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SBN -87- 90000
Als COMMON SUBLUXATIONS of the HUMAN SPINE and PELVIS
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micrographs that page. To access this to the propt "Updates "Updates area reseved Atlas photogaphs can be Web page o downloaded to your fIes
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Als COMMON SUBLUXATIONS of the HUMAN SPINE and PELVIS William J. Ruch, DC
R Pss B Rn
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EATON
This book is dedicated to the the meory of Norman N. Goldstein, PhD. Hs gi was guidance inspiration, and encourageent even in his final days
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Biographical Information William j Ruch, D. C. has been in private practice at Noth Oakland Chiropcic Clinic in Oakland California for nine yeas r Ruch grduaed from he Univerity of San Francisco with a BS in ioloy in I975 and received hi DC from fe Chiropractic College Wet in I986 Dr. Ruch is a member of the nternationa Chiropractic Aociation the American ack Society and an intrucor fo Chiropractic iophysics nc Dr Ruch pent even year developing pinal and pelic disecion pcedures and ha tudied photographed and X-yed more han two hundred and fifty human cadavers in the course of his research His exensive photographic libry of these studies fom the core materia for thi book. He taugh dissetion of the human pine at fe Chiopractic College Wet for 6 (/2 year duing which time he amassed he extensive knowledge of pinal and pelvic paho)hyiology upon which which the text heavily elies. e has authored nine articles on clinical anatomy in the Journal of Clinical Chiropctic and ha had everl of his cadaver specimen and X-ray photogaphs 1blihed in the book Ciica Chroactic by C. Plaugher Willias and Wilkins 993
Designed by Wlliam Ruch and Paul Marcus. Typogaphy and ayot by Pau Macus\ Gene Ecectcs, Bekeey Californa. Poto Maskng by Pau acus Sheeen Has an Ova Destanau Oigna ustatons by Susa Davis Inexed by Sheeen Has
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An Atlas Of Common Subluxations Of The Human Spin And
Ivis
IN THE ANTERIOR TO POSERIOR VIEW WITH MID-SAGIAL MID-SAGIAL SECTIONS
SPECIMENS AND XRYS
BL Preface
vii
Acknowledgment .. .. v Inroducton
Bographca
Colopon (Poducon
.
X
Xl
X
CHAPTER ONE
Nom Human he hee Snl e Coln .. 2
he
he hecl Sc Cod
he
Moion o he
CHAPER TWO
Paophysoogy ophys oogy Sblxion nd he Cel Neo
. 1
CAPTER
Subxatons of Dcion l o Sblio1 o he Cec Secion I:
ih
Ceic Ce 9
46 h Reeed o yhoc Ce () 52 52 Ceic Sbxio Sbxio . . 58 Sblxo
Secio I Sbxion ih Lo o Secion III
Ce Sigh o iy Nec
Loe
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CHAPTER FOUR
Sxao of e Toacc Spe Discussion" " " " " " " " " " " " " " " " 77 Expande 'fable o Contents o the Atas o Subuxations o the Thoracic Spine" Section I Sublxations with a Norma 'fhoracic Cuve "
Section III Subuxation wit a Reversa o te Lower Curve Section IV Subuxations with Antroesthesis o the Uer and Loer oracc Vertebrae. Section II Subuxatio with a Reersa o te Upper Curve
Section V Hyperkyphosis o te 'fhoracic Curve Additional MRIs and X-rays
. .
" " " " . . . . .
CHAPTER FVE
Slxao of e Lar Spie 7 Discussion xade 'fable o Contents o te Atas o Lumbar Subuxations " "
Sectio II Subuxations o the Lumbar Sine with a Loss o Lordoic Cuve .
Secton I Subxations o the Lumbar Sine ith a Lorotic Curve
Setion I Subluxations o the Lubar Spine with a eversal o te Lordotc Cuve Additional ray/MRI Comarison
.
7
CHAPTER SX
Sblxao of e Pec Gile Discussion Discussion " 7 Visera Ipatons o Pevic Subuxation 'fhe Sacrum
.
Te Sarilia Joints " " . . 7 Pevi Motion Pevi Tit an Imaging . e Lumbosara eationshp .
The Pubic Syphysis Syphysis
Physioogia Subuxations Fexio! xtension otatons
Anterior to Posterior Pevi Searing Sueior to Inerior Pevi Searing Te Geriatri Pevis Non-Physiologia Subuxations
" " Intrasacral Subuxations " " " "
9 ·
Goary Referece e
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PREFACE he se hs bee desad he ae
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es deed ae dvdas As a ha sde I eeved a ess s ad ha he hea ad Whe I ee d e ab he ea wgs he kd sa d aa wh a sa shd be based he s eesve de eae ssbe ssbe Kwedge he aaa ad as he ha evs s ed eahg ss s , b eda eda Oe wd ewed eda sh he adaves ea e ee ha dsse se Whe ased ab s he aay he s sad he e ba ad a a b ae " He we add e ha he sdes sdes ae a he eg s eda hw s a as bease he eahes a eah wha he d kw eveeba dss bease we d k a I we he ab y w e e ea wha I eeded w I e e I seed I sa d e we ae aa wa beag he ae sa ae eazed I was ses deedaed deedaed he geed ha veeba a ae vasa vasa ses wk w k as a d shw e ha hese a ad geeae ega ss I ave bee abe be he w dsbed hs s essea I b as ad sges ae see ve eae beg bease a desadg he aa ad he ha eed s M s a hs bk
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ACKNOWLEDGMENT Colege-West this project to this study oud not hav occurrd. very hepful wth my never nding requests I woud aso thank the many now doctors who gav their ble time n th anatomy aboratory to hep this Especay I wr Partridge, Jim Peter Fisk, Avn Steve Mgan and Martien Crozer There wer many mor I can nam now but I a get vauabe use of ths book and know that the work and efforts apprciat apprciat the doctors who reviwed th text wrote vauab comments and etters They ar Drs Water Freeman asarsky and Grad Cum aso want to thank attornys Gn Harrison Don Pau Sver or their revw comnts whch wer hepfu in carifying text I woud ike to thank Dr Lnda Fraly Inc of San ose Ca or taking me back to schoo, Lews of X-Ray or donating xray equipment to th anatomy aboratory aboratory Dr Dr Robinson for my whoe survying and a the materia Mtche Mtch e Boyce for and makng t "dummy proof Eis cick and a the rest Deirdre McCarthy for Donna Robbns for th edtin edt in and terminoogy Susan Davis her work for hep wth ithout any one of you ths coud not have Invauabe work on the fina Paul of this book wer the typsttng pcture Marcus and heren Harrs Gnera Ecectics wr many over the years who were supportive. I hav ben so fortunate fortunate they are too numerous to name I thank you
Wilam J Ruch D C Oakand August 1996
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I NTRODUCTI ON ijur o h liga di ailag oi au do ad ohr iu ou iiia ila aio ul a ai ai ad iobili iobili o h vrbra i h olog o ial ooarhrii ad a I od ad brai h ad alr rvou rvou blood ul ul aiv oqu o ubluaio rioraio lo o oral alig a h a ord adig o a ad o o aua a b a riou riou halh ao ar o hi boo i orgaizd io i p ad aaoial a d hiologi hiologial al o Cha 3,4 ad a oo o ha i o o h o rvial i ad a did o ho
ar ad ha or oo o i h odr o ro a a a a i hih h ha a arhiur ha a ublua (dvia) oral h h boo a b dibd i h XYZ la h Caria oodia o dvaio i Z la aior o ob oid Ou irior o h lvi dal ih ioia roaio aroud uaio ad harig dioaio i h Z ad Y h boo ao oai advad iagig Sa ad a d ad lvi o ih hir aoiad Xra h MR ar o ai ad 1 gaul o hir kid iag o b ud or duaioal puro bliv hr ar a ubr o ha a hiorai Mdial prol d o o biohai roo g oo a ll a orhopdi ad urourgo i ol valuaig ijurd aia a hav arial ha ho h a o o iu daag a ll a uur o rauaiall ua ro rol l ad ra o h uur halh a d o hi h iropai poio d o hav a b ad aao a aoi i ruu ruu o hua hu a ho hi boo a oibu o ou ubuaio ad o or h
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Chapter 1: Nomal Human Spie: Structue Ad Dyamics
1
CHAPTER ONE Normal Human Spine: Structure and Dynamics Tis cater will dscuss te normal sinal column as a comex and dyamic stuctue Te norma ysiology and anatomy mst be stdied befoe one ca understad the atologica affects of sub uxato comexes Emasis w be aced on the hysoogy of the motio of e central nervos system and its suortig tissues witin te noma sina column. Te shae of te sina coumn and canal, ostue, and the ressues on te sa cord ae intimatey eated Poo osture is not eely a efecton of er soality or caacter t ca be a eflection of alteed sinal cues and mislaced body masses xames ae disacement of te head in elatio to the ib cage and dsacement o the b cage in eation o e elis. Te dslacements defom the sinal coumn and rest n joint dysfunction What s not commony uderstood is the esuln disrution of he sinal cod, which brigs with it imaired senso ad eceto functio Te sinal column as three systems of integated tisses Unde orma condi tions, each system moes dierenty and has dstct dynac quates fom the others (Se Fge - When heahy an nomal, te tee sysems moe synchoousy ad in amony. eea o the cases wich cange the sina column from te nomal state ae ca accdets, comusoy edcation, and defomng o bodies to moden life
Fge NEAR NOAL SIN The normal spial colm has lodotic cves the cevical and mba egios ad kyphotic cuves in e thoacic and sacal egons. The pos, baistem ad spinal cod ae al a contiuos stcte Thee is space the spinal caal betwee the spna cod and the fot o the caal in the netal postion Thee is slight dsc degeeatio in the anteio o evey dsc Disc height is nomal with some vey sight anteo disc blging
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2
Atlas of Common Sbxations of the Hman Spine and Pevis
THE THREE SPINAL TISSUES
abou moo h moon vov com on o h caagnou ac bwn h vba a al h jo ucu. oma moon ac a a um o omo h ho ogca ocng o ud cang nun ul and wa mnaon. h moon vnd ahoog u S ag 10. gmna moon combn o gv globa o "abolu moo bdng bdng owad. Th Th moon o h vba va wh h con o h vbal col. Bcau h caagou
Th h nal u a •
•
•
h vba column l wh h vba dc gamn ac caul, ca ag ad mucl. h hcal ac cong o h dua ma aachnod ma ub o nvo o cnal nvou m. h ba m na cod and nv oo (oncod u ac a Bg cal ow cnal nvou u) Th om h clvu o h occu o h na canal and o h acum and cocc connuou u om h on o h conu mdula and cauda qua.
ach m S Fg 12 ha a d wa o movng bad o ucu cu and funcon go ogh and ach ha comll dn u and hand oon n a uqu wa W wl dcu h ucu and moon o ach m n councon wh h abou o globa moo o nomal al colum
The Veeba Colmn
Fg 12 H H SYSS OF HE HAN SPINE:
Th m h vba column On ac o h vba coumn no wl acad h "3 on wgh bang m o mo o h vba S Fg 1 Th occaaa a ojon m a nal nal h aaoaal jon. Th 3 on bco a 3o wgh ba ng m and hu man dow o h 5aca jo Sud ndca ha h no ma vbal bod/dc un ba abou 36% o h bod wgh ad ach o h wo ac ba abou %. ld wgh bag chang h aonh ad cau ad bon modlng. W kow ha gavaoa oc volvd w nomal holog ac av cau oooo. Tho ad gavaona oc (ald wgh bag) ca ald bon. ubluaon chag wgh bang o h volvd on d o and ducd vab a co o h bluaon. Th vbal coum a much nvgad m d am o dcb v ba coum moon wh vaou m bu a will ag ha h moon bwn ach vba accumua o gv ova o
1 -HE V EREBRAL
(A) (B) (C) (D)
COUMN Veeal ody Disc Spious pocess igae lavu
2HE MENINGES OR HECA SAC (E) eca wall 3PONSCORD 3PONSCO RD SSE RAC (F) Spial cod
Fg 1 HEE POIN IGH ANG ee p weig eaig e cevical spie e poseio aiclaios o aces povide weg eang suppo as well as e ody and dsc. (A) Disc (C) aina (D) Uciae pocess (B) Poseio aiclao E Spina cod o aces
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Chapter 1: Normal Human Spine Structure And Dynamcs facets are n dfferent planes of orientation and he dscs ae o deen szes and shapes, e cevca vertebrae move differently tan te toracc vertebrae wc n turn move diffe enty tan te lumba vertebrae. Te moton between ea ai of vetebrae (segmenta moton) su as C4 and C5 4 and T o L4 and 5 s unque eac contribng to fexo extension and istng of te ole sne gob a o bsoe moon
o.
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3
The Teca Sac Te second system te tea sac s con nected to te to bottom and gt and left sdes of te snal cana cangng sae ding motion (See Fge -6 Te anges of te sinal canal in norma moon are transmtted to te tecal sa as defoming fores A common exame s hen ng on a baoon moon one exects t to cange sae deom
b.
Fge 1-4 NORMAL ANATOMICAL RELAONSHPS OF HE SKULL AND VEREBRAL COLUN
Photo Laminectomized specimen with skin removed fom back o skull, to sow elationsips o stuctues. (Posterio view) (A) Base o Skll Skll (Occput) B Vetebal aey C Aas 0 Mandible E Tecal Sac
Photo Same specmen wit occipt patially emoved to sow the ceebellum (F) Ceebelum G Ineio Ceebela Ae
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4
Atlas o Common Suuxaons o the Human Spne and elvs
T "al or "a is sd o dsr obnd dura/aanod ar ad or suorv sruurs. dra ar is oug nosing bran o sa. aranoid ar is nnr nng of sa "sudua sa b bw wn n dura and ara ara nod a is a oa sa (See Figure 18)
s sa dosn' ray is n a nora sal olun. a s wy r "a s usd o dsrb s singy sng sru wi dua ar on on sd and ara noid ar on or aologia ondi ions an aa s sruurs bu nora y y a or non as a sing sruu
�/ . C
@
c.
Fgure 1> NORMA ANAOMICAL RLAIO RLAIONSHIS NSHIS continud
hoo c. ame seme wh o oeed ad eebellm emoved wh he sl he neal oson elave o he e (G)) 1 eve ooles (G (M) 8ansem (A) enal Audoy Meaus (8) Aous ee(V II) (H) nal Aessoy ee (XI) (N) eebella ossa () Jgula oame (I) Deae Lame (0) Ou ( edge) (D) Glossohaygea Glossohaygeall eve(X) (J) 2 eve ooles (P)) Ineo eebella Aey (P (E) Vagus eve(X) (0) Arh o Alas K 3 eve ooles L)) heal sa (dua sde) L ) Hyoglossal ee ee (XI) (R) Dosal nal Aey 'Colo repesetaton of the bove figue appe fte umbeed page 80 Copyrighted Material
Chapter : Normal Human Spine: Structue Ad Dyamcs "Jnngs s a collc m sd o dscb all h spong ss of cnal nos sysm s ncds h ca I sac (hca h pa ma da lgamns (AKA dncua dncua aachnod abcua abcua a wb of bs bs n h subaac subaacnod nod spac aachng aachng o
Q.
5
aacod ma and pa ma a holds cba spna ld (CS) as a cuson fo h spna cod mdan spm s a ngl s o ss n oso canal bwn h cod and h hca h mnngs od suppo and con shap o h cod ssu
b
ig ure 1-6>:· ig EFECT O HEAD FLEXION AND EXTENION ON THE CENTRAL NERVOU YTEM
0 Flexion(head tiped forward) incrass t distanc btwn t occput and t coccyx, terefor lngtnig lngtni g t nural canal ad the the strtcig th cord ad braistm. (A) Note stretcng stretcng of t t dntat ligamnt ad t movmt of t braistm down toward t occiput Note ositions of Dntat Ligamnt Braistm Bas of Occiput Arc o Atlas (refer to Fg 1-5 or kys to anatomical structurs)
Extesio (ad tied backward) decreases t distac btw t occiput and t coccyx sortning and relaxing t cord ad braistem (B) Not t rlaxd lft dntate ligamt ligamt e foldd rlaxed dura mater (tecal sac) and t distac of te braistem from te occiut Not ositios of Dentate Ligamt Braistem Base o Occiut Arc o Atas Tecal sac
' psn f h b pps f nmb 80 Copyrighted Material
6
Atlas of Common Sbxations of the Hman Spine and Pelvs
Natural Lodotic Cuve
Fgur 7 Exteio of a lorotic crve n compario to exo. e coee of the amina a pio procee i exteio ote e poeor apect of the caal. Compare te flexio poitio wit the large pace eee eac amia an pio proce e pial cor a tecal ac go from eg o e ie of a cocavity to the otie of a covexity
Thee ae some signfcan effts of absolue moon on he spina cod. Veba coumn flexion (fowad) nceases h lgh of he spnal cana and spnal cod h ne disance fom e foamen magnum o he coccyx inceases wh eac ndvdua e amon of change can be 23 nches from xeme exenso shoened poson o eeme fexion egeed poson See Fgu . Tis s accompsed e veeba column by lama ad ace sepaaon nd poseo dsc eg ncease See Fgu 7 Also, n laea fleon he concave sde s soeed and he covex sde s engheed. Fo sace n gh laea flexon e gh sd o e spl canal s shoe n eg han he sde o e caa Absolue moon ags he sape o he spnal cana The hecal sac s made of he same ssu fom op o boom and as noma ube dyamcs I defoms as a ube n fleon and
exenson Is ne lengh wll ay nvesey wih he diamee The onge he ube ges he naowe i becomes, whle he shoe he be ges he wide becomes The voume emains elavely he same hougho he vaous osi ions he veebal column can assume Loss of e nomal spnal achecue can change his elaonsip wh mecanca and hydua pessues a esul n aology Te ecal sac n he nomal spna coumn soud be aached o he foamen magnum and uppe cevcal spine and coccyx In beween, should be fee of aachmen o he veeb his s no scly ue because he neve oot seah of evey neve oo is an exenson of heca sac whc aaches o e neveeba foamen (IV and dsal issue See gre hese ohe aachmens ceae sghy dffe e dynamics han ndependen uba suc es
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Chaper 1 Normal Hma Spne Scre Ad Dynamics
7
ge 8 NORML ANOMICAL RLAIONSHIS AXIA VW
©
Axa sn hgh h C71 ds S hw h pnal shah and h nv oo n h IV s an xnsin h ha sa hs shap and psin o spinal d is nmal
(A ( C) (D
v shah v Spna d Spna ha sa
(E Epidal spa (F) Ds (G Inv Invtba tba amn (IV F ) ( Sbaan Sbaanid id spa
THE SPINAL CORD e tird syste te "ponscord tissue trct, nudes te entire spin I cord fro e conus edlris to te brin ste nd the pons t so incudes te nerve rootlets tht gther to for te nerve roots. is s l connuous tssue e spinl cord nd uc of the nervous tissue o te centl nerous syste is cly c ly n orpous geltinie substnce he spinl cord s ttced to the thecl sc vi te p ter, spin nerve rootlets, dentte ligents rcnoid er, nd the filu terinle s the tecl sc chnges in spe with norl poson cnge o te ndividl, the pons cord tissue rct lso chnges n spe nd posi to n forwrd fexion, te cord oves nteri ory in te cnl nd increses in over ength his otion cn cnge the retionsip etween te neve roots nd the forine e nteror to posterior dieter of te cord decreses nd e righttoet deter increses. e dete ents, being ony on te rgt nd lft side o e cord, cse dferent ction in ter flexion nd rottion s te person bends nd/or nd/or rottes to one side, the dentte ligent on te conce or shortened side rexes whe te dentte ligent of the convex side is stretched is pulls the cod to the convex or longer sde o the cn wy fro the pincing nd copressng side of the
spine is cnge n te shpe o the cord cnges te shpe o te tiny rteres nd cts s pup is norl puping ction ction pushes te red bood cels nd nutrients trough te cord tisse, creting cre ting te bood fow tht tht occurs n the lower centrl nervous syste. s stted erer, wen the spn coun is elthy, te tree systes ove n rony. Segentl vertebr coun oton is nue, differing wit te section under observtion Deforing forces of the vertebrl coun during norl otion re trnsitted trogh the thec sc s nifor otion Despite the uneven, unique intersegent oton of te vertebre, te otion o te tec sc, under norl conditions, trnsits unior force to te spinl cord is is very portnt point. Stnding with jst crnil fexion wi stetch the eninges nd cord l te wy to the cde equne. e spnl crd needs nd reires unifor distribtion of ths otion ong its entire ength for nor functn. is leds to distribution o forces to the whoe "ponscord ssue trct, tus heping to reduce te occurrence of deforing forces severey fecting one prt o te cord nd csing nervous tiss i njury. njury. he nervous tissue so needs tis otion nd chnging shpe to dever dequte nutrients, becuse te otion cts s pup for te whole C.
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8
-
Aas of Common Sbxaons of he Hman Spine and Pevis
Figure 1-9 NORMAL PNL ORD ORD - ANAL RELATONH RELATONHP P I tis individal te spinal cord does not completely fill te vertebral canal Minor -posterior -posterior disc buging buging (as at C5C6 and C6-C7) as occurred witout directly impigig o te cord so tis idividual may ave expereced oy minor symptoms or oe at all Note te ealty cervcal curve E Tecal sac (A Pos (F) 8raistem (8) Des o C2 C2 (G) Spinal cord (C) Disc of C2-C3 (D) Posterio logitdina ligame (H) Spinous processes
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Chape 1 Noma Huma Spne Sce And Dynamcs
ere ae ndidual dfferenes or ariaions in e diaeer of e sinal ord and e daeer o e ereral aal. S igs 9 a 0. e seee dfferee s alled o gea anal senosis Soe of e lial laions are a e aaoal varaon an anfes self as dfferen syos w e sae dagnoss or raua. wo peole sg
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9
ex o ea oe i a ar wen is earended an ae oleely differen resoses o e nuy. ey a ave differen syos, o ans ad reovery es s is e asis for using syndroes o desre e ange of effes of yes of iues oe of e sy os w e resen n era eoe and no in oers ee e sae aden
®
ig 0 Cevical spna ana naowing o snosis. he eatshp betwee he size the caa ad pial cd ca vay between indivals In thi specimen he pnal cd ccpes the entie cana y changes i the hape i the wal f he caal can have significan elgical cseqences ) aw spina canal light antlisthesis f C6 elatve t C5 C) pial cd D) lightly nawed spina cd
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10
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tlas of Common Sublxations of the Human Spne and Pevs
Moton of the Vertebra Coumn The discs o te vertebral coumn are o allowing fexibility of e spina colun so the ead and eyes ca interact wt the envronent. Ths leibiy s essenta to vascuar ow n te capilaries of the spnal cord. The bendng, twisting and tning an indivdua does s iortant or e nutrient and oygen delivery to te aos and neurons o te centa nervous syste is otion is aso essentia to te ealt o the discs and gaments o te
vertebra coumn Tey also equre motion or nuent and oxygen echage Studes sow foced obily initiates degeerative changes of the jont tssues Te ibocytes that aintan te tissue are starved with stasis So the dscs deiver moton to the spina coumn no shock absorbing nction. The lexby ey exbit s ecessary or ter heat as we as tha t of te evous tssue t ssue
o
b.
