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Disorders of the adult spine

Function of the spine:


Stability
Balance
Movements (cervical and lumbar spine)
Maintain posture
Function of the spine:
Stability: if two adjacent segments of the spine can not be displaced from
their junction
Disorders of spine:
Mechanical: instability
Biological:
Intervertebral disc diseases
Tumors
Inflammatory diseases (eg. rheumatoid arthritis, ankylosing spondylitis)
Infections (tbc destructive process substance of vertebral bodies is
destroyed compression, Potts gibbus)
INSTABILITY OF SPINE
Abnormal movements between adjacent spinal segments, that can be proven by
imaging technique
- serious condition with potential neurological damage, requiring immediate
operation
Examination in disorders of the spine
Anamnaesis: time of onset of pain, character of pain (consistent with movement,
radiating into periphery)
Look: posture (antalgic), deformity
Feel: muscle nodules (myogelosis) - lasting spasm
Move: cervical - lumbar spine (pain on certain movements!)
Neurological examination: sensation, movements - power of muscles, reflexes
(patella, Achilles jerk)
Examination in disorders of the spine - imaging techniques
X-ray:
Skeletal maturity, deformities of individual vertebrae, deformitiy of spinal
segment(s),
intervertebral space (narrowing, osteophytes)
CT: narrowing/compression of spinal canal
MRI:condition of spinal cord
Contrast injection: myelography (show stop - compression of spinal canal),
discography
Contrast myelography: combined with CT

Right L 5 nerve root is cut off sign of nerve root compression by disc
prolapse

Lumbar 4 nerve root symptoms:


Motor disorder:_ m. tibialis anterior
Reflex disorder: patella areflexia or hyporeflexia
Sensory disorder: lack of sensation at inner edge of foot
Instability of spine:
SPONDYLOLYSIS SPONDYLOLISTHESIS (Potential instability may lead to
true instability with severe neurological damage)
Localisation: lumbar spine (L IV-V, L V S I)
Morphological disorder: vertebral arch is broken (without displacement
spondylolysis
with displacement - spondylolisthesis)
Causes :
congenital (dysplastic) ,
traumatic,
degenerative,
pathological (tumor)
Spondylolysis:
Vertebral arch is broken at pars interarticularis
Most frequent types:
1. Dysplastic
2. Degenerativ
3. Traumatic
Classical
appearance on X-ray:
Scottie dog
a. Spondylolysis
b. Spondylolisthesis: + displacement
Most severe form of spondylolisthesis: spondyloptosis
5th lumbar vertebra slipped forward fully displaced
Sacralisation of 5th lumbar vertebra: transverese process of 5th lumbar vertebra
nearly fused with sacrum
segmental disorders of the spine: disorder, pathology is localised in to one (or
more) segments

Disc herniation
Intervertebral arthritis
Intervertebral arthrosis (degenerative process)
B: osteophyte, compressing on nerve root
intervertebral disc still intact

Various forms of intervertebral disc disorder


Various forms of disc disease (discopathy):
a. Sprain with edema around disc
b. B. disc protrusion
c. C disc rupture
d. All 3 can cause nerve root irritation and/or compression

Antalgic postureTypical clinical sign in disc disease, or sciatica (sciatic nerve is affected)
A: disc protrusion under the nerve root leaning towards this side releaves the
pain
B: disc protrusion is above nerve root leaning towards the opposite side releaves
the pain

Antalgic posture leanes away from the side of pain: sign of Pisa
Intervertebral disc types according to localisation:
a- central (may compress the spinal cord),
b- mediolateral
Compression of S 1 nerve root:
Motor signs weak flexors
Reflex sign: Achilles areflexia
Sensory signs: outer edge of foot hyposensibility
Lasgue sign, or straight leg raising: if nerve roots of sciatic nerve are affected,
extreme pain can be provoked (typical sign in sciatica)

Spinal canal
A: normal width
b.: spinal stenosis narrowing of spinal canal, may cause spinal cord
compression
(can be caused by disc prolapse, fracture of vertebral body, tumour)
Operation: discectomy (can be done percutaneously, with endoscope too)
Transpedicular fixation introduction of screws through pedicles into vertebral
body, screws connected on each side with metal bar
Used for treatment of spinal instability

-Transpedicular fixation of lumbar 4-5 segment (posterior


stability) + TITANIUM CYLINDER in the intervertebral space (to provide anterior
stability)

Disc prosthesis in cervical spine: future trend?


Tuberculosis of spine
Infection spreads to vertebral body by blood
Localisation of infection: on both sides of intervertebral disc (above and below
Consequence: collapse of vertebral body above and below the affected disc spave
leading to sharp angulation (KYPHOS)

TBC of spine: Potts gibbus, Potts paraplegia (if spinal cord is compressed)
Tb of spine: Destruction of 7.-8.-9- thoracic vertebral bodies, with wide
paravertebral soft tissue shadow- cold abscess (it will sink eventually downwards
and cause fistulation around the inguinal region)
[Fistula=abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not
connect]

Tubecrulous sinus filled up with contrast (sinogram) cold abscess seen on buttock
Compression of cervical spinal cord: due to destruction of C 5 vertebral body TB)
Tuberculosis of spine
Treatment:
Combines antituberculous chemotherapy (streptomycin, INH etc at least three
drugs at the same time,at least for 6 months)
Surgery: evacuation of abscess, decompression of spinal cord
Low back pain:
It is so frequent, that it became a disease in itself
3 forms:
1. Transient backache- simple back strain - , rest, antiinflammatory drugs are
sufficient
2. Sudden acute pain with sciatica:pain radiating along The sciatic nerve - disc
prolapse is likely - operate if severe disc prolapse is detected
3. Chronic low back pain- arthritis oir arthrosis of intervertebral joints (may
mimic disc prolapse, MR or CT are helpful diagnostic tools) spinal instability
may be the underlying cause too
BEWARE: TUMOR INSIDE The PELVIS OR METASTATIC BONE TUMORS MAY BE ThE
UNDELYING CAUSE AS WELL!! (ALWAYS NEEDS CHECKUP THOROUGH
EXAMINATION TO EXCLUDE MORE SEVERE DISEASES)
Causes of low back pain from the spine, from organs inside the pelvis,
metastatic disease

Osteoporosis treatment(?)
KYPHOPLASTICA TECHNIQUE
Ballon pressure 3,4-20,4 atm
Th5-10
lateral-extrapedicular INSERTION OF CANULA
Th10-L5 transpedicular insertion of canula, through
which bone cement is injected into balloon in collapsed vertebral body