Gross Pathologies

Question 1

Spondylodiscitis is the classic pattern of TB with relative disc sparing in

Answer 1

Anderson and Vaccaro, (2013)

Question 2

Poverty, overcrowding, malnutrition and alcoholism as contributing factors to spinal TB

Answer 2

Patel et al., (2016)

Question 3

Lumbar vertebrae most commonly affected in spinal TB then T, abscess a common pre-diagnosis complication
8% of pts had non-contiguous spread

Answer 3

Batirel et al., (2015)

Question 4

Older age, neurological deficit and spinal deformity at time of presentation all predictors of poor outcome in spinal TB

Answer 4

Batirel et al., (2015)

Question 5

Spinal TB can result in vertebral collapse, spinal deformity and functional disability, involvement of soft tissue common

Answer 5

Batirel et al., (2015)

Question 6

Spinal TB more common in children and young adults and risk 20-37X higher if co-infected with HIV

Answer 6

Garg, (2011)

Question 7

Characteristically detroys disc space and adjacent vertebral bodies, formaiton of a cold abscess around a lesion also characteristic

Answer 7

Garg, (2011)

Question 8

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

Answer 8

Garg, (2011)

Question 9

Scheuermanns is a rigid kyphotic deformity due to anterior wedging of at least 3 thoracic vertebrae that occurs in the growing spine

Answer 9

Loughenbury and Tsirikos, (2017)

Question 10

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

Answer 10

Loughenbury and Tsirikos, (2017)

Question 11

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

Answer 11

Loughenbury and Tsirikos, (2017)

Question 12

Mechanical factors found to play a significant role and endplate abnormalities may also contribute to the clinical picture

Answer 12

Loughenbury and Tsirikos, (2017)

Question 13

Scheuermanns a juvenile osteochondrosis, may result from excessive mechanical stress on a weakened endplate

Answer 13

Palazzo et al., (2014)

Question 14

Between 15-20% of Scheuermanns associated with scoliosis

Answer 14

Palazzo et al., (2014)

Question 15

Get vertebral wedging, irregular vertebral endplate, Schmorls nodes, disc degeneration with Scheuermanns

Answer 15

Palazzo et al., (2014)

Question 16

Indication for surgery in Scheuermanns extreme thoracic kyphocity and unremitting pain

Answer 16

Poolman et al., (2002)

Question 17

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

Answer 17

Poolman et al., (2002)

Question 18

Ank spond is a systemic inflammatory disease whose pathogenesis is not completely understood but HLAB27 positive immune cells have been implicated

Answer 18

Ranjith and Divya, (2013)

Question 19

Age of onset of ank spond is second or third decade of life and affects males 2-3X more than females

Answer 19

Ranjith and Divya, (2013)

Question 20

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

Answer 20

Ranjith and Divya, (2013)

Question 21

NSAIDs effectively treat pain, physio also mainstay

DMARDs may be used later in ank spond disease course

Answer 21

Ranjith and Divya, (2013)

Question 22

Structural changes in ank spond mainly caused by osteoproliferation as opposed to osteodestruction

Answer 22

Braun and Sieper, (2007)

Question 23

Sacroiliitis is the hallmark of ank spond, especially in earlier disease

Answer 23

Braun and Sieper, (2007)

Question 24

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

Answer 24

Braun and Sieper, (2007)