LOSS OF MOTION RESULTS
I
Figures - A & B LOSS OF JOT TISU
An X-ray and specimen f a cervical spine with fusn f all the gamens and reslg loss f he dscs a her jin isses (A) Veeba bdies 8) Dsc spaces (C) Calcified pserir lngidinal ligaen D) Calcified aneri gudinal ligae (E) Faces r zygpphyseal ins ae fsed
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Caper Paopysology Te Hma Spe
CHAPTER O
Pathophysiology Of The Human Spine Spa Sblxao ad te Ceral Neos Sysem ubuation a erm ued to decrbe the o of normal jont ntegrty t le than a luaton o a compete o of ntegt ad e
F 1 YPES OF COMMON SBLXA SBLXAJONS JONS bxt f vertebe invlve te tree Oints f tw djcet vertebre ds d tw zygppysel jints Nte te ptgic chnges f te zygpphysel jts s we s te discs
than a docato of wo adacent bone joned by an articuaon n the cae of the human pine a ubluxato nolve two adjonng ver tebrae the dc, ad two pair f facet or gld ig join. o of noa integrty ru in the drupon of the connecng oft tiue, pamodc contracton conting of "guadn repone to jont dtre by the urronding mucature. oint pace often become edced, ad ange of motio become imted, often accopaed by pan and nfammaton. n the midagta pane of the human pne the mot common pattern of ubluxato are a complete retolithei S F 1, a
A) A c cmpete mpete retrlisthesis: te bdy f tis verebe is pster t bth the speri nd iferir segmes. 8) tirstepped relistesis tis vertebre is psterir t t te sperir vertebre bt nterir t e inferir. (C) A cmplete terlstess: tis vertebre is nterir t bt e sperir d infeir segmets
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Alas o Commo Subluxatios o te Huma Spie ad Pevis
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F - ae d a The endple dmge indictes rm tht hs heed bt s left ijued sf tisses The stbility d ltered mecnics f te njured jOints results in cricy degeertive cges. Pictred ere is pir f bugng discs with teir -rys indictig ccficti f te A. nd discs (A) stepyes (C Bulging dscs (D) Dessicted dscs (B) Dmged endpltes
atepped etrolhe, and a complete anteroehe Thee occu n all combnaon o om ubluxaton coplexe when more than two vetebae are nvoved Th the e oogy of oteoartht of the pne, degenera tve on deae, and pondyo. o of or mal jont ntegrty ater weght beang of the jont, put abnorma abnorma tre on oft tue and bone, and ntate degeneatve rocee n tme the vertebral body develop "u or oteohyte of varou type. e are ued to loong at vertebral bode from two dmenon, the and lateal ay The end pae change are three dmenonal and ae the repone to the lo of normal weght beang S C ) The ubluxa ton o a vetebrae can do one o two thg to a jont hyeroad h jont o unload the on oth condton wll caue the one and jont tue to change. oma oton nteruted caung deteroraton of al avacula tuc tue gament catage, and othe connetve tue Th ao tue fo the facet or
zygopophyeal ont. reothe hype load at lea one c and pu heang foce on the anteror longtudna lgamen ., the potero ongtudna gament (.. the annular ng, nucleu pulpou, catlage pate pate and capuar gaen The bugng twtng and tanng tue attached to the end pae pll, puh and tretch t t woren wth tme becomng rreverble S Fre -) ctued ae two bulgng dc n the anteoatera drecton wth calcfcaton of ar of the . and end ate The coplete etrothei uually caue more dc degeeaon, end pate change, faet clero, and pnal cana change The tatepped retrothe moe comon and aocated wth dc bugng pna cuve and pna canal change The anteohe not a coon an can be aocaed wth ethe o both o the othe tye. The change om noma algnmen n the cervca pne can alo have vacula cone uece. The hae o the veteba atey can
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Cape Paopysioogy Of Te Human Spine become onger an more narow ha normal om yphoc eformy of the cervica pne echanca tre can generate a ympathetc torm an a regiona vaoconcton cauing taton of the aerial wal o the vetebral artey an t tributare he inuverteba. n gre 4 an aal cut wa mae at the me of he boy o beow the upeor artcatng facet face t but above the tranvee procee ewe from below t apparent tha rotate eative to an he nferior atcuat ng acet o on the eft contactng an comproming e vertebra artery The verte bal artere are the boo ppy to the cervical pna cor an any mparment ca ave avere eult. oor vacua crcuation from reure on the arterie hat uppy the pnal cor a preure on the pinal tue tef i a natua coneuece o ubuaton o the ne a can be only oe of the many eut of hypoa o he pa cor te. ultie ubuato of the verebral col mn can have a pofon efect on the qualty of movement nutto, a general health of the central nervou ytem T effect occur ue to the baic anaomical fact tha the hape
of he vertebral coumn create the ape o the pal canal whch n rn etemne the hape of the ower centra evou ytem (na cor baem an erve oo ubuaton of the vetebrae change the hape o the vete bal caal. uay t change an nceae n engt of he cana. Te more change, he greater the effect on the centra nervou yem a the pna co The amou of change ue to uatn ca vary with the iival the mber o ver tebrae invove an how te curve are aere There eem to be ubtantal ara varatio beteen the iameer of the cana a amete
ge -3
Psterr Pster r vew f C1 nd C b lne f ct Fgre 4 s thrug C1 nd C Fgure 4 is tp sectin lking frm ndereth
@® C-1 _.
X As s vewed n tnsvese sctin fm belw
ge -4 SUBLUION O ttin C1 t C wit cclsin cclsin f te veebrl ey by C1 ineir fcet. A) Bdy f C Veebl tey B) perir ticlting fcet f C E) rnsvese prcess f C1 (C) Inferir rtictng cet f C1 (F) pinl crd Copyrighted Material
4 Atlas of Common Subluxations of the Human Spne and Pelvis
o th pa cod The pace betwee the bony caa and the pal cod can ao vay wt ndvdua See C 1. Th expain how ome peope ca toe ate me cage due to ubluxato tha ote n ome cae th pace, o o gvee o the yem, ca expa why eatvely mo ubluxato ca caue dte o oe peo nevou ytem, whle a econd peo ca toeate ad ca cange n the veteba comn wt ttee o o dte n the ae o tt o th ec od peon one mgh be abl to ect ome ympom o exam but geneay n he cond cae te peon ee to ejoy good heath
e 5 VEREBRAL VEREB RAL COLUM WH MULPLE SUBLUXAIOS WH CURVES MAED NE: iss sly d't degeer degeerte te nless there re sbltins they hve suffered sme rhitetrl distrbe elthy diss u et t pthlgi nes s ge nt be ftr. here i s reded r eded ervil rve th psterr d terir dis blging d lss f ds height. 1 Nte: rd impressins withut sgifint sensis. 2. rtined rd i pper thri despite lmst nrml rve ll diss wth vris evels f degeertin nte psterr wll itdurl dhesins dhesins enpping vslr strutures 3. Redued mb urve nd ss f dis heght nd hydrtin
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Chaper Pahophysology The Hma Spe
g -6 EEBA EE BA COL COLUMN UMN H MULILE SUBLUXAIONS AN LOSS O CUS Here we see a eversal f cervica crve with canal stesis ad crd ctact at C56 The thracc se has rgressive aterr srrig with hyerkyhsis frm alteed weight bearig ad stersis. creased thracic crve chages de t cmressn fractres T6-T2. Nte hyertrhy A.L.L. T5-T2 Nte Nte crd/caal cntact 5-T9 iscs have dak brw areas that crresd t calcified aearace X-ray. Lss f lmbar curve adds t flexin defrmty f etire vertebra clm and reslting r sture.
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1
h orma archtctra fatur of odoc ad khotc curv a a como of huma S gs -6) gr - hr ar ar ormal curv o ha h mu l msags ad bugig dscs ar o srously imgg th cod h crasd hoacc curvaur ad rducd crvcal ad bar curvs hav ac od h thoracc sctio o th sa cord o h atror wa o th caa. O ca obsv th orma otur o ths dvdua n g g -6 thr thr s alt altrd rd crvatr o al scos ad a rsultg oor ostur, ad a b forward or xo dormty of th ia coum
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Atlas of Common Suxations of the Human Spine and Pelvis
Fige 2-7 MULTIPLE SUBLUXATONS WITH CURVE REDUCTION D CORD CONTCT The Th e lower cevical cevic al spine has has by far far th most injur injuries ies and degener degenerative ative hanges of any any section of the the se. Bo B o n the cadavers and in our patients n clica practice, the C4-C5 and C5-C6 segments show the greatest reae anteroposterior anteroposte rior displacement i the ntire cevical spine (Hadey 1964) They are also remote rom the head head a therefore are more vulnerable to whiplsh than the pper segments
Note te canal stenoss of the cervcal regon as a esut of the revesa of the lodotc curve and osteopytc changes. Ts change n te shape o e canal s an ncrease n ts ength The aeo poon of te cevcal snal cord s n coac w e antero wall of the cana as s the md oacc cod om TS to T9 Ths con dton s vewed e eta poston ny ostua cange o moe exo, as sttng n a car ncreases the ao ad vasca com promse of the cod and nee oos Lookng at Fge 7 we see a aea cev cal Xray ad specmen Tese fgres ave e dscs gaments ad a entral nervos system stll ntact Ths s caed a md sagtta secton
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What we see s a change n te norma relaton shp of te vertebrae C3C4 mostly C4-C C 5C6 and C6C7 Tese are very common sb uxaton pattens otce the amount of cange n only the subuxated segments Ts cannot be completey exaned due to age becase C C C3 jont complexes are the same age as C4 C5 C6. The cage n the poston of the vertebae C4 C5 C6 cases an ateraton the sape of the canal that affects the cervcal cord eage ment or blge The cevca spne s comessed n ths regon ad te canal narrows de to te dslacement of te vertebae posteror to eac oter An exampe s the C5 osteo nfeor
hapter athophysology Of The Human pne
Fe 2-8 LIPLE SBLXAIONS WH A REVERSAL OF HE CERVICAL CRV ss f f ve starts wit C23 ad a plee plee retristesis f C t C4 ad C6 with with rd mprmise C4-C7 Vertebral bdy earg eargemet emet fs stesis f the aal ad sgifat ater aterir ir sprig f C47. C6 ret t C7 with avtati ad ear fs f ds.
bdy bein cse t the supe spina amina unctin C his is cued h the act tha the t diamete C's bdy has inceased by amst 2 de t ateed eih beain which s a a esut suuati. any studies sh that bne emdels t stess hen eiht bean stess is ateed the bne chanes its shape t accdate the eiht eai e est il be dsc deene ati and eentua usn his cnditin can ead t ceica yepathy th aius symp tms f the the pe exteities exteities and may as hae a seius effec n the est f the spina cd functin
Fe 28 is anthe specen ith its ass ciated ay shn me adance deenea tn. utipe subuatins a n sandin natue hae a pund effect n the cena neus syse and in the shape f the etebal cana. e see in bth specimens a adica chane, especiay n Fe 2-8 ay hs is a esut f he suuatins that hae alteed the cate. hese satins hae ceated a en defmity he ceica spine Fe 2-9 ae shn a ceica and ay f a paient hee ae se simaities eteen Fe 28 and Fe 2-9 e histy f the patient is hen kin a a desk, he ad
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8
As of Common Subuxons of e Humn Spne nd Pelvs
aasthsia biatay to th fns anss dminshd fls shoud and nc ain and som pain in his ams h MR o this patin as akn in th cumbn poson no in h osiion ta t cad h symptoms symptom s ot if by yin don on his bac h patint F -10 has a simila ob m, ttin if by ayin don on h back ha a midsaittal i o h nti spin sn in th position n hich it as tan h spina cod is in th anio poton of th cana fo to Tl0 h patint ts lif (had nck, soac and bac ain) in this osition. obm is aaatd hi sat d at h ds ith h nc ld oad. n boh cass sins of sn s na a cod dstss a sn
hil in a osion tha is symoms n boh hs cass cical flion ncasd symoms caus o th oss o th noa cu that is aady in his mi sbuxatd cica sn, a on than noma cana is c atd ith ion sttcin th sina cod and ssin it no th buin discs and oso hyts h cod s latd to th antio o ton o th cana n in th cmbnt osi tion his is not noma h anio snal aty can b compssd by th posto ostohys and buin discs his contact can b ducd hn th patint s yin on his o back and th cica spin o umba sin s n tnsion (S F -1 h sa of th cical cu o yphosis) can nthn th
F 9 CERVAL X-RAY AND MR[ SUD H LOSS OF LORDOS[S he laeral -ray of hs paie clearly shows he loss of crvare muliple slxaios loss of disc hegh, ad oseror oseophyes This MR shows loss of curvare ("mary eck) reslig rom poserior suluxaos a C3 rero o C2; C rero o C3 ad C5 rero o C6 Noe he loss of disc heigh ad poserior sprrig he spial cord is mch smaller diameer ha he vereral caa i s he eherg or srechg of e cord agais C3-5 ha makes hese sgifica rolems The poserior dsc ulgig ad oseophyes of C35 are acually i coac wih he spia cord i he eural spie posiio, a posio of elef for his paie of laeral paashesia i he per exemiies Hs sympoms were rogh o y siig a his desk doig pape work We have o exrapolae hs chagig posiios o he chagig legh of he verea caal.
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Capter atopysoogy Of e Human Spine
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F 2- MIDSAGAL MIDSAG AL MRI SUD Y O HE EIRE VEREBRAL VEREBRAL OLUM SEE I HE OSIIO HE SUD Y WAS AKE e nteriorty o te cord in te cnl o C to T9 teteng) sows te ovel eect o te reverse curve is tetering o cord nd te yokyoc curve o te tocic sine stndg or suine vews igned segents wt reduced curve. nteor ocon o te sil cod in te cn i te suine vew troug ost o te torcic sne oss o lordotic curve in te ubr sine is lexio deority or lengtening o te c oe scr disc Cet ervous syste tesion is trnserred to cude equine l te wy to te Is We eed to exrote ostur cge ro suie to lexed (seted or oter) ostios. oe terio cod dslceet i e neutrl osiion Ptient ctully ges relie in is oson, l lexion irites er condtio
F 2- ERVIAL XRAY D MRI SUD SUD Y SHOWING SHOWI NG REVERSAL O URVE Cervicl MRI nd X-ry o se individu sowing eves o lordotic curve or cevicl kyosis oe te strigteing o e binse to tocic cord, coete etrolistesis o C lrge intersios distnce ro C7 elrgeent o C body due to yer lodg nd bulging discs Consider te noic d ysioogc cnges wit ctive ersistet cervc exion s requred by ny jobs.
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20
-
Alas of Common Suuxaions of e Hman Spine and Pelvis
Fge 212 & B X WS OF H R D ORD
b.
o
(). hi pim i g viwd at th C7 lvl Nt th antrir aal wall ntat and lattnng th pal rd hi ndividal wa a a ptn wh ditin and p akn Can th vntra hrn n y valarizd? (C Fat A D (D Spinal rd (B Nrv t (E Lamina
b T
MRI
an axial viw at th C5 lvl aly hw th pal rd tthrd againt th antrir wall th vrtral aal At thi lvl th rd ha lt it mal almt rund apparan It i vrly lattd ad vulral t vn lght ptrir di lging ad minr tphyt Can w aum th antrir pinal artry ha any ld lw
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@
Fg 213B PDUR SONS/POS SONS/POSRIOR RIOR W
Figure 2-13 PIDUR DH S IONS/ IONS/R ROR OR W pidural adhin tw th antrir vrtral aal wal and th thal a (Da Matr h ti ar uppd t rly mval rlativ t ah thr h adhi ar th rult hr ilammatn d h lxati th vrtra and d tag OJO (A Bdy vtra vtra (C hal wall (D Spal d (B pidral adh
pidural adhin i th ptrir prtin th vral anal h adh ar th rlt hrni inlammaty tat i th ptrir ptrir t ad th vrtral lmn a gn ad vn th thal a pa a v rtl and ari A Ta wa (C Spin pr (D Ligamnum lavm (B pidra adh
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Cape : Pahophysology Of he Human Spne
1
Fge 15 Fge -14 IRAHCAL OR SBARACHO AHSIOS tese seces sw sterir srcnid dess in te trcic en te verter clum ey ec ve teteed te sinl crd wt lre cntct es ist te cn wll Snce te ser cn wll letes mre te stretc irritn is eter in te sterir emisee te tecl sc (A Sil crd ( Srcid desis (E) Limetum vm (B Verter dies (C ec wll ( Sus cesses
c in the ceric e e nd the etire spin I cord ote the strght ppernce o e spin cord nd stem the ncresed distnce eteen the spous processes o C37, the su ution compex inoing C3-7 uging dscs the inoed segments d osteorthitic chnge o compete etrosthesis. he compoets of the cerc suution com pees ter ordotic cures he resuting eects on the cetr nerous sstem cuse pro found heth ce chnges. n Fgr 1A e see the disced spn crd in specimen t te C7 ee ith the e t suce o te spn cord n contct h the erior of te spin cn s s deomng deom ng o te nteo nd ter tcs tc s of the cod nd cn no e considered no ge 1B the ie is C5 sho ig the spin cod fttened gis the teror
o the cn ere is deormg o the scur s e s neur structues e ni m studies re cer. e he cod is deormed ered conducti resuts hen this ppes there re to mn components; durtio d intensit o ong period the condio perssts is importnt ecuse e studes sho decresed conductiit ith crese in time of deforming orce e inten st is oious fctor. fctor. en the ncrese in tethering or compression occurs e conducti it decreses here s 70% incidence o degrees nd forms o cod deortion in e rndom poputon o 1 cders other compcon o the deomng eect e ectss o suutio copees o the eer coumn is infmmo nd resutng desios n Fge -1 ou see epidur desos tht he deeoped ecuse of chronc nmmtio.
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-
Alas o ommo Sbxaos o e Hman Spe and Pelvs
Thee e obous subuxtions with end stge dsc degeneton n F 2-13A the du mte (te outside of the thecl sc) is dheed to the PLL. his conditon seeely mpis the nom indepedent motions o the thec sc nd te eteb column. (Se C ap e 1). The dhesons cn be etense in the spnl cnl Fe 213B sows dhesions of the du mte to the lmn nd gmentu £m in the poseio wl of the cnl Ths hs to be uthe esticte condition to o otio nd hysioogy Thee e two min fctos t wo hee: the degenetio of te disc nd lig ment tssue s essently nflmmtoy conditon nd the bnoml mechncs of e tebl motion uttng unusul stess on he the c sc nd ohe mennge stucues hs uses n inlmmton o the menges inse the subchnoid spce (Se F 21 and 215) ee e two speciens ith subch noid dhsons n both cses the thocic cod s teteed gins the nteio wll of the cnl is ondtion, moe tn ny othe choncl ly pls o stetches e posteio eements of
the thecl sc The pesistent ttin cses nmtion nd dhesions of the mte chnoid mte medn septum, nd t chnod tbecule. n boh ses the cec cue is eed by sbuon omplees The tctonng nd iitton o the thocc cod nd mennge tissues s one mjo est lso thee must be impe C ow n ths e ong with the eed biomecncs of te ee Fe 216 o the ppence n the ocic spine ote the iging densy of the desions s sim to tt of the spn cod In situ e dhesons e dense nd entp teioles nd nee oolets. s demonsted sublxton o the ete bl colum colum hs mny mny spects spects tt tt nteee nteee w noml helth The etebl coumn is cope stuctue with mny types of tisses tht when ethy wo in ony tetion of the noml chtectu etues o the e teb coun cn e seee eth conse quences tht n dnce with incesing du tion nd intenst
Fe 216 HORC SINE MRI X EWS OF EHERED SPIN CORDS te baahd adein and rdaa nat in the rembe ti the a r i in the wrg art f te anal fr i in A) Vertebra boy (8) Sinal rd () Sbarahd irahea aden
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Chaper 3: Subluaios O The Ceca Spne
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CHAPTER THREE Subluxations Of The Cerical Spine Discussio The motion and support of the ead are main eatues o the uniqe jont coplexes of the cevical spine. The ateration of the noa architectre alignng the head with te thoracic spine is te primary case of degeneratve change he blood sly of te cervical spine, face, ad wer head are cotroed by the ntegrity of the vertebra column (See Fge he chages cased by subaton of the ceica etebrae can result in eadaches as a patent coplaint e cevicogenic origins of most headaches ae only atialy appreciated by te ealth care communt. Bood fow to vita parts of te centra nervous system can alter de to sba tions of the cerca spine. Headaces can aso be cased by head to thoa misalignent wit the CM spas tat can deeop and comress the eternal glar vein. hs deceases o stops bood drainage fro the face and side of te head. ome headaches are cased by inflam ation of te tendinos attachents of he C nto th mastoid process de to conic spasm Wn te head is accleated in a different way ro the thora te cervica spn wi defor is is comonly eered to as whpas bt I prefe te te "bucking. cking is an engneeing ter that conves partial coapse of an architecta stcture, an
accrate descripton o the rests o the head being sddeny acceerated ies an hor faster and in a different direction than te tho ra. he reslt s anterior to posteor as we as rotationa misalignets Wt preservation o te nora ordo ordotc tc cu e the cerca cer ca spine undergoes none of the canges o osteoathitis even n od age ost osteoarthritis o the spne s te reslt of ncorrected sblations and remoded bones and oints due to th cronica ly atered weght beang. Osteoartritic
Fge he hea a cervical pine can malign an ave altere trcture he verteral artery an ther vacular a nervu ytem cture can uffer a cange in fnctin Ne te pti f the verteral artery an relatnhip t the cervical pine a the hea hee arerie uppy the pina cr verterae igament an rantem wth l (A Hea (8 Cervcal pine C Verteral artery
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Ala o Coon Subuxaion o e Huan Spne and Pelvi
@
F his is a MR of a cervical spe lower head and pper thoracic spine. he suuxated sixh vetea has formed posteor oseophyes he eroisthesis of C6 he posterior osteophytes ad the lama of C-7 have creaed a canal steosis (A 8ainstem (8) Ceeelum (C) Spina cod Posterio osteophytes (E) Lamina
anges ind dis degeneration spial anal stnosis intervrtebra foran naroing ninate pross yprtropy and faeta s rosis S Loss of ont aignnt or sbxation of ervial vetebae rsts in anges to al isses of afftd seg ens Tis also as nfortnate onses
fo aas of t entral nervos syste (S F Te sbxations atr ose of te vertbral arteris and tribtaies and terefore ater t bood fo in tose vasuar srtres S p Te sbxations an ae te sap of te spina ord brain se and pons (S F Atrd sa
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Capter Sublatons O The Cervical Spine and blood suppy to the cetra nevous sysem ca chage i funcon. Te acos a ca lead o aeed funcon ncde e ype of anaomca eaonsps, e dgee of cange, and e me o duaon of suuxaon Some paes ave a facos wokng agans em, wle oes ae moe founa. Te ceca spne as mo capact to cange n eng an he other otons of e spe poseo ceca caa wa as moe fxo-exenson ange of moo an
25
any oe pa of veea coumn Te ce e of e cecal canal ca engen cm om fu eenson o fu feo. Ta s eay alf e oa cange osse fo e woe spne Te oss of e odoc cuve can ad to c o moe of engh to the whoe canal, ema ety stretcng e sna cod, ansem, pons, and nee oos Wh cean fexed pos ues o osons, an ovesecng of lowe NS can ake place
Fe 33 hi pecimen ha a reduced canal dameter ad a large lower cetra neo yem. e cmbinatio ha created a pial canal teoi he braintem i compeed ad ere a hypolordotic or redced ceical cue. he C56 dc bulge a mo cage n the anterior caal wal C5 and C6 are ubuxated ad the dic ad end plate ae eded and reduced the c aa at that point n thi ituaion a mal dc bge ca be cncally ignificant (A) Braintem (B Spial cord (C Ed plate change (D) C56 dic bulge
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26
Atlas o Common Subluatons o the Human Spne and Pelvis
Hed o o snen n e e she of neuoo nd vsu suues o e nek nd e unon s oud so en o e n nd n w e ed o e neo onudn en e bk of e esous ee Fe 35 e ndbe s oved b e uses o n. e neo usu ous od
e ndbe e b ens o e hod bone nd e se d ves. Subuon o e ev sne e h neen nd no ndbu w be ossbe e seens esened e oon ens o subuon; oweve s s no o ee deon o es of buon.
e 34 wo MR axal views of the cervical spie These views sow a stetched spina cord The upper picture is a vew a C-4 The left to right dameter o the spna cod s elongated The dentate lgamets have narrowed and puled on each side of the spinal cord, makig it wider The lowe picture is taken at the CT1 CT1 eve ad also shows a widened cord (A Vertebal bod () Spinal cod (C amina (0 Spinous process E Picture ke showing the evel vewed and angle o sca
HARYNX EGOT
CERVICAL E
SNA COR
I
I
Fe 35 Ce /Se Aes e oat esophagus hoid bone larx and other stuctures attach drect o e aeor o the cervcal spe. These strctures ca be alteed i shape ad eg wth head-tothoax misalignmet
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Epanded Tabe O Conens
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CHAPT CH APTER ER THREE THREE - EXPA EXPANDED NDED TABLE TABLE OF CONTENTS Alas o Subuaons o e Ceca Spine
SECTION I: Subluxations with lordotic cervica curve 8 pairs)
A & B SUBLUXATION WH OOTC CERVICAL CURE
A & UBLUlONS WIT ORDOC CRVICAL CURE
g32-33
Pg. 30-31
A & UBLUATJON ORDOTIC CEICA CURVE
Pg36-37
3435
A & B BLAO WIT LOROTC CRCAL CURVE
A & SUBLAO WT ORDOTC CERVICAL CURV
40-4
38-39
A & B UBLUAO W LOROC CRCAL CR
4243
A & SUBLUATO IT LORDOTIC CERVICA CURE
A & UBLATJO IT LOROC CRVICA CURE
P4445
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Alas o Common Sbaios o he Hma Spe and Pelvis
CAPER REE EXPA EXPANDED NDED ABLE ABLE OF CON CONENS ENS Alas o Sbuaons o he Ceical Spie
SECION I Sblxao wih lo of lordoc crve (raigh or miary neck (3
Pates B ULUTO W 1T 1T O Of ODO U (righ o my nck)
g. 44
e 0 A ULUXJO I O O ODO gh o y ck)
g4849
pairs)
A B ULUXAIO WIT O OF LODOI E gh y )
g 01
SECTON III Sblxaion wih revered or kyphoic crve 12 pair
Pe A UUXAO EE D O KYO U Upp evc subuxn
g. 23
5 A UBUXAO E O OT Md-cv ubuns
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s 31 B BXIO I EE O K'O E U cvc subu
g.. 4 g 4
P 6 A UXAIO \ E ED O KPO U c ubuo
g 0-1
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Pe 4 A B UXIO T O KPO UE per cvi uuo
g
7 A UBXIO T EEED O KO U Lw cvc ubuxn
g23
Epanded Tabe O Conens
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CAPER CAP ER REE REE EXPAN EXPANDED DED ABLE ABLE OF OF CONEN CONENSS Aas o Sblaons o he Ceical Spine
Plates 3-18 A 1 SUBLUXATION WH REVERS OR KYOC CRVE Lowr crvical ublxn
g5
lt 21 A 1 SU1UATONS WH RVRSE OR KYPOC CUR Midceril blton
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Plates 9 A SUUAOS RRSD OR KYPHOC CRV oer cerc) bltoJ
g g
le 20 A SUAONS WTH RVRSAL RVRSAL OR KYPHOIC CURV owe crcl bla
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Pltes 22 A SUTO WT RVRSA OR OTC CRV An -ray MRI compariso
Ple 23 A SLAO WH REVERSA OR KYPHOC CURV A X-y MR compri
g-5
g23
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Aa of Coon Subluxaion of he Huan Spine and Pev
laes 3-1 & B SUBLUIONS WH LORDOIC CERVICL CURVE This is a example of a modest lordotic cervical crve wit sigs of old trauma. Note te verebral algnment congenital steosis wh virtually no posteior dsc bulging A of the cervica discs are sUbstanal and hydrated despite te sigs of od trauma Te discs had plenty of time to degenerate post accidet bt are heaty. Anterior bulging and spurrig ave occurred at CC5 and C5C6, along wit compression fractes of the C5 and C6 vertebral bodies
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Chaper 3: Subluxaion O he Ceical Spine
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This type o jury is cosistet with a all where the dividual lads o their buttocks with head lexg orward violetly. (The umbar damage i this specime would support this The mai poit is the lack o AP misaligmet. All segmets except C1 ad C2 show very slght stairstepped sbxatio; C3 is retro to C4, C4 to C5 to C6 ad C6 to C7 However, sice the vertebral bodies still share weght-bearig with the acets disc degeeratio has ot occurred to a proouced degree spite o the tramatic ijury (A Compressi Compressio o actues o aterio aterio vertebral bodies (8 Osseos epai ad chages idicatig old tauma
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Alas o Common Suluations o the Human Spine and Pelvis
aes 2 A & B SUBUXTIOS WITH ORDOTIC CERVICA CURVE e modest lordotic cure despite the signs of trauma and subluxations has allowed some normal weight bearing This specimen shows erebral canal stenosis a the sublxated porion of the spine and stairstepped retrolshesis from C through C5 with compete rerolisthesis of C6 (to C5 and C7) (A) he erebral bodes at C4 C5 and C6 appear to hae been anteriorl crushed; crushed;
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Chapter Subluxations The Ceica Spne
(8) he diss have ulged aerirly ad aiati the aterir lgituda ligamet has urred at CC5 C5C6 ad C6C7 A traumati lexi eve suh as a head s may have aused these ijuries I spite the trauma the diss are al preset ad hydated. (C) he ly sigiat dis damage is at C5C6 where teaig ad psterir ulgg have urred (Phase II degeerati). he ulge impiges damatay the spal rd s it was pray iial sgiae t the idivi dual.
