 and 35);41
4.3.11.9;The Lumbar Spine L1-L5 (Figs. 36 and 37);42
4.3.11.10;The Sacrum;42
4.3.11.11;The Intervertebral Disc;44
4.3.12;The Growth of the Thorax: 4th Dimension of the Spine;44
4.3.12.1;Bodyweight;47
4.3.12.2;Parasol Effect;50
4.3.13;What Size Deficit for Which Arthrodesis?;51
4.3.13.1;First Scenario: Arthrodesis of the Thoracic Spine;51
4.3.13.2;Second Scenario: Arthrodesis of the Lumbar Spine;53
4.3.14;All Scoliosis Will in Time Become Identified as a Growth Cartilage Disease;54
4.3.15;The Growth of the Spine: From Normal to Pathological;54
4.3.16;Managing Infantile Scoliosis Is Controlling the Vilebrequin Effect;55
4.3.17;Suggested Readings;58
4.4;The Growth Cartilages of the Spine and Pelvic Vertebra;60
4.4.1;Neurocentral Cartilage (NCC);60
4.4.2;The Ring Apophysis;68
4.4.3;Ossification of the Pelvic Vertebra;73
4.4.3.1;Bone Age During Puberty;75
4.4.4;References;81
4.5;Morphologic and Functional Evolution of the Aging Spine;82
4.5.1;Age-Related Structural Alterations;82
4.5.1.1;The Intervertebral Disc;82
4.5.1.1.1;Structural Modifications;82
4.5.1.1.2;A Fragile Avascular Tissue;83
4.5.1.1.3;A Genetic Predisposition?;83
4.5.1.1.4;Genesis and Contributions to Aging on Histomorphological Features;83
4.5.1.2;Aggravating Factors;85
4.5.1.2.1;Mechanical Factors;85
4.5.1.2.2;Inflammatory Factors;86
4.5.1.2.3;Vascular Factors;86
4.5.1.3;Specific Features in the Cervical Spine;88
4.5.1.4;Lumbar and Cervical Tandem Lesions;88
4.5.1.5;The Posterior Arch;89
4.5.1.5.1;Facet Joints or Zygapophyseal Joints;89
4.5.1.5.2;Spinous Processes;91
4.5.1.5.3;Ligaments;91
4.5.1.5.4;Muscles;92
4.5.1.5.5;Bone;94
4.5.1.5.6;Aging and Neurological Control of Posture;96
4.5.1.5.7;Proprioception;96
4.5.1.5.8;Vision and Visual Motor Control;97
4.5.1.5.9;The Vestibule;97
4.5.1.5.10;Central Integration;98
4.5.2;Functional Alterations Associated with Aging;98
4.5.2.1;Postures and Dynamic Balances in Normal Adults;98
4.5.2.1.1;Bipedal Folding Chains;99
4.5.2.2;Sagittal BFC;99
4.5.2.2.1;The Spine;99
4.5.2.2.2;The Pelvic Girdle;102
4.5.2.2.3;The Two Lower Limbs;103
4.5.2.2.4;Coronal BFC;103
4.5.2.2.5;Transversal BFC;104
4.5.2.2.6;Postural Control;106
4.5.2.2.7;Functional Alterations Related to Aging (Table 1);107
4.5.2.2.8;Body Balance After Surgical Correction;111
4.5.3;References;114
5;Part II: Postural Anatomy;117
5.1;The Standing Position: Its Principles and Spinopelvic Relations;118
5.1.1;Introduction;118
5.1.2;Form and Position of the Pelvis;118
5.1.2.1;Limits for Pelvic Parameters;119
5.1.2.2;Influence of the Pelvic Incidence on the Shape of the Pelvis [4];120
5.1.3;The Lumbar Lordosis;121
5.1.3.1;Remarks;123
5.1.3.2;Pelvic Incidence Relationship Lumbar Lordosis;124
5.1.4;Global Balance of the Thoracic and Lumbar Spine. Position of C7 (Fig. 11);124
5.1.4.1;Values of Overall Balance;125
5.1.5;Mechanisms for the Compensation of the Spinopelvic Balance;125
5.1.6;Spinopelvic Origin Balance;126
5.1.7;Spinal Imbalance;126
5.1.7.1;Primary Compensation Mechanisms;126
5.1.7.2;Influence of the Shape of the Pelvis on Pelvic Version;126
5.1.7.3;Algorithm of Spinopelvic Balance (Table 1);127
5.1.8;Analysis of Spinal and Discal Constraints: Influence of Spinopelvic Balance;127
5.1.9;Conclusion;127
5.1.10;References;130
5.2;The Reserve of Hip Extension and Its Relationship with the Spine;131
5.2.1;Applications;134
