Spinal Cord & Nervous System Illustrations from
The Netter Collection of Medical Illustrations
COMPLETE VIDEO TRANSCRIPT
In this video, spine surgeon, Dr. Irvin Sahni, discusses spinal cord – nervous system illustrations to help patients understand how the body works as well as treatment options for back pain/injuries, including pain management, injections, and minimally invasive spine surgery to name just a few. Spine Center of Texas operates in New Braunfels, Seguin, and San Antonio.
Dr. Sahni: 00:00 Alright guys, I thought I would just real quickly do a facebook live for one reason because I didn’t get to do one last week, took the entire office to Las Vegas for a team building and a conference and so I didn’t do a facebook live so figured I would do in real quick. This is not her. And if you watched one of my previous videos you got to see. I use, I actually showed some illustrations from netter that were from the book I use in medical school back in 1992. And exactly that book is actually in pretty good shape anyway. This is a newer, well I don’t know how much new work because the guy died a long, long time ago because republished or whatever should we worked a better. But this is a specialty med or this netter covers the nervous system specifically, whereas the other net or covers the whole body and other netter was really good.
Dr. Sahni: 00:49 Um, but uh, this one specifically covers nervous system and there’s frank. I don’t know if you guys get to see that other. This one’s a little, uh, a little more conservative. The other was hilarious. He’s like kicking back with a cigar. I love that picture of her book for sure. That again, sometimes. Anyway, this one goes through and really talks about the anatomy and detail. So I’m excited to be able to share this anatomy with you. A lot of people really seem to enjoy when I share these details with them. Um, you know, it’s always sometimes easier for some people to understand what the more detail that you have. I realize some of this, this is, this is um, cranial orders and sinuses and the parts of the brain. So I am an orthopedic spine surgeon, although I knew my head and neck anatomy quite well in stone over very well because I have to dissect the pupil’s next in order to get their neck surgery.
Dr. Sahni: 01:40 But it has the very excellent illustrations of the spinal tracks and the cranial nerves. And so those, those are, we can even talk about something like bell’s palsy sometime or maybe some sort of more central nervous issue with. This also contains a commercial grower in the spinal cord. And here’s that picture very similar to that other picture that we was looked at, showing the spinal nerves is an exit between the lateral masses and even show some of the muscles that are being innovated. Again, I’m just kind of showing it really. This is showcasing off netters amazing. This is an MD who lived many years ago. I think he probably died. I don’t remember. I’d have to go back and look, but you know, he’s in the middle of last century and he was incredibly talented and could draw any in, in topical part. And of course he had to do this from looking at the drawings are actual cadavers. But uh, he is considered the Picasso for sure, of these anatomical drawings and it’s really cool because he’ll go through and break down just the vascular system like he’s doing here, showing the vertebral artery going up to the brain or he’ll show this amazing view of the vascularity of the spinal cord itself and how the nerve roots actually connect to the spinal cord.
Dr. Sahni: 03:19 Here’s some vagueness system in the bone show where the veins are, how they ran their in the epidural space there surrounding the spinal cord. We run into these a lot when we’re operating. This is really what causes most surgeries to really bleed. You’ve got to try to do your best to control that bleeding. This is showing the spinal thalamic tract, which are really, you know, this is really interesting. Alamic. There’s all kinds of different tracks that are motor tracks that are sensory tracks that are trucks that I’m perceived, pain, perceived vibration, etc. Can even talk about that sometimes if people really want to. That’s really getting into the weeds that kind of like making your neurologist or a neurosurgeon and our sponsors and I suppose Completely unnecessary, but very interesting to see how these tracks crossing called decky station where they actually go for one side of the spinal cord, the other.
Dr. Sahni: 04:10 So having an injury to one side of the brain can actually effect, depending on the track, the opposite side of the body or the same side of the body, depending on specifically what track we’re talking about. And we could see these tracks here. It’s got a cool the way he drew the fingers in a face on the surface of the brain, kind of a brain map, if you will. There’s one you can read. there are some brain mapping, if you will. Another example of some brain mapping. Anyway, manner was amazing. And um, this will be probably from now on my go to book if I want to show you guys something. Um, and so here we have the poster. This is showing the gangland I’ve never really broken down the nerve roots for you, but they really aren’t just as simple as a nerve trunk, single electrical cable coming off a larger electrical cable.
