Dorsopathies Flashcards
What are the deforming dorsopathies? ( 7 )
- Hyperkyphosis
- Hyperlordosis
- Scoliosis
- Spondylolysis
- Spondylolisthesis
- Torticollis
- Spinal osteochondrosis
What are causes of hyperkyphosis?
- degeneration of IVDs
- failed normal development
- week longitudinal back muscles
- compression fractures
- Scheuermann’s disease
- ankylosing spondylitis
- DISH
- hemivertebra
- posture
What is Scheuermann’s disease?
- developmental disorder of the spine
- Calvé disease / juvenile osteochondrosis of the spine
- abnormal growth of thoracic spine
- hyperkyphosis
What is a swayback?
Hyperlordosis
What are causes of hyperlordosis?
- increased abdominal weight (pregnant or obese)
- weak lumbar spine flexors (iliac, psoas)
- compensatory to kyphosis or scoliosis
- posture (gymnast, high heels)
Where is a scoliosis most likely?
Thoracolumbar region
What actions differentiate a structural from non-structural scoliosis?
- flexion
- lateral flexion
- lying prone
What are the causes of a structural scoliosis?
- idiopathic
- congenital
- neuromuscular, neuropathic, myopathic (eg. poliomyelitis, cerebral palsy, neurofibromatosis)
- infection, radiation, trauma
What are the causes of a non-structural scoliosis?
- leg-length discrepancy
* antalgique posture
What is the definition of a spondylolysis?
Defect (uni or bilateral) of the pars interarticularis
What is the definition of a spondylolisthesis?
Anterior slip of one vert on another, with or without pars defect
What are the causes of spondylolisthesis?
- congenital
- degenerative
- trauma
- post-surgical
- secondary to bone disease
How does a spondylolisthesis cause pain?
By consequence of the slip: • facet syndromes • anular tears • sacroiliac syndrome • nerve root compression • spinal stenosis causing neurogenic claudication
What is a torticollis?
- twisting and abnormal position of the head due to abnormal contraction of cervical muscles
- with or without pain referral to supra-scapular region
- sudden and severe pain
- congenital or acquired
What are the spondylopathies? ( 8 )
- Ankylosing spondylitis
- Sacroiliitis
- Vertebrae or disc infection
- Spondylosis
- Spinal stenosis
- Anterior spinal and vertebral artery compression syndromes
- DISH
- OPLL
What is ankylosis?
abnormal stiffening and immobility of a joint due to fusion of the bones
What is ankylosing spondylitis?
- chronic progressive arthritis with eventual ankylosis
- sacroiliac and spine (axial skeleton)
- bilateral
- men x10
- onset at 15-35yrs
- familial, HLA-B27 antigen
- chronic aching and stiffness
What is DISH?
- Diffuse idiopathic skeletal hyperostosis
- generalized spinal and extra spinal disorder
- ligamentous calcification and ossification
- broad spectrum presentation
What is Forrestier’s disease?
DISH
What is are the clinical features of DISH?
- complaints similar to DJD
- morning stiffness, low msk pain
- ALL
- lost cervical and lumbar lordosis, increased thoracic kyphosis
- localized pain, swelling, ossific masses (Achilles and quad tendon)
- dysphagia (20%)
- diabetes mellitus (20%)
What is OPLL?
- abnormal ossification of PLL
- results in compression myelopathy of spinal cord
- cervical most common, thoracic is least
- insidious onset
- motor and sensory loss mostly in legs
- sometimes msk-like pain in spine
What is true sciatica?
Pain in lower limb along the course of the sciatic nerve, radiating from the buttock does the back of the thigh and leg
What is the pathophysiology of sciatica?
- consequence of irritation, pressure, compression, stretching, entrapment of sciatic nerve or its roots
- L4, L5, S1, S3
- caused by muscle pathology or SI joint disorders
What is are intervertebral disc disorders?
- disorders of degradation of annulus fibrosis and nuclear pulposis
- affected by repetitive microtrauma, macrotrauma, or aging
- Bulge, protrusion, herniation, sequestration
What is dessication?
- effect of aging
* replacement of hydrophilic glycosaminoglycans within nucleus pulposus with fibrocartilage
Annular fissure
deficiency of one or more layers of annulus fibrosus
What is the difference between bulge and herniation?
Circumferential projection of annulus outside of the vertebral body surface area
Bulge: more than half
Herniation: less than half
What is the difference between IVD protrusion and extrusion?
Protrusion:
• local bulge of annulus
• annulus is torn from centre to periphery
Extrusion:
• nucleus pulposus migrates through the torn annulus
What is sequestration?
- discontinuity of the nucleus pulpous
* free fragment can now travel within subarachnoid space
What causes radiculopathy?
impingement of nerve roots
What causes myelopathy?
impingement of spinal cord
What is spinal stenosis?
- constriction of spinal canal by bony or soft tissue intrusions
- central stenosis or lateral recess stenosis
- causes neurogenic claudication
- back pain, radicular uni/bilateral pain, gait problems, paraesthesia, numbness
What is neurogenic claudication?
- relative ischaemia created by spinal stenosis
* further aggravated by increased oxygen consumption in those nerves
What are the causes of spinal stenosis?
- osteophytes
- Pagets disease
- neoplasm
What are the causes of sciatica?
- spondylolisthesis
- pregnancy
- piriformis irritation
- calcification of OPLL
- deformity of ligamentous flavum
- trauma
- osteophytes
- abscess or tumour in spinal canal
What are causes of torticolis?
- congenital muscle deformity
- poor sleep posture
- fever
- cold
- muscle spasm
- trauma
How do DISH and OPLL compare?
Differences:
• ALL vs PLL
• dysphagia vs sensory, motor, incontinence
Same:
• degenerative
• >60, men
• comorbid with diabetes mellitus
How does ankylosing spondylitis compare to DISH and OPLL?
Same: • degenerative • chronic and progressive • generalized spinal or extraspinal • asymptomatic or variable • men
Different in ankylosing: • inflammatory arthritis • SI ascending to spine • positive for HLA-B27 antigen • 15-30yrs • affects eyes, lungs