5.2.1.1;Stretching;134
5.2.1.2;Surgery;135
5.2.2;Conclusions and Perspectives;135
5.2.3;References;135
5.3;The EOS System: Overall Assessment of Balance of the Vertebral Column and Its Movements;136
5.3.1;Information Provided for 2D Alignment of the Body (Fig. 2);136
5.3.2;Information Provided by 3D Volumic Surface Reconstructions Obtained Through Computer Software;138
5.3.3;References;143
6;Part III: Descriptive Anatomy;144
6.1;The Cranial Vertebra;145
6.1.1;Phylogenesis;145
6.1.2;Centre of Gravity of the Head;147
6.1.3;How to Recognize the Exact Position of the Head on Lateral Radiographs?;147
6.1.4;What Radiological References May We Use? (Fig. 13);150
6.1.5;How Is the Sagittal Cervical Balance Below the Cranial Vertebra?;151
6.1.6;References;153
6.2;Surgical Anatomy of the Vertebral Pedicle;154
6.2.1;Anatomical Studies, Dimensions and Orientation of Vertebral Pedicles in a Normal Spine;154
6.2.1.1;Overview;154
6.2.1.2;Comparative Anatomy by Location;155
6.2.1.3;Orientation [6] (Figs. 2 and 3);155
6.2.1.4;Interpedicular Dimensions [3, 6];156
6.2.1.5;Radiological Assessment of Pedicle Dimensions;156
6.2.1.6;Applications to the Target Pedicle and Contribution of Navigation;157
6.2.1.7;Point of Entry to the Pedicle [7] (Fig. 5);157
6.2.2;Special Cases;158
6.2.2.1;The Pedicle in Scoliosis (Figs. 6 and 7);158
6.2.2.2;Dysplastic Pedicles of Neurofibromatosis [8];158
6.2.2.3;The Pedicle in Vertebral Malformations;159
6.2.3;Conclusion;160
6.2.4;References;161
6.3;Sacrum Anatomy: New Concepts;162
6.3.1;Study of Radiological Correlation of Pelvic Parameters and Lumbar Lordosis in Standing, Sitting and Lying (Supine) Positions (Fig. 1);162
6.3.1.1;Introduction;162
6.3.1.2;Patients and Methods;162
6.3.1.3;Radiography;163
6.3.1.4;Radiological and Statistical Analyses;163
6.3.1.5;Results;163
6.3.1.6;Discussion;163
6.3.2;Neurovascular Risks During the Insertion of the S1 Screw: An Anatomical Study;164
6.3.2.1;Introduction;164
6.3.2.2;In Vivo CT Measurements;165
6.3.2.3;Results;165
6.3.2.4;Discussion;165
6.3.3;Pelvic Fixation: Surgical Techniques;166
6.3.3.1;The Biomechanical Zones at the Level of the Sacrum (Fig. 3);166
6.3.3.2;Screw Insertion at S1 and S2 (Fig. 4);166
6.3.3.3;Jackson’s Intrasacral Rod (Fig. 5);167
6.3.3.4;The Galveston Stem (Fig. 6);167
6.3.3.5;Iliac Screw Insertion (Fig. 7);167
6.3.3.6;Iliosacral Screw Insertion (Fig. 8);168
6.3.3.7;S2 Iliac Screw Insertion (Fig. 9);168
6.3.3.8;“T-Construct” by Vialle (Fig. 10);170
6.3.4;References;170
6.4;The Pelvic Vertebra, the Cephalic Vertebra and the Concept of the Chain of Balance;172
6.4.1;Introduction: Foundation for the Concept;172
6.4.2;Anatomical Basis for the Pelvic Vertebra;173
6.4.2.1;Morphologically;173
6.4.2.2;Intrapelvic Degrees of Freedom;174
6.4.2.3;On the Other Hand, the Degrees of Freedom Around the Pelvic Vertebra Are Quite Considerable;175
6.4.2.4;Plasticity of the Pelvic Vertebra;175
6.4.2.5;The Texture and the Bone Architecture of the Pelvis;175
6.4.3;Physiological, Pathophysiological and Mechanical Implications of the Pelvic Vertebrae;176
6.4.3.1;The Pelvic Vertebra as an “Intercalary Bone”;176
6.4.3.2;Practical Consequences of These Findings;179
6.4.3.3;Therapeutic Consequences;180
6.4.3.3.1;The Paralytic Pelvic Obliquity Correction Strategy;180
6.4.3.3.2;The Three-Dimensional Equilibrium of High Grade Spondylolisthesis;182