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Alas o Common Sblaions o te Hman Spine and Pevs
aes A & B SBUXATIOS WITH ORDOTIC CERVICA CRVE I th viw th cv i maitaind with th ubuxation and damag at ach gmt with dc blging clnically inigniicant Thr ar light ubuxatio at al vl with o of potrior dic hight at vry gmnt and lo o acta jint pac with burnation (hyprtrophy of act. Not that th lo of ntrpio pac-pinou contact can cau oy chang Thi i condary to th lo of th potrior dic hight
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Chape 3 Subuaions O he Cecal Spne
(A ote fuson of posteror posteror of verteal odes odes of C6 and C formng a permanent protrso no the verteal caa (8) gamen gamenum um flavum potruso potr uso ad cord cotact at C3 ca e assocated wth oss of dsc heght wedgng and slxaton
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Atas o Commo Subluatos o te Hma Spie ad Pevs
aes 4 A & B SUBUATIOS WITH ORDOTIC CERVICA CURVE e cue i omewhat maintained with C anterior to C C retro o C with dic tearing C4 ook a g wh ght dic tearing C5 i retro to C4 (xray look wore) dic tearing wih ome brown degeeraton w o o dc hegh C6 light retro to C5 with dc earig and bulgg anterior and poterior C7 retro o C6 w oero purring dic earig and brown degeeration poerior joit change he cerebe ad ban tem ca be drawn dow into the
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Chape 3: Subluxaon O he Ceical Spine
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base o te occiput causing ateial compessio ad ceebella ivagatio ito the spina caa (A C2- has litte cuve and loss o acet joint space. ( Ifeio ed plate wdeing is the hallmak of hype loading te vetebal body ad dsc dsc (C Caal stenosis is is the esut o the widened edpates and blgig disc disc (0 Note ceebella ceebella compession to occiput E Bain stem cotact wit the clivus Ceebellum invagating tough te foame magnm
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Als o Common Suluons o e Humn Spine nd Pevs
aes 5 A & B SUBUATIOS ITH ODOTIC CEVICA CUVE Minor tairtepped retrolithei ha occrred which developed poterior pr ad ome dic bulging bt the normal lordotic crve ha prevented maor canal change
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Chaper J: Subuxaion O The Ceical Spine
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7 3 is rero to 4, 4 to 5 5 to 6 ad 6 to Slight posterior bugig ad loss of oserior disc height is vsile etwee all segmets ad a aeior buge ca e see at 6- Deformatio Deformatio of of the vereral odies dcates altered weg eari earig g egi egig g at 4
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0
las o Common Sbaions o he Hman Spne and Pevis
aes 6 A & B SUBLUXTIONS TH LORDOTIC CERCAL CURVE This specimen shows relatively slight subluxations at evey seget with accompaying disc degeneration C is anterior to the occiput occiput and C and C s e C and C4 (complete retrolsthesis) C4 C 4 is slightly rtro to C5 and C6 is aterior to bot C5 ad C7 complete anterol isthesis)
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Chapte Subuxatons The Ceca Spne
1
Note that the cervical lordotic curve has been maitaned, indcatig that the facets are still weght-bearig. Approximation o the spous processes has occurred with loss o disc height ad cavitatio. Spurrig has occurred the lowe segmes ad the caal senosis s mnor Ecroachment o the spinal cord has occred only a C4C5 ad perhaps slighty at C5-C6 ad oe o the segments have sed. Aterior spurrig is sible at C4C5 C5C6 and C6C7, ad a disc ear ca be seen o the Xray at C3C4. Disc tears, eve promiet pro miet oes (eg. (eg . the dsc betwee betwe e C2 and C3) may or may ot show p o Xray; however they do appear o MRls
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Atlas o Common Sbaions o e Hman Spine and Pevs
aes 7 A & B SUBXTOS TH ORDOTC CERVCA CURVE hi ecimen ha a moderate lordotic cure with ignifcant dic degeeration and urrg at the ublxated egment here i alo cord contact from C to C5 with compreio o the anterior cord at C45 C1 i anterior C4 i a complete retrolithei to C ad 5; teari g o C4 dic; but near fuion with prring poterior and anterior note tearing or ire of C45; C5 etro C6 with tearing
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Capte : Sbuxatos Of Te Ceca Spe
6
7 and pring C etro to C7 with on o poterior C-7 tearig o di withot ge o C7 peror edpate moderate anal teoi with C4 di lge igniat wih lexio alo wit C- igt igiiae with exon A) C4 poterior ody retro to C3 moe oer to lama o C, teoi i worened
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44
Atlas o Common Subuations o the Human Spe and Pelvis
Plates 3-8 A & B SUBUAONS WITH ORDOTC CERVICA CURV Mo commonly injurie to the cervicl pne occur t the C5-C6 nd C6C7 dc c hve the gretet cpbility for nteropoterior movemet nd which beig frthet rom the hed, re the mot vebe to whiplh. Occionlly however injurie pecificlly fect the md-cervicl vertebre nd dic
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Chape 3 Subluxaio O he Ceica Spie
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Almost a segments segments are subxated subxated C 3 is a comp complete lete retro (to C 2 and C4) C4 is compleely antro (to C3 and C) and C6 is completely retro (to C and C7) Disc teang ad bulgig is evident trougout, ad is most proouced from C3-C4 troug C-C6 bu becuse te odotc curve as been maitained, steosis of te verteba canal is minor and e disc bulges do not impige po te spial cord altoug close at C6-7 disc Spious pocesses of C4-6 ave approximated because of disc egt loss ad te facets ave been aeced by te altered wegt bearig
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Atas o Common Sublatons o te Hman Spine ad Pevs
Pates 9 A & B SUBUXATIOS WITH LOSS OF LOOTC CUVE (Straight or mitary neck) dda how pronoced traghtening o the neck a well a o ie ad bon chage chag e caed by aeed weght bearing. C1 i aterior aterior C i a complete complete retro (to C and C4) C5 retro to C4 ad C6 a compee retro (o C5 ad C).
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Chape 3 Subluxaon O he Cecal Spne
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ota oss of the e sally ivolves at least oe or more compete retrolisthesis isc shearg ad blgg occ from C3C downward Broadenig o ed plates is evidet beow C dicatg increased weight bearg in he veebal bodies. Aterior bging and end pate deormaion at C5-C6 ad C6-C7 were probaby tramac in orign. A Note tat tat the relaively sgt posterior posterior disc bge at C3C impinges o the spinal cord cord
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Aas o Common Saions o he Hman Spne and Pelvs
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Paes 310 A & B SUBUXAIOS OSS OF ORDOIC CURVE (Sagh o mary ec is spcimn sws a ss f crical cur wit a sligt rrsal frm C4 trg C6 wit a cmplt rtrlistsis f C C s rtr t C, C4 t C, C is a cmplt rtr (t C4 and C6), and C6 is rtr t C Disc tarig (sar), spurrig and ss f disc igt can b s indicating a lgstanding frward altrati f wigt baring
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Chapter 3 Sbatios Of The Cervical Spie
(A) Nt that th pns and brainstm ar ttrd agaist th pst sac sac f t ds and trasrs lgamt Intrducti f ay fx rtbral rtbral cumn will caus furtr ttrg at tis pint ) Incrasd trspinus distac dcas gng f th caal. (C Subluxatin and nd nd plat cags cags s didua maks t pstrir disc bulg bulg at C5-C6 clinically sgca Adancd disc dgrain is idnt a mst sblxatd ad scraly srssd part f t crca spin
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Aas o Commo Subluxaios o he Huma Spine and Pevs
Pates 311 & B SUBUXIONS WIH LOSS OF ORDOC CURV (Staight o miitay neck) Note te canal stenoss rom cronic degeerative canges due to subluxatio. C2 etro C3 wt tearig and bugi buging ng of te te disc, C3 anterior to C2 ad C C reto to C3 wit maor vetebral bod cages C5 a compete retro to C and C6 wit near uso of C and
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Chape 3 Subuxaions Of The Ceical Spine
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C5-6 with postero spurring and further stenosis C6retro to C7 with tearing ear fusion Note loss of posterior disc height C23 with spious cotact and facet jammng ad sclerosis his ca also be see in all the facets de o loss of dsc heght ad altered weight bearing of subluxaton (A Facet degeeration (8) Cord-osteopyte contact
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Alas o Common Subluxaios o he Human Spine and Pelvs
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Pates & B SUBUXIONS WIH RVRSD OR KPHOIC CURV Upper ceica subuxations This vew sows a reversa of the lordotic lordotic crve at C2-3. etro C3 to C2 with disc tearing ad blgng C is a complete retro to C3 ad C5 with disc tearg and wedging C6 is aterior to C5 with dsc teaing and blgg ad nea fusion
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Chaper 3 Subuatios Of Te Ceical Spie
postriorly. All discs ar tor wit atrior spurrig ad disc blgs postrior. Canal stnosis is due to t subluxatios and t rsultig altration of soft and bony tissus A Small comprsso fracturs of of atror and supior rtbral bodis bodis C3-C6 C3-C () Spial cod and canal contact fom C3-C
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Aas o Commo Subuxaios o he Huma Spe ad Pevs
Plaes 313 & B SUBUXONS WH RVRSD OR KPHOIC CURV Upe ceical subuxaions his secmen shows a evesal of he lodotc curve at C3 with stenosis of e vertebal cana a te subuxated segments, wc maes he eaively minor dsc bulges a C3C C-C5 and C5-C6 clinicaly significant
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Chape 3: Suluaons O The Ceca Spine
Gapping at t facts indicats that wigt baring has bn transfrrd t th rtbra bdis i th mid cicas C is atrir t th ccipu and C2. C3 is a cmpt rtristhsis t C2 and C. Buging and taring f t C3- disc ha ccurrd C is rtr t C6 with a sigh ss f disc hight A pstrir disc bug is isib at C56 with crd cact. C6 and C7 ar ary aignd with rma caa sap and si h sbxatd rtbra prbaby ha irfrd with th cntra ns systm
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Atlas of Common Subxations of the Human Spine and Pelvis
Pas 14 & B SUBLUTIONS H RVRSD OR KPHOIC CUR Ur crvca subuxatio s divdual suffered degeeraio i al of his cevical discs de o sublxatio of every segmett C sperior o te des ad aterir to te posterior m of te foame magm segme ad te C2 spos pocess coactig te dosal suface of te spia cod C3 is a complete retrolisesis wit a reversal of t odotic crve at tis evel I addito t appears tat C is ateror to te occiput ad C2
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Capter 3: Sblatons O Te Ceical Spine
57
h dgr f pstrir bulging and spurring frm t sbxas as rsutd acquird stsis T spial crd is tractid agas atrir wall f th vrbral canal wit cntact t crd C3 s a cpt rtr t C2 ad C4 wit rducd dsc igt taring and ps bgng and wt a cavitatd disc at C3-4. C4 is rtr t C wit sprrig ad paral fusi at C4-. C6 s rtr t C ad as partially fsd wit it pstriry C7 is rtr rtr t C 6 t disc as cllapsd cllapsd bu t fs as t yt ccur ccurrd rd Al f t dscs ar blging pstrily and antrir bugig ccus frm C34 trg C6
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58
Atas o Common ubluxatons o the Human pne and Pelvs
Paes 3-5 A & B SUBIONS IH RVRSD OR KPHOIC CRV Md-ceica subuxaons Shown ere s an nterestng oput C1/C2 reaonshp C1 s anteor to the oput and the poseor arh has beome weght bearng C2-3 looks good, wt a good ds s retro to C3 wth ds narrowng posteror and ust a t of ateror brow degeneraton wth sgfant endpate hages. 5 retro to C wh ds tearng, neross and moderately sgnfant posteror sprrng wh ord mpgement.
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Chaper 3 Subluaons O The Ceca Spine
59
Nt casd ndplat ticknss t X-ray wic gs t apparanc a blgig disc in t spcimn. C6 is a cmplt rtrlistsis t C ad C7 Spinal cd ctact ad cmpms rm subluxat pstrir spurring, and sgicant DJD wt dsc buging f C & 6 C6-7 ks k s sgncatly dgnatd wit wit mir blg bt bt nar sins - nt s n X-Ray. Nt act jammng jammng C3 t C6 - wr s caag facts? ss disc igt causs act sclrsis and srtning f t caal.
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60
Alas o Commo blxaios o e Hma pe ad Pels
Pas 316 & B SUBLUXIONS IH RVRSD OR KPHOIC CURVE Mid-cica subuxaions C1 aterior to oput and C2; C2 & C3 look aigned ut faets show altered weight eang C retro to C3 and C5 retro to C with dis tearing of C3- ad C-5 wth posterior sprs and loss of dis heigh fusion of C5 and C6 C6 is a omplee etrolisthesis to C5
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Capte 3 Sblations Of Te Ceca Spine
and C7 with tearig o C6-7 and posterior blging sigca caa senoss from sblxation and the expected degeneae cages Note: etebral body daee o C-5 & 6 compare to C and C7 signiica cod copesso ad canal stenosis at C6 and C7
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Atla Cmm Sblxati he Hma Spie ad Pevi
Plates 3-17 A & B SUBLUXATIONS WTH REVRSED OR KYPHOTIC CRE Lower cervicl subuxtons this speimen here is a reversal o the rve at C6 the lordoti urve the upper cervial area is mataied ad well-hydated dss have pesisted. Hypertrophy o the aets in this region indiates that they suered altered weighearing utio
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Chape 3: Subluaons O The Ceical Spine
63
C1 s antrior to th occiput and C2, C3 is rtro to C2 C4 is rtro to C3, C is rtro to C4 and C6 shows a complt rtrolsthsis to C and C7. Bulging spurrig loss o disc hight ad disc taring hav gun o dvlop at C4C and C5C6. Not canal snoss and spinal cord impngmn ginning at C4-C. C6C7 shows signiicant loss o disc hight with ulging and sprring antriorly and postioly h whol disc appars to hav colapsd thr is o visil in o shar). No impigmt on th spinal cord which is tthrd against antrior surac o th vrtal canal at this lvl
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64
Atlas of Common Subluxations of the Hman Spine and Pevis
Pates 318 A & B SUBUTIO WITH REVERSE OR KYPHOTIC CURVE ow cevica subuxations is spimn has a rvral o th loroti rv at C6-C7 with signiiant or ompromis rom C3-C7 h spa bin or at C-7 an omprssion o or into antrior anal wall C-C7 ar u to trationing. Morat ongnital stnosis. Not C2 an C7 anal siz; s lvls ar nar normal an r in iamt
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Chape Sbxaons The Ceca Spne
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There C2 is alied with C3 with a healt healthy hy dsc ; C3 is stepped behid C or C4 is aerio to C3 with dsc teari ad b o C3C4; C4 is reto to C with tearn ad bli edplate chanes are moderate C s antero to C ad C4) C has become a complee atroesthesis C is rero to C wth sicat endpate chaes ote the ecotic brown) tsse C disc aso the disc mateial al the way ot between "sprs o C ad C. C sed with C etro to C ote edced ponte leue and the brainstem is wel below occipt A) Braistem
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Atlas of Coo Sublxatios of the Ha Spe ad Pevs
Pates 319 A & B SBTIOS WTH REERSE OR KYPHOTIC CURE wer cevica suuatins n this ndiidal th C2-C3 dsc is normal bt C4 is tro o C3 with a isibl in of shar in th dis C5 shows ompl rtrolsthsis (i.. is rtro both o C4 and C6) with a shar lin and postrior sprring a h C4-C5 dis and compl fsion at C5C6. C7 is ro to C6 with prononcd loss of dis hght dis shaing and postrior spuring
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hapter 3: Sblxations O The ecal Spne
67
(oe: MRl dc hea appea a a ac lne thogh the dc) At te level o C2, he pna cod et n a paco veeal caa oweve at C thogh C7 the oadeed end plae o te veeal ode ave eed n caal teno (naowng) o the pot wee te pnal cod actaly compeed h poaly ad clnca gncace o te dvdal
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Atlas of Common Subluatons of the Hman Spine an Pelvis
Ptes 320 A & B SUBLUXAS WH REVERSAL R KYPHC CURVE Lowe cevc subutons Ti eron eient utaine a injur eee affete er oer eria ine eera ear before er eat an a eon ee ama atere er er eera eria ne ot before er eat Note te amot norma oroti re from 1 troug a damati traigtening a reera of te at te 5 ee. 3 o a omete ateroe 2 an ) a
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Capte 3: Subxatios O Te Ceical Spie
69
C4 aneo to C5 Howeve the C2C3 and C3C4 dc how on ght degeneaton epte lght dc ulgng the veeal ode have not et egu to change hape the lowe pne C5 completel et (to C4 and C6) and C6 completel ant (to C5 and C7) The C5-C6 dc ha gncant degeneaton howg damatc o o heght ateo and poteo lgng ad alteaton o the hape o the veteal ode to accommodate ateed weght eang. The C6-C7 dc ha heaed and ged poteol and ha ot heght poteol The poteo ulge at C5C6 peng to the pnal cod The dc elow t appea to e tochng ut not et deomng the cod
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70
Atas o Common Sblations o he Hman Spine and Pevs
Pte 32 & B SUBUXTIOS WITH REVERSE OR KPHOTIC CURV Mdcevc ubuxto I tis spcmn a rvral o t loroti crv is prsnt rom C4 trog C7 Canal stnosis as occrr bt t inivial origal possss a larg vrtbral canal as s t t C2 an 2 vls Howvr t t cor is ttr ttr against t antrior surac o t caal startig at C4 i is a xtrm xampl o t pial cor omg omg o shap o t spinal canal
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Chaper 3 Sbluxaion O The Ceca Spne
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(2
T1
T2
Note hat a psedo-ot has formed etwee the posteor arch of Atlas and he spinous process of C2. Te spinous processes o C3 C4 are missg ecase tey were rotated ot of the midsaggital plae wen the specimen was cut) C3 is retro to C2 C4 is retro to C3 C5 is retro to C4 C6 s a compete retrolistesis to C5 and C7) ad C7 s retro to T1 The C5-6 C6-7 and C7-T discs ave competely degeer degeerated ated ut te vere vererae rae have not yet fused Aerior sprring s ponoced, ut posterior spig does ot appear sigiica except at C6-7 Noe tat te T1-2 disc is not slxated ad appears to e uy hydrated
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72
Atlas o Common Sblxatons o t Hman Spn an Plvs
tes 22 AB SBXATIO WIT WIT REVERS REVERSA A OR KYOTIC CURVE A X d RI op ris on. This is a lateral evial X-ray ad mid-saittal ervial MRI o the sae eso Ths shows a reversal o the ordoti ve. There is a retrolisthesis o C3 to C2 C4 to C3 ad C4-5 the later pair orm a posterior apex o the "kyphosis or kyphot urve. Note the braistem ad spial ord have straihteed ad there is lose otat at the C5C6
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Caper 3 Subuxaion O Te Ceical Spine
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leel and direct cotact at T3 and T4 The cereellm has cotact with the posteor ifero occipt, in the netral position. Fleio and an increase caa egth wll add to ts deformity (A) ereellm (8) 8rastem () Spinal cord
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Atlas o Commo blatios o the Hman pine and Pelvis
Paes 323 B SUBLUXTIO SUBLUXTIO WITH REERSL OR KYHOIC CRE Xay Xay ad MRI co cop ao This pair of images is the lateral evial X-ray ad MR of the same person The spinal ord s moved to the ateror portio of the canal and has lose otact with the C5C6 osteophytes and dis Ligamentum flavum at C6-C7 is ulgng into the aal partly from
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Chapte 3 Subations he Ceca Spne
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he loss of disc eigh nd verebr mislignmen. Te collecive loss of disc eigh in he verebrl column c prly elieve cord ensio by decresg cl lengh (A) C56 oseopyes (8 pinl cord C) Ligmeu Ligmeum m flvm beween C6 nd C7
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Chap : Suuxaios O Th Thoacic Spi
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CHAPTER FOUR Subluxations Of The Thoracc Spne Discusso The way in whic he bs are ataced n the thoracc region of he spine makes i signi cany diferent fro he cervcal and lubar egions. Each rib atculates wth a ansverse process o a set of deaces on the sae ver tebra and o te adjacent inferior verebral body e ribs bween T2 and 10 aso attach to the disc beween defacets, and have e appearance of hree sal joint coplexes ese include two sall synovia oins and an nervening fibrous ont were t conacts e disc. In Figur 41 he b-disc articuaon IS
seen at te T2 disc Subluxaion can ae any o a o these ariculations, just as t altes nerveebra discs and acets e cobined efecs of tese compex ib articaions with he veebra and te exten sve newok of spportng igaents ad us cles give e thoacc spine the qaiy of being a sngle funcional unit hs is caled e ib cage e head rib cage and pelvis copise he three asses o e axial seon he con necing and uc ore obe cervica and uba coluns can bucle when ese asses are displaced The ead can displace relave o he horacic spine and the horacic spine can dispace relaive to e pelvs Many dierent ters ave ben used o descbe te evens a generae coon subuxaon coplexes The piary sblxaion copexes can occur in the oracic spie iself as a resut of varous
gr 41 This is a axia viw f th snd ribs artiuatin with th T2 dis Ths a stvrtbra jits A ( (C (
is Cstvrtbra jnt Rib pia rd Copyrighted Material
E Csttransvrs Csttransvrs t F Tansvrs pss G aina () pins prcss
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Alas of Common Sblxaions of he Hman Spne and Pevs
llstrton of torcic spine wit syptetic cn sowing orientton of Fgure 2 and 3
I I 1."/
"
V;eba Sympahe Can
Figure 2 ORC ORCC C S[ TR[OR TR[OR W T SYMT SYMTT[C T[C C A AD D RS ROS[ ere s n ntoic po o e e s eos sse o e osoeeb osoeeb os Te se be edey nteror to e osoerteb onts. Costoertebrl sbton nd e reslting degenerte joint cnges re concoitnt wit ertebrl sublton nd te degenertie cnges t tose joints Costo-ertebrl sublution nd te sclerosis nd inflton cn cuse significnt ptology to te tonoic neros syste
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( (8 (C (D (E (F (G ( (I
Endptes Discs Intersegentl twig reries nterior r of nere root Ribs Intercostl ein Intercostl nere nercostl rtery Syptetic cin
Cape 4: Subuxaions Of Te Toa Spne trauas ib articuatons are all posteror structures, and provide increased strutural support in that area The anterior aspect, o prised of the vertebra bodies and dss of the thoracic spne is therefore ore o re vulnerable to change than te posterior aspet ere anteroesthess and retrolisthesis o the thoracic verterae ocr, atering the shape o the verte ba caal. ven though dd not have the eas o e or stdy e in detai, have o aoee e aeaesess a rotation a sxato oexes Moe eae anatoica studes ths area ae eee The vertebra ana is considered o e a posterior structure, ut anterior hanges of the tho raic spie an indeed afect the ana ribs and other osterior structres Moe iportanty they a affet the neura ontets the spia ord and nerve roots. the thoracic spine
Discs Symptetic cin ibs Itercostll eres Itercost Itercostl eurosc eurosclr lr bdles
79
Fre 44 is posterir disc erition t te 1 1 0 leel e disc s psed te posterior longitdi ligment d tecl sc ito te spinl cord (A Vertebre (8 Disc (C ernition (D Posterior logtudil ligmet (E ecl sc (F Spinl cord
Fe 4 ( (8 (C (D (E
there is an extra-spina nervos syste copo nent to onsider. The sypatheti hain n the thoraic spne is at or near the osto-vertera joints (See Fre 4 The ntegrity of the sypathetic hain s at risk hen these joints are su luxated. hroni degenera degenerative tive hanges have een observed to ater the nervous tissue of the sypatheti hain There can e a varia tion eteen individuals as to the oation of the chain. n Fre 4 the sypathetic hain s over the coso-vertebral oints and in Fe 4 the hain is oriented over the osto-transverse osto-transverse Jnt. ne of the ost coon postura patterns n our soiety is anterior eight bearing or ds plaeent of the head anteror to the ri cage or shouders, usualy haracterzed by oss of the evical urve This T his has an portant portant ipi cao or the thorai spine ver tie, the eg o e ea carre haitualy i a ate o oso a eae a eorg force o te ora se a ase ease yo urvature The coo aeas gaay a eoes orse over a perod o e so e patient ay not be aare of pain or disoo only an increasing pereption o stiffness and ac of exibiity
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80
Alas of Common Sblxaions of he Hman Spine and Pelvis
Vrtbral bods n th thoracc spin so is ar coprssd antrorly or tha pos trorly, akng th dgshapd Th addd postrior staby that t ri artca tions and th nok of lgans provd to th trasvrs procsss, caas and pdcls may rtard postror crushig durng crta kds o traua. sould aso notd that th thoracc sn is uch lss sscptbl to postro spurrg than th crvcal ad luar sps
ostrior hrnia tion o th thoracic discs dos occur. g 44 a T disc. t shold b notd that th or th thoracc disc hri ato, th or h nroogcal involvnt. c th cous dulars ds at T2 or th disc hrnaton at T coud affct th nu rons o th lgs or vn th bladdr.
