IVD PATHO Flashcards

1
Q

Discopathy: def, composition & components

A

= degeneration of IVD

→ Inner gelatinous nucleus pulposus
- Type II collagen : resistant to compression
→ Outer annulus fibrosus
- Type I collagen : resistant to tensile strength
→ Cartilage end plates (sup & inf) - Nutrition : glucose, oxygen, …

Proteoglycan & collagen = skeletal structure of disc - Aggrecan : most common proteoglycan in disc
* 70% of nucleus pulposus
* 25% of annulus fibrosus
High concentration of aggrecan
- Enable tissue to support compressive load
- Loads transferred equally to annulus fibrosus & vertebral boby
Chondrocytes:
- synthesize matrix : proteoglycan & collagen
- Break down matrix : Matrix Metalloproteinase (MMPs)
Turnover maintained at highest level in adolescence - Decrease progressively with time
Injured disc : higher concentration of catabolic cytokines & MMPs
- Healing process overtaken by degenerative changes

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2
Q

DISCOPATHY: factors, consequences & features

A
  • genetics, nutrition, smoking, cell senescence, degraded matrix product, fatigue failure of nucleus, heavy load
  • loss of viscoelasticity , hydrophilicity, hydrostatic pressure of nucleus pulposus, supply of nutrients by diffusion , disk height because decreased water content, resistant to axial load, no longer fct hydrostatically under load
  • stress load along end plate & annuls = annular bulge
    Loss of height alters mechanics of facet joints: osteophytes at disc margins, at facet joints margin, periarticular fibrosis, buckling of ligament flavum
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3
Q

DISCOPATHY: symptoms, cells & fcts

A
  • Degenerative disk ≠ symptoms
  • Most important causes of degeneration: impairing its healing response
  • Age-specific prevalence estimates of degenerative spine imaging findings in asymptomatic patients
  • disk degeneration, signal loss, height loss, bulge, protrusion, annular fissure, facet degeneration, spondylolisthesis

Neurotransmitters promotes peripheral sensitization - Substance P
- Calcitonin generated peptide
Mast cells: Promotes inflammation, Neovascularization, Neoinnvervation
Low pH stimulates neurogenic (& non-neurogenic) pain: Phospholipase 2
* Intraneural oedema
* Demyelination
* Axonal injury

Spontaneous regression: Bulging : 13%, Protrusion : 41%, Extrusion : 79%, Sequestration : 96%
Complete resolution: Sequestration : 43% & Extruded : 15%
Timeframe: 3 months to 1 year

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4
Q

DISC HERNIATION: ≠ steps & definition of each, % of spontaneous resorption

A

Bulging = extension of disc margin behind margins of adjacent vertebral end plates

Protrusion = posterior longitudinal ligament remains intact but nucleus pulposus impinges on anulus fibrosus
Extrusion = nuclear material emerges through annular fibers but posterior longitudinal ligament remains intact
Sequestration = nuclear material emerges through annular fibers & posterior longitudinal ligament disrupted. Portion of nucleus pulposus protruded into epidural space

=> 67% of spontaneous resorption

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5
Q

FEATURES OF STENOSIS

A

Mainly cervical (CSS) or lumbar (LSS)
- Congenital
* LSS associated with CSS (10%)
- Acquired
* Degenerative arthritis
* Degenerative flava ligament * Spondylolisthesis
- 3 joints complex
* Disc – intervertebral bodies – facet joints
- Location:
* L3-L4-L5
*L5-S1 anatomically wider
- Stenosis: Central, Lateral, Foraminal

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6
Q

FLAVA LIGAMENT & DEGENERATION

A
  • 80% of elastic fibers: prevent buckling - 20% of collagen
    DEGENERATION
  • Hypertrophic scar formation * Repeated inflammation
  • Ossification over time
  • Genetic component (e.g. Asian)
  • Elastic fibers being replaced by collagen * Leads to buckling
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7
Q