6.4.3.3.3;Compensation Phenomena Occurring at the Level of the Pelvic Vertebra;183
6.4.3.3.4;The Possibilities of Anatomical Changes in the Pelvic Vertebra with Bilateral Pelvic Osteotomies of Sagittal Reorientation of the Trunk;183
6.4.3.3.5;The Therapeutic Consequences of the Notion of the Cephalic Vertebra Are Just as Important;185
6.4.4;Conclusion;187
6.4.5;References;187
6.5;The Cranial and Pelvic “Vertebrae” Are They Real Vertebrae?;189
6.5.1;Introduction;189
6.5.2;Formation and Growth of the Skull;189
6.5.2.1;Somites;189
6.5.2.2;Basicranial Chondrogenesis (Figs. 2, 3, 4, and 5);190
6.5.2.3;Craniofacial Ossification (Figs. 6 and 7);191
6.5.2.4;Craniofacial Growth;192
6.5.2.5;Conclusion;193
6.5.3;Formation, Growth, and Aging of the Pelvic Ring;193
6.5.3.1;Phylogenesis;193
6.5.3.2;Formation and Growth of the Sacrum;195
6.5.3.3;Formation and Growth of the Coxal Bone [24–26];197
6.5.3.4;Formation and Growth of the Sacroiliac Joint (SIJ);200
6.5.3.5;How Is the Acetabulum Oriented According to the Pelvic Position?;201
6.5.4;References;206
6.6;The Intervertebral Disc;207
6.6.1;General Characters;207
6.6.1.1;Biomechanical Specifications;207
6.6.1.2;Anatomical Structure [1–3];207
6.6.2;IVD Ultrastructure (Fig. 4);208
6.6.2.1;Glycosaminoglycans (GAG) [7–13];208
6.6.2.2;Collagen [14–16];209
6.6.2.3;Water and Chemical Composition of Human Discs [8];209
6.6.3;Proteolytic Enzymes [17];209
6.6.4;Vascularization and Innervation of the Disc;210
6.6.5;Role of the Disc;210
6.6.5.1;Movements and Constraints;211
6.6.6;Variations According to Spinal Levels;212
6.6.6.1;Disc Fissuring and Herniation (Figs. 9 and 10);213
6.6.7;References;215
6.7;Anatomy of the Thoraco-Lumbar Facet Joint;217
6.7.1;Formation of the Posterior Thoraco -Lumbar Joints [1];217
6.7.2;Morphology of Posterior Thoraco-Lumbar Joints (TLJ);217
6.7.2.1;Morphology of the Posterior Thoracic Joints;217
6.7.2.2;Morphology of the Posterior Lumbar Joints;218
6.7.3;Participation of the Posterior Articulations in the Overall Stability of the Spine [1];219
6.7.3.1;Vertical Stability;219
6.7.3.2;Horizontal Stability;221
6.7.4;Participation of Posterior Articulations in Vertebral Dynamics [1];223
6.7.4.1;Flexion-Extension and Tilt-Rotation (Fig. 8);223
6.7.4.2;Facet Asymmetry;224
6.7.5;Innervation of the Posterior Articulations;224
6.7.6;Most Common Pathologies of Posterior Lumbar Joints;224
6.7.7;References;226
6.8;The Spinal Ligaments;228
6.8.1;Ligaments in the Suboccipital Area;228
6.8.2;Ligaments of the Lower Cervical Area;232
6.8.3;The Ligaments of the Thoracic Area;232
6.8.4;Ligaments of the Lumbar Area;233
6.8.5;The Ligaments of the Sacral Area;238
6.8.6;Ligaments in Spinal Pathology;238
6.8.6.1;Traumatology;238
6.8.6.2;Degenerative Pathology;239
6.8.6.2.1;Cervical Level;239
6.8.6.2.2;Thoracic Level;240
6.8.6.2.3;Lumbar Level;240
6.8.6.2.4;Tumor Pathology;241
6.8.6.2.5;Spinal Deformities;241
6.8.7;References;241
6.9;Sacroiliac Joints;242
6.9.1;Descriptive and Functional Anatomy of the Pelvic Girdle;242
6.9.1.1;The Pubic Symphysis;242
6.9.1.2;Sacroiliac Joints;242
6.9.1.3;The Sacrococcygeal Joint;243
6.9.2;Biomechanical;243
6.9.2.1;Static: The Pelvic Girdle Is Hyperstable;243
6.9.2.2;Kinematics of the Sacroiliac Joint;244
6.9.3;Conclusion;248
6.9.4;References;249
6.10;The Normal and Pathological Spinal Muscle;250
6.10.1;Introduction;250