T
C
0
2
2
g 4 HYPERKYPHOI O H HORACIC PIE Te toracc vertebrae 6 and 7 ave copresso fractres wt ore anterior eigt loss Te reslt is an aneror translaio of te spnal cord to e anterior wal of e canal. ote cord conact fro T5 to T7 A) Copression frac fracres res (8) Spinal cord C) Discs
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gr 4 PERKYPHOI A A REUL O OEOPOROI Copression fractres of T6 and 7 ave increased te kypotic crvatre ote te spial cord contact wit e canal wall fro T1 to T7 ad sall disc prorsions into e cord. A) Vertebrae (8) Discs C) Spinal cord D) Disc protrsio
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Color Plate (same as Figur 5) NORAL AAOICA RLAIONSS continud Same speime as Figur 1- wit oput opeed a ereellum removed, wit t ul i te eutral postio elative to te e (G) erve ootlets (A) Iter Iteral al Auditory Meatus (M) Braistem (H) Spa Aessory Nerve (XI) (N) ereela Fossa (B) Aousti Nerv(VII) (I) Detate Ligamet () Jgula Foram (0)) Oiput (ut edge) (0 (J) Nerve rooles (D) Gossoparygal Nerve(IX) (P) Ieor ereellar Artery Vags Nerv(X) Q Ar o Atlas K 3 Nerve rooles (L) eal sa (dural sde) F) ypoglossal Nrve (XII (R) Dorsa Spa Artery
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b
Coo P Sm g 1-6 EECS O HEAD LEXION ND EXENSION ON HE CENA NEROS SYSE
) eo(ead tipped forwad creases e distace bewee te occip ad te coccy tereore egteg te eral caa ad te srecig e cod ad astem (A Note stretcig o te detae lgamet ad te movemet of te astem dow owad e occipt Note positios of Detate igamet Braistem Base of Occpu, Ac of Atlas (refer to Fg for eys to aaomca srcues
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Eso (ead ipped bacward deceases deceases te dstace bewee e occip ad e coccy soig ad eaig te cord ad braistem (B ot te relaed ef deae ligame e olded, reaed dra maer (eca sac ad te dstace of te braisem fom t occput. Noe positios of Detate gamet Basem, Base of Occipu Arc of Atas ecal sac
Cape 4 Sblxaons Of e oacc Spne 81 COMPRESSION FRACURES Wt trumtc or otoporotc compron frctur t torcc kypotic curvtur incr (S Fg 45) puing (trctioning) t pinl cord nto t ntrior portion of t cn nd up gnt t vrtr bod ny ructul dfct uc otopyt or di bug wi v mor vr ciic impic tion ti t i dformig trn Fgr 46 ow ow dic buging nd potrior pur of torcc vrtbr , , nd 7 v md mprion i t pin cord T torcc pi cord giv r o vnl nrv root wic r t motor nd (outgoing) nrv ptwy o vc T o p y co pomy ppyg ood o o o v o w vcr d omic motor nu on r oud n clo proimty ypoi of ti nur ti d t ct cnc rul not known T drmtic rut by om ciropctor cn b ttrbutd to cnging t vculr condition of t pnl cord rtr tud r rcommndd. Trctioning of t cord cn ld to n infmmtory condition tt rut n fbrou dion inid nd outd t tcl c
nvoving t cord nd nrv root Fgr 47 ow t cord (n t ntrior comprtmnt of t cn, ndctng ttrng) wt nrv root droppg ow towrd tr ntrvrtbr form Ty r nmd n t d, fibrou ntwork tt commony rut from croic nfmmtion i fibrou m cn trp nrv roott proim to t rv root o tt crtn poito d cton coud cr t mo v fmmo d cog c ypo d o ov c c g d gt of cod d c c ntr mdd poo o occ pl cord v pod o tm t bnc of com pion, ttrg rlt cung dcr of nur coductvty tudi ow tt nit rod of irritton nd ncr in nitivty nd conductvity of t nrvou tiu i fo low by drop in conductivty tt rult in o of mpu T mut corrt wit lo of vicrl n motor function Ti i ignificnt fctor n t cronc dblitting potrl cng tt fflct mny popl in Wtrn octy.
Fg 47 SUARACHNOID ADESIONS. Aeo te baraco pace ae ommo we te pial cor i tetere Note te erve rootlet i te aeio A) Vertebral boie D) Sbaacoi aeo 8 Dic C Spal cor Nerve rootlet E) Tecal ac
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82
Atlas of Common Subuxations of the Human Spine and Pevis
ndicates Antero aspec
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Le sde
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Figures - A & B Thoracic Spne: MRI Axial View of Tethered Sna Cords () (B) (C) () (E
Vertebrl boy Spin cor Rib he Neck of rib rvee poce
Note the pin cocl cotct eve i the ecbet potio givig te ptiet relef Becue of gvty thee tie icte pnl cor pre teion i the net poitio The rexe pin co hol be in he poterior or botto prt of e c vere pyiologicl tenio wil ret flexe poiton (b) onger force over tie will chge the pe of l te tie
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Chapter 4: Subluxations Of The Thoracc
ANTERIOR
83
BEARING
Anteror IS a very common of our postural codito, and habits. What mercas consider ormal posture s, s , fro huma body's pot of view ot oral at all e st in chairs get ad out of cars st n cars ad sped hous readng or starng at a computer screen wth our heads iclined forward can tevered into space Evoutonarily speakng human activities They and mandatory are havg a ncreases the ca because most desk or couter and eve watching TV causes relative to the thoracic the head to go se thus cervical curvature and
thoracic term malpositiong malpositiong and whch can be associated associated with cardovascular problems Loss of ligament and joint tssue changes These have have gotte names Marie-Strumpe spondylosis it s all the same atve process The resut s to altered bone ferent mechansms IJury weght bearing The wth tme The of ad chronc dstress due to overall pos chages are coditons coditons Duration ad magtude of the dstress on the nervous system are the
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as o Coon Sbuxaons o he Han Spine ad Pevis
CHAPTER CHAP TER FOUR - EXPAND EXPANDED ED TABLE TABLE OF CONTE CONTENTS NTS as o Subuxaos o he Thoracic Spe
SECTION : Subluxations with a nomal thoacic cuve (1 pai
Plates A & SUBLXTIONS WITH OM KYHOTIC CRVE Th sow rcic spn t mor coprsso frcus ad ultipl ds ri. Pg. 8687
SECTION I: Subluxations with a evesal of the uppe cuve (3 pais
lats & PR TOCC CV REVES tolstss Torcc s J
Pg 8889
lts & Toc tosss: pp Toc
Pg 9091
lt & Toacc Sp ss: tocic U
P92-93
SECTON II: Subluxations with a evesal of the lowe cuve (3 pais
lts 4-5 & OE TORCIC CRVE VS
(T7)
c Sp : oJisss low o
Pg 94 Pg 949 95 5
Plts 6 & OWER TOCC CRV RES Toacc S tolstss f low toi
Pg 9697
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lts 7 & OWE TOCC C RVRS
Pg 98 Pg 9899 99
Expaded Tabe O Coes
5
HA H AER ER OU OUR R - EXAND EXANDED ED ABL ABLE E O ONENS as o Sbxaios o he Thoracc Spe
SEION V: Subluxations with anterolisthesis of the upper and lower thoracic vertebrae (3 pairs)
lat 4-8 & B HOCC PP OO D OR EOTHE
g 0 00 00 0
at 4-9 & Tcc p p - atol atol pp ad lo vtba
Plates 0 cc p pp lo atolt
g 0 02 203 03
g 00
SEON V: Hyperkyphosis of the thoracic curve (3 pairs)
lat & HERYPHOI Toacc p o pug t Otopo a Hypkpo
g 00
at 4-12 & ov pu t Hypkypo cu y Otopoo
Pla 3 & ov pu ad Hyppo
g 0
g 0809
Additional X-rays and MRIs
Pla 44 A Tocc p -ay a o Patt Co tt Du to lt Cuv
g 2 g 211 1 3
lat 4-15 A & ypypo u to Compo Fctur
g 5 Copyrighted Material
86 - Aas of Common Sbxaions of he Hman Spne and Pelvs
Pates 1 A & SULUXATONS WTH A NORMAL KYPHOTC CURVE Ths shows e horacic spine wi inor copression fracure and uipe disc herniaon Al the discs i ths specen show aterior rown degenerato ndicatng poo iitio (fld exchage ad cocay o ydao o a pa of the dsc. Sgns o aa are see n the end pate distrances of the inferior ody of T3 down to the speror edpate of the ody of T1 O This is a rest of the sxations s xations of T1 to T1 0
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Chapter 4 Subluxations Of The Thoracic Spne
T1
10 11
12
and the resulting osteophyte dvelopment o the aeted segments T2 is retro to T1 with dis ulgig slightly T3 is retro to T2 with dis herniation and ord onta 3 ad T have signs of ompression and there are misaligmets of T to T9 T aterior to T7 with dis herniating ad mild ord ontat;T9 -10 dis heriatig with ord otat note normal aligmet ad appearane of T11 and T12. (A i hena henaio io
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87
tas of Coo Subuxatos of the Ha Spie ad Pevis
Pat 42 A & B PPER THORAI RVE REVERS Antroithi ppr Toracic I Th cprssi fractur 2 has cratd a wd shapd vrtba bdy h vrsa f th ra kyphtic curv btw 2 ad cd b a adaptiv rspns t this traa r a pstrir t antrir frc ccrrin i ths aa This has rstd n a "dishin r indtain f
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Chapte Subuxaos Of he hoacc Spe
9
T1 2
10 11 12
this prtin f thracic spin T T s a cpt antrsthsis ad th apx f this cuv vrsa Fr th 4 disc and bw tr is antrir brw dnrati hat indicats indicats pr ydratin in ths prti prti f th dics T6 T ks aind xcpt fr TT wh wh siht antrir spn Th T6 T6 ara is shty ff t sata pan.
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9
as o Coon Sbxaions o he Han Spine and Pevs
Pates 43 A & B Thoracic Antrostsis: ppr Toracic II This spcn has dfinit sins f traua wh cprssin fractrs fr T6 thrh T2 Thr s a disc hrniat at T2 with crd cntact Th pp thracic crv rvrsa cud b an adaptv rspns t th wr hracic traa ad sting dfrity t a dirct pstr t antrir v
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Caper 4 Sblxaons Of e oracic Spine
1 2
10 11 12
he aterior reverse apex is at -5 -5 wit a omplete antrolesthesis of 5 espie the ompressio fratres, a kyphoti rve retrs to te lower thoai spie
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9
92
as o Coo Subuxaios o the Hua Spie ad Pevis
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Pat 4-4 A & B Tora Sp Atrot pp toa I Ths spcin has sins f d traa with tip snts cprssd and scrtic Thr is ss f nra dsc iht and sprrin atriry and psiry Th cv rvrsa has a antrir apx f 34 with stairstpp sbxatins T 4 t T2 isc dnratin d nratin has advacd t na sin f T89 and T9 with pst b and na cd ntact i th ntra psit (Ths ans that fx f ay part f th vrtbra c d ak ths pstrir dis prtrsins cay sinifcant)
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Chper : Subuxons Of The Thocic Spie
T1 2
12
he nerir eple purring n ic ulging s scie with terir lgiuin ligme thckeg rm t 11 ( terr purs en pte chnges (8 Hyper Hyperrph rphyy f
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93
94 Alas of Common Subuxaons of e Human Spne and Pevs
Pe 45 A & OWER THORACC CRE REERSA (T7 Thorcic Spine: Aneoihe lower horcics 2-6 appear normal norm al exept for endplate damage wit sligt spurring anteriorly with all segmets indiatng an anterior weight earing in tis person's posture. here s a mild reversal of the thorai uve with an anterior apex at 1 o. Compression damage rom to
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Chape : Subxaions O The Thoacc Spine
95
2
10
11
12
T2 and a ndpa ndpas s hav sgns f pa A dis disss hav ai bown dgaio wih a hma's nd i h supi T8 dpa 2 vba bdy has sufd a ompssin fau Na noma agm was maiad ad ds pahoogy is oy mda abs
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96
Aas o Common baions of Hman pin and Plvs
®
laes 46 A & B LOWR THORCC CR RRSAL Tora Spe Aeroshess of ower hoas Thi peime ha a moderate reversal o the kyphoti urve ro o h a anterior apex at T9. T12 di look K th lght ron degeneratio o d T3 reo o T2 ith aterior purig o T2T3 ith light di tearing an uging. Fom T3 to T2 there i ateror purrig lo o di height anerorly h ro degeneration T6 retro o ih ompreso o T6 or Shmoals node on the ineor end-plate o T6 T- teag
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Chapte Subxations O The Thoracic Spie
T1 2
10 11
12
wi dgrai 7 7 ar aignd wh margina and nmargina pys A ndpas appar av rpaird frm signifia axa ading (A) A dpas appar appar dsrupd in varius dgrs () Para Paraspa spa pys 8 0 ssifain ssif ain A (C) Apparan yprrpy yprrpy A 13-7 (D) pina rd rd N arir psin psin aa aa (E) r ar inraha r subaaid adhsins drsa asp h d wh nrv ad vasua nrapmn
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97
98 Aas o Common Sbuxaons o e Hman Spne and Pevs
ae 47 A & LOWER THORACC CURVE REVERSAL Ti peimen a a reveral of te kyphot uve from T to T with a aeo apex at T9. T26 look normal exept or te aterior di degeeao ee ae uuxation of T to T2 with varying degree o degeeao aeor purrig endplate eroi ad
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Chape Subxaions Of he hoacic Spne
2
aioy bgig bgig discs T s a comp oshsis wih T2 having signs of compsson pa anio ani o spng ad sigh posio spi spig. g. T is sv DJD wi caviaion of h disc (A Hypopy of A A fom T8 o T T Th spina cod cod s anioy dispacd fom fom T2
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99
Atlas of Common Subuxations of the Human Spne and Pevs
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Plates 4-8 A & B THORACIC UPPER POSERIOR LOWR ANTEROLISTHESIS T3 s T2 wi mpssin f T3 ay ss f va dy igh aiy and dgnain f an dis T23. N d i ai aa T7; T 4 an S mpssin fau f TS aniy in ss f vba dis hig wh dis dgnain ani T6 s TS wi a dis bug ad dgnain T7 s ai T8
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Cape Subuxas Of Te Tacc Spe
T2
10
11
12
with ntrior dic dgrtio rtro to 9 ntrior dic dgrtion with vry light potrior dc bulg 9 i rtro to 10 1 0 with ntror dc dgnrto d vy lgt potror dic bulg 1 O- i norm cpt for ght dhydrtion d hydrtion nd dgnrto dg nrto ( 24 ppr o hv hv ght ucr comprion (8 h intrtcl dhion ntrpping nrv root nd blood v
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101
0
Aas of Common Sbluxaons of e Hman Spine and Pelvis
® lats 4-9 A & Thoracic Si arolshsis ur ad lowr vrtbra T- look nomal with slght own degeeation; T3 is et to T showing dis teaing with anteio and posteio ulgig; T is eto eto to T3, wth slight ateio spg agnal osteophyte) T5 is eto to T Thee is slight own degeneation o a dss
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Chpe Sbons Of he horcc Spne
-
103
T1 2
10
11 12
ee i lo of te i gtl plne t T3 n beow expong prt of the otie n ie ege of the tec c (A)) Begi (A Begig g of ccificto ccificto of ic T6-7 to 12 (B) Prp pyte of O2 () Hyperophy o nterior ogui oguinl nl ige fro T3 to l () Spi co o o terior wl of cnl Copyrighted Material
04
Aas of Commo Sblxaos of he Hma Spie ad Pelvis
at 410 A & Thoai Spin pp an lowr antrothi here are ompression ratres with loss of height of T6 and 9 Aignment looks K throghot All diss have slight to moderate DD.
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Cape Sbxaos Of e Toacic Spie
T 2
0
2
Compression Fracture 9, not a Schmoral's node; 9 0 cavtatio; 0 tearing is a slight but complete ateroisthesis 2 s retro to with disc tearg, slight cavitatio and DJD. (A) Spinal cord
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105
06
Aas Cmmn Sblxans he Hman Spine and Pelvis
Pes 4-11 A & PRKPOSS Tho Sie Progressie Surrig wih Oseoporos Tho Oseoporosis is nd ypekyhosis This spemen has a inease in the kyphoti atue with sigs o taa ad alfiation of a pat of the anteo longitdial lgament Almost a o e edplates ae dispted with anteio dis aowng fom T2 to T7 ad ow degeeao thogho T3-T11 ook aligned.
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Chaper Sbxaons O The Thoracic Spine
-
T1
11
12
(A) Major marginal ostophys at T5T6 T5T6 () TT has sgficat cacificaon of atror d sc ad ALL (e Th hyprtrophy o o th ALL ALL from T4T8, ony pa is cacd T34 ad fror sgmts hav hyprophy of th AL.L as a rsut of comprssio and strss ( T90 and T T 0 hav sgficant dsc dhydratio and cacification (E Not antror pacmnt pacmnt of cord T59 T59 This condition of th ALL. hyprophy hypr ophy from T3T cod qafy as I bcaus mor than thr conscutiv sgmnts ar ivovd (A ary stag?)
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107
08
Aas of Common Subuxaions of he Human Spne and Pevis
@ ®
Pates 2 A & B Pogessive Surring with Hyperyphosis ause b Osteoporosis Tis speimen as ese te kypoti rvature as a resul of sxatos ompressio fratures, d oss o terior dis eigt eween T and T9. Tere s very sligt ompression frtre o . 5 s reo to T wit very sligt ompressio frture of T5 wi alifiation of te dis T6-2 ve oml lignment u nges due to ompesson fratures of T6-T12
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Chaer Subuxaions Of The Thoacic Sine
2
10
11
12
(A (8 (C (
Some dic dic have dark brown aea aea that correpod to cacfied cacfied appearance on X-ray There aterior vertebra body prring from to 12 Hypertophy of A.LL fom S2 hee pal cord/caa contact rom S to 9
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09
110
Aas o Common Sbxaons o he Hman Spne and Pelvs
les 43 A & rogessive Spuing nd Hyperkyphosis. There appea o e o erior/poerior uluxion he hyperkyphoi i due o ompreion ae o T5 o T11 wih ome lo of di heigh. T6 o T ha a aerior fuio wih parap of four egme egme [ISH]
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Chapte Sbxation Of he hoac Spine
T1 2
10
11
12
( Cod and ana ontat Note: his ididua had a nea oma eia ue ad umba ue
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11
114
-
Alas f Cmmn Subuxains f he Human Spne and Pevis
Pa A & B Hypkypho du o Compo Facu Here are wo MRs of e sae ivial wi ifferen rass or "snals hee are oressio frares of 5 7 9 a 10 wih only 5 sffei a major ane of shae ee is a oerae rerolsion of 5 ino he aa wi sinal o oa n e sine osiion
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Caper 4 Subluxaons Of e oacc Spne - 5
Certan flexed positions caused moderate to severe radiating ri and cest pain in te 56 area Cevicl ypo lordosis adversey affects te spna spna cord after an injuy to te toracic spine Tere is tractioning of te cord from 3- caused y cevical ypolordosis and yperkyposs of te toracc spine is image is taken in te recument postion wic gives te ptient ele e symptoms apear wile sitting and worsen wit neck lexo
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Chapte : Subuaton O The Lumba Spne
7
CHAPTER FIVE Subluxations Of he umbar Spine Dicuion The lumbar spine bears oe o te body's weigt tan an oter pat of te vetebra coumn, as its assve bod and obst acets indicate. Noma, a odotic cuve is present or soud be present in te uba spine. Bot te anges o te acets and te ange beween te pedices and verteba bodies necessitate tis cuvate Separations o te spinous processes and acets (exion) incease te ength o te posterior wa o te spna cana and pt a te weigt bearing on the discs A thee point eigt bearing sstem eists wit te two pas o facets and veteba bodes eac bearing roug a td of te gravitationa oad. Anatoma studies o tabecuar patterns o the bone cea indicate tat te acets ae weightbeaing joits In Fge 5 a CT Scan o 4 sows pertroh o te eft aticu ar acets a cets and oss o oint space, common eatures o subuation
Ateation o the curve of te ubar sine can cause these atcuar acets to separate or he oad Shting o ost o te gavitationa oad to te discs and vertebra bodies can occur wt an unequa oadng o te articua acets ote te osteoptes and ateed jont space is on te et in gre 5 Chonc subaton o te ua spine stops noma moton of te discs and interupts te ydac function See ge 52) s specimen as three eves o dsc degeneration. otice te aignment o and and te condition o te disc Tere s misagnment o posterio to , wit wedging teaing, and buging o te disc Tis condition s caused b subuation and te resuting oss o noa motion and per oading The 4 disc is even moe dstessed which is caused b te retoistesis o 4 Tere is sig niicant dedation teang cavitation and oss o disc eight
Fge 5 CT SCN OF 4 D DVVD D WTH CHOC LMBR SBXTO SB XTONS NS ND OSTE ORTHRT e aeed wegt earg as afected e facets ad ody of te vererae Note tat te yertroy of te verteae i te ody and articuar facet is o e let (A) Body of verterae (B) steoytes o "surs "surs (C) Dimiisd jit sace (D) Altered facet (E) Spios process
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8
Aas o ommon Sbuxaons o e Human Sine and Pevis
Fure -2 A VIEW OF VARYIN ARYING G DEGREE OF DIC EAH Note the diHerent oditios of he diss i the same indvidua The sbuxatios and dis degeneratio are intimately related Whe normal aigment is matained he ds an be in good health regardess of age A the diss in this speime are the same age bt only the subluxated motor units degenerate
Fure -3 HE HYDROPHIIC H YDROPHIIC DC he L2-3 and L3 diss have been exposed to tap water after the lumbar spine was ut i a sagittal pane The nuleus pulposus in this adaver have absorbed the wate and have bulged This is an expeted phenomenon The anar walls ad end pates normaly ontan this water absorbing gyoprotein matrix These diss ovey motio between ad transmt the load to te vertebrae (A) Nuleus plposs
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hae Sbxaios Of The Lmba Se
9
F -4 SOCK ABSORBNG VR V RBRA BRA BOY The sperior ad ifeor ed plates plate s have bee damaged ad repaed with the defomg fore beig absorbed by the L2 vertera body der the load the edplates defe more than the anlar was Notie the dss dss have remained reatvey healthy and tha he aigment was not dsubed by the tauma (A) amaged ed pates () Vertebral body (C Diss
Dscs ae no Sock-Absorbers. intbal isc is t ast aascu la suctu in th boy o main hahy it is nt uon th cosant, sow inux o lui n F -3 t hyohc natu o t uclus losus s monstat na no a iscs. t xosu to wat th wy cut o t nuclus uosus bug ou wit th absob wat h nomal isc has bwn o % olum o wat. any suis a b conuct on th subjct, but th atst sac cats that oag an unoaing uin noma sal motion is h ima mcasm o isc nuon an lui xcan This xchang imaiy aks lac toug t to a boom n ats a not as ously tougt hough th annua wals.
Aitoal stuis iica hat th isc coay to oula is ot imay a shoc absob. o monsta tis oint F -4 shows a anatomical scmn an its ata Xay. Th vtbal bois th n lats an t mulay on n aticua ct mo uing loang tha t annula ings n oth wos t buin o h annua ings s ss than th owing an bng o th n as into th lay bon o th vtbal bois uing loain. T uclus uosus is not scal in sha coay to t issio cat by llustatos F ) n th umba sin has a kiny a sa in coss sction, an in cooal scton, is uiom in ight, an smbs a coun. Th who nucus uosus is wi a it s igh.
