Ankylosing and ossifying conditions of the spine

Question 1

Other names for ankylosing spondylitis?

Answer 1

Bamboo spine, Andersson disease

Question 2

How common is ankylosing spondylosis and what is the peak incidence age?

Answer 2

0.4-7.3/100.000
peak incidence 17-35yo
male 3:1 women

Question 3

what gene is associated with ankylosing spondylitis?

Answer 3

HLA-B27 more than 90%

Question 4

WHere in the spine does ankylosing sponylitis start and how does it progress?

Answer 4

From SI joints and progressing rostrally.

Question 5

extraarticular manifestations of ankylosing spondylosis?

Answer 5

*uveitis
*inflammatory bowels disease
*psoriasis

Question 6

Cauda equina is associated to ankylosing spondylosis but noone knows why. How can it be treated?

Answer 6

Laminectomy or !LP shunting!

Question 7

What warrants surgical intervention in ankylosing spondylosis?

Answer 7

In severe deformity with unstable frx or neurological involvement.

Question 8

What is more common after even small trauma in ankylosing spondylosis pt?

Answer 8

SCI. More often in the lower cervical spine.

Question 9

What is an Andersson lesion?

Answer 9

A disco-vertebral lesion from inflammation or frx where mechanical stresses prevent the lesion from fusion and cause pseudoarthrosis.

Question 10

What type of subluxation can be seen in ankylosing spondylosis pt and even more in RA pt?

Answer 10

rotatory subluxation of the occipitoatlantal and atlantoaxial joints.

Question 11

What need to be thought about in case of myelopathy for ankylosing sponylosis pt?

Answer 11

A laminectomy might aggravate the situation due to bow-string spine.

Question 12

What is OPLL?

Answer 12

Ossification of the posterior longitudinal ligament

Question 13

Which population has most OPLL?

Answer 13

Asian

Question 14

Special causiousness is needed in case of surgery of OPLL pt. Why

Answer 14

As the calcification of the posterior longitudianl ligament might inlcude the dura, its a high risk of tear - 16-25%.

Question 15

Distraction during surgery of OPLL is prohibited until the SC has been decompressed. What are the rec. postoperatuvely?

Answer 15

Rigid immobilisation for a LONG time - 3 mo after 1 level ACDF or corpectomy.

Question 16

What is warranting surgery for OPLL pt?

Answer 16

• moderate to severe myelopaty pr radiculopathy. (progressing)

Question 17

What approach is usually used for OPLL surgery?

Answer 17

anterior approach.

Question 18

Where in the spine is OPLL mostly situated

Answer 18

In the cervical spine 4-5 levels.

Question 19

WHat population mostly get diffuse idiopathic skeletal hyperostosis DISH?

Answer 19

Caucasians. mid 60s

Question 20

How many % of DISH patients have disease involving the whole columna?

Answer 20

70%

Question 21

Is the SI joint involved in DISH?

Answer 21

No. That differs from ankylosing spondylosis

Question 22

Are the discs involved in DISH?

Answer 22

No that differs from ankylosing spondylitis

Question 23

What is seen on CT in DISH?

Answer 23

Flowing osteophytic formation of the spine in abscence of degenerative, traumatic or post-infectious changes.

Question 24

What are the clinical complaints in DISH?

Answer 24

Usually no symtoms. Morning stiffness and mild limitation of activities.

Question 25

What may happen in an unfused level?

Answer 25

It can be VERY unstable.