6.10.2;Normal Descriptive Anatomy;250
6.10.3;The Cervical Muscles;250
6.10.4;Deep Muscles;250
6.10.5;The Peripheral Muscles;251
6.10.5.1;The Sternocleidomastoid (SCM);251
6.10.5.2;The Trapezius;253
6.10.6;The Intermediate Muscles Extending Upwards;254
6.10.7;The Intermediate Muscles Extending Downwards;255
6.10.7.1;Scaleni;255
6.10.8;Thoraco-Lumbar Muscles;256
6.10.9;Posterior Muscle Group;257
6.10.9.1;The Deep Plane;257
6.10.9.2;The Intermediate Plane;257
6.10.9.3;The Superficial Plane;258
6.10.10;Lateral Muscle Group;258
6.10.11;Anterior Muscle Group (Fig. 20);259
6.10.11.1;The Aponeurosis;262
6.10.11.2;The Thoraco-Lumbar Aponeuroses;262
6.10.12;Action;263
6.10.12.1;Stabilizing Action;263
6.10.12.2;Dynamic Action;264
6.10.13;Histophysiology;265
6.10.13.1;Distribution of Muscle Fibers According to the Spinal Level;265
6.10.13.2;Morphological and Functional Variations of Muscle Fibers;266
6.10.14;Paravertebral Muscles in Spinal Pathology;266
6.10.14.1;Elemental Lesions, Lesional Groups;267
6.10.14.2;Lumbar Instability Resulting in Chronic Low Back Pain;268
6.10.14.3;Arthrogenic Kyphosis;268
6.10.14.4;Idiopathic Scoliosis;269
6.10.14.5;Muscle Integrity After Posterior Arthrodesis;270
6.10.15;References;270
6.11;Configuration of the Posterior Lumbar Muscles: Study of Lumbosacral Malformations and the Extraforaminal Approach (ELIF);272
6.11.1;Purpose;272
6.11.2;Background;272
6.11.3;Anatomy [6];272
6.11.4;Patients and Method;272
6.11.5;Results;273
6.11.6;Discussion;274
6.11.7;Conclusion;276
6.11.8;References;276
6.12;Vertebral Column: Muscles, Aponeurosis, and Fascia;277
6.12.1;History;277
6.12.2;Organogenesis;278
6.12.3;General and Semantic Organization of the Muscle;279
6.12.3.1;Curvatures: Anatomical and Biomechanical Fundamentals;279
6.12.4;Musculo-Aponeurotic Static and Dynamic Mechanical Imperatives;282
6.12.5;Comparative Anatomy: Curves and Muscles;283
6.12.5.1;Numbers;283
6.12.5.2;Old Nomenclature;284
6.12.5.3;Modern Nomenclature;284
6.12.5.4;Muscle Insertions;284
6.12.5.5;Intrinsic and Semantic Morphology;285
6.12.5.6;Sarcomere and Myofibrils;285
6.12.5.7;Titin: The Primary Elastic Protection of the Sarcomere;288
6.12.6;Muscles and Aponeurosis;289
6.12.6.1;Muscle Fasciculi and Aponeurosis;289
6.12.6.1.1;Muscle Fasciculi and Pennation: Topographical Economics;289
6.12.7;Aponeurosis: Fundamental Structure;290
6.12.7.1;A Historical Conceptual Error;290
6.12.7.2;Intrinsic Structure of the Aponeurosis: Endomysium and Perimysium Aponeurosis;291
6.12.7.3;Mechanism of the Aponeurosis;293
6.12.7.4;Muscle with Parallel Fascicles: Pseudo-Penniform;296
6.12.7.4.1;Unipennate Muscle (Fig. 30);296
6.12.7.4.2;Bipennate Muscle;296
6.12.8;Angles of Pennation Articulation and Muscular Power;297
6.12.9;Muscular Action and Topography;298
6.12.9.1;Topography and Global Functionality;298
6.12.9.2;Muscle Direction;301
6.12.9.3;Muscle Torsion;303
6.12.9.4;Monoarticular Muscles and Mechanical Rotary Results;304
6.12.9.5;Polyarticular Muscles and Resultant Mechanical Rotators;305
6.12.10;Mechanical Properties;306
6.12.10.1;Muscular Work;306
6.12.10.2;Muscle Yield;306
6.12.10.3;Fascicle Mechanic Performance and Physiological Cross-Sectional Area (PCSA);306
6.12.11;Global Mechanical Properties of the Muscle–Aponeurosis–Tendon Complex;309
6.12.11.1;Muscle Functions and Composite Beam (Fig. 49);309