F CROSS SCON OF A NORMA MBAR SC he lmbar diss ad vertebrae have a dey ea shape with a sligh mpression at the postero sde he nuleus pposus is in the posterior poo of the dis (A) Anuus fbosus (anular rings) (8) Nuleus plposus (C) Poserior impresson
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20
Atlas of Common Subxaions of he Human Spne ad Pevs
Th umb sn n Figue 6 shws tht thgh the etb hs sustnd essn fue the den dss he emned ntt wth he lgnme ne n m. The etebl bdy nd d ltes he ten the bnt f the fe efmng t the t ushng The ds s f mehnl uss sed hyu system, s ly
) 2 vetebral body () Neus plposs () Repaired ompresson inj inju uyy to 2
smll mu f f (but % s st u g nml messn Th emng s flud s t defe se the nnu gs e nmlly elst The ed tes defm messg the tbeule f h meduly bne Ths s the ehnsm f he etebe t bsb fe he sen f hyus shws th f tdued t ne
Figue -6 A LARG NUCLUS PULPOSUS PRORUSON NO L2 he 2-3 dis has potruded up into 2. Note on the X-ray a bone repa has taen plae that happened some tme ago his is another example of the vetebra body absorbing the deformng fore of trauma wth the nles puposs expanding into the veteba body of 2
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Chaper Sbxaos O The Lmbar Spie
end f a fid fied syste is atatcay tansfeed t the the end f that syste; tht is the ce is tansitted nt ased Thus wen the ua spe is cmpessed the fce is tansitted t the vetea dies s that they as the ad ( shck s F -7 denstates wen the fce is t geat, the vetea dies can actay capse The ve
2
tea dies f L2 tugh L have a suffeed cpessin factues the t P aignent wa nt sigficanty ateed ad the discs have eained elativey heathy The discs eng hydhiic ceate an stic pessue that wi cause the disc t epand t fl the avaiJa sace
F -7 COMPRESSION FRACURES OF HE LUMBAR SPINE W NEAR NORMA AIGNMEN s specien as compression fractures o L2, 3 4 and 5 e ordotic cuve ad te A to P aignmet ave been aintained despite despite te trauma. Notce tat te dsc eigt as as actua increased in ceran areas
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22
Als of Common Subuxons of e Hmn Spine nd Pevis
Types of Lmbr Subluxons he bations of the lmbar spine are cassified accoding to the changes n arcitectre e lordotic crve of te lbar spine s an essentia architetra featre bl blaons general ase less neral invovement i the ordotc crve is mantained Fge 8 is a comparison of lmbar spines. n g 8a is anerior to with ds tearing and other sgns o degeeraton he sacrm has moved anterior to and the dis as toay desic cated, ndicating an od, ong standing ondi tion ote he a of osteopyti sps and cana stenosis he ordotic rve preserved normal weight bearing of most of he jonts and maor bony hanges did no or. n Fge 8 the lordoss s lost wit the sblation of and and widenng of the vertebra bodies as taen pace his ocrs at the site o the sblation only. ote the ange in spina anal width at the sbation and overall anal engh
g 58 shows a lmbar spine with the carateris "stairstepping of vertebra bodies that have bcked nder deforng strss here clearl is a oss of norma agnment between and esting n a reversa of te lordoti rve e verebra segments have ndergone hroni degeneaon as a res of the atered weight bearing isplaceent of opposing end pates cases a searing of the annls and nes. he nopling of faets stress o aceta apses, or hperoading and stress on the disc ann ls, ase a propoceptive gardng by te paraspnal mses and the intrinsi msces of te vertebra colmn his los te verebrae into the bled position and ths interpts the pmping motion tat is neessary for or ma flow of fld in and ot of the dss he discs, o orse, begin a sow poess of dehy dation and degeneraton
o
c
Fg -8 A COMARISON O SUBUXAIONS WH A LORDOIC CURV WIHOU A CURVE AND A REVERSED CURVE. In i a et f ba pe te curve and te ape f te cana are tiate ivoved. In cpain to b, te differece i te te pina caa ent can be be noed, o oner ben in b. e pe in c a a eve oer pia caa ta or b Ao te pattern of deeeration are differet Sbxatio occurrin wit te curve intact ave ide deeneratve cane I b te cana tenoi i apparet and in c e verebra bod widein ad prri are obvio
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Chap Subuxaos Of Th Lumba Sp
23
Fge 9
Fige 10
Laeral Lbar Xray of a 20 year old w L5 podyolie e fif lumbar veebra i broken ad eparaed e enire pie cluding e L5 verebral body ad uperior aricula join ave ubluaed anerioy A) Body of L5 vereba vereba (C fero ariculaion ( Break in aricular of L5 arc of L5 Sacru
Laeral lubar Xray o 75 year od wi pondyloiei e fif ubar verebra i broken and eparaed e fif lumbar veebra veebrall body fued o e acru Paien dee croic croic pain Noe aineace of Lubar curve (A) L34 ubao (C) Fued L5S1 oin Sacu (B) Break in L5 verebra
Fige 1
Fige 11 Coeup o L5 pondylolie in 2 year old i iuy occured a age 6. e fi lubar dic i eared by e ifed end pae and ign of anerio purrg are pree e lo of dic eig add o e picure of a croic ijury in a young pero (A) Anerio pur (C) Narrowed L5S1 dic () L4 ubuaed Sacru poerorly o L5
Coeup of pondyloei in a 75 yea old Noe e L5 verebra a fued i e aneor poiio relave o e acu e gap beween e aneor par of L5 and e poerior par i ll viible (A) L5 (B) Gap i L5 (C) Sacru
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Atlas of Common Subluxations of th Human Spin and Pvis of osteoarthrtis of the spine is Loss of the norma curves ncreas that change the vertebrae. on the
ver-
Soft tssue to a subluxation For ea can restrct oton of nearby pe, the sueror of the ape the acru can becoe peranent wt a hortening o to the uboacra facia and ent of the erector lower acruTh s the noral otion at east the ower ubar The cond ton ceated ceated ubuation reut In what s oony referred to a degeneratve di the oteoartrit agent the ubuation which caues atered weight bearng Man studies demontrate that the sblution ou trau matcal either ntanty or repettively and ncreaed degeneration take place over tie at thoe ees
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Expaded able O Coes
CHAPER FIVE
25
EXPANDED ABE OF CONENS
Aas o Subluxaios o e umba Spie
SECION I Subluxations of the lumbar spine with a lordotic curve (15 pairs)
late 5 A & B BAR NE - ear ora lt subluaion Pg. 128-129
lat A & B LUMBAR LUM BAR INE - Varia Variato to n te ora" ora" uba cue Pg 134-35
lat 5 A &B &B MBAR IN vaiato (no lubar urve Pg 130131
g40-141
Pg 13 Pg 1322-13 133 3
at 55 A &B &B MBAR MBA R N A a a orl lordot urv wth L-aal wedgg Pg 136-37
lat 5 A &B LBAR INE INE - ee ee a ubluae gnt wth th curv antaed
lat A &B &B LUMBAR NE - L a a omesio omesio atur with cleo ad health dsc.
late A &B &B ow vaatio vaatio n a LUMBA IE - T ow noral lumba urv g 138139
lat 58 A &B &B UMBA NE - varao n oral or al ba ba curv curv - g 142143 Copyrighted Material
late 9 A &B late UMBAR INE - orma di di abov a ajor ajor bluato daaged dc g 144 g 144-14 -145 5
26
Aas o Coo Sbluxaios o e Hua Spe ad Pelvs
CHAPER CHAP ER FVE - EXPAN EXPANDED DED ABE ABE OF OF CONEN CONENS S Aas o Subuxaos o e Luba Spine
Plt 5-0 A B MBR S - his deos MBR deostat tat 5cum wding th ano dsplcemet of th scu
Ples 5-11 A &B UMBAR SPI Tlis sows omlt tolstesis o L4 d patially of nd S wt ed g sion Pg 14819
g g 6 67 7
Plts 5-3 A &B &B LUMAR SPI The ed-gs ed-gs o degtio, ost tu Pg 5215
Plates 51 A B UBR SP - Ths llusa UBR llusates tes nol nol ss low daged dsc wh odoss nd Pg 15 Pg 1501 0151 51
5-4 A &B &B UBA SP Th hs suluxted suluxted sments wt te cue med squHa tosess to [he segm elow o stateppin Pg 15 Pg 15 15 155 5
SECON : Subluxation of the lumbar pine with a lo of lordotic curve (6 pair
las 5-5 A &B &B LMBAR S Thi show show hypolodo with oe sigifct luatio g 156157
lates 516 A &B &B AR S his illustts illustts uatio wt a lo o lodoc ue and ios tage dic detio g 158 g 158-15 -159 9
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Pltes 5-7 A B UAR S - Te sluxato comlx comlx o th ecime nvols he e lum sn Pg 160-161
aded Tabe Of Cones
CHAPER FIVE
27
EXPANE ABE OF CONENS
Aas of Subux Subuxaions aions of e Lumbar Sne
Plates 5-8 A &B - This shows muliple lxations wih loss of crv
LUMBAR SPNE
Pg 6-63
Plats 19 A &B - Ths llsats llsats sbaios sbaios jn ndsags of dgnation wit a oss of lodoc curv
SNE
g 64 g 64-6 -6
la 5-20 A B - This spcimn as mtpl saons and h ndsas of dgio BA S
g66-67
SECION I: Sublxations of the lmbr spne wth a reversal of the lordotc crve (4 pars
las -21 A &B hs dvd a vrsal o lm odoc cr wh complt olths of 4
B SIN
Pg 68-69
Plat 22 A &B - Sqtl eolsss "ssppi of l- o a rvsl of h lodotic crv
MAR S
foig
a
g 707
la 5-23 A & is compl olisthss cing a val of t lodc v
BAR S - 3
g 72g 72-73 73
Addona X-ray/MRI Comparson
Plates -24 A &B his sows sows a vs vs o he lodo th pp lm pe
UBAR SP N E
SUBXTOS
Pg74-75
Pla 52 & WTH A OSS OF ORDOSS An X-ay ad J compiso
Pg 76Pg 76-77 77 Copyrighted Material
28
Aas o Commo Subuxaos o he Huma Spie ad Pevis
Pates 51 A B LMBAR SPIE SPIE near norma siht subuxations Some o te lordotc cuve t pecime a been maintained maintained L and 2 oo aliged Te et o te pine i a revered tartepping tartepping wit eac verebrae beig poteor to e next ineor vertebrae L2 i ligtly retro to L3 w ligt dic bulgg
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Chapter 5: Subluxations Of The Lumbar Spne
slighy retro o L4 wth dsc buge; L4 rero o he sacum with dsc wedgng and bugng. (A) L4-L5 have spnous pocess conac L3
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L5
wh dsc wedgng
L5
-
129
s sghty rero o
30
Atas o ommon Subuxa'ions o the Human Spne and Pevs
Plates 52 A & B LUMBAR SPNE variatons in "ormal umbar curve This is a good example of slight degenerato processes i the discs with mior antro and retro dislacement L is sighty antro to T2 with a small osterior uge slght tearing, and the eginings of rown degeneatio aneiorly aneiorly L2 is sighly atro o L with sigh tearig ad aterior
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Cpe 5 Subxios Of Te mb Spie
T1 2
L1
2
brow degeeraon 3 is anro o 4 wi anerior brown degeneraio and earng. 4 is sligly ano o 3 wi brown degenerao earng. 5 is sligy rero o 4 wi brow degenera degenerao o earing ea ring ad wedgng e sacr is rero rero o 5 wi sigcan earig, caviaon and soe loss o disc eig. Noe e absence of eve oderae A o P sblxaions n e bar spine.
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32
Alas o ommon Subluxaons o he Human Spne and Pevs
Plates 5-3 A & B LUMBAR SPNE SPNE - L has a compre compress ss on fractu fracture re wt scleross scleros s and heal healy y dss ds s.. This secimen has suffered a trauma with a resulting comressio fracture of the L vertebral body This fracture reaired ad the L4- ad L-S 1 discs have taken the loss of voume for the L vertebral body L14 L 14 look early aliged wth slight anterior disc brown
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ape : Subuxaions O Te Lumba Spine
33
degeeratio; L4- ad L-S have wedging accomayig comreo fractre of L here a slight but comlete retro of L with a L4 osterior disc bulge his secime has only minor signs of degeeration because he ce is maained his is aother examle of the vertebral body absorbng the shock
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134
Aas o Common Subuaions o he Human Spne ad Pevis
lates -4 A B LUMBAR SP - Variatons Variatons in in the the norm norma a mbar urve urve Tis spece as a lordoic Ue Ue wi wi si lubar verebrae ver ebrae wi w i dsc degeerao degeera o a a correspods o e degree of sbluaio L s slgly rero o L2 w slg disc bulgig
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hapter : Subluxatons O The Lumbar Spne
3
L2 is retro to L3 wit sligt dis tearg L3 is retro to L4 wit sligt tearig ad uging L4 s retro to L wit di teaig wedging, ad uging L5 is sligtly antro to L6 wit modeate wedging ad igt teaing L6S look alged
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36
Alas Cmmn Sblxains e Hman Spine and Pelvis
Pate - A B LUMBAR SP A ea oma o ootic otic cuve wh L-aca wegg wegg is perso ad a ear oral alignen wi e sacru agled or subuaed poseriorly e coracure of e oracolubar fascia can ake peranen is sacral ape posero subluao L is rero o L2 w disc earing and anerio ad poseor bulging L2 -3 ae aligned wi slig wedgig 3-4 s nora e L4- a gne s near noral, wle e
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Cape 5 Subuxaios O Te Lumba Spie
1J7
sacrum is ony slgtl retro to L wit sgficant posteior disc eigt lossanterior and posterior bulging and tearg Lac o A to P sblxation results in less DJD (degeneative jont disease Note: e sacal discs sow tat sacral motion was persistent is lumba spine is a god example o DD assocated wit sblxation and normal discs associated wit alignment and a normal cve
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138
Alas of Common Suuxaions of e Human Spne and Pevs
Pate 6 A B UBAR SPIN Ti ow variatio i a"orma lumba curve
2 loo loo alied b he edplaes appear appe ar daaed ad repaied wh a Scha's de f he sperir sperir 2 endpae wi sme disc ea 3 is ained w 2 2 b has end plae daae da ae wh repair o bh
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Chaper 5: Sbluxaions Of The umbar Spine
39
OTE The nuleus has epanded into the bod of both 2 and 3 wth near nor dis. 4 ooks aigned wh 3 wit some endpate damage repair posteror ds bulging, and sligt tearing 5 s antro to 4 with ds tearing posterio bulging and loss o dis height. The sarm is antro to 5 with signiiant dis tearing wedgg and loss o ds heigh.
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40
Atlas o Common Subluations o the Human Spine and evis
Pats 57 A & B LUMBAR LUMB AR SPNE Ths s pcm pcm has s uluxa uluxatd td sgmts wt th curv curv aitad aitad Tis sows tere are sigs of trauma wit repair in te verteral odies Tere is minor to moderate A to P sl slxato xatos s ut te normal lordoti rve s preset 2 look aligned wit ompressio ompr essio rature o 2 Tere is dis wedging and expanso o neus pulposus into verteral ody o 2 3 is reto to L2 wit disc teang wedging, and sligt posterior ulgig
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Chape : Subuxaos O he Lumbar Spine
4
L4 is etro to L3 wit dsc tearing wedging, and posterior bulging L is retro to L4 wit disc tearing, sligt caviation wedging and blgig Te Lsacrum aligmet ooks ormal Note: Te L2 verebra body deformation wit comessive force idicates it took te absortion of te sock not te disc
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142
Aas o Common Subxaions o e Huma Spie ad Pelvs
Pate 8 A B MBAR SP - vaat vaatio io i omal umba umba uve uve I
In this specime L L4 has good agnment with slight anteo own degeeatio. L is sightly eto to L4 and the sacum makng L a complete etolistesis
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Car 5: Sbluxaons Of Th Lumba Sn
e -S isc s wee, bun anerrl, an wih isc tearin Noe he pesence of a rotic curve
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43
144
tlas o Common Subuxations o the Human Spne and Pevis
Plates -9 A & B subuxaton wth daaged dscs LUMBAR SPINE - Norma discs above a ajor subuxaton Ts spcimn as maintaind a modeat lodotc cv and te sublxations o L5 and t sacm did not gnat mao ostopytic canges L 1 tog L4 av noma alignmnt L5 is sligtly anto to L4 wit ncls dsiccaton taing and cavitaton
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Cape 5 Subuxaons O Te Lumba Spine
45
he sacru is sniicatly antr to 5 with ajor deeerative chanes desiccation o the disc ad ear usin
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46
Alas of ommon Subuxaons of he Hman Spine an Pevis
laes 0 A & B LUMBAR SIN SIN - This emostates emostates L -saum wedgi wedgigg with aeio dispaeme o the saum his specime has sinifica disc deeerai he presece of orma ad ear orma dcs. 1- are ear ormal or mal with the beinnin of brow deeeraio 3 reto o ad
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Chapter : Subluxatons O he Lumbar Spine
47
4 wt 23 dsc tearg ad lss f eght 4- lks gd wth sght wedgg ad tearg, the sacrum s atr t wth fus f psterr aspc f bth segments Te dsc has aterr blgng, tearg and cavat The A t P subluxat f he sacrm stpped nrmal mn and dmed the dsc Cntratre f the thraclmbar fasca fxes te subluxatn.
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48
Ala o Common Subluxaion o he uman Spine and Pelvi
Plate 511 A & B LUMBAR SPIN - Thi how complete ateoithei o L4 a patall o L a S wth e tage uio his is a specimen that has ever segent slxated wih the lordotic crve aintaied A L compression actre with repair has occurred L2 is atro to L with disc wedging tearg, ad posterior gig; L3 is atro to L2 wit slight wedgng tearing, ad ugig L4 is
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Caper 5: Subluxaos O Te Lumbar Spe
atr t 3 with dic tearig caitati light bulgg ad igificat pterir dc heght l i ret t 4 with dic teag, cavitati ateir ad pteri blgig he acrm i igficatly retr t with fu. A) A.L . hyper hypertrphy trphy (8 L 1-5 piu prce prximity C) L f midagitta pae at L3 (D) Sacra dic Copyrighted Material
149
Alas o Common Subluxaions o e Human Spne and Pelvs
Pate 2 A & B LUMBAR SPINE T utate noma dic beow damaged dc wth odo mantaned
In this specime there are derees f sblxatin wit crrespdi deeerative canes is retr t L2 wh w h sinificant edpae disturbace, loss f het ad anteir ad
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Chaper Subuxaios O he Lmbar Spe
psterr dsc bugg L2 s retr t 3 wt purrg ad lss f dsc egt 4 s aterr t L3 and L wt dsc wedgng, bulgng and brw degeneratn. degenera tn. Te sacrum s slg slgtly tly retr t L wt lss f te dsc egt and calcfcat te te lrdtc curve s mataned ad tere s sgnfcat sclerss f te facets ad sme f te spnus prcesses.
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152
As o Common Sbxions o he Hmn Spine nd Pevis
ae 5-13 A & B MBAR SIN The ed-ae o deeeaio po tauma L
hs significnt endplte endplte repirs with nterior nd postero sprring is no to with signfcnt loss of sc heght blgng bl gng ntero n posterior posterior teng nd enplte reprs 3 ntro to with isc terng bulging, loss of eight, n impresson into the inferior enpte of 4 is ntro to 3 n with endplte epirs nterior posterior
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Chapter Sblxations O e Lumbar Spine
3
©
spurrng dsc tearng and aterr and psterr bulgng. bulgng. 4 has slght aterr and psterr spurrng dsc tearg anterr ad psterr bugng and lss f dsc heght Te sacrum s sgtly ant t wt dsc tearng aterr and psterr blgg lss f eght, and ater sprng. (A) Spnus pcess pcess cntact cntact frmg pseud-jnts 8) Hyprtpy f anterr lngtudal lgament (e) arrwg f spal canal due t sg ad dsc bulgng Copyrighted Material
154
As o Commo Subluxos o he Hum Spie d Pevis
lates 14 A & B LMBAR SNE This has subuxated segments with the curve curve mantained, sequental etroisthesis to the segmet beow o staisteppng Ts specmen as a subatio at every leve Te degeneratve d egeneratve canges are imited because te lordotic cve is maintained. is antro to T12 w spurring anterior and posterior disc bulgig and oss of eigh L2 is antro to L 1 wth dsc earing, calcificatio of disc, ad the aterior ogitudina gament.
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Capte Subuxations O he Lmbar Spne
T1 2
L1
2
5
ote fractre of L nferor acet. L3 s antro to L wth dsc tearng loss o eg calccaton of anteror dsc, and anteror ad posteror sprrng L4 s antro to L3 dsc tearg cavtaton cavtaton,, and anteror ad ad posteror spurrg L s retro to L4 wth anter antero o and posteror dsc blgng and loss of dsc heght Te sacru s reto to L wth dsc teag cavtaton, wedgng ad ear fuson of the posteror aspect o L and ote lack of spos pocesses on X-ray due to persagttal plane of the specen
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1 56
Alas o Coon Subluxaons o he Huan Sine and Pevis
Pas 15 B LMB SN s shows hypo ordos ordoss s wth on sgn sgnfcant fcant subuxaton subuxaton is specimen s ner nrml lignment nd ints wit e presence f ne significn subxtin L2 is slig sligy y nterir t L 1 w sig s ig dsc tering, nerr nd pster bugng d endpte dmge L32 s gd gnment wit nrm disc L4 is significntly rer L3 wi nterir disc bulge lss f dsc eigt nd ne fusin
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Chaper : Subuaions Of he Lumbar Spine
s atr to 4 w a st posteror dsc ble 5 ad sacrm almet s ear ormal wt s aeo ad posteror dsc bl A) cmoral's Node aato of ces pposs to etebral body) of feror 1 edplate 8) Caal steoss at 3- 5
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7
58
Aas o Common Sbluxaions o he Hman Spine and Pelvis
Plates 16 A & B LUMBAR SP is ustates subuations wit a loss of ordoti urve ad various stages of dis degeneation Subuxatin resuts n degeneratin e ss f rdtic cuve as rested in e icrease i te verteba bdy widt in tese subuxaed segents L - and L-3 eary ra wit te beginnig f brw degeneratin degeneratin 4 is etr t 3 wit sigs f a cpessin cpessin fracture, ater and psterir sring, disc tearing and anter and psterr bging
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Cape Subuxatios Of he Lumba Spie
L4 s a complete retrosthess; L5 s atro to L4 but posteo o e sacrum wth ateror spurs he L4-5 dsc has tear catato ad sepaao o he posteror lotudal lamet from L5 because of the posteror dsc mrato mra to he L5-S1 dsc has wed tear ad posteror bul oer the back of the sacral base he edplates of 3 4 ad 5 dcae trauma wt repar ad L4 as oss of ateror body heht
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60
Atlas of Common Subluxations of the Human Spine and Pelvis
Paes 517 A & B UMBA SPE The su subluaon bluaon compe o hs hs specmen s pecmen nvoves he ere umbar spe Tee s stastep stastepp p o ech semet pstely t the e belw, elmat the ltc cue Ts c etue the st pstue wt te pels be taslate ately t e x L 1 s et t L2 has maj eplate spu a epa pcesses cat cc -tem ct L2 s et L3 wh sca spu tea lss heht ad edpte ches. L3 s et t L4 wt sc tea
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Capter 5: Subluxations Of Te umbar Spine
-
161
minor anteor bulging, ad loss of heig There s ateio ogitudna igamet yperopy. L4 is reto to LS or LS is antro o L4 and te sacum with disc tearing, wedgig, sight cavtato ad bulgig S-1 as disc wedging oss o dsc heigt ad ea usion The saca disc 1-2 as wedgig sligt postero bulging and agulatio o 1-2 segmets. Note tat eve jot s subluxated tis exampe. (A) pous pocess pseudo-oint fomaion due o o loss o disc eigt
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62
Atla of Common Sbxation of te Hman Spne and Pev
Plaes 8 A & B LUBAR SP Ths shows s hows pe pe sbxaon sbxaonss wh loss o cve Th pecme ha choc oteo tateppg o erebae 24 to the egmet aboe 1 eto to 2 t dc teag, catato ad edplate epa ad ha a lght coeo acte 2 eto to 3 wth poteo pg ed pate epa d edgg teag ateo ad poteo bulgg, ad lo o dc heght 3
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haper 5: Sblxaions Of The mba Spne
16
rtro to L4 with disc taring cavitation oss of disc hight sight wdgng and spurring 4- ar aignd wit sght taing wdgng, ad infrior dpat rpair wh th comprsso fractur indicatng trauma to hs joints h sacrm appars appa rs sghty antro to with dsc xpaso ino t L vrbra body disc wdging, oss of dsc hight and nar fusion of -S1 his pattrn of a sbxaion compx is oud in idividas wh an antior pvs postur
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Alas o Common blxaons o he Hman pne ad Pevs
Pas 5-19 A & B LUMBAR SPE This us us as as suluxaos i s s as o ao ao wh a oss o ooic cu eto to 2 ad ha feo edpe eol ad epa th ateo p dc tea, ad ateo ad poeo bul 2 eto to 3 th ateo ad poteo pu ea o th ateo ad poteo dc bul ad lo of heht
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Chaper 5 Subluxaions O The umbar Spine
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L3 is retro to L4 wit anterior an posterior spurrin sniiant avitation tota oss of is matrix an wein of te spae L4 is retro to L5 w some anterior s anuus remainin wit avitation, antero an posterior spun oss is e an matrix L5 is antro to L4 a to te sarum w s tearn avation anteror an posterior in, an oss of eit. Ts suuxaon patern o L5 a te sarum an e esrie as a "sara ase poseror
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Alas of Commo Subluxaios of e Huma Spe ad Pelvs
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Pates 520 A & B MBAR SPNE his specie has utiple sub subluat luatios ios ad he edstages o degeeatio It has a edced rdss wth chrc lss jt terty rm 1 t . Nte the ceased ertebral bdy wdth de t the altered weht bear prdced by the sUblxats 1 s retr t 2 ad has er ad sper edplate damae ad sprr wth dsc tear aterr ad psterr bl, ad lss dsc heht
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Chapter Subuxatons O The Lumbar Spne
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3 retro to 2 wth poteror prrng, dc tearg blgg wedgng, ad lo of dc heght 4 retro to 3 wth dc cavtaton ateror and poteror bugng ear fo ad ateror ad poteror prrng 5 retro to 4 wth dc tearg lo of eght ad ateror bugg e acrum5 egmet are algned wth a ear orma dc llutrate how blxaton relt n croc degeeratve cange of te volved vertebrae (A Spnou proce cotact cotact from lo of dc heght
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Alas o Common Subluxaons o he Human Spine and Peis
Pas 2 A & B UMB SNE s individua as a vesa of umba ordo uve wt ompt rtostesis of L4
h pecmen ha gncant poteror dplacement o L4 whch cau lo o curvatre L1 L1 and L2 have near normal algnment. L4 retro to L3 and 5 (complete retrolthe wth tearng and lo o normal dc heght
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Chater Subluxaons O The Lumbar Se
6
L5 antro to to L4 wth tearng of the dc ad a ght dc bulge poterorly, lo of dc heght ad atero ad poeo purrg of the 5 uperor ed plate he acrum lghtly lght ly eo o 5 wth l ght wedgng and tearng. A) he acrum vew peragttal wth the frt acral erve decendng from the caudae equae
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Aas of Common Subuxaions of he Human Spne ad Pevs
Pates 522 A & B LMBAR SPE Sequet Sequeta a etosth etos thess ess fo fo a stasepp stasepp o LIL5 to a eves e vesa a o e odotc cuve Tis specmen's lumbar spne is a sblxaio copex s retro to T12 wit sligt OJO. L1 L 1 is sligtly retro to L2 wh aeo spurrg disc tearing, and anterior and posteror disc blg 2 s retro to L3 wit anteror sprring,
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Chter ubluxons Of he Lumbr ne
thickeig of the aterior longitudinal ligament and wedging of the vertebral body of 3 with g of ed plate repair and anterior and poterior dic blgig 3 i retro to 4 with aterior purring and wedging of dic tearig anteior and light poterior bulgig 4 i retro to 5 with dc tearig an ight poterio bulging anterior pring lo of dic height, ad pio proce approimatio he acrm ad 5 are mialigned acrm aterio) with mior dic tearg ad light blging ad wedgig Note the iceae in the length of the pial caal Copyrighted Material
72
Alas o Coo Sbluxaos o he Ha Se ad Pevs
ates -2 A B LUMB SPE L3 is a ompete retroistess ceatn a eesal o t odotc cue
Tis speime speime has ha s sffered sff ered an injry a sblxaed sblx aed and a nd damaged dam aged L2 rog rog 4. Noe he alered leng ad widh of e spinal anal L2 s sghy rero o L w sigifia end plae desrio indiaing a ompresso frare of L2 wh anerior and poseor dis blging eaing wedging ad anerior ad poseor sprrg.
