 Hello, good day everybody. This is Dr. Sanjay Sanyal, Professor, Department Chair. This time I'm going to demonstrate a few clinical coalitions pertaining to the cervical vertebral column and the lumbar vertebral column. So what you see in front of you is the articulated vertebral column. Up here we have the cervical region. The seven cervical vertebrae are there and you can see the cervical spinal lobes are coming out and you can also see the vertebral artery going through the transverse foremen on both the sides. So this is the cervical region. We shall mention a few clinical coalitions pertaining to the cervical region because of its extreme mobility. Down below we have the thoracic region. You can see the thoracic myl thoracic kyphosis which is normal and you can see the thoracic spinal lobes emerging through the intervertebral foremen. And further lower down this is the lumbar region. You can see the slight lumbar lobes which also is normal and you can see the lumbar spinal lobes emerging with the intervertebral discs in between each vertebrae. We shall mention the clinical coalitions pertaining to the lumbar region also because this is the weight-bearing region and it also has got a considerable mobility. So therefore we shall focus on some few salient clinical coalitions pertaining to the cervical vertebral column and the lumbar vertebral column. So let's start with the cervical region. Suppose a person gets a severe flexion injury of the cervical spine. We can get what are known as stages of flexion injuries. Stage 1, 2, 3, 4. Flexion injury means when the cervical vertebra bends forward. In stage 1 we have rupture of the ligaments especially the interspinus ligament and the intertransverse ligaments and maybe partial ligament and flavor. Stage 2 is associated with up to 25% translation of the cervical vertebral body one above the other. Translation means about 25% of the width of the vertebral body moves forward on top of the vertebra below. That is called translation. So stage 2 is up to 25% translation. Of course it will be associated with the ligament tense. There will also be bulging of the nucleus pulposis. Stage 3 is up to 50% translation. That means 50% of the width of the vertebral body has moved forward in relation to the vertebral body below. And stage 4 is up to 100% translation. That means the whole vertebral body has moved completely away from the vertebra below and it is also associated with face it jumping. So these are the stages of cervical flexion spine injury. This is a lateral x-ray of a cervical spine for patient with stage 3 flexion injury of the cervical spine. If you take a close look at the x-ray you will find that the C5 cervical vertebra has translated approximately 33% over C6. So this is the stage 3 cervical flexion spine injury. Then we can have herniation of the nucleus pulposis. The one which was traditionally referred to as prolapse of intervertebral disc. We usually get herniation of the nucleus pulposis in the lower cervical region. Classically it occurs at the junction between a mobile part of the vertebral column and the fixed part of the vertebral column. And this also happens when there is a flexion injury. The herniation of the nucleus pulposis is usually posterior lateral which I shall demonstrate in the lumbar region but it can also occur in the cervical region. Excessive cervical manipulation, especially chiropractic manipulation has been documented to produce dissection aneurysm of the vertebral artery. Which you can see running through the transverse foremen and this dissection aneurysm can produce posterior cerebral stroke. If we have extension injury of the cervical spine then we can get tear of the ligaments, anterior longitudinal ligament and we can also have injury to the spinous processes and the lamina of the cervical vertebra. If we have extension of the head and neck and then flexion that is called whiplash injury. Then we can get what is known as a central cord syndrome where there will be sacral sparing. Now let us come down to the lumbar region. The lumbar region is also a weight-wearing region so therefore it is known to regenerative osteoarthritis, wear and tear, osteopenia, osteoporosis. Apart from that we can get what is known as spondylolisthesis. What exactly is spondylolisthesis? A degenerative break of the parts inter-articularis between the superior and inferior articular facials. Then we get what is known as slipping of the L5 vertebra on S1 and that is called spondylolisthesis. For this to occur there has to be bilateral spondylolisthesis, lumbar L5 that means both sides the parts inter-articularis of L5 should be degenerated and broken which will allow the whole lumbar vertebra to move forward on the S1 that is called lumbar spondylolisthesis. We can also have herniation of the nucleus pulposus and you can see here in this model they have given us a representation of the herniation of the nucleus pulposus. This herniation also typically occurs in the posterior lateral region and it also compresses the emerging spinal nerve. The rule of thumb to be remembered is the herniating nucleus pulposus whether it is in the cervical region or in the lumbar region it compresses the nerve of the higher numerical value which means that if there is a herniation of the nucleus pulposus as shown here between L4 and L5 vertebra it will compress the L5 spinal nerve. Similarly if there is a herniation of the nucleus pulposus let's say between C6 and C7 it will compress the C7 spinal nerve. So that is about the herniation of nucleus pulposus. Apart from that as I have already mentioned the lumbar vertebra is highly prone to degenerative wear and tear and also produces osteophytes which can produce lumbar stenosis which can be accurately diagnosed by myelogram or MRI and when we have a patient from lumbar stenosis one of the extreme forms of treatment will be to do laminate tibene or pedical transaction in order to relieve the compression of the spinal cord in the spinal nerves. So these are some salient points about the clinical collisions pertaining to the cervical region and the lumbar region. Thank you very much for watching. This is Dr. Sanjay Sanyal signing off. If you have any questions or comments please put them in the comment section below. Have a nice day.