6.12.11.2;Purpose, Symmetry, Variability;310
6.12.11.3;Volume and Strength of Muscles;311
6.12.12;Law of Third Dimensional Articular Dynamic Rotational Centering;311
6.12.13;Muscular Ambivalence: Articular Chains and Stato-Dynamic Effects of Muscles;312
6.12.14;Muscle Force and Levers;312
6.12.15;Compliance;312
6.12.15.1;New Compliance Concepts: Muscular Fascicles and Fascia (aponeurosis);313
6.12.16;Fasciae;313
6.12.16.1;Terminology: Fascia of Contention;313
6.12.16.2;Structure of the Fascia;314
6.12.16.3;Properties of Fascia;314
6.12.17;Clinical Implications;315
6.12.18;Muscle and Infiltration Fat: Aging;315
6.12.19;Conclusion;316
6.12.20;References;317
6.13;Functional Anatomy of the Erector Spinae: Review;319
6.13.1;Introduction;319
6.13.2;Descriptive Anatomy of the Paravertebral Gutter;319
6.13.2.1;Plane of the Transverse—Spinous Process Muscles (Deepest);319
6.13.2.2;Plane of the Spinalis and Semispinalis Muscles;320
6.13.2.3;Plane of Longissimus and Iliocostal Muscles;320
6.13.2.4;Plane of the Splenius Muscles;320
6.13.3;Anatomical Models (Figs. 1 and 2);320
6.13.4;Control and Genesis of Trunk Movements During Walking;322
6.13.5;Erector Spinae Muscle Activity During Locomotion;323
6.13.6;Theory of Chronic Lumbago of Muscular Origin;323
6.13.7;Conclusion;324
6.13.8;References;324
6.14;Connective Tissues of the Posterior Aspect of the Trunk;326
6.14.1;Introduction;326
6.14.2;Fascia Superficialis (FS);327
6.14.2.1;Introduction and definition;327
6.14.2.2;Composition and Location of the FS;328
6.14.3;Function;328
6.14.4;Fascia Profundis (FP);329
6.14.5;Lumbosacral Region;329
6.14.5.1;Posterior Layer of the Fascia Profundis, Lumbosacral Region;329
6.14.5.2;Middle Layer of the Fascia Profundis, Lumbosacral Region;329
6.14.5.3;Anterior Layer of the Fascia Profundis, Lumbosacral Region;329
6.14.6;Thoracic Region;330
6.14.6.1;Posterior Layer of the Fascia Profundis, Thoracic Region;330
6.14.6.2;Intermediate Layer of the Fascia Profundis, Thoracic Region;332
6.14.6.3;Anterior Layer of the Fascia Profundis, Thoracic Region;332
6.14.7;Cervico-Cranial Region;332
6.14.7.1;Posterior Layer of the Fascia Profundis, Cervico-Cranial Region;332
6.14.7.2;Intermediate Layer of the Fascia Profundis, Cranio-Cervical Region;332
6.14.7.3;Middle Layer of the Fascia Profundis, Cranio-Cervical Region;332
6.14.7.4;Anterior Layer of the Fascia Profundis, Cranio-Cervical Region;333
6.14.8;Innervation;333
6.14.9;Fibres and Receptors;333
6.14.10;General Conclusion;336
6.14.11;References;339
6.15;The Spinal Canal;341
6.15.1;The Central Spinal Canal (Vertebral Foramen);341
6.15.2;Limits (Fig. 1) Superior and Inferior;341
6.15.3;Peripherals (in the Horizontal Plane);341
6.15.4;Diameter—Internal Surface;341
6.15.5;The Reserve Volume (RV);343
6.15.6;The Cervical Spinal Canal;343
6.15.7;Thoracic Spinal Canal;344
6.15.8;Lumbar Spinal Canal;344
6.15.9;The Lateral Recess;346
6.15.10;The Intervertebral Foramen;347
6.15.10.1;Form and Orientation;347
6.15.10.2;The Cervical Intervertebral Foramen;348
6.15.10.3;The Lumbar Intervertebral Foramen;349
6.15.11;The Transverse Canal;350
6.15.12;The Spinal Canals and the Movements of the Column;350
6.15.13;Degenerative Pathology and the Effects on the Spinal Canals;352
6.15.13.1;Spinal Canal and Lateral Recess;353
6.15.13.2;The Intervertebral Foramen;353
6.15.14;References;358
6.16;The Spinal Cord;359