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Chapter : Subluxatios Of The umbar Spie
7
L is retr t L2 with dis tearng and wedgng. L is a plete retr. L is retr t L with ds tearng avan wedgig blgig with pressin fatre f L and ante spng L is retr t L with dis tearg and signifiant lss f eg e saru is slighly antr t L with near fusin f segents A Thikenig f A AL LL L ver L2- (8 Spinal aal arrwing (e) End-stage wedging f L-S
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Aas o Common Subluxaons o he Human Spine and Pevis
Pte 524 A & B LUMBAR P Th Th how reer reerl l o the the ordotc cure in the upper ur pne hi pecme ha uffered compreve force cauing anterior verteba damage of 12 ad L 1 L 1 i a complete retrolthe retrolthe 12 ha an anteor compreon fracture with lo of te anterior vertebra body height L 1 i etro to 12 wth dc wedging, tearig anterior and potero buging, ad an aterior compreio actre wih lo o vetebra body heigt L 1 i retro to L2 wth dic earng bulgng, ad aeror ping L2 i rero 10 L wth dic
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Caper Subuxaons O e umbar Spne
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T1 2
2
wedging and aeo sg and blging oserioly wih some kind of change in he L2-3 disc ha is no radiograhc 3 s eo o L4 wih earing of he disc and oserior buging ad some end lae damage L4- ook age wh sligh earing and wedging. he sacrm is rero o L wih near fusion. (A Sagial secion of cos medlaris ad caudae eqnae B Noe how caudae equiae comonens are uled arond oseo caa o he sacrm Cervical fexion can make his worse
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7
Alas o Common Subluxaions o e Human Spine and Pelvs
®
as -2 A & B SBLIONS H LOSS OF LORDOSIS A Xay ad MRI copaiso his indivdual has suffrd a subluxation of 2: a omplt rtrolistsis to and 3 3 4 and a nd ar all postrio to th sgmnt bow bow his loss of lodoti urv has a signifianty damagd dis at its apx h vbra wit th mos A to P dsplamnt av dgnativ angs Not t ostophyt fomation at
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Chaper 5 Subuxaons O The Lumba Spne
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only L2 and L3 The end pate damage indicates old rauma. he sacum s anteio to L5 an and d thee s a sacal dsc at the the S 1 -2 leve The sacum has ost ts kyphotc shape ad the lowe sacra discs ae gone he sacal oigs of the eecto spae ae taut i the supine positio, idcatig thei elaxed ela xed st stat ate e has moe supe io sacal apex taslat taslaton on (A Osteophytes (D) Sacum (E) S1 -2 disc (8 Degeeating disc (e) Endplate F Eecto spinae
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Chapter 6: Subluxaios O The Pe Grde
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CHAPTER SIX Subluxations Of The Pelvic Girdle Dsussio h du th pvic girdl is thrbon comp incudg h sc d gh d lft innomnts. nnomintis Lt wod mning "nonm fring to its mbyonic oigin s th sprt bons: th ilium ischu nd ubis) T oints unit th bons of t plvc gid; th two scroi1ic joits d h pus syphyss Th scrum is th bs of th spin d t pvc gd s ho s h cho for quit substnti pt of th muscur systm of th spin, gs tho nd d A of th bdominl, hip nd thigh muscs og o h pvc gidl s do
th two g bck uscs th cto spi nd th tissimus dosi S Fgu 6) o it is not dfficut to s how subutions of th plvic grdl cn ffct ny or ll of ths musc goups cusg h o cotct bcom hyprtonic, o go nto spsm Th y o udstndng th tology of uch "ow bck pin is th intgrity nd function of th thr pvic os n Fgu 6 so o h muscs dictly invovd wth scolic ot d puc syph ysis motion d intgrity r iusttd Th bdomin wl muscultur hs its infior ttchnt from th pubic symphyss, mdy to th postio spct of th iic cst o suuto vovig th oint nd pubic symphysis wl dvsy c h rctus nd trnsvs bdominus nd i d tl bdomin obi muscs Th
Anterior
Posteror
Vew
Vew
Fgu 6 Tese llstratns are aterr an psterr vews f te pevs a e a sce gups f te back p an abmen All te muscles epcte ave prprceptve lnks t te sacrlac jnts a pbc sypyss e fgure n te left s te aterr vew a te rgt s te psterr vew f te pelvs. A e aba al wc nclue rects a transverse abmnus ternal an exteral blque musces (8 e majr p fexrs psas a acs a qaats lumbrum ( e erectr spnae spnae muscles e eep p muscles nclue guteus mnmus an meus prfrms gemes e a spe bturatr terus terus an qaratus femrs Copyrighted Material
Atas o Common Subuxatons o the Human Spne and Pevs psoas and lacus musces w be ecuited neu ooca to uad and poect e nued ont b miin tei ane of motion Te pos teo musces w be n te same ateed state hese muscles ae te eecto spinae atssmus dos, and te deep p musces. Te deep ip musces as we as otes, expeence distess wen pevc subuxation causes te acetabuum to sft eatve to e femoa ead tocante, ad saf s te ip ont ates tese eatio shps te bottom of e e foo must si contact e ound. nass of ese pobems is compicated b e vaie of pevic tts encounteed (See Fe 6-15). Muscua dis tess pain and imited ane o motion wil be o some of te cinica smptoms Te oss of motion noma oint space and fid excane iniates deeneatve pocesses Te neuoo nvoved is ve compex and wi be discussed on in enea tems e tissues ae embedded wit neuooical sensos of vaous tes Howeve, t is exteme impotant to ndestand tat te uadin (spasmed) musces aoud te smpsis pubis ca ie an ote musces be eieved on b coectn te subuxation and emovin te noxios popocepive inpt ino te centa nevous ssem Te nevos sstem ma neve adap to neuooica input fom noxious po pioceptve stimui aisin fom ont disess (subuxaton) Tis neuooica penomenon is pesent i a te studied mammaan euo muscuoseeta sstems Te sacum ives ise to te saca neves and te ntena iiac ate ies contibte te aeies to e pelvic oans Te ae etopeitoea ad ae adesed to te bac o dosa suface of e abdomina inin Mecanca dstess can dispace adomina tissues awa fom te ois of te nees and ateies
Visceal Impications o Pevic Subuxations vaiet of compaints can esut fom sub uxations of te pevic oints includin uoen ita and intesina poems In a noma emae pevis, te boad iament stetces between te two ia suspendi te ovaies and te uteus See Fe 62. We he pevc ide subux ates te boad iame skews as te iia dis pace wit espec to oe anote This chaes te position of e ovaies and te uteus in te abdomna cavit, and can exacebate an pob em tat mit exist. Te pevic examination can evea it and tende muscuatue on one side and te teus tactoned to one side. I tink ta a ae pecenae of ecoloical pao ma be te est of unesoved pev tauma Coection of the subluxation compexes of te pevic ide as been sown cnical to eeve o evese tese conditions. I ave aso encounteed instaces of testicu a pai ensun fom subuxation of te pubc smpsis Tis can be expained anatomica b te fact tat te testicla neve, ate, and ven avese te top of te pubic am befoe e descend no he estices ceatn a neuo vasca bude at can become entapped in some indivduas.
Fe 62 Ths lstrat epcts the vares, fallpa tbes ters an bra gament the pelvc grle These gyneclgcal strctres are suspene n the pelvc grle by te bra gament. Wen te pelvs sblxates te nrmal relatnshp s altere (A) vary (B) allpa tube ( Bra lgame (D) Uterus
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Capr 6: Subuxaios O T Pvc Gird T Sacru sm s sl p s so on I v fon t vn spms s o v v ss n t sm n 52 n 5253 S Fiu 63 psn of s mps sl oo s fom psoo on of vw folnos s s moto fo svvl s s ss t o, n o l l o, t so os ms sum n so jons n fom top o oom fom fon o Fu 64 pp of s stus on v of ps of m osons n ffn S F 616 o s ffn vws on s o m von poss mo ompl t sum pl o nl ppn o ou o nw wn S Fu 615
sm s n nv ml s u fom p fuson of s v ls wt o nnonts t so ons n ff v w vl s ul fs s l poso o os o smns s ontos w spl sl of n ops no pos o fo os t s nv oots sm s f sp sts pt fso of 5 to 52 n 52 o 53 ms o lf 53 4 n 5 fs 2 ps of s I ss ouo lf son sss sl mo s pvousl mon psool fun on of nvtl ss sss moon s msm of uton n wst lmton s s l o sm fo vsl ns ss ot of sm s oous oou s n f wl s ss s w s t tvl ss of fly s ol o nsm fo f un n fo v s mn o o v n plts v oon s mus lso fo sl s psolo fno S Fu 63 sm of ol v s ovosl fl stu w t sl ss Fiu 63 Thi i a viw of th ara di of an yar old ma Th majory of drly pimn had pritnt aral di Th mot prtnt wa th S2 di Th S23 di wa oftn obrvd Th S34 di wa oaonaly n abo 25% Thi viw wa ihtly off th midaittal plan ot h prn of annlar rin and a nl ppo Th ara di a oval i hap in h A to P and orona plan XY plan o th ontino ortia bon that mt b ado dn Thi inifiat vidn of ara motion front o ba ad id to d Thi i th aaomial xplanatio of th arm pmpin th rbropinal lid in th pina aal Sara moton i lily to b onnd to tra nrvo ytm phyioloy ad fnion (A Ann fibro ( l plpo ( otx of am
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2
Aas of Coon Subxaions o Huan Spin and Pvis
The motion of the legs rotatng fom the acetabulm rocks the nnoinates with the anterir and posterior thigh sclatre The sacrotberos and sacospnous ligaents con necting to the sacm from the nnominate tansfe ovemen atenating bac and or ad. The fem s an enormos leve A han d Ie on a rench as long as the leg ould snap a 3/4 qate nch tightened bolt n a partial tn he joints and igaments that hod the pelvic girde together st ithstand tremendous rotationa and shearng foces Pat of the stength and stability of the pevs is its exibil ity he sacm, orming the bottom o the spnal canal st confer motion to the entie
oer centra nevos syste from the sacal neve oots to the bainste Motion of the spna cord is the ao echans fo capi lary blood fo A statc spinal cord has redced blood fo The sacral discs are evident to the 9th and 10th decades o fe n the limited stdy pre sened here thee s evidence of intersacal sb laton Fgs 636 og 61 on pags 202203 The 51-2 dsc has a dosal and vental cotcal bone coverng his i thicen ith los of integity beteen te 51 and 52 seg ments and the disc i dehydrate. The 52 and 53 segments see to hae te same elatonsp
Fg 6
hi how the hman pevi from he anterio and poerio view The hree oint o the pelvi the rih and left acroilac oint ad the pbi ymphyi ca all be een oe he acrm i wider at h top (thi i cale the acral bae arrower at e botom (hi he acral apex The acrm i alo wider i the ateior apect than the poerio (A) Sacrm ) Sacroliac oit Pbi ymphyi
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Capr 6: Subxaions f T Pvic Gird
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T T Sacroiiac Joins coc ons hv wo comonns: os n cnos synov) hv s sc mo hn nvs' scoc jons, n hv ou xm von mon scms mn ncs n sh, conou, n sz o h on h bs s n som scmns n sml n ohs; ohs; h cnous shows h sm von, n h s no conssency n h os o on o h oh gs 6-5 n 66). c von n no m on s nq mon h os ons
Oh jons only show mjo von om "nom cono njy o ss cl oon o h h scol scolcc jon cn smooh n o my u n cono I cn b n h sm n s h os oon o mos nls h m o onon hs mon o von o hs sc jon cox cn ln h w n o sons s o y n covy Clncy s com on o n h scoc jon onc n, nv ly covs
g 65 Thi illtrato a lateral view o e arm The ariae ad yovial porto of the joint i eeraly aterior and infrio o the fibro portio of the oint The two omponent vay n ize and ontor bewee individal Thi the mot individaly nqe jont ompex i he body The aroila jot varation an expan the different repone o injy ad eovey amo individal (A e atilae porion porion o the 8 joint ( e fibro porio of the jo
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wo o P aoa Jo w The aroilia joint ha a bro ompoe wh i poeror and perior o he alar ae The aria or atilae omponen i aterior ad ifero There i artilae on boh rfae and yovial fld i a ommon findi The arilar ae an be mooth or onored ee Figue 7
Fu
S
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osrior
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84
Atas o Common Subuxatons o t Human Spn and Pvs B
gur 67 Fronta ecton of the 8 joint of ealmed mae pecime 8 ndcae the acral de of the 8 joint A and concern a 2yearold oy C to I cocer male pecme older tha 60 year Arrow are drected at rdge ad depreo The ridge ad depreon how are coered y intact catage, whch wa checed y openig te joit afterward With permission of Or Vleming. Ognally pubihed in SPINE (uopean d), 99,: 3-3 Copyrighted Material
Chapte 6 Subuxatons Of he Pevi Gide
5
Fe 68 Becase f te annlar rngs an a pulpy center ts llustrates a mtn segmet Searng r tearng f te ntevertebral scs ave been etale n prevus capters Smlar sruptn can ccur t te pubs sympyss. Searng f te vertebrae tear te sc; searg te ubc bnes tear te pubc sympyss. Te prblem wt te pbc sympyss ver te IVD s avng te trasverse prcesses a spnus prcesses as lever arms t mve te vertebrae e pubc sympyss as te legs as levers fr mtn Ts structure must wtstan te sgncant mecancal avantage tat e legs ave as levers. A Aular rg B Nucleus pulpsus
he Pubi Symphysi Symphysiss The hr joit o he pelvi gile i he pubi yphyi a avauar broartlagio i The e o eah pub ra i ov ere by yale ariage a the broarilagi o pa i betwee ha auar rig wh a plpy pogy eter t i very iar to a ierverte bra i, eve ito avae age Exrapolaio ro itervertebra i pyio ogy wol iae a he pub yphy i uppoe to ove (See Fe 68 or ee it ao obai uiiet utriet Te pbi yphyi ie ay other ovabe oit a ublxae a i iere iretio. Beae o te opex lgaeou a ular attahet tat oet to the pubi rai h ubluxaio a wreak phyioogi al proprioepive a aul havo o he eg orax a aboe.
Fge 6-9 ev y wi e g e o o 75 eee (Di of Fe 611) Te pubs sympyss s swng mvemet wt te eft pubc bne superr t te rgt.
Fe 610 (D f Fe 612 Ts sbluxatn f te pubs sympyss s crnc an sclerss as ccurre. Ts patent a a lng stry grn p an lw back pa.
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186
Atlas o Common Subluxations o te Human Spine and Pelvis
® Figu 6 pvc Xy wt t rigt g i dductio to 75 dgs (Usd wi pmissio om t Iod pubisig comy) Te sacrlac jnts can be seen t be asyetrcal wt te let 8 jnt separatng re tan te rgt. Te pubs sypyss s als swng veet wt te let pubc be superr t te gt (A) Let saclac nt (8) Pubs sypyss
® Fgu 62 pvic Xy wt t igt g i dduco to 50 dgs (Usd wit pmissio fom t lfod pubsig compy) Te gappg te let 8 jnt s re prce a e pevus pctre Te pbs sypyss as cntue sw oby ts pstn (A) e! 8 jnt (8) ubs sypyss
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Chape 6 Subuxaons Of he Pevi Gidle
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Pevi Moon h joi of h pv gird h rog in h ody. dyi udi minor o moo (S Figus 612 ough 64) h Xry wr wg brng h lg r h v h mov h pvi join, no umbr moion. h h pur r poon of xrm moion r nd rng dduion nd forwd flxion of ip d rqui hl bliy. h pvi moio n hr i oml wi lg moio Bu h p rn of dipln n hr r ommonly lo n in pn wh oh f o h floor ymmy of h S[ jo nd pub ymhyi n w i ur oion gn of d pholog odo. mny of h p of pvi grd
®
Figu 63 pic g l g i y f xio
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The let 8 ot as gappg smlar to prevos X-ays Te pubs sympyss s sowg some movem (A) Let 8 ot (8) Pubs sympyss
®
Figu 64 pic y it t ft g i ypfxio The rgt 8 on ontt gappng an showng moveme. movem e. Te pbs sympyss s se so te rg pbc bone s slgtly speror A) Te g 8 t (8) Pubs sympyss
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188
Atlas of Common Subuxations of the Human Spne and Pevis
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Fe 61 Ts lustrates te range of ormal angles of pelvc tlt Te anteror tlt s a typcal female feate Te sacral base angle approaces zero or s perpecular to te floor Ts s a neutral pelvc tlt Ts s consere ormal but a range of angles betwee a s commonly fon Ts s a posteror tlt of te pelvs Te sacral base age ca be as g as 45 egrees. Ts s a typcal male tlt A cetral X-ray wt A to P recton wll gve ffeent appearances troug eac of , , an Te appearance o Xray wll cage aga wt comparsos of recumbent an stang or seate vews of te same nvual.
Pevic Tit and Imaging
Fe 66 Ts lateral X-ray of te lmbar spne an pelvs ave te planes of vew of te CAT sca supermpose on t. Note e tree ffere ages f vews fr te scans Algnment a symmetry are mportant t evaluae but e varey of agles of vews ca make ts task more ffcut
The norm pevi i while sndn n vry 45 derees beween he exemes of he nero nd poseror posions Se Fe 6). The AP Xry n show srl bse os perpendir o he enr ry of he Xry or one ery prle The Xry is rely js sdow pire This ompies evion nd dnosis This so ives differen pperne on imin Fre 66 shows he si s ies es of of x xi i I or rossseion piues in dvned imes MRI or CT n The i of he pevs n hne he piue o he pei ois The irreur onors nd nes of he sroii jois mke esy evion impossibe The sndi or weihberin AP Xy n hve differen l hn remben Xry of he se person The seed AP Xrys of he pevi hne he ne ye in. n Fes 67 d 618, he AP Xrys of nerio il nd poserior re sown. The diosis is he sme for boh individus, b e ppene s diffeen
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Capr 6 Subxaions Of T Pvic Gird
8
Figure 617 his is a AP Xay of an anterior tilted peis ith a superor subluxato of the let inominate ote the reatie alignment of the pubic symphysis; his s because e pubic rami are parale to he central ray (A) . Rg nominae () Rig 8 ot () Le nnomiate D Le 8 joint (E) Pubis symphysis
Figure 618 his AP Xray o a posterior tted pelis has a superor ef inominate noe the asymmet o the 8 joints and he msaignmet of the pubic sympyss his appearance s possbe because the pubc rami are perpedicula to the centra ray (A) Rig nominate (8) Right 8 joint eft inominate D eft 8 joit (E Pubic symphysis
Lbosacra Raionsip The occence of even sgncant oseoas he lmba spe can be a slen condton. A njy o te pevs ncoves conc egeeao an sgca sbluxa-
ons Reakale acvty evels can e enoye w massve on ysncto o e lmba spne Te ece onse o pan can e ny o e pelvc onts (See Fgre 619 620
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Atas o Coon Sbxatons o t Han Spin and Pvis
Rght
o.
Rght
b
g 61 PELC TILT AND X-RY PPEARACE mpl p an (gh PI wh plaal p b b
Has a posterior tit he speror pubc ram are see becase they are generay perpedicar to cea ray Sbject as an accompshed athete for decades, and as st oring out he fm as taen (b) Has a anterior tit and the pbic rami are geeay parae to the centra ray ote: in both cases spia segments ere not tender he paets caimed very physicay active ives and deied "yeas of pai Both had the same compait of right eg pai S joint don the bac of the eg ith recent singe event ose ote the spina damage and the denia of pain and restricon of activity
Rght
o
g 60 PEVC SHEAG nn phy phyg g ban ban - V l hang n h pn n dgna ah h lmba pn Pl P hese are A ad atera vies of the mba spine and pevis o a 72 year od oman ho deies ay hstory o bac pai pror to a recen garden reated event ote fso of L23 and other chage chagess of the umbar spne Subject s a sied (and regar) baroom dacer
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Capter 6: Sblxations O e Pevc Grde
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PHYSIOLOGICL SULUXIONS ge 621 how an aia lane MRI an of an individua who omain o right hi and lg an. Th an i tan with h R ndiating th atint' ight and th L indating th atint ft Th to antrior whil th bottom i otio, with th ilium (o inominat ad arum aaing in otion (li a i of brad hi i a rt am o how ubluation o th lvi gird a manift thmv o MRI Noti th ft ium mor otior tha th right o ao th arum i narrow on th t tha it i o th rgt. Thi woud indiat aral latral fxion or tiing o t lft with th a of th arum ang to th right. Thi att i within th hyioogia imi o th igamt. It i haaid by imitd motion aud by mu guardng ai and rdud ymtry of gait
Thi i an xaml of a ubluation omlx o th lvi gird It rut in a ognizabl ain at ad houd b viwd a a da ntity tring th ntral rvou ytm th rihral nrv and th oit auing rori otiv guarding of om or al o th mu attahd to th lvi girdl. It i imortant to ow that v ubuation an b viwd on advand iaging dvand magig uualy fou o th lum bar i, ad it i ony in th at fw an in th tudy that art of h vi gird an b n It i ruial to ay o attntion to tho tai of th advand imaging whn atint rnt with lvi and abdomna omant thigh ram or ain ad tndrn
ge 621 his a MR axial iew of e peli. e subluxaio of the sarum is see at te rigt saroilia joit with e right saral ala aterior of te iim Usig te grid to ealae te sarum appears rotated or e ilim has moed poseriorly Also ote te differee i te diameter of te rigt ad left psoas idiatig spasm of te rigt psoas G Left psoas (D) Syoial portio portio of S jOit (A) Rigt psoas Fibros portio of SI joit H ase of sarm (B) Rigt sara ala (F) S1 spious (I Left ilium e Rigt ilim ote the ommo explaatio by radiologists of tis subluxaio omplex is: poor patiet positioig." e Xray teiias say tat te patiet s flat o their bak with arms at the side aliged wit te grid as best as pOible te twists ad msalgmets are i te paiet" Copyrighted Material
Atlas of Common Subluxations of the Human Spine and Pevis
Fexion/Extension Rotation P/AS) otton of n nnomnte nnomnte on te e e s com mon pec sbton ptten e of te nnomnte s moton te p e nteo n etenson p ese sbton pt tens e psooc sbtons f otton s eteme te pbc so sbtes s est ees one ms of te pbc
NON-PHYSIOLOGICAL SULUXTIONS fom n
ssecton o o t nnomntes one n Y n Z (e Ctesn coonte conton eUes sncnt mont o ment o n t s not so tt sbstnt sb e knon postons s te ke to sbton pt stcte mon n et n cn
occs n te nes n ctes o te tsef n some ns te c contct s ft n otes t m ebt sopn e n te sme s tt sbton m ook e mon ns Conese sbtons m mm one s note n te em ee 6 d 6-8 te sme o te left nnomnte tts ee compete 6 s ppence eme t n nteo tt n Fe 6 8 s me t pec tt 65
De to te scoc not en es to n om o tomenson ep n te pOtn te e obe n tee o mke mttes een moe confsn te o obeness s mc ton conton te ont ppose oon se spe n pone m
To Posterior Pelvic Shearing T +Z O Z
one nnomnte cn tnte ete to opposte se ette " s +S stnce o tnston n te Z ete Z o SZ cn occ cse jont n spton o ese pttens ptte ns of s mts of te s nonpsoo not ke ecoe to conton e ecoe mte stts tke to fncton mn monts to fe es o pec sbton s te b n feences n te We ton
onts no fom speo to n fom to nteo so tt one nnomte cn tnste n te Z s te to te ote See 6, sen of one nnomnt o t to te ote c noes tee te nte otton o scm n o te sbton ppes to be n nfe m n net o tnston of te o posteo pes te sbton cn be bone cn ppe to see to te e on one se nston nston te x m so ncese te so n poject me s so be ot ton pbc m
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Capte 6 Sbxations Of Te Pelvic Gide Speo to Infeo Pevic Seaing The
Y Or -Y
Innmnate
Dpcemet of te iointe in te + Y pne i uuy ce by iificnt um uc fin on one icium o one oot wit te knee etene Ti ipcement of one innonte retie to e ote i te B iutrton i Figur 623 ow trnton of
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te woe inomite i te poitie Y i T ret i oe inominte ben upeor to te oter Howeer te e bution cn pper to be ifferent in ti AP Xy wt ifferent pec tit or intnce te + Y ubution in n nteror peic tit i not ie y to be een A pyic em of te pubc ym py te oter jont n nmk i te key to yzn ti conitio A uperor pbc ypyi i uoune y ie
Figr 622 LVC SRN nn physgc physgc subuxatio subuxations ns his is a illustratio of a theoretial iew from aboe lookig dow o the whoe peli grdle, ot jst a slie. the three joits of the pels are see, the rght ad eft saroia joits ad the pubi symphyss are aliged. the rght pubi rami is ateror or etral to the left ad the sarum is rotated. he shearig of the pelis will hae the appearae of positie ad egatie Z plae traslatios of oe iomiate relatie to the other i the axal ew his type of ijry ioles saral rotatio as the right iomiate shfts forward or aterior to the left t is diffilt to desribe the axs of rotatio the aryig peli tits Pubi symphysis shearig, tearig ad 8 joit ligamet damage are ery ikey i ths type of jry.
