Gross Pathologies Flashcards
Spondylodiscitis is the classic pattern of TB with relative disc sparing in
Anderson and Vaccaro, (2013)
Poverty, overcrowding, malnutrition and alcoholism as contributing factors to spinal TB
Patel et al., (2016)
Lumbar vertebrae most commonly affected in spinal TB then T, abscess a common pre-diagnosis complication
8% of pts had non-contiguous spread
Batirel et al., (2015)
Older age, neurological deficit and spinal deformity at time of presentation all predictors of poor outcome in spinal TB
Batirel et al., (2015)
Spinal TB can result in vertebral collapse, spinal deformity and functional disability, involvement of soft tissue common
Batirel et al., (2015)
Spinal TB more common in children and young adults and risk 20-37X higher if co-infected with HIV
Garg, (2011)
Characteristically detroys disc space and adjacent vertebral bodies, formaiton of a cold abscess around a lesion also characteristic
Garg, (2011)
Symptoms of back pain, paraplegia, deformity
Neuro-imaging guided needle biopsy gold standard for diagnosis
Anti-TB drugs for all and surgery for some if indicated
With early diagnosis and treatment prognosis is good
Garg, (2011)
Scheuermanns is a rigid kyphotic deformity due to anterior wedging of at least 3 thoracic vertebrae that occurs in the growing spine
Loughenbury and Tsirikos, (2017)
Presents with a cosmetic deformity and T pain but symptoms tend to settle with skeletal maturity so most cases watch and wait
Pathogenesis is unknown so best treatment debated
Loughenbury and Tsirikos, (2017)
For moderate to severe deformities can brace but deformity tends to recur once brace removed
If deformity greater than 70d then surgery is advised but approach is disputed
Loughenbury and Tsirikos, (2017)
Mechanical factors found to play a significant role and endplate abnormalities may also contribute to the clinical picture
Loughenbury and Tsirikos, (2017)
Scheuermanns a juvenile osteochondrosis, may result from excessive mechanical stress on a weakened endplate
Palazzo et al., (2014)
Between 15-20% of Scheuermanns associated with scoliosis
Palazzo et al., (2014)
Get vertebral wedging, irregular vertebral endplate, Schmorls nodes, disc degeneration with Scheuermanns
Palazzo et al., (2014)
Indication for surgery in Scheuermanns extreme thoracic kyphocity and unremitting pain
Poolman et al., (2002)
Using a combination ant and post synchondrosis at final follow up kyphosis had increased to an average of 55d (70d pre-op) which was significant, as was the increase in lumbar lordosis to compensate for this
Due to removal of instrumentation in 9 pts despite showing solid fusion
Poolman et al., (2002)
Ank spond is a systemic inflammatory disease whose pathogenesis is not completely understood but HLAB27 positive immune cells have been implicated
Ranjith and Divya, (2013)
Age of onset of ank spond is second or third decade of life and affects males 2-3X more than females
Ranjith and Divya, (2013)
Typical findings of ank spond include syndesmophyte formation, squaring of VBs, end plate destruction, sacroilitis and sacroiliac fusion, loss of lumbar lordosis, diminished chest expansion
Ranjith and Divya, (2013)
NSAIDs effectively treat pain, physio also mainstay
DMARDs may be used later in ank spond disease course
Ranjith and Divya, (2013)
Structural changes in ank spond mainly caused by osteoproliferation as opposed to osteodestruction
Braun and Sieper, (2007)
Sacroiliitis is the hallmark of ank spond, especially in earlier disease
Braun and Sieper, (2007)
DMARDs not as effective as TNF blockers in ank spond, which show effectiveness in improving pain, function and inflammatory markers
TNF blockers reported to put more than a 1/3 of pts into remission
Braun and Sieper, (2007)