6.16.1;Description;360
6.16.2;Anatomofunctional Organization of the Neural Centers of the Gray Matter;362
6.16.2.1;The Central Formation Area;362
6.16.2.2;Dorsal Horns;368
6.16.2.3;The Ventral Horns;371
6.16.3;Anatomofunctional Organization of the White Matter;376
6.16.3.1;Somatosensory Ascending Pathways (Fig. 20);376
6.16.3.2;Descending Pathways;381
6.16.3.3;The Pyramidal Tract or Corticospinal Tract (Fig. 22);381
6.16.3.4;Extra Non-pyramidal Tracts;382
6.16.4;In Total;383
6.16.5;References;384
6.17;Spinal Nerves (Innervation of the Spine);386
6.17.1;General and Nomenclature;386
6.17.2;Descriptive Anatomy of Spinal Nerves;386
6.17.2.1;Relations of the Nerve Roots;386
6.17.2.1.1;At the Lumbar Level [1–6];386
6.17.2.1.2;1.1.1 Anomalies of the Lumbar Roots [16–18] (Fig. 7);389
6.17.3;Innervation of the Spine;389
6.17.3.1;Innervation of the Ventral Territory [22–24];390
6.17.3.2;Innervation of the Dorsal Territory [1, 21, 25, 26];393
6.17.4;Applications;394
6.17.5;References;396
6.18;Anatomy of the Spinal Meninges;397
6.18.1;Introduction;397
6.18.2;Phyllogenesis;397
6.18.3;Ontogenesis;397
6.18.4;Descriptive and Topographical Anatomy of the Spinal Meninges in Adults;398
6.18.4.1;The Dura Mater;399
6.18.4.1.1;Morphology;399
6.18.4.1.2;The Fixation-Points of the Spinal Dura Mater;399
6.18.4.1.3;Vascularization;401
6.18.4.1.3.1;Arteries;401
6.18.4.1.3.2;Veins;401
6.18.4.1.3.3;Lymphatics;401
6.18.4.1.4;Innervation;401
6.18.4.1.5;The Relationships of the Dura Mater with the Leptomeninges and the Spinal Nerves;402
6.18.4.2;The Arachnoid Mater;402
6.18.4.3;The Pia Mater;405
6.18.4.4;Meningeal and Perineurial Cysts;407
6.18.4.5;The Epidural Space;408
6.18.4.6;The Subdural Space;409
6.18.4.6.1;Functional Anatomy;409
6.18.4.6.1.1;Mechanical Functions;409
6.18.4.6.1.2;The Spinal Meninges in the CSF Dynamic System;410
6.18.4.6.1.3;The CSF System in the Immune Defense of the CNS;411
6.18.4.6.1.4;The Meninges in the CNS Development and Injury;411
6.18.5;References;411
6.19;Intrinsic Innervation of the Spine;414
6.19.1;Intervertebral Disc and Vertebral Body (Figs. 1, 2, and 3);414
6.19.1.1;Which Receptors?;414
6.19.1.2;Which Pathways to the Spinal Root?;414
6.19.1.3;Evolution;417
6.19.1.4;Clinical Anatomy;417
6.19.2;Neural Arch (Fig. 4);417
6.19.2.1;Which Receptors?;417
6.19.2.2;Which Pathways to the Spinal Root?;417
6.19.2.3;Clinical Anatomy;418
6.19.3;Conclusion;418
6.19.4;References;418
6.20;Spinal Vascularization;420
6.20.1;Embryology [3, 4];420
6.20.2;Spine;420
6.20.3;Spinal Cord;420
6.20.4;Blood Supply of the Spinal Structures;421
6.20.4.1;Prespinal Vessels;421
6.20.4.1.1;Thoracic Aorta (Figs. 2 and 3);421
6.20.4.1.2;Abdominal Aorta (Fig. 4);422
6.20.4.2;Blood Supply of the Vertebral Structures (Figs. 5 and 6);424
6.20.4.2.1;The Vertebral Body [10, 11];424
6.20.4.2.1.1;The Ventral Group;424
6.20.4.2.1.2;The Dorsal Group;425
6.20.4.2.2;The Costovertebral Joint;425
6.20.4.2.3;The Dorsal Arch;425
6.20.4.2.3.1;Intracanalicular System;425
6.20.4.2.3.2;Dorsal System;426
6.20.4.2.4;The Intervertebral Foramen [6];426
6.20.4.3;Blood Supply of the Spinal Cord (Figs. 5, 7 and 8);426
6.20.4.3.1;The Radiculomedullary Arteries;426
6.20.4.3.1.1;At the Cervical Level;427
6.20.4.3.1.2;At the Thoracolumbar Level;428
6.20.4.3.1.3;The Great Ventral Radiculomedullary Artery (The Artery of Adamkiewicz);428