igue 623 LVC SN on physologc subuxatons
is a A to P iew of a ormal peis ad is the A -P appearae of a posite posite Y traslatio of the iomate o the left relatie to the other (Note the sarum is tipped ad the sara apex is to the eft of the pbi symphysis ad the spae betwee the isha spie ad the saral borde.) Aso ote the sblxaio of the pbis symphysis wth the pbi ram o the left beig eleated relatie to other I do ot feel this a iidetal fid g he psoas iliaus, ad all he msles attahig to the ishim ad pubis wil be adersey afeted his type of ijry ioles saral shiftig with the aa eleatig wth the superior iomiate his ioles pbi symphysis ad 8 joit iury ad trsi ligamet damage bease of the o physologi displaemet of the segmets. Possible tearig of the pubis symphysis takes plae Axia magig iews wil show the right ilia rest before the left i seqetialy iferior iews Rotatioal dsplaemet a be oomitat wth Y or Z plae displaemet. Combiatios of these subluxatio patters i al plaes a be preset i oe idiidal Copyrighted Material
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Aas o Common Sbxaions o e Hman Spine and Pevis
sntn musutue e ps e tede o not, nd ppo ee in to te oint Compso ppton nd ontt of the s eosties shoud indte tt one of e innomintes s dsped n the osite Y dietion. Fge 624 shows n seton of CT sn t te ee of 2 his is n dned dinosti ime of hon subution of te peis The symmety jont seoss, nd ottion re sins e gde dstortion
subseuent to tum n this se te tient hd fen off of odn dok 15 yes ee Fgre 625 is n MR of the 2 ee with the srm nterio to both Ui The left is wose thn te ight This ptent hd been ht in rosswk by n utomoe nd sfeed d onset of eft owe e pysis nd foot dop Te eft innominte ws supeio to the ht uution of the peis n e sinfnt eth fto dese y e ny systems
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Fge 624 This CAT sa of the S leel shows a subluxatio omplex of bo S os ote the differee i width betwee the right ad left sides of the sarum This daes a te sarum is tipped The ef side is arrower ad therefore a lower leel of the sarum makg mak g e ef saral aa higher ad the apex agled towards the left. The left ilium is posterior larger, ad a a deet agle tha the right iomiate The left SI ot is subluxated with the sarum aterior to e m (A Right lum (C Rght side of the sarum eft SI jot 0 eft side of the sarum (F) ef ilium ( Rg S o
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Fge 625
s s a MRI of a subluxated pelis The left iomiate is posteror to the sarum, the sarum is roated he ght side of the sarum is aterior to the right ilium, ad the ili are asymmerial This is the appearae of sigifat pei distortio resultig i eurologial defiit alered gait ad musle atrophy (A Right ilium et ilium (C Sarum (8 Right S joit 0 ft SI joit Copyrighted Material
Captr 6: Sbxatons O T Pvc Grd
5
ser Ran f he Rgh Innmnae Relave he Lef A o Xy n e se ecmbe) oson
Figue 626 POSTROR OR ON ROTATON OF ON NNOMNT (a complt rotation of th rght innominat or a rght P subluxaton) hs is a recumbent vew of a osterior evic tilt with a comete osterior rotatio of the right innomate he rght osterior sueor iliac se (PSIS is ferior to the et ote elevation o right bic rami orrection of subluxatio resulted in immediate reef and ability to wak A) ight innomiate ' ( ight osteror suerior iliac sine () Subxa Subxated ted bc symhysis D e PSIS
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Atlas of Common Subuxations of the Human Spne and Pevis
CAT Scan: Axa view Fgu 67 ROTATONAL SUBLUXATONS physioogic subuxatons ositv and ngati rotations on th X axs.
This 12 panel series shows ght inomiate posterior rotatio reative to the let ad o left aterior rotatio. Note the sacra otaio, a subluxato that accompanies his condio because of the obiqe oentaio of he sacroiliac joints Aso note the righ side s o the readg lef and the top et pane s the most inerio view ad bottom rigt the most superior Some frames have been labeed to hep indicate level o mage (A Posterio ight ilim Le (8Let ilium
o
Le
b
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Chaper : Suuxaios f Te Pevic Girde
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Pevc Shearing Non-physioogica suxaios
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g 628 Sbxaion o bi ymhyi (A) Lef puc ody () Puic sympysis
Anterior
Posterior
ig 629 MR and Xay aaanc o combnaton o haing ad otaton In te MRI the rght innomiate s aterio +Z) to the lef ut s posterior to te sacrum idicating a roation (rt PI) comatio of sluxations I the X-ra te left innominate is superior (+Y) to e right side
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Aas o Coon Subuxatons o the Huan Spne an Pevs
Pevc Seang nonphysoogca subuxaon of pevs
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Right
Le gu 630 Standng -P plv X-a o a uuxad pv is is an exape of pelvic seaing a nophysiologca subuxatio tha st incude ligaet daage he left innoae has sperior a +Y displaceet sublxation bt in te standg position appeas lower he acetablu has oved p bt te foot still as to be on e goud angling and tpping the pelvs ote the sacu s te left side of e pelvic ri (A Right ioinate () Let innoate ) Sacru
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Chape 6 Sbaio Of he Pevc Gide
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Speo batio of ef nomae
gu 63 PC SHRG non physologc sblxato sblxatons ns V This CT scan shows the top of the left iliac cest n the uppe ight panel The second fa right panel shows te top of the right iiac crest This idicates a 15mm differece height A supeor or + Y sblxatio of the eft inominate is present Symptoms included severe left bttock hip and leg pa The patiet was efered to an orthopedic sugeon who recommended sgey of the mba spe (A) Planes of oetatio of te te scan show wt supine ateal lmbar Xray () eft ilac crest (C) Right iliac crest (0) L5
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Atas of Common Subuxations of te uman Spine and Pevis
Supeio subuxation of ght innominate
Q
Q
b b.
c
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c.
Figu 632 LVC S - nn pygic ubuan is s a CT sca of op of pevis wi rig iominae Y or superior suxaion e pae waks wih a gai ad as anormaies ha are improved wi e correcion of +Y rig innominae ransaion. (A) ig iominae () ef innominae
Figu 633 LVC S nn pyigic pyigic ubua ubuan n X
ig innominae has +Y ransaio Noe ef roaion ad aera fexion of 4&5 due o superior eevaio of righ side of sacra aa. No Noe e ack spaces in discs in paes wo ad four of discs 45 and 5 5-S 1. Paien waed wih cae ad ad ovious gai anormaiy.
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Chapter 6 Subuxatons Of he Pevc Grde
21
he Geratrc Pelvs
iure 634 Dea from same sudy as ure 634
iue 634 Multiple inuries have rendeed s yea od man able to walk Note the asymmetry of the sacroliac oits ad the misalignment o the pbc symphyss. This s a example of sperior ( Y ad anteo +Z seag of te left inominate The mscles of the hp thigs, abdome and back were al rigid and painful. The patiet was flexed at the hip as well as in kees and eeded assistace to move Correctio of the pelvic subuxatios allowed ths ndvda o wa aded. (A) Left sacroiliac oit
Note shift of the left pbic bone pwad eave o e right This ca reslt i spasms o the psoas rects abdomius, and thgh muscles (A) Left pubic bone
ue 635 Deal rom same sudy as ure 635
ue 635 Ths 2 yea od has a so soy y of a y falls requires a walker, ad moves slowly a fexed orward positio Note the asymmetry of the sacrolac Oints and pubic sympysis Ts is an exape of a speo + Y and antero (Z) right inomiate with a significant lef nnomae posteror rotation (A) Right sacroili sacroiliac ac oin
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oe e sgfcant dfferece in the shape of the obturator foramen and the eg of e pbc bones Ths indicates otation has ake place between te two innominaes. A) Rght obturator foramen (8) Lef obao foae
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Atas of Common Sbxatons of the Hman Sne and evs
Intasaca Sbxatons
Fgue 636
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Mt idividul idividul ve cr l dic i wu wud d idcte crl mti i nrml Nte te L-S S S-2 d S2 -3 dic re preent with te beginnig ign degee e nnulr wll re de d e crticl brder f te c dc e thceed. (A LSdc SS-2 dc C) S2 -3 di dic c 0 Ctex f cru
Fgue 637 Shwn re crl dic in n eldely pecien Nte te dic betwee te egment f S1 nd S2 S2 nd S3, d S3 nd S4 he vc tructure cfer tin nd eed t peit lte int life Nte te l e dc heigt heigt t te S2 -3 dic d e gg f S3 A S1-2 dic ( S2 -3 di dic c (C) S34 dic
Fgue 638
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A crl dc wit degeetive t bve d belw. he he L-S1 i ered d degeeng becue f the ubx pterrly Nte the ppece f S3 beg ligly nterir t S2 ggeng n intrcrl ubluxt A L-S1 dic ( S1-S2 dic (C) Site f S2 -S3 fui fuin n 0 S3
Cpe 6 Sblxios O e Pelvc Gidle
sc Sblxons
gure 639 hs shws a sa saa a ds w h ed sage degeean degeea n abe and belw. he 5 5--S has sheaed and fsed L5 is se he sam he S12 dis is dehydaed and he al bne has hkened S s angled n enal den and he S2 ds s gne. (A) L5 () S1 (C) S12 dis S2 (E) S
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igue 640 his a e f a saal ds wh a healhy L5-S1 ad a fsed S2 S 2 - n he L5-S 1 ds s slghly wedged aely. he S12 S 12 ds s dehydaed and eded sbsane wh a hkeng f he al be. S2 s agled n a dsal den A) 5-S ds (8) S1 (C) hkeed ex S2
igure 6 hs seme has a sga sblxan f S1 ane L5 wih fs. he S-2 ds as baely essed and he a bne has hkeed (A) L5 () L5 L5 S1 ds (C) S1 S12 ds hkened ex
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23
oa beg le e e
GLOSSARY
-
05
f e e wll f e le f le le e uudg ue
als brass
abdomal oblqe msles: tera ad eteral
Te eel blque e lwe b d e e ce d le dle Cc f b e bde Cc f e de lelly bed d e e eebl clu eed e bce f cc ee T7T d ee e lc Te el ce e club f e l fc� e e ee u b d le Cc c eel eed e bce f cc ee ee ee d e gdle egy wl cue ee plly fully cc dup e pl cue cue by e e ucle gudg
absolte moto
cup-ped elel ufce f elly by e feu cule
adopte
ucle f
e e f f e bdy; el
ateror lotdal lamet
exed f e bd be e cu r upp upp e clu d ue e eebe
ateror spal artery
uple bld e ubce f e pl cd ublux c blck e e pl ey d wll cue e cd bece yc
aterolstess
f eeb w l
atero/pasteror
Deced f e f wd e bc
Te ue f cey c ey f e cu e b Te wee w e cccyx
araod
e pel fed e cu d Te ed f e
Te de eece f
f e ecl wll Te pce dce
artrts
ublu cc eg e e
A to P e pe dec X-y.
ateror
ape
lcled ee ffec e ee eebl lu ee e cecl eg glblly ffec e e f e
aetablm
Te ue ccec f wc c e ucleu eeebl dc ydulc cpcy ulu fbu d c be cc w f e
fl f Te c c cd f e pe cceed by
artlato
dce bewee w e be Tue ced w cul f e el
atlatoaal
d
pce bewee e w cecl eebe
f p lly fee e ec e T ccu f e epe epe uy due ublu e fc Te de f e ede' cpe bewee e ue ALL e lgudl
C lcg w e wc pe Te l cule e x e fe
adesos
altered wet
I e eebl cue, l ec blced bewee ee p w fce d e e
cul
atoom eros system
d f e eu ye f ee f efle e cl luy fuc d ee e gld d ucle
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A S h H S P
vcur
of and waste through connectve tssue v motion.
of the spna cana conditon a narrower cana ca be a sen condtion unt
xi
or spn! cana stenoss s a resut of of vetebrae wdening endpates endpates and the
to the C2. Pertainng to the axa pane of the the Y Cartesan coordnate 3. to the aa of the bones the sku 1, hyod, and vertebra coun. .
thnwaed bood vesse that connects and venues through whc aterias between bood and tssue ces The for a network or peus n aost a the body's tssues Bood fow s whic act as nked to the otio of te a pup
xi ding
to the cervca oad eerts a in whch an aiay force that resuts i ongitudinay vertebra body Ths a fractue of a can be fro the top-down or fro A echans of
xi
is the first The second cevca bearng syste in the coun The dens of the as Cl and akes a thOugh he whch the head and atas Oate sdeosde rotaton of the ead XIs artcuates superory wth the atas at the wo artcuar facets and nferory wth C3 at two nferior nfer ior artcuar artcu ar facets and the boy of the verteba va the intervertebra dsc
cpue
The ebane that encoss a Jont jo to for a cosed fbers wth a the nside structue can resut n usce and tendon nvoved
ctige
A specazed connective tssues fbers and
® of the bran to the cord ade up the obongata pons and dban. The bran ste is wth the cord nd subject to forces ntated n vertebra coun Te boo suppy to the bran ste is dependent on te negrty of te vertebra arery
The atri s aascuar (wthout bood suppy) and rees on oveent to aian ts heath and
interacng t s found transitona ateria fro bone to the ntervertebra dsc atera as we as the pubs
bucking
Deforaton of an acitecra structure due to acceeraton or deceeration of of the structre Ths woud be a te for
tein crdinte ytem
A threediensiona coordinate sste n
whch the coornates of a point ar � ts dsances fro three These are nes or Y and Z aes o panes t s sed to poston n uan anatoy
©
ccified
and hardened tssues caused of tcacu caciu carbonate and sats. They n the fraework fore the fbers of the atrx of a tssue Ths can be a nora response to stess or a response to abnora I stress
ccifictin
of nera sats The pocess of wthin wthin a tssue or stcture
cude
Neve rootets of the spna nerves that arse off the ower of the cord n the t s the Latn for horses whh it ooks ke These harke fbers for the ubar sacra nerve roos and
cvittin
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Te foration of a ntervertebra dsc by of tissues The
Glossa 7 initiated by searing, loss of movemnt and hyperloadig wic inerrupts te nutrient pmp. central nervous sysem T brain ad spial cord e part of te erous system at is cotained in te skull and ertbra comn. cerebellum Te portio of te brai ying postrior to te medulla ad pons cocerned wit coordiato of moement. Damage ca case ataxia ac of mscle coordatio) dstrbance of gait ad seere dizziess T posito of te cerebellm in te occpt ca be canged wit vertebral colum cages Te blood sppy is ertebra artery depedent. cerebrospinal fluid Tis plasma like id cotiuosy circlates trog te entrices of te bra ad spinal caa srroding te spia cord in te subaacoid space Te motio of te ertebral col col mn mn and sacr is t spposed mecaism of circato. cervcal Of or pertaning to te eck cervical cue A essential arcitectral featre of te ma spine Cags n te shape of te cerial spe rest in cetral ervos syste deformatio and joint patoogy T cerica cre s lordotic or te coex side of te curve s vetra I. cervicogenic Symptos prodced from probems i te ec i cericogeic eadaces iateral cericogenic deafess chronic Log-term or reqently recrrig. chronc nflammaion A log-term, localized protctie respose to tissue njy desiged to destroy, dilte or wall off an ifectig aget or ired tisse Caracterized by redess pai at sweig and reuced or loss of fnctio. Loss of joint integrty enrates a inflammatory rsponse. clavice Te colarboe. Te edial ed of t claicle te sternal extemity is rounded and articlates wit t sternm. Te broad fat atera end te acromia extrei ty ty articlats wit te acromion o te scapla Tese articulatios are primarily ligamets and capsles ad o te oly bony articlation of te pectoraI pectora I grd e to te cest. clivus Te aterior porton of te occipita bone It orms te ot part o te forame magum Te dens of te axis attaces to te cs coccyx Te ost inferior portion of te spine, attaced to bottom of te sacrm I is te fso of te tee or four coccygea erebrae
ad is tragular i sape Te sacrococcygeal ligament s contiguos wt te sacrotuberos gaents compression fraure A fracte d to impact oadg in wic te bo as bee crsed Se i te ertebral bodies of osteopeic patients conduciviy Te abiity o a tiss to codct a curret or nere mplse congenal senosis A narrowng of a opeig or passage de to ierted ariatios. conracure A state of deformatio and sortenig of a soft tisse sc as a mscle or tendo so tat t caot passiely attai ts oral gt 2. A state of dmiised or oss o compliace of a norally pliat tsse A sorteg wit a decrease rage of motio, a como feature of croic sbxaio conus medulars e inferior ed of te spia cord. t is tapered ta pered or coesaped ad eds at at te lee of te iterertebral disc betwee te first and secod lmbar ertebrae in te adul corona Te frota plae. t dides te body ino aterior (rot and posterior back portios 2 Te XY plane in e Cartesia coordiate syste cortex Te dese boe tat forms te extrna surface o a bon caled cortca I boe 2 Te oter part of a orga. corcal bone Te dese oter wall of a bone cosoansverse Pertaiig to te rbs ad trasers processes of te ertebrae. Te traserse process is posteror to te rib ad articlates wit te eck of te rib. coso-vertebra O or pertaiing to a rb ad a ertebrae Te typical costo-ertebral joit T2-T is a tree jont compe made p of te ead o t rb sperior and nerior demifacets ad te iterertebral disc
eNS
Cntral erous system cross secion A secto formed by a pa cuttig troug a object sually at rig angles to a axs. 2 Usally te XZ plae of te Cartesia coordiae system cranium/cranal Te cra ca be deed as te boes of te skull a protects te bran and t organs of sigt arig ad baace icldg te frota parietal temporal, occipital speoid
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08
Ata
Common Subuation of
and ethmoid bones Cranial Cranial can be deined as a subdivision o the body ormed orme d brain the cranial bones and containing
of the oss o noral unction o process o a o a tissue A
joint disea sease
A chronic condition characterized a space or loss o norma motion The process articular causes bone hypertropy, and new bone in the o the joint the weightoints The most common pathologica eature o this condition is subuxation and resulting oss o space
deydrato The loss o water rom any tissue or rom the
demaet
torac c vertebra toracc articulates with the heads
structure that the ribs
des
projecting rom the body o second cervica vertebra that articulates wth the interior o the anterior arch o the 1[as t acts as a around which the atlas rotates t is aso the odooid process
detate lamet A narrow ibrous band situated on eah side o the cord throughout its entire ength and the anterior ro the posterior nerves The inner border is continuous the mater he outer serrated border is at interva Is to the dura ater The dentate the spinal cord in Synony: denticuate
desated acing water
crumbled
deato A variation ro noral
asses 2 Dislacement o one o the reative to the others When When at rest is no onger with one or more coordinate coordinate system
ds The intervertebra disc
Human Spine and Pevi
ebrato A radiodensity eature on Xray that is a product o o the at the surace o a bone This is aso caled sclerosis and is part o the o the shape and articular is a comon eature o degenerative in an articulation that deines the disc rom The it ro the above and adacent bony corte o the vertebra There are endpates on the and inerior suraces o each body
epdral adeso An adhesion between the vertebral ana wa and the dura ate in the epidural space This can be due to subuation and the a eature o joint disease and mechanical distress t can aso be seen as a resut indng ectious insut or post
spae The outermost spinal cord and inside
the brain and dura ter
eretor is the largest uscular ass o the bac and consists o three iiocotais nd originate on the sarum iliac crests and ascend the and rib cage to the nec and in some cases the su These in turn consist o a series o usces The iliocostais group placed the longissius group is in placeent and the spnalis is edially edial ly The proprioceptive are to the sacroiliac and the o the iim relative relative to ribs and
esopas A uscular colapsibe tube that ies behind the that connects the to the stoach posterior wal esophagus is adhered to the anterior surace o the cervical t is 23 to 25 cm and at the o te passes the the esophageal and portion o the terminates in the stoach t is innervated by aong others the vagus nerve recurrent nerves and the cervica chain
eeso
DJD.
The unolding o a oint so that the two articulated are oved the to head and or spine is canal is shortened
disease
dorsal Relative to or situated on the back oposite o thoracic
dro The dura mater The outer wall o the theca sac
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arm or 2. A distal or termina ortion
Glossar foramen magnum Te
facet
209
in te base of the occiita cania cavit and te cod/bain ste asses
Te noma ocess fo bone fomation 2 Te end stage of te degeneative
of joint patoogy te tota oss space and of wo bones bones
position, and n position. Thee ae te sueio facets at the end of the veteba facet at the infeo end te inferio of the veteba facetal capsule encosues of te veteba coumn on te insde Te with to alteed Theshod
glycoproten A macomoecue that is a cobination of and component of inteveteba disc gravtatonal load The foce by te mass of the on te joits due to gavity Te inceases infeioy of a functiona aspect of a usce spasm ie to potect a Ths is a
connective tssue of te body Fascia is inteconnects a the bod tssues femur Te o bone Its poxima end aticuates with acetabuum of the ipbone
hernaton n
tat contains coagen fibes of vaous combinations in the matix Te fibes n bundes imbedded in a mati Te containng types in te sympyss and at the of tendons and to bone fibrous o composed of dense and inteconnecti inteconnecting ng tissues tissues fium terminale The tead-ike attacment of te conus meduais to te bottom of te theca sac t is and an etension etension the pia mate flexion n te it can efe to fowad ead towads knees Fexion the cana and spina cod two ats move cose etemities foramen togh wic neves o bood A but can pass Usuay found in consist of a combination of tissues
to te human inteveteba inteveteba an nteveteba disc that the otudes otudes outsd e te annuus annuus ad pessue on nevous tissue is Tauma Tauma and othe excessive foces on te disc can esut in a oss o annuus fibosus ntegity ntegity nuceus
hydration o
to combine wit
wate hydraulic
a fluid under pessue, e.g an neveebal dsc A hyauic sytm anss foc an affinty fo wate The nuceus of te inteveteba disc is and ote due to components bone bone that is a of the axial skeeton but does not with any othe bone t s ocated in the neck It suppots between te mandibe and te tongue and povides fo some of its musces and fo musces of te neck and
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20
Alas of Common Sbxaons of he Hman Spne and Pes
hyer khoi The condition o the khotic cue of the thoacic spine haing a greate tha nomal ce hyeroad The loss o noma thee point weight beaing can eslt in all the weight being uppoted b one poin o oint leadig to ecessie loading. This will cause an alteation of the tssue boe ad lgamet to accommodate thi change in weight beag hyeroni An adectie o hpertona condition of muscl and tedon tesion that is significantl geate than normal retig muscle tone It ca be diectl elated noious popioceptie ipt fom the oin dstess, ubluaton. Hertoic musces at rest shod be a neologca indig. t leads to loss o oint sace ad educed atcua ecusio t is a common featue o artritic degeneaton. hyerohy An increase in thickness o sze of an ogan or tsu This suall occs as an adapte esonse to inceased stress o demand on a tise or ogan. hyo kyhoi The condition o the kphotic cure o the thoacic pie hag a lesse than omal ce hyolordoi hyolordoi he ondition of the lordotc ce o the ceca and lua pie haing less tan the noral ce
Q i1iu mule he iliacus oigiates at the iiac osa and base of the sacum and insets with the tedon of the psoas maor at the ese tochanter of the emu Acton is to fle and rotate te thigh lateal, ad it alo lees the etebal col neation is the femoral nee. Popioceptie links are to the sacoilac oit and the pubi smphsis. ilium The ilium is the superior and lagest o te tree oigial bones of the nomate Its speio boder, the iliac crest eds ateriol n the anteior sperio iliac pine Poseriorl, te iiac cest ends i the posteior supeior iliac spie he posterior ieio iliac spine is ut ineior to it The spnes see as points o attachmet or the abdomial wal ad erector sinae msclature Inerio the posteror ineio iiac sine is the geater scatic notch The interal sace o the ilium see rom the medial side is the ilac ossa, a concait where the ilacs mscle attaches. Posterior to this fossa is the iliac tubersit, a point of
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attachment fo the sacoiliac ligament and the auicua sace, which aticlates with te sacu to o the acoiliac oint. imbbiion The low o absopto o o id though o into a tissue Osmotic pessue or the pumping actio o motion ae the most common echanism o imbibition. inferor Lowe in place o position, anatomical lose to the eet. inferor ailar fae facet infammaion The protectie eacto of tssues to al orms of in and ritation t is a neoloica esponse inoling ascla chages haracteried b heat ednes, sweling, ain, and loss o fnction nnomnae The ip bon n earl lie it i te bone, the ilim ischium and pbis The thee ones fse as the idiidual eace adoescence neroal Between the ris. nerinou ligamen Thin almost memane like lgaments that onnect spinos pocesses with ies unn antersupeol fom the ape of the sino pocess beow towad the oot o the spno proces aboe. The are embedded with popoceptos and othe nere stctues. ineeebral di he thick, fibos, aasca pad between he etebae. Composed o a nuces pposus (ceter) ad an anuus fibrou (ote 'al t is agl composed of water and theefoe a hdauic sstem and it tamit foce to the etebal bod. t s theefoe not a ock aborer bt allow a flebe ertebra colum ths is essential to snal cod asca function) ineeebral foramen Openings that are along the latea bode o he itererteba canal. The are ormed anteiol b the inteertebal disc the lowe otio o the erteba bod aoe, and the per otion o the ertebal bod below posteriorl b the posterio zgapohseal oint and ligamentum lam and superiol and neorl b the a erteba pedcle. he spinal nee oots and ascla componets of the spial column pass thrgh these openings. inrahel nsde he thecal sac o the suarachnoid space, between he arachnoid ater and the a ate inraheal adheio A adhesion between the aachnoid mate and pia mate hs s a podct of iammation and wl caue an 1teruption of nomal thecal and sinal cord dnamics o
loa motion It can ao fuid fuid acar tructur.