Dr. Sahni: 04:55 It’s actually a lot more complicated than that. And there’s something called the poster. It gangling there’s an anterior root of the, uh, of the nerve root, etc. Anyway, but we can talk about that one portion containers in my rack, signs warning contains the century axons, etc. And Then of course reflex arcs also pass through at those levels. And then you know, that’s where you get your reflex is when the doctor picture knee with a hammer. We could always talk about that sometime if you want, um, goes through and really talks about the levels. Like if someone were to have a, a injury at say I believe christopher, he was c three, four or four or five, I think he was three, four, I can’t remember. I’d have to go back, but it’s very high. So it shows you all the downstream effects. And so for instance, you had a um, like for instance in a patient who is born with a defective spinal cord, people call it, some people call it spinal bifida.
Dr. Sahni: 05:50 Um, that’s not completely accurate but, but anyway, yes, they have a defective spinal cord. They’ll often have a level down in the lumbar spine, l three or four. So everything below that level would be effective. And that’s kinda what this is helping you understand, is what are the levels, what did they contribute in, what will be affected downstream from a lesion that occurs at a specific level, say l three, four, or [inaudible]. And this is a nice map showing the dermatomes. So this is just the century on the surface of the skin. We often, you know, the things that doctors memorized is that t four is the nipples and the 10 is the belly button. And so someone, if when you’re, when you’re basically taking a little, I’m a needle if you will, you not standard number two, you’re saying, do you feel this? Do you feel this when you’re trying to determine the level, this is how you estimate that level.
Dr. Sahni: 06:38 You would know that if you the patient, oh yeah, no, I can’t feel anything you know, six inches or eight inches below my nipple. You would know that that level they have is somewhere between t four and t 10. Probably something along the lines of c seven. But that’s how you would help us map that out. And this is just for century, these are sensory dermatomes. These are also the ones that would be effective, say if you have a c, six pensioner or you might feel that numbness in that area. This is why I [inaudible] affects the thumb and the fingers, [inaudible] and fixed effects the middle finger. And so, um, you know, and in sciatica, s one goes down the back of the leg and l five tends to go down the side of the leg and this is what’s felt, the numbness or tingling or the pain is felt in that dermatomal distribution because you’re pinching a specific. But all I’m doing really here, it’s just going through and showing you the amazing artistry. Uh, frank netter who is just, you know, nobody even knows you exIst. If the guy was truly amazing. Here’s show this. He drew this example of a tumor. This is probably a neuroma. Yeah, it is an early. I’m a, um, and so,
Speaker 2: 07:44 uh,
Dr. Sahni: 07:47 that is a tumor that has basically grown around the nerve sheath and it’s expanding. And so as you can see here, it’s showing compression of the spinal cord. So this is all tumor right up to here. that’s the spinal cord sort of being shifted over to the opposing side and this is all tumor right here. So anyway, and this is showing it when it gets, when they open up the dura, you actually have to cut through the door. normally we try not to invade the dura, but in some cases you actually have to go through the dirt to get a tumor out of the spot anyway, just showing how. And this is great because this is a clinical book as well as showing illustrations. It’s going to go through and shows a really good illustrations at the same time describe these clinical syndrome such as cervical disc herniation, spondylosis, funnel isis, closest my obligations, and then we get into the spinal trauma anyway and they’re just going to show some.
Dr. Sahni: 08:44 Some fractures, I’m sure c, two, etc. Burst fracture. So that kind of stuff. So this will be. I just got home from our trip and this book waiting for me. I’ve never owned this particular book. I own a lot of books, obviously on never owned this particular book. Um, and so it’s very exciting because I really love frank netter. There’s when we talked about interest, cervical surgery recently, and this book would have been perfect for me to show how the plate and the graph goes on. Just real quickly show you. Do you remember actually showed video of me removing the disc material and exposing the spinal cord decompressing at one level. This is traction. I’ve certainly used this before. Unfortunately I’ve used this beforehand. I’ve used that before anyway. Uh, and I’ve done these before. Poster decompression where you come in and remove the bone, exposed the spinal cord to get the pinch off and if that patient hasn’t gotten better than one I did recently.
Dr. Sahni: 09:45 He had not gotten better. This probably would’ve been my next step to then go from the back because he did have a little bit of pressure on the back as well that because he’s up and walking and doing fantastic. There’s no reason to do more to him unless he needs it. And here’s what that looks like on extra. Putting those screws in from the back. Pretty pretty brutal. Anyway, this was intended just to be a yes. I’m still here. Yes. I’m still doing facebook lives. I have not abandoned you, just been kind of busy. I’m just wanted to share this really great book, uh, with netters illustrations in it and I will hopefully be using this and one of our next facebook lives to demonstrate the anatomy so you can have a good understanding of structural anatomy and how it’s affected causing a spinal pathology. And don’t worry, we’re still going to be talking lots about nutrition and health and wellness as well. Anyway, you guys have a great day.