6.20.4.3.1.4;Other Variations;428
6.20.4.3.2;The Longitudinal Arterial Axis;428
6.20.4.3.2.1;Ventral Spinal Artery;428
6.20.4.3.2.2;Dorsal Spinal Arteries;429
6.20.4.3.2.3;Lateral Spinal Artery [13];430
6.20.4.3.3;Intrinsic Spinal Cord Vascularization;430
6.20.4.3.3.1;Central Arteries;430
6.20.4.3.3.2;Peripheral Arteries;430
6.20.4.3.3.3;Anastomotic Arterial Pathways [14];431
6.20.4.3.3.3.1;Anastomoses of the Afferent Arterial Supply;431
6.20.4.3.3.3.1.1;Superior or Cervicothoracic Area;431
6.20.4.3.3.3.1.2;Midthoracic Area;431
6.20.4.3.3.3.1.3;Thoracolumbar Area;431
6.20.4.3.3.4;Peri-Axial Anastomoses;431
6.20.4.3.3.5;Intra-Axial Anastomoses;431
6.20.5;Venous Drainage of the Spinal Structures (Figs. 12 and 13);431
6.20.5.1;Intra-Vertebral Venous Network;431
6.20.5.1.1;Medullary Venous Network;431
6.20.5.1.2;Intradural Drainage;432
6.20.5.1.3;Extradural Plexuses [15, 16];433
6.20.5.2;Extra-Vertebral Venous Network;434
6.20.5.2.1;Vertebral Veins;434
6.20.5.2.2;Perivertebral Venous Plexuses;434
6.20.5.2.3;Ventral External Plexuses (Longitudinal Prevertebral Vein);434
6.20.5.2.4;Dorsal External Plexuses (Deep Cervical and Dorsal Intercostal Veins);434
6.20.5.2.5;Basivertebral Veins;435
6.20.5.2.6;Communications Between the Vertebral Venous System and Systemic Veins;435
6.20.5.2.6.1;Longitudinal Prevertebral Vein and Azygos System;435
6.20.5.2.6.2;Inferior Vena Cava;435
6.20.5.2.7;Focus on the Filum Terminale [12];435
6.20.6;References;436
7;Part IV: Functional Anatomy;437
7.1;Systemic Approach to the Functioning of the Spine;438
7.1.1;Introduction;438
7.1.2;Organization of a System;439
7.1.2.1;Qualitative Analysis of the Vertebral System (Fig. 1);439
7.1.2.1.1;The Entries;439
7.1.2.1.2;Transducers (Receivers or Sensors);440
7.1.2.1.3;Controls;440
7.1.2.1.4;Tissue-Based Control;440
7.1.2.1.5;Cellular Control;441
7.1.2.1.6;Neurological Checks;441
7.1.2.1.7;Outputs;441
7.1.2.1.8;Feedback;442
7.1.2.2;Quantitative Analysis of the Vertebral System;442
7.1.2.2.1;Partial Analysis;442
7.1.2.2.2;Analysis of Overall Functional Capacity;442
7.1.2.2.3;Performances;443
7.1.3;Fault Factors of the Vertebral System;444
7.1.3.1;Failures Related to the Vertebral Structure;444
7.1.3.2;Transducer Failures;445
7.1.3.3;Failures Related to Controls;445
7.1.4;Conclusion;445
7.1.5;References;445
7.2;Kinematics of the Spine;447
7.2.1;Methods for Measuring Spinal Mobility;449
7.2.1.1;In Vitro Measurements;449
7.2.1.2;In Vivo Measurements;449
7.2.2;Amplitude of Spinal Movements;449
7.2.2.1;Segmental Amplitudes and Motion Analysis;454
7.2.2.2;The Upper Cervical Spine (OC1C2);454
7.2.2.3;The Lower (Sub-Axial) Cervical Spine;456
7.2.2.4;The Thoracic Spine;462
7.2.2.5;The Lumbar Spine;462
7.2.3;Evolution of Amplitudes with Age;462
7.2.4;The Movements of the Vertebral Column in Daily Life;464
7.2.5;References;474
7.3;Spinal Balance;475
7.3.1;The Choice of Words;475
7.3.1.1;Balance;475
7.3.1.2;Alignment;475
7.3.1.3;Equilibrium;475
7.3.1.4;Posture;475
7.3.1.5;Stability;475
7.3.2;From Alignment to Equilibrium;476
7.3.3;Importance of Spine Anatomy;476
7.3.3.1;The Pelvis;476
7.3.4;Thoraco-Lumbar Spine;476
7.3.4.1;The Cervical Spine;477
7.3.5;Spine and Central Nervous System: (CNS) and (PNS);477
7.3.6;A Word from Neurosciences;477
7.3.7;Search for Harmony;478
7.3.7.1;A Look at the Future;479
7.3.8;References;479