t fow of
and
sa
apct of t icium and innoinat t point of contact in t of t acrotubou ligamnt, fori mitndinou and fmoi mucl
sm
infrior an of t tr bon tat mak up t innoinat It contain an cial pin a r ciatc notc bow t and n icia iciu a ram wic oin wit pubi and t form t obturator foramn
IVD I V.F
ntvrtbral dc Intrrtbra foran
yposs
xci otion in crtain It i mbddd wit propriocptor and otr nrv tructur o of (ubuation) initat initat lgametm lam
ow atc tiu attacd to and tndng tndng btwn t vntral potion f t amna btwn t rtbra. clo t pac btwn t rtbral arc t pnal cana.
lordoss
to a ordotic c
lordot re
A noral arctctural fatu of t uan vrtbra colun in t crvical and umbar rgion_ t i t angl formd in drawn from t and t infior t cur cur nrou tm
lmar
to t owr btwn t toa and t tbra
to a kpotic cur.
lmar re
A norma arcitctural fatu of t uan vrtba coumn in t toracic and acra It i caractizd b t t ntra or antrio Altration of kotic crv cang t ap of t cntr nrvou t and otr aocatd ti.
lmosaral
kypot re
ama
n t it i a itr id tat unit pinou proc tbra arc. t
t ucuatur of t owr toracic and lubar wit wal t acm iliac crt and toracoumba fcia. muc A
lametmzed
rmoval of t amia or arc of on or mor rtbra ordr to xpo t nura mnt of t cod
lary
tat oc box t i a ort connct t panx wit t i in t midlin of t nck antrior to t fourt it crvca rtbra C4C6
An
lateral leo
A flxion to itr id
lateralstess
A dpacmnt latral to normal
gamet
fibrou conncti tiu oning two or or otr tructu uua to
docation of an articuation
resoae magg
tat u radio wav fid to t inid of oft tiu contat witout bon r ao cnt of t watr contnt and condition of t intrtbra dic madle
owr
ateral
On t id Oppoit of dia.
of t pin Uual
An ntial arcitctura fatur of t uan n t of t of t pin rult umbar nrou t dformation and patoogy umba curv lordotc or t t vntral o conv id of t cur antrior urfac
lxato
2
margal steopytes
A orizontal bon xtnio of t rtbral t t rpon of t bod to a of t ntrtbral dic ua a a ult trauma i ofication ro to t du to altd
mastato
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22
Aas of Common Sblxaons of he Hman Spne and Pes
mastoid roess Th ostio latal ojctio of th toal bo iio to th xtal auditoy matus This is th oigin of th occipitalis ad dgastic uscls ad nstio o stoclidostoid spis capiis and longissimus caitis mscls medal Na th midlin of th body medullary bone h maow at of bon, occupyg sac withi th cot of a bon meningea Pining o h nings meninges Th suotiv ad closg tisss o th ctal nvos systm; th dua mat th aachoid ad th pa mat ad oth stuctus hy otct ad at oton to th ctal ous systm midsagital vtical la at th midli that divids t body ito lft and ight otios militay nek oss of th cvical cuv It is a staightnig ath than a vsa MR
Magtic soac iagng myeloathy h athological coditio of th sial cod o nvous tissus suall casd by lat stags of dgativ joit o �sss Ths changs to th snal cod odc signs ad symptoms of cod dysfnctio.
nerosis/neroti h dath of a cl o go of clls comisig a tissu o tissus as a sult of inj o disas nee root Th bundls of v fibs that ais fo th sinal cod jo togth as a nv oot Ths budls a aid and a th dosal ad vta v oots h oos cobin fo th sinal v nerve rootets Hai-li fibs xtdig fom th sial cod Thy covg atally ad gat ito a fib ad oot neuron v cll whch has a cll body ddits ad a xo. neutral osition Noal aatoical position; th body is ct ad facig obsv ams hanging at th sids
neurovasular bundle bnd of vs and blood vssls that both invat and spl blood to a gion o tissu non marginal osteohytes n ostohyt foming o th vtbal bod ot at th dpat. This ossificatio ocss is a sos to stss d to altd achitct nuleus ulosus Th glcotin hydohilic ct of th itvtbal sc t is a hydodnamic stuctu that has a gat flid cotnt tha th st of th disc ad sists comssion
© osmot h ss that dvos wh two solutions of difft concntatios a saatd by a mabl mba ossifiation Fomation of o covsion into bo oseoarhriis ogssiv joit disod involving dtoatio of th aticula stcts sally du to tauma ad loss of omal jont tgity Th nologcal spons to th atd joit mchanics is mscl guading iflammatio dcd joint sac catilag oson ad icasd bo fomation in th sbchodal gios gios This coditio coditio chgs t sha a fuctio of th joit and can b dscibd as dgativ ont disas This codition can occ as a st of th pathogsis of subluation osteohyte pojction o otgowth of bon a bon spu Th iss attachig o isting into bon can b nd mchaical distss causig its calcfcatio and fomig th otgowth osteooross bon dsod chaactizd b> dcasd dsity of nomall minalid bon sultng i bo faglit Causs of ostoosis a ostmoas dss dit chonic ilnss ad doc abomalts
- arasagital tical l that dos not ass though th idln ad that divids th body o ogas ito qal lft and ght otions ara sinal hyte Ossificatio of th soft tiss stcts tht suod th vtbal body Tis ossificatio ocss is a sos to stss d to altd achitct. arsthesi conditio of altd ssato
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-213 la
e o he bo roesses oseiorl rom he bod o oe wih he lmi o eiher sie These sruures ssis i weigh o he es
rermos sure o he ilium proproepto
The
rdle
hree boe hee joi h he weighberig d musulr o he ruk d lower exremiies he lower bdoml viser wo oie boes h wh he srum smhsis he emurs e o orm he hi A mor mor orio o he musle mss rses rom he Disorio o he subluxio resoses o he musles wil iiie orgs
sesors mos o whih e i d issues. proproepte relex
A uomi resose o musle eo iiie b simuli h rise rom oi isress. The relex mehism sel is meied meied b ere simulio o moor eur�s o ivolved musulure. musulure. Se here is dire oeio he sil or evel wh o moor euro is This ours i ord lesio viims below he lesio s o he reexes sdrd
sear
protrso
A o-hsiologi isleme o he iomies relive o eh oher i he Y d/or Z ligme iur he sroil jois d he ours i ubis
o he I he ierveebrl dis uleus ulosus he o he ulus ulus ibrosus ours i ll direios direios roud he erimeer o he s
psedo-jot
paryx
A lse lse o o is ormed where wo boes o o eh oher whe shold be r. Como i o he sie. The os ommo ourree he is he resses i he lumbr
The hro This is rego sl vi orl d erior hed o he
pa mater
The ier membre o he he s ivess or overs he ord d roos o d or mrix he mer o he shes he or I is d hoi mer vi he dee oher sruures.
PL
PSIS
The
ili
psoas major
Poserior logudil ligme
pos
bove he The r o erl ervous medull erior o he oes he o wih he bri o he bri wih eh oher The o he ibers o he os moor d sesor rs h oe he sil ord r meull wih he ue r o he bri sem
posteror
erve edos
bk o dorsl sues o he bod
The sos origies he rsverse roesses o he lumbr verebre isers he lesser roher o he emur The io lexes roes he d lso exes he verebrl olum erved he lumbr erves 2L3 I hs liks o he sroili jois he lumbr erve roos exi he sos he lumbr lexus bell edos o he musle The hes o he dihrgm d erio
pb body
The medl orio o he side wih he he ubis sympyss
impr ession ion
A omil eue o he ierveebrl ds he idee sure o l o he gve
The ubis
posteror lotdl
h rus o he oserior The sures o he verebrl boies I eeds rom he xis ow he eire o he verebrl olum. I wides he verebl o reiore he ierverebl iss l overs he erior sure o he
ereor gos.
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boe. Eh dis lled d
24
Aas of Common Sblxaons of he Hman Spne and Pes
rus abdomnus The rcts bdomius orgites t th pbic crst d pubis symphysis d isrts t th crtig of th fifth to svth ribs d the xipoid procs t ctio to coprs the bdoe d fx the erebr com ervtio frm the brche of tocic v T7-T2 Propriocepte iertio is been pubic bo d ower rib cg Uiterl or b trl rectus bdomius spig c be ig of pubs symphysis subx subxtio tio rumbnt position Th body poitio of yig dow o horion srfce rtro Abbevit Ab bevition ion for retristhei retristhei.. rtrolisthsis Ay posteior dspcemet of vertebr retio to the oe beow t csng stres nd pobbe terig of the us fibrosus nd cus pupous Ao the terd bomechic d oss of nom moio esutng fro retroithi is the tioogy of most degenertie or rthritic cges to the disc vertebr body fct nd other socitd socitd tissus rtropulsion Th pocss of being pushed poteriory Ths usy dscrbes vtebr body frct d fer to fgmts tht hv movd bck ito th spin c rib e of the bon tht form the otr keeto of the thox The twv pirs of rb form te rib cge The rib rticulte wit oe of the twee thorcic vertbre t te tvse proces d with oe o two of the vertebr vertebr bodis Th terior ed i i ttched ttched t secton of crtge oied to the term he frt sv pir th tre ri b, r coectd dircty to the tm by thir cot crtigs Th ext thre pis the fse bs r ttched idirect to the term Ech is connected by its crtilg to the rib bove t. Th st two pirs the fotng bs d frey i the mces of the terio body w roots Nerve ootet rotation The movment rud xi. ne of the piry motios i physics The uit of mesueent i usuy i degrees
saral Th wig-k pojectios eoig fom th trsrse prcsss of S Thy for prt of th sc bs d th tr edgs fom prt of the croiic oit saral apx The iferior pct of th scrum tcutig with the speror potio of the coccyx saral bs The supeior spect of th scr rticutg with te iferior portio of 5 d tery with iomites saral disc Th dic betwee scr segmets As the cum ge it begis to fse becomig for prctic purposes ig b fexibe bo Whe thee bones S-S5 rticte th itecr discs min i p d ct t the sme the interverteb discs of t othr vrtbr Th cortex of the crum s contigos bt this mt b flexbe strcte Physioogic fctio of itrcr dc cessitte motion the on mchnism of trto d wst eimti � T scr dcs do wht the ierertebr discs do: confer fxbity Th is oy o chnm fo fid nd ntt exchge fo te intervertebr dc nd tht is mbbtio troug moto Tis must so b tre fo sc dsc physoogy d funo solia joint The pired tictions betwe the sm d th ic bo i th pv. Th two ont compexs e difft i ch idiid Som of the fctos e the sie of the ont sie of ech potion shp of ch poio d oriention of ech portio to ech othe Ts fctors cod xpn the diffrt espos to t sm treten with te me digoi saoilia ligamnt (antrior and posrior) Aterio This igmen i contigos with peotem of iium d scrum This is on of t tructures ivoved with S ont iuis stning pri wth eithe physioogc o on-phyioogic subuxtion Poterio This igmn is contigos wt d ttched t th mbocr fci from boe d the medi ttchmnt of the gts mximu mximu msc from bow t coect te scrm nd the iim bhind d fom the cief conectio betwee the bons sarospinous ligamnt Te gt fo th t I dge of the scm to the spie of the iscium Tis gmet ong wit the scotberos igm
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Glossa 2 5 is
oe alied in the aial lane to the eslting in deoation noles neos oint sle and neos tisse sttes esides the eteae.
ili teosit saoteos oes the oad
joint Saoilia
sacrotuberous
sinuvertebral
o the he ligaent o the lateal sa t the ihial o the ith the saoteos an e tendon tendon o o the ies Uniateal o the ligaent an otate and o the sa eteen the ili a ontalateal and iitation to old e a ato in a he saoteos ith the one otion to the sa the leg.
A sall o ateial o the eteal ate that entes the inteeteal oaen t slies lood to the theal sa and sinal od Loss o lodot e and slation o neos eial eteae an ase tanslation o the theal sa and nee oots into the anteio all o the sinal anal and the inteeteal oaen sineteal sineteal ate old ase
soft tissue
he non osseos tisse o the inlding inteeteal diss, nees asla sttes onnetie and ligaents
socrum
he sa is a tiangla one oed the sion o saal eteae It laeall ith the nnonates seiol ith L5 and he sa is ie seaate ith the hild and 5 ae sed oses a o a one
spasm
nola slat ontation It an e de to senso nee entae o ental neos all o hih an de to slaton.
sagita
A etial lane that diides the his is the let and the oodinate sste
canal
1
Schmorl's node
An
In the inease inease in densit densit o an aea aea sall in oial one in the o an atilation atilation his an ineased hite on Xa and assoiated ith hanges o o an esonse to ineased stess on a o a n sleosis is hadening o thikening o a tisse o ogan sall an inease in is tisse Anohe te o a eteae in the ontet o the eteal oln. o a lage o stte 2. A
A ontinos hannel thogh the eteal oln. anteio all is oed the osteio saes the eteal odies and inteetea diss and the longitdinal ligaent he osteio all is oed the eteal eteal and the lainae the inteeteal Canal lein ineases 5-7 the length oe etension and and otation eate a onaeone oation o the lateal saes o the ae aeted the o oste the sinal oln. anatoi elationshi ith the od and adae the lo deteine the enta neos the of the eial sine s a that aets the entie length o the anal, ain ste and nee oots spondylolithesis
e ateio o a etea in eation to the loe etea etea Usall assoia ted ith a ea k o ate o the eleents o a eteae.
spondylosis
One o the
tes sed to indiate hanges o oth the dis and the oints o the sine is a o osteoathitis and naong o oth the dis sae and the
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6
Atas of Common Subuxations of the Human Spine and Pevis as well as the presence of The most common etology s
seru The breastbone It s ocated n the medan ne of the aneror chest wal and measures about 15 cm n length The sternum conssts of manubrum the three basc the medal and the phod process The anubrum artculates wth the medal or proxal ends of the clavcles as well as the frst and second rbs The body o ndrectly wth the artculates second tenth rhs va the costa the phod process pont for the rectus nd transversus abdomnus muscles
sa cou The spna column incudes the al the tssues of the vertebral and cord.
sa cor The ower part of the centra nervous system nsde n the vertebra vertebra coumn t as a contnuaton of the medulla oblongata at the nferor part of the bran stem and extends from the foramen magnum of the bone to end at the nerve cels and al parts of the to the bran cord t shape wth the cana and shape of can ncrease n The rom ful extenso extenson n to and cord Wth the dentate the edges together, left and ncrease the coronal and The anteror to posteror dameter makng the cord appear oval on cord axa vew Pa mater nvests the wth roots nto the cord matr subarachnod space s the CSF fed space of the spnal between the cord and the sac covered wth the achnod mater
subaracho ahesos An adheson arachnod and adhesons
subaracho The
the arachnod and pa cerebrospnal Oblteraton of seen n ord taen n the supne of etra nervous syste tetherng and oss of space due to fbrous adhesons or stenoss s and reate to seere consdered
subura sace Theoretcal or space between the dura mate and arachnod mater t ooks and acts le a hence the te theca adhered of tssue are These two
sa aar A process
subuxato oss of jont descrbes an
and ntegrty Ths to the ont stctu res suc ont supportng and fasca IS the most common etology of osteoarthrts and s characterze mmoblaton nfammaton pan and musce spasms
caa part of a vetebra that posterory from the a lever arm or ntroducton of moton by attachng muscle groups
surr or lp on or near the An artcuar margn of a bone Vertebra spus are are al dsc anteror and lateraL
sueror Stuated above or towards the the body or of
part of
acuar acet facet
sue The
of the upwards
when on the back
syathetc cha ong nerve on each sde of the vertebral coumn the base the skull to te coccyx t s the extravertebral extra vertebral of part of the centra nerous syste the autonoc nervous system
n a or narrowng of an openng or passage such as the spnal can be congental or acqured t s a common fndng wth chronc subuaton wth nvoved segments
syathetc evous
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One of the tw autonomc nerous system of preganglonc neurons n the lateral couns of the thoracc segment and
two
Gossar o lumb gmn o pin od I onnd i po noling o ngy Pbl gngli pin n oo bn obd o b dy dy d oni po o olun olun
y uoundd by nd d og Diupion o noml u nd limid mul ng o moion ldig g g i lod o bom oni IS
endonendinous nion o mu iu om d bou od o bnd i i o bon Mu onion on ndon i mo bon i nd o uu eheed od syndome A oion o ign nd o n nou ym di om oni o nu n in b oumn Cizd by nion o od ino nio nl l pny o no pinl y y Alo Al o non ilum minl o od ion heaheal T o l o p o du m nd noid m hoai o pin o oi TT2 hoai uve An ni u u u u o umn in o oi pin nou ym domion nd oi u i o on id o u i n hoaoluma fasia A bod iu pin bdomin mul nd do I onn o o umb um nd ili hoax T ht; th thoa n age eaing ig bing ym in b oumn i bd on ig diibud bn body o b nd o ym o
-
217
in bl oumn om C2 o poin dynmi o iu nd ld o ooi See l aeula T inn o mduly bon li lik onuion ld bul bon 2 bu o noid di ibou d onning inn u o nod o m ahea I i ubul o i i i nio o aioned e.g .g ) od o pin oumn ansvese adominus n bdominu oigin ii lumb nd ilg ilg o i ib nd in lin lb nd ypoid ion i o in ll ion oion o un Innion i om bn o oi n I i nd ind o oii ympyi nd o ib ansvese poesses bony b min o pniu n nd o mul ohane R o g on o mu bony poubn proj om bo nd l o n o mu T guu m piiomi obuo upio upio nd inio in g o
uogenial T gion o oo bo ympyi bound by pubi nd iil uoii nd onining d uu
vasula mny blood ining o o vasoonsiion A nuoogily mdid d in i o lumn o bood ud oion o moo mul n l o
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28
Subluxations of the
Atlas
enta
and Pelvis vsea
to the ateo of dor&al
font side of the
s a banch of the subclavan atey, t the cevcal cod and canal suces. It ees lowe ad the foamen n the sxth evcal veteba and ascends though he foamna n the tansvese pocesses o all the vetebae above ths t passes though the eneah the posteo posteo the du occptoatlanal mate and aachnod etes he skul thogh the foamen anum eteba na S snal canal eeba oumn The fleble colmn of the aal skeleton
Copyrighted Material
a ollecte tem o
n whch one pat o he and foced o then suddenl n
to he aa! and posteo o he S face
Reference
2 9
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224 -
of Coon Sbxatons of the Han Spne and Pevs
VernonRober VernonRobers s Pre C J Canges n e I nerv nerver erebra ebra Dscs o e Lumbar Sne and er Rheumatlgy ad Rehabiitat 1 1 6121 Veemng Soecka R C Descron o e Func on o e Lower Sne C nca naomca naomca and Bomecanca roac A Lecture delvered at the th Aual
Meetig Meetig the Ameri A merica ca Aciat Aciat Forda Medce 1 994 Orando Forda R Vokers Vokers C W Veemng Snjders C J Reaon Beween Form and Funcon n e Sac roac Jon Pa I Cnca 1 99 0 0 2 1 0 1 1 2 naomca Vokers C W. Veemng Soecka Soeckar r Snjders Snjders C. J Reaon Beween Beween Form Form and Funcon n e Sacroac Jon Par I 0 2 1 1 1 5 Bomecanca Spe 1 9 9 0 Veemng Van Van Wngerden J P Sn jders jders C Soecka R caon o e , Load caon Sacrouberous In uences on Sacroac Sacroac 1 Jon Mecancs 4204 209 Voger J B. W. C , Genan e N orma Sacroac Sacroac Jo n C Sud o Pati Pa tie e n t s, 1 984 984 1 51 4 4 Vousnas S Macwen G D Saga Proes o e Sne Clcal Clcal ad Related Reearch 1 98 6 2 1
Bo
Nerves Sen e Veebra rer and er Cnca 1 988 988 121 60164 60164
Yabuk S & Kkuc S Nerve Roo nraon and Smac Bock n xermena o nraradcuar Bood Fow Spe 1 20901906
Yamada D Sanders, Paosoog o "eered Cord ual Neururger Neururger 1 9 8 1 J M IBo Yamasa Gece T V Mecano sensve eren eren Uns n e umbar Face Jon The ual Be 1 990 6865-8 6865-80 0 ad t t V M Seer Yu S Inerverebra nuus Fbrosus Fbrosus n Radlg 1
M
Zagra C Pace Baarn Zerb Zerb , jeo F Maarea Per G Poseror Sna Fuson n Scooss: omogra and Bomecancs 1 98 8 8 2 1 5 5 5 1 6 1
Waanabe R Parke W w. Vascuar Vascuar and Neu ra Paoog o Lu mbosacra ual Neururger 1 9 8 6
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Index
INDEX ® Abdomna 91 obque musces musces 1 9 9 t sses sses n ng 0 Absolute moton 3 se also Goba moton Acet Acetabuum abuum 0 9 Adaptve response 90 Adhesns
i n t ra ra th th ec ec a 1 4 1 ogtudna 0 9 3 1 0 3 0 5 3 3 J
Annuar Anns fbosus Anteror ongtudna gaent ALL
Artcuat Artcuato o A utonomc nevous system system Avascuar 5 brocartiagous n trasaca 1 9 0 structes Aa 0 1 1 9 1 94 1 9 seeton Aa oading oading 9
Bra Bra n ste ste 3 3 3
1 subuatons o the umbar s p p ne ne 3 sub uxaton ack o and OJO, 3 sacrum sacrum 4 vew of of norma pevs 93 positon positon 1 95 Xray Xray in Arachnod mater mater 4
34 oss ervicogenc 3 hronc naaton ubar subuaton 3 posteror spasm the cause some 3
occy 5
1 1 3 1 4 4 1 4 9
03 9 ostover ostovertte bra 9 anatoy and and nutrent
AP (Anteror to 0
5 5 5 9 1 S joint 1
vertebra artes artes an coordna te syste syste 9 audae equnae 9 1 av av t t a tt on o n 4 5 0 1 3 1 4 4 1 44 44 5 5 5 5 9 9 1 1 5 3 entra nervous syste e N.S 3 3 , 4
Copyrighted Material
225
u u d ervca cuve
aced 0 s /s L d sc sc s s 5 0 9 PLL 0 0 lso PLL ac ca ca ton 0 3 3 L L oss oss o d sc sc height and 0 T racture T to 03 T 9 9 0 a n d T O 0 T I 1 0
-
rana oss secton n a dva nced 9 of umbar o sa sa cr cr u m 1 9 urve se cervca ordotc umbar thoracc
1
o Common Subuation o the Human
and Pevi
© Facet 2 atered
1 0 0 1 2 0 77 60
2
17 1) 180 1 91
t pe dsc dsc 8 6
nferor
of of sacrm 1 45 83 1 22 patterns ca ses sbl.xation 54 1 DJD Degenerative jont d sease 1 8 2 2 Dehydraton 0 1 , 1 7 1 203
80 thoracc Hydration 14 oss ow 8 6 poor 8 9 (mbbton) vertebra end 18 Hydrac fncton nterpton, 1 7 20 syste
superor ncoupng wegt bear ng 3 4 1 2
Fbros 1 8 3 Dentate gaent 4 5 7 26 Desscated Dsc 7 1
Gycoproten 1 1 8
19 3 6 6 1 7 1 8 1 9 4 3 ,
crana 7 Dorsa spna artery 4 Dr a a ter ter 2 4 5 20 22
9 1 24 24 1 5 2 2 1 5 6 6 6 77
59-64 21 177
19 1 92 feon/etenson 7 87 00 atera 7 9 1 2 00 Foraen agn 6 37 56 Foramen 4 6 7 ntervertebra 24 1 7 42 C 5 ad C6 60 C6-7 fse wt C7 65 C 6 7 7 4 3 10 cervca
79 ypertropy of ALL
8
3 4 62 1 1 7 uncate process 24 ypokyphoc 1 9 ypoordotc 2 8
2
- C 93 Iacs msce 1 1 191 1 1 96 8
Etenson 3 7 25 hp 92
theca sac 3 7 pper
S2S3 4 a d sed b y age
8
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8
19 20 ntercosta a rtery rtery 78 79 nerve nerovascar nerovascar bndes, ven 78 1 9 3 4 4 4 9
Index 119 teeteb teeteb dis Iteetb ome see IV 203 1 ts 101 tthe 1 4 , shi tbeosties 1 94 9 1 9 3 Ishim 1 7 9 6 LVE teteb
Pei
1 180-1 1 9 1 1 93 9 3 1 94 94 1 9 9 9 20 1 2 0 3
esoe imgig M 107
227
P
1 9 9 2 4 8 1 , 24 24
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