Spine, Nerve structure - Meninges

Within the spinal canal, the spinal cord is surrounded by the EPIDURAL SPACE. This space is filled with fatty tissue, veins, and arteries. The fatty tissue acts as a shock absorber and keeps the spinal cord from contacting the bony tissue of the vertebrae.

The brain and spinal cord are covered by three layers of material, called Meninges. The main function of these layers is to protect and feed the delicate neurological structures.

The DURA MATER is the outermost meningeal layer and is made up of strong connective tissue. Also called the DURA, it is gray in color and generally easy to identify within the spinal canal. The dura extends around each nerve root and becomes contiguous with the EPINEURUM, a membrane covering the spinal nerves

The SUBDURAL SPACE is a very small space between the dura and the next meningeal layer, the ARACHNOID. The arachnoid layer is highly vascularized with a web of arteries and veins that give the impression of a spider wed. It is thinner than the dura and is subject to injury.

Below the arachnoid is the SUBARACHNOID SPACE, which is filled with CEREBROSPINAL FLUID (CSF). The CSF helps to protect the nerve structures by acting as a shock absorber. It also contains various electrolytes, protect, and glucose. A spinal tap can be inserted into the subarachnoid space to retrieve CSF for various chemical analyses.

The innermost lining of the meninges is called the PIA MATER. It is closely adhered to the spinal cord and the individual nerve roots. It is highly vascular and supplies blood to the neuro-logical structures.

Reference: http://www.back.com/

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Nerve structure of spinal cord

The Spinal cord functions as a sophisticated network that carries information from the outer elements of the body (skin, muscles, ligaments, joints) through the sensory tracts, to the central “computer,” the brain. Data are processed there, and new information, such as muscle control, is sent out through the motor tracts of the spinal cord. Part of the Central Nervous System (CNS), the spinal cord is located immediately below the brain stem and extends from the foramen magnum to L1.

The spinal cord is a firm but delicate structure that contains both gray and white matter. Compression, distraction, or other manipulation can result in significant injury to the spinal cord.

At L1 the spinal cord terminates as the Conus Medularis. Below L1, the thick but flexible dural sac (also called the thecal sac) contains the spinal nerves collectively known as the CAUDA EQUINA. Also contained within the cauda equina is the FILUM TERMINALE, which extends from the conus medularis to the coccyx and acts as an anchor to keep the lower spinal cord in its normal shape and position.

The individual nerve roots of the cauda equina are suspended in cerebrospinal fluid. At this level, it is possible to pass a needle safely into the thecal sac for evaluation of spinal fluid or injection of various materials such as drugs, anesthetics, or radiologic substances.

Reference: www.back.com, www.brain-spine.com.hk, http://www.necksurgery.com

The information provided aims to provide educational purpose, if you have the described conditions as above, please consult your neurosurgeon.

Back Pain and Degenerative Disc Disease: Are Artificial Discs the Solution?

There has been considerable excitement among surgeons as well as patients following the recent FDA (Food and Drug Administration) release. The excitement among patients with degenerative disc disease stems from the impression that there is now a safe way to eliminate pain from degenerative discs while at the same time maintaining normal motion. Many of these patients have heard about others with similar problems undergoing fusion procedures in the past, who still continue with persistent pain or had more than one attempt at fusion without success or have developed additional levels of disc degeneration requiring an additional fusion procedure. They have also heard of the successful results following disc arthroplasty in Europe which has been highly publicized by the media in the United States. 

Early Detection and Lumbar Fusions
This is definitely an exciting new addition to our armamentarium for the treatment of degenerative disc disease. When we look at how the evaluation and treatment for degenerative disc disease has developed over the past few years an almost unbelievable amount of progress has been made. We now are better able to identify disc disease early on with MRI and pain generators with discography and facet blocks. Where only a decade ago, lumbar fusions were being performed through large posterior incisions, now they can be performed percutaneously through incisions that are barely visible either anteriorly through the abdomen or through the back. With the use of presently available instrumentation, success rates for one level fusions approach 90-95%. Unfortunately, not every patient who has degenerative disc disease and has a successful fusion has a successful clinical result. There is still a group of patients for whom fusion does not effectively alleviate pain.

Disc Replacement: Risks
Disc replacement arthroplasty has the potential for the treatment of many of the spinal motion segment disorders that are currently being treated both successfully and not so successfully by one of the many fusion techniques. At this relatively early stage of disc replacement development, we do not know all of the problems that may be encountered following these procedures. Because the surgical approach is through the abdomen either retroperitoneal or transperitoneal (around/through the stomach), there are some predictable complications including vascular injury, thrombophlebitis (vein inflammation accompanied by blood clot formation), nerve root injuries, injury to the ureter, and retrograde ejaculation in males.

We also know that a number of disc replacements have failed and have been converted to a fusion with variable clinical outcomes. The removal of artificial discs, especially at the L4-5 level, is fraught with a significant risk of vascular injury because of scarring around the prosthesis. We do not know at the present time how long these prostheses will last and how well they will function. Will they provide enough motion to prevent adjacent segment degeneration, and will the patient with multilevel disease be a candidate for this procedure? Certainly we know that artificial joints produce wear debris and an inflammatory response which escalates over time where this is obviously not a problem with fusion. 

Optimism and Early Results
Spine surgeons in general are very optimistic and excited about total disc arthroplasty and appropriately so. There also will be a learning curve by both the spine surgeon as well as the access surgeons who provide the exposure. Appropriate training via courses and cadaveric labs will help to minimize the learning curve and potential complications. There will no doubt be many improvements and modifications in the prosthetic designs.

Early results are certainly encouraging in the hands of the investigational surgeons but are fraught with the many problems common to the development of a new procedure. Total disc arthroplasty is likely to be a better solution than fusion for many degenerative disorders of the lumbar spine as design improvements continue to be made and as further experience defines the indications for its use.

Reference source: http://www.spineuniverse.com/treatments/emerging/artificial-discs/back-pain-degenerative-disc-disease-artificial

The above information is for educations only, if you have any related disease, plese consult your neurosurgeon for more information.

What is neurosurgery? And what is the neurosurgeon do?

Neurosurgery is a specialty of surgery which provides the critical care, prevention, diagnosis, evaluation, treatment, and rehabilitation of neurological disorders. This includes the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify the function or activity of the nervous system, including the hypophysis and the operation and non-operative treatment of pain. As such, neurosurgery encompasses treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, and the skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland, disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.

What is neurosurgeon?

Neurosurgeon is a surgical doctor specialized in neurological disorders.

Central Nervous System (CNS) disorders - Stroke, Parkinsonism disease, Dementia, Brain tumors, Acoustic neuroma, Arteriole-venous malformation (AVM), etc...

Peripheral Nervous System (PNS) disorders – like Back pain, Scoliosis, Sciatica, Low back pain, Neck pain, Neuropathic pain, etc…  .

Reference information: www.brain-spine.com.hk, http://www.surgery.cuhk.edu.hk/neuro/default.htm

The information above is used for educational purpose only, for any enquiries, please consult your neurosurgeon for medical advices.