Pathology of the Spine Focused Flashcards
Define scoliosis.
A lateral curvature of the spine.
Define kyphosis.
An outward curvature of the spine.
Define spondylolistheses.
Spondylolisthesis is a condition in which a bone (vertebra) in the spine slips out of the proper position onto the bone below it.
What is the apical disc?
The vertebra in a scoliosis curve that is most displaced, most rotated yet least tilted. Typically the vertebra in the middle of the curve.
What is meant by compensatory curve?
A curve above or below a major curve that tends to maintain normal body alignment.
What is gibbus?
A sharply angular kyphosis.
Define the term idiopathic scoliosis.
A lateral curvature of the spine with rotation having no known cause.
What is meant by the term pelvic obliquity?
Deviation of the pelvis from the horizontal in the frontal plane.
What is a Risser sign?
Used to denote the degree of skeletal maturity. Measured by the state of ossification of the iliac apophysis.
What are the 4 main scoliosis patterns?
Congenital - abnormality in bone present at birth.
Idiopathic - no known cause.
Neuromuscular - damage to the spinal cord or nerves which affects growth of the spine.
Others (metabolic, syndromic, post-traumatic, iatrogenic etc.)
How are scoliotic curves generated?
The anterior column grows faster than the posterior column leading to anterio - posterior wedging of the vertebrae. The body tries to balance this reaction leading to a lateral bending and rotation of the vertebrae.
Define failure of formation.
Development of part of the vertebra fails usually due to injury to the blood vessels to the developing cartilage model of the bone before 56 days of intrauterine life.
Define failure of segmentation.
Immature vertebra fail to separate. Can lead to Bloc vertebra, just on one side called a unsegmented bar leading to scoliosis, or the joining of the anterior vertebral bodies leading to hyperkyphosis.
Define complex.
A mixed pattern of vertebral abnormalities where parts of the vertebra fail to form and other parts of the vertebra fuse together.
What is bloc vertebra?
A congenital defect in which two or more vertebral bodies are fused without an intervening disc.
Name the scale used to grade spondylolisthesis and explain how to measures the amount of slip.
Meyerding Scale
Grade 1 less than 25% Grade 2 25%-50% Grade 3 50% to 75% Grade 4 75% to 100% Grade 5 Vertebra above lies anterior to the vertebra below, spondyloptosis
What special diagnostic tool is used to diagnose spondylolisthesis?
Lateral x-ray
Oblique x-ray for viewing the pars
What does DDD stand for?
Degenerative disc disease
Define spondylosis.
Degenerative processes which affect the intervertebral disc.
What are the different Spondlos
Listhesis - A defect in the construct of bone causing a forward displacement of one vertebra onto an adjacent vertebra.
Lysis - Displacement of one vertebrae over another with fracture of a posterior portion of the vertebra.
Losis - Degenerative process which affect the intervertebral disc.
Describe the natural processes of degeneration which all discs are subjected to as part of the aging process.
With age comes an increase in the amount of collagen in the disc resulting in a decrease in the amount of fluid, making the disc more prone to dysfunction and damage through loss of elasticity.
With age the annulus becomes distorted resulting in tears in the annulus.
In the nucleus the loss of fluid is simultaneous with an increase in collagen.
Describe the four stages of a classic disc herniation.
Intraspongi Nuclear Herniation
Protuded or Prolapsed Disc
Extruded Intervertebral Disc Rupture
Sequestrated Disc
Describe Intraspongi Nuclear Herniation.
Nucleus migrates out from the center in the annulus but does not cause any change in shape.
Describe Protruded or Prolapsed Disc.
Nuclear material extends to the annular wall causing it to bulge, but no material breeches the wall.
Describe Extruded Intervertebral Disc rupture.
Nuclear material has escaped from the inner confines of the annulus through the wall, but the protruding piece of nucleus is still attached to the nuclear material within the disc.
Describe a Sequestrated Disc.
Nuclear material has passed through the wall of the annulus and lies within the spinal canal as a free fragment separated from the main body of the disc.
Define spinal stenosis.
Reduction of the diameter of the spinal canal due to new bone formation which may result in pressure on the spinal cord or nerve roots.
What is Klippel-Feil syndrome?
A congenital malformation of the cervical spine characterized by the fusion of two or more cervical vertebrae.
What does the term metastases mean?
The development of secondary malignant growths at a distance from a primary site of cancer.
Describe the 2 ways in which spinal cord tumors are classified.
Intradural - occurring inside the dura
Extradural - occur between the bony spinal canal and the dura mater.
Give two examples of a benign, primary spinal tumor.
Haemangioma
Osteoid osteoma
Osteoblastoma
Giant cell tumor
Give two examples of malignant, primary spinal tumor.
Myelomas Plasmacytomas Malignant lymphomas Ewings sarcomas Chordomas
What is a “winking owl” and which diagnostic tool would show it?
In one of the pedicles and it is shown in a P/A x-ray. The tumor will show as a dark or winking eye so long as there is at least a 30% loss of bone mass.
What are the four types of spinal infection?
Osteomyelitis - An infection of the vertebral body.
Discitis - A rare spinal infection of the disc.
Tuberculosis
Epidural & Intradural Infections
Which patients are most susceptible to getting a spinal infection?
Patients with osteoarthritis, those on long-term steroid therapy, recipients of organ transplants, and the mal-nourished.
What type of force creates a burst fracture?
A compression force.
On a standard review of neurological injury post trauma, what two key functions are tested for?
Motor and sensory functions
What is Frankel classification?
From 1968 A - complete B - sensory only C - motor useless D - motor useful E - recovery