7.4;Biomechanics and Spinal Modelling;480
7.4.1;Introduction;480
7.4.2;Geometric Modelling of the Spine;480
7.4.2.1;Geometric Modelling of the Skeleton from Biplane Imagery;480
7.4.3;Biomechanical Modelling of Spine;483
7.4.3.1;Biomechanical Modelling and Conceptual Analysis;484
7.4.3.2;Subject-Specific Modelling and Treatment Planning;486
7.4.3.3;Personalized Simulation to Estimate the Resistance of an Osteoporotic Vertebra;486
7.4.3.4;Personalized Simulation to Estimate the Effect of a Scoliosis Brace;487
7.4.4;Postural Alignment, Barycentremetry and Muscle Modelling;488
7.4.5;Conclusion;490
7.4.6;References;490
7.5;Anatomy Is a Living Language;493
7.5.1;Anatomy: Open Thought on Modernity;493
7.5.2;Embryology: The Essence (of Things) of Life;493
7.5.3;Growth: A Volumetric Revolution, a Morphological Emancipation;493
7.5.4;Growth Is Not Linear;493
7.5.5;The Interdependence of Growths Explains the Domino Effect;494
7.5.6;The Vilebrequin Effect Is Omnipresent;494
7.5.7;Puberty Idiopathic Scoliosis: Indomitable;494
7.5.8;COBB Angle: A Virtual Value;494
7.5.9;Balance: A Priority, an Ardent Obligation;494
7.5.10;After Growth the Spine Continues Its Destiny;494
7.5.10.1;The Time Has Come to Review the Hierarchies;494
7.5.10.2;The Muscles and Their Fascia Play an Essential Role;494
7.5.10.3;The Curvatures of the Column Promote Mobility, Elasticity, Resistance, and Balance;494
7.5.10.4;Scoliotic Disease Is a Life-Long Illness;495
7.5.11;The Surgeon Has a Physical Relationship with the Anatomy;495
7.5.12;Anatomy: A Regalian Discipline;495
7.5.13;Research: Positive Insubordination;495
7.5.14;Tomorrow: Another Day;495
8;Index;496
Section I: Phylogenesis and ontogenesis: 1 Comparative anatomy of the axial skeleton of vertebrates.- 2 Embryology of the spine.- 3 The growing spine.- 4 Growth cartilages of the spine and pelvic vertebra.- 5 Morphological and functional evolution of the aging spine. Section II: Postural Anatomy: 6 Standing up. Its principles. Pelvic spinal relationships.- 7 The hip extension reserve and its relation to the spine.- 8 The EOS system: interest in the overall assessment of the balance of the spine but also its movements and balance. Section III: Descriptive Anatomy: 9 The cranial vertebra.- 10 Surgical anatomy of the vertebral pedicle.- 11 Anatomy of the sacrum: new concepts.- 12 The pelvic vertebra, the cephalic vertebra, and the concept of the chain Of balance.- 13 Are the "cranial and pelvic vertebrae" true vertebrae?.- 14 The intervertebral disk.- 15 Anatomy of thoracolumbar posterior joints.- 16 The spinal ligaments.- 17 Sacro-iliac joints.- 18 The normal and pathological spinal muscle.- 19 Configuration of posterior lumbar muscles. Application for Study Of lumbosacral malformations.- 20 Muscles and fascia.- 21 Functional anatomy of the erector of the spine: a review.- 22 The conjunctive structures of the posterior surface of the trunk.- 23 The spinal canals.- 24 The spinal cord.- 25 Spinal nerves (spinal innervation).- 26 Anatomy of spinal meninges.- 27 Intrinsic innervation of the vertebral column.- 28 Vascularization of the spine and cord Functional anatomy.- Section IV - Functional anatomy.- 29 Systemic approach to the functioning of the Thoracolumbar spine.- 30 Kinematics of the spine.- 31 Spinal balance.- 32 Biomechanics and modelling of the spine.- 33 Anatomy is a living language.
