Ankylosing and ossifying conditions of the spine Flashcards
Other names for ankylosing spondylitis?
Bamboo spine, Andersson disease
How common is ankylosing spondylosis and what is the peak incidence age?
0.4-7.3/100.000
peak incidence 17-35yo
male 3:1 women
what gene is associated with ankylosing spondylitis?
HLA-B27 more than 90%
WHere in the spine does ankylosing sponylitis start and how does it progress?
From SI joints and progressing rostrally.
extraarticular manifestations of ankylosing spondylosis?
*uveitis
*inflammatory bowels disease
*psoriasis
Cauda equina is associated to ankylosing spondylosis but noone knows why. How can it be treated?
Laminectomy or !LP shunting!
What warrants surgical intervention in ankylosing spondylosis?
In severe deformity with unstable frx or neurological involvement.
What is more common after even small trauma in ankylosing spondylosis pt?
SCI. More often in the lower cervical spine.
What is an Andersson lesion?
A disco-vertebral lesion from inflammation or frx where mechanical stresses prevent the lesion from fusion and cause pseudoarthrosis.
What type of subluxation can be seen in ankylosing spondylosis pt and even more in RA pt?
rotatory subluxation of the occipitoatlantal and atlantoaxial joints.
What need to be thought about in case of myelopathy for ankylosing sponylosis pt?
A laminectomy might aggravate the situation due to bow-string spine.
What is OPLL?
Ossification of the posterior longitudinal ligament
Which population has most OPLL?
Asian
Special causiousness is needed in case of surgery of OPLL pt. Why
As the calcification of the posterior longitudianl ligament might inlcude the dura, its a high risk of tear - 16-25%.
Distraction during surgery of OPLL is prohibited until the SC has been decompressed. What are the rec. postoperatuvely?
Rigid immobilisation for a LONG time - 3 mo after 1 level ACDF or corpectomy.
What is warranting surgery for OPLL pt?
- moderate to severe myelopaty pr radiculopathy. (progressing)
What approach is usually used for OPLL surgery?
anterior approach.
Where in the spine is OPLL mostly situated
In the cervical spine 4-5 levels.
WHat population mostly get diffuse idiopathic skeletal hyperostosis DISH?
Caucasians. mid 60s
How many % of DISH patients have disease involving the whole columna?
70%
Is the SI joint involved in DISH?
No. That differs from ankylosing spondylosis
Are the discs involved in DISH?
No that differs from ankylosing spondylitis
What is seen on CT in DISH?
Flowing osteophytic formation of the spine in abscence of degenerative, traumatic or post-infectious changes.
What are the clinical complaints in DISH?
Usually no symtoms. Morning stiffness and mild limitation of activities.
What may happen in an unfused level?
It can be VERY unstable.
