Ligament & Spine

The interspinous ligament connects each adjacent spinous process. The fibers extend from the base to the tip of each spinous process. Anteriorly, the interspinous ligament is adjacent to the ligamentum flavum; posteriorly, it is adjacent to the supraspinous ligament. in the cervical spine, the interspinous ligament becomes part of the ligamentum nuchae, a fibro-membranous ligament posteriorly and cranially to attach to the occiput.

The supraspinous ligament is a very strong band connecting the tips of contiguous spinous processes. It extends from c7 (vertebra prominens) to the sacrum. above c7 these fibers are part of the ligamentum nuchae.

The ligamentum flavum, also called the yellow ligament, consists of elastic fibers oriented vertically that extend from the anterior inferior surface of the lamina above to the superior posterior surface of the lamina below. Unlike the ALL and PLL, the ligamentum flavum is not continuous. There is a small space in the midline between the right and the left fibers. The ligamentum flavum tends to thicken as it progresses down the spine, beginning at the axis (C2) and extending to the sacrum.

Lumbosacral Ligaments

The iliolumbar ligaments extend from the transverse processes of L4 and L5 to the iliac crest.

The lumbosacral ligament is a thick, fibrous band that extends from the anterior-inferior aspect of the trans-verse process of L5 to the lateral surface of the sacrum.

The are two types of SACROILIAC LIGAMENT:

• short sacroiliac ligaments: Composed of horizontal fibers extending from the sacrum to the posterior part of the iliac bone
• long sacroiliac ligaments: Composed of fibers extending vertically from the sacrum to the posterior superior iliac spine

Reference: www.knowyourback.com.

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

Lower Cervical, Thoracic, and Lumbar Ligaments

The important ligamentous structures of the lower cervical, thoracic, and lumbar spine are discussed below.

The ANTERIOR LONGITUDINAL Ligament (ALL) is composed of thick, longitudinally oriented fibers extending from the axis (C2) anteriorly to the sacrum. The ALL is broader at the level of each vertebral body than at the level of the discs where the fibers adhere to the annulus fibrosus. The ALL attaches to each vertebral body superiorly and inferiorly at the levels of the endplates.

The Intertransverse Ligaments extend from the inferior surface of the entire length of the transverse process to the superior surface of the adjacent transverse process.

The Costalligaments connect the heads of the ribs to the vertebrae.

The POSTERIOR LONGITUDINAL LIGAMENT (PLL) is weaker than the ALL. Its fibers are also longitudinally oriented, but are less dense. It runs from the axis (C2) caudally to the sacrum. The PLL is narrow at the levels of the vertebrae, but the fibers extend laterally at the disc levels. These fibers may help to contain herniated disc material. Like the ALL, the PLL is attached to the vertebra at the superior and inferior margins, and to the annular fibers of the intervertebral disc.

Reference: www.neuropainhk.org

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

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.

坐骨神經痛治療 - 水刀手術

椎間盤切除手術是治療腰背痛及坐骨神經痛的方法之一，手術會將壓神經線的髓核組織抽出，但傳統手術5%患者傷及神經，令患者出現腳麻痹等後遺症，痛症復發率更高達10%。香港引入椎間盤水刀技術，用幼細的水柱作手術刀，將突出的髓核組織移除及吸走，傷口僅3至4毫米，手術期間傷及神經線的風險也低於1%。

坐骨神經痛及嚴重腰背痛的成因主要是椎間盤突出，壓神經線，產生痛症。腦外科專科醫生藍明權表示，患者可以接受椎間盤手術，將突出的組織切除，紓緩痛楚。但他指，傳統的手術需要在皮膚上開一個5至6吋的傷口，再放進金屬鉗、刮齒、電熱刀等手術儀器，約5%患者會被儀器及電熱刀傷及神經線，在手術後出現腳麻痹等後遺症，五年內的復發率也高達10%。

香港去年引入最新的椎間盤水刀技術，切除椎間盤組織，藍明權解釋椎間盤水刀分主機、穿刺器及水刀切除器三部份，主機可產生及控制強大高速的水能，經由水刀切除器對椎間盤的組織進行準確的切除，同時吸走切除出來的組織物。

參考資料: www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

腰椎間盤構造和病變

人類的腰椎是支撐人身體的重要構造。腰椎由多塊稱為椎骨的硬骨和稱為椎間盤的軟組織組成。椎間盤的結構組織,由軟骨板、髓核和纖維環組成,具備緩衝壓力的作用,亦避免椎體之間互相磨擦。椎間盤好像中間填滿啫喱狀物質的車呔。