SPINAL STENOSIS: translation & classification

A

Translation of one vertebra over caudal one - Anterolisthesis
- Retrolisthesis
- Usually preceded by spondylolysis
* Fracture of pars articularis
Classification
- Dysplasic (congenital)
- Isthmic
- Degenerative
- Traumatic
- Iatrogenic

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8
Q

RADICULOPATHY: def, causes, pathophysio

A

= range of symptoms produced by pinching of nerve root in spinal column

  • Herniated disc
  • Degenerative spine component
  • Degenerative change in disc
  • Hypertrophy of ligamentum flavum * Osteophyte formation
  • Nerve root distortion
  • Intraneural oedema
  • Localized inflammatory response (chemical pain mediator within disc)
  • Focal nerve ischemia (impaired circulation)
    SCHÉMA
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9
Q

MYOTOMES

A

Motor weakness
- C1/C2 : Cervical flexion
- C3 : Cervical lateral flexion - C4 : Scapula elevation
- C5 : shoulder Abduction
- C6 : Elbow flexion
- C7 : Elbow extension
- C8 : Thumb extension
- T1 : Finger Abduction
- L1/L2 : Hip flexion
- L3 : Knee extension
- L4 : Ankle dorsiflexion
- L5 : Big toe extension
- S1 : Ankle plantar flexion
- S2 : knee flexion

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10
Q

DERMATOMES + grading

A

Deep Tendon reflexes - C5/C6 : Biceps
- C6 : Brachioradialis - C7 : Triceps
- L4 : Patellar
- L5/S1 : Achilles
0 = no response; always abnormal
1+ = slight but definitely present response; normal or not
2+ = brisk response; normal
3+ = very brisk response; normal or not
4+ = tap elicits repeating reflex (clonus); always abnormal
5+ = sustained clonus; always abnormal

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11
Q

RADICULOPATHY: pressure & ischemia

A
  • pTunnel < pVein < pFasciculus < pCapillaries < pArtery
  • 20-30mmHg disrupts intraneural venous circulation
  • 40-50mmHg suppress arteriolar & capillary blood flow Herniated disc : 50 – 250mmHg
  • Position-dependent paraesthesia - Demyelination
  • Slowing of nerve conduction
  • Influx of inflammatory cells
  • Elevation of osmolality = Œdema
  • Intraneural & extraneural fibrosis * Impaired gliding abilities
    Affects both large & small diameter nerve fibers
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12
Q

≠ between Lx & Cx spine

A

Nerve root mismatch
Cx: C6 nerve root travels under C5 pedicle = mismatch
Lx: L5 nerve root travels under L5 pedicle = match
Extra C8: nerve root allows transition => no pedicle

  • ≠ nerve roots affected depending on location of compression * Central
  • Posterolateral
  • Foraminal
  • Because of vertical anatomy of lumbar nerve root paracentral & foraminal disc herniation affect ≠ nerve roots
  • Because of horizontal anatomy of cervical nerve root central & foraminal disc herniation affect same nerve root
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13
Q

RADICULOPATHY : TABLEAU

A

Tableau

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14
Q

SCHEUERMANN’S DISEASE: def, features, etiology, prevalence,

A

D: developmental disorder = juvenile osteochondrosis

F: Thoracic vertebral wedge > 5° in 3 or more adjacent vertebrae
* 45° < Thoracic kyphosis < 75°
* Structural deformity

E: multifactorial: genetics, juvenile osteochondrosis…

P: in Europe 8% > 50y

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15
Q

ANKYLOSING SPONDYLITIS (BECHTEREW): def, causes, prevalence, diagnosis & clinical presentation

A

D: type of arthritis that causes inflammation in the joints and ligaments of the spine

C: unknown but often environmental factors & genetic

P: 0.1 – 1.8% / Onset < 35 years / Male > Female (3/1)

D: based on symptoms, medical imaging & blood test

CP: - Affects sacroiliac, zygapoohyseal & costovertebral joints
- Pain in heels, ischial tuberosity, iliac crests, humeral epicondyles & shoulders
- Noctural pain
- Morning pain & stiffness
- Asymmetric peripheral arthritis
- Uveitis with pain & photophobia

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