Degeneration of the Spinal Column Flashcards
What type of arthritis can you get in ages 0-20?
Juvenile Chronic arthritis
Septic arthritis
What type of arthritis can you get in ages 20-40?
Anklylosing Spondylitis (AS)
Osteitis Condensans Illii (OCI)
Systemic Lupus Erythematosis (SLE)
Psoriatic Arthritis
Reiter’s syndrome
Rheumatoid Arthritis (RA)
Progressive Systemic Sclerosis (PSS)
Synoviochondrometaplasia (SCM)
What type of arthritis can you get in ages 40+?
Osteoarthritis (OA)
Gout
Disseminated Idiopathic Skeletal Hyperostosis (DISH)
Hypertrophic osteoarthropathy (HOA)
Calcium pyrophostate deposition disease (CPPD)
What are the anatomical classifications of joints?
Fibrous
Cartilaginous
Synovial
What is Monoarticular?
Number of joints involved - affecting only one joint of body
What is Oligoarticular?
Number of joints involved - affecting a few joints
What is Polyarticular?
Number of joints involved - affecting many joints
What are the 3 categories of joint disease?
INFLAMMATORY
DEGENERATIVE
METABOLIC
What are symptoms of inflammatory joint disease?
soft tissue swelling -oedema
juxta-articular osteoporosis
uniform loss of joint space
may be symmetric if polyarticular
> likelihood of bony ankylosis with inflammatory arthritis
may have periostitis (sero negative)
POORLY DEFINED EROSIONS
E.g. Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS)
What are symptoms of Degenerative joint disease?
nonuniform loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
Asymmetric
What are symptoms of Metabolic joint disease?
“lumpy bumpy”; soft tissue masses
well marginated bony erosions
preservation of joint space - initially
What are the signs of Arthritis?
Tenderness around the joint margin
Firm swellings of the joint margin (probably d/t the soft tissue, cartilage & bony outgrowths at the rim of joint) eg. Heberden’s nodes
‘Bony’ swelling & crepitus (one of the best signs in the clinical differentiation of OA from other disorders)
Signs of mild inflammation (cool effusions)
Decreased ROM
What are the symptoms of Arthritis?
Pain and tenderness
Stiffness (‘gelling’) after inactivity (early morning stiffness, usually <30min)
Restricted, painful movements (difficulty with certain tasks), often accompanied by pain
Feelings of insecurity (feels unsafe) or instability
Functional limitations and handicap
What are the red flags for Arthritis?
Malignancy, Infection, Inflammation
Fever
Night sweats
Unexpected weight loss
Night pain
Objective neurological deficit
Drop attacks
What is the Epidemiology of Degeneration of the Spinal Column:a) Cervical Spine
Changes predominate in the lower C-spine (C5 – C7):
- Cervical disc spaces:
- M/C at C5/6 then C6/7
- Uncovertebral joints:
- Same levels often involved - Apophyseal joints:
- M/C at C4/5 and C6/7
Single or multiple levels involved
Rare in <40yoa
Common >40yoa
70% of patients >70yoa
M=F – increases in female with age
What are the affected components of Degeneration of the Spinal Column:a) Cervical Spine?
Articular cartilage
Synovium
Uncovertebral joints
Facet joints
Intervertebral discs
Cervical plexus
Intervertebral ligaments
What is the clinical presentation of Degeneration of the Spinal Column:a) Cervical Spine?
Pain
Stiffness
Crepitus
Limited ROM
Joint instability
Mild synovitis
What are the Facet Arthrosis findings in Apophyseal Joints?
Aka Facet joints or zygapophyseal joints
Facet Arthrosis findings:
Joint space narrowing (reduced height – space)
Osteophytes - marginal
Sclerosis - subchondral
Subluxation- misalignment
What does Intervertebral Degeneration look like?
Decreased disc height
Vacuum phenomenon
Vacuum cleft
May indicate annular tearing
Osteophytes
Canal stenosis
Due to projecting posterior osteophytes
What is Uncovertebral Joint?
Aka Luschka’s joints – formed between uncinate processes (C3-C7)
Uncovertebral Arthrosis
Hypertrophy
Initial Sharpening
Blunting
Bulbous appearance
Foraminal encroachment
Oblique views
Best to determine osseous encroachment into intervertebral foramen
What is the radiological findings of spondylosis?
Osteophytes
Claw
Broad based
Vertically curvilinear
From shear forces on traction spurs/ osteophytes
Traction
Early phase
2-3mm from vertebral body endplate margin (corner)
Horizontal and taper
Suggest shear type translation loading forces – dysfunctional stage
What are the Affected Components Degeneration of the Spinal Column:b) Thoracic Spine?
Thoracic Intervertebral Disc & Spondylosis:
Mid to lower thoracic spine
Less pronounced changes here than other spinal areas
Disc space narrowing, osteophytes, Minimal sclerosis
- Osteophytes tend to be right sided, (presumably d/t pulsations of the aorta)
Intervertebral osteochondrosis:
mid thoracic spine
Costovertebral & Costotransverse arthrosis:
Typically at T9 and T10
Often overlooked
Implicated in pain production which may simulate cardiac or upper gastro-intestinal (GI) disease
What is the clinical presentation of Degeneration of the Spinal Column:b) Thoracic Spine?
Pain in back
Pain and tenderness at level of involved facet joints
Muscle spasm
Loss of motion
Joint stiffness
Localised swelling
What are the facts and figures of Degeneration of the Spinal Column:c) Lumbar Spine?
M/C affected area - particularly lower L/S (L4/5 and L5/S1)
Symptoms:
- LBP
- Local tenderness
- Leg pain
Causes:
- Inflammation
- Micro trauma
- Injury
Risk Factors:
- Genetics
- Excessive strain
- Obesity
- Smoking
What are complications of Degeneration of the Spinal Column:c) Lumbar Spine?
Segmental instability
Degenerative spondylolisthesis
Retrolisthesis
Senile kyphosis
Limbus vertebra
Hemispheric spondylosclerosis
Discal calcification
Spinal stenosis
What is Intervertebral Osteochondrosis (Degenerative Disc Disease - DDD)?
Retrolisthesis – may be early sign
Decreased disc height (Intervertebral osteochondrosis)
Disc space narrowing to varying degrees
Endplate Sclerosis
Vacuum phenomenon - late stage
Nitrogen gas in nuclear and annular fissures
2-3% of general population
Subluxation
What does facet arthrosis look like?
Loss of joint space
Subchondral sclerosis
Osseous overgrowth – osteophytes – bone spurs = (“proliferation”)
AP view
Unreliable due to facet orientation
Lateral view
Sclerosis
Caution IVF narrowing on this view - ? rotation
Obliques
Best radiographic view
Sclerosis, joint narrowing, osteophytes
CT – Study of choice
What is Sacroiliac Joint Degeneration?
uni or bilateral
may/may not be symptomatic
- If so, pain & tenderness
patients are usually >40 years
Usually, joint space loss
sclerosis on the iliac side - common
Osteophyte formation usually at the anterosuperior or anteroinferior aspect
periarticular bridging osteophytes – causing joint ankylosis
no erosions of the subchondral bone plate