當椎間盤老化或因為意外受傷，這個”車呔”會出現裂痕，而椎間盤的”啫喱”會從裂痕流出。流出的髓核亦可能壓迫神經線。病人會出現腰背痛或坐骨神經痛。

椎間盤脫位及椎間盤切除手術的後遺症
椎間盤的髓核如果因病變或因手術時大量流失，便會造成椎體之間互相磨擦，最後造成長期背痛，骨刺形成，和坐骨神經痛的復發。傳統椎間盤切除手術病例中復發機會高，復發時間6個月至10年不等。

腰椎間盤核心更換手術
腰椎間盤核心更換手術，是針對此情況而發展的手術。此手術從微創腰椎間盤切除手術的基礎上發展出來的手術。如果病人的髓核因病變已經大量流失或手術時需要切除大量的髓核便可考慮用這新技術。原理是安置一粒特種纖維PEEK制造的圓珠代替髓核，使椎體硬骨不會磨擦，並使脊椎關節保持活動能力。

由於結合多種微創腰椎手術的技術(包括管道微創技術，顯微鏡及儀器，神經線監察技術和X光導巡) 腰椎間盤核心更換手術的傷口比標准椎間盤切除手術的傷口環要細，住院時間環要短，併發症出現機會更低。

參考資料: www.brain-spine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

全面腦血管病普查減中風危機

仁安醫院神經內科專科梁浩雲醫生，神經外科藍明權醫生及心臟中心總監李少隆醫生表示，電腦掃描在中風普查中擔當重要角色，有助及早偵測腦血管病，大大減低發病的風險！

俗稱中風的腦血管病，是全球第三大殺手病，也是引致成人殘障的主因!據衛生署統計，零九年全港約有26,800人次因中風住院，死亡人數超過3,400名!

中國人稱腦血管病為中風，是由於病發前無明顯徵兆，來去如「風」。不過專家指出，中風並非防不勝防，一些細微病徵如頸痛、頭痛等，都可能是中風先兆。加上中風近年有年輕化趨勢，故建議四十歲以上人士定期接受心臟及腦血管病評估，預防中風！

中年發福容易中風

「去年中突然感到頸痛，我以為只是工作過勞，未有理會。直到出現口齒不清及左邊身麻痺而求診，才知道中風，原因是右側頸動脈有血塊阻塞！」

經詳細檢查後，醫生更發現他同時有高血壓、高膽固醇、糖尿病及肥胖問題。現正接受抗凝血藥物治療的他，表示病情進展理想。「雖然左手活動能力較差，拿水杯都唔夠力，幸好左腳活動正常。」

細微徵狀 不容忽視

中風是源於腦血管阻塞或爆裂，令腦部神經細胞因缺氧而壊死，影響身體機能。仁安醫院腦神經內科專科梁浩雲醫生指出，林先生的個案是典型因「三高」引致缺血性中風，估整體個案約70至85%。「香港人飲食及生活習慣不健康，常吃高脂高膽固醇食物，容易導致血管栓塞，是中風發病率不斷上升及年輕化的主要原因!」他提醒，中風的搶救黃金期為病發後首三小時，故一旦出現中風徵兆，必須馬上送院治療，以減低對身體造成的破壞。「除手腳麻痺外，亦要注意頸痛、頭痛等細微病徵，均有可能是中風先兆。」

潛在「心」病誘發中風

「三高」病人是中風的高危一族。不過即使無「三高」或肥胖問題，也不等於跟中風絕緣！五十歲的陳先生一向健康良好，血壓、血糖及膽固醇指數通通正常，只是間中覺得心跳不規則。他表示情況持續了半年，但由於無仔氣促，亦無胸口痛，還以為問題不大。「直到有一日，我突然覺得右邊身乏力、更出現少許口齒不清，入院後證實左腦有輕微血栓塞，心電圖檢查更發現我有心房顫動問題!」

心律不正  增中風機會

仁安醫院心臟中心總監李少隆醫生解釋，中風很多時跟心臟問題有關。最常見是血壓高引致的「爆血管」，而心房顫動病人六有7至10%機會併發中風。「心房顫動即心跳不規律，令心房無法將足夠血液泵出心臟，滯留的血液久而久之會凝成血塊，當鬆脫的血塊游至腦部血管，便會形成阻塞，造成缺血性中風。」

李醫生表示，由於患者通常無明顯病徵，故心電圖檢查在中風普查中擔當一個重要角色。「據知陳先生病發前三個月，視力曾出現短暫模糊，假如他當時及早透過檢查發現心房顫動問題，便可透過藥物治療預防中風！」

參考資料: http://hk.nextmedia.com/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向神經外科醫生查詢，而不應單倚賴以上提供的資料。