spondylosis

Question 1

Define spondylosis?

Answer 1

Progressive degenerativeprocess affecting the vertebral bodies and intervertebral discs, and causing compression of the spinal cord and/or nerve roots

Question 2

outline the aetiology of spondylosis?

Answer 2

Osteoarthritic degeneration of the vertebral bodies leads to the formation of osteophytes

These osteophytes protrude on to the foramina and spinal canal

This leads to compression of:

• Nerve roots - radiculopathy
• Anterior spinal cord – myelopathy

Question 3

what are the risk factors for spondylosis

Answer 3

Genetics

Age

Spinal injures

Question 4

outline the epidemiology of spondylosis?

Answer 4

Mean age at diagnosis = 48 yrs

More common in MALES

Lumbarand cervicalspondylosis are the most common

Question 5

what are the symptoms of spondylosis?

Answer 5

Can be ASYMPTOMATIC

Back pain and neck pain which can radiate down the arms (radiculopathy) due to pinched N

numbness in fingertips/ clumsiness in hands (cervical)

Meds only a temp fix (diazepam may help relax the muscles?)

Limited flexion of the spine

Paraesthesia

Weakness

Weak and stiff legs

Gait disturbance

Atypical chest pain(cervical)

Breast pain (cervical)

Pain in the face(cervical)

Question 6

what are the appopriate investigations for spondylosis?

Answer 6

Spinal XR

• May detect osteoarthritic change in the cervical spine
• Rarely diagnostic in nontraumatic

MRI

• Assessment of root and root compression, to exclude spinal cord tumour, nerve root infiltration by tumour/granulomatous tissue

Needle EMG

• May reveal myotomal pattern of denervation

Question 7

what are the signs seen on examination of arms?

Answer 7

(cervical) basics LMN signs:

• Atrophy of foremarm/hand muscles
• Segmental muscle weaknessin nerve root distribution
• Hyporeflexia
• C5/C6 lesions – inverted reflexes may be seen due to LMN impairment at the level of compression and UMN impairment below the level
• Sensory loss – pain and temperature
• Pseudoathetosis– writhing finger motions when hands are outstretched, fingers spread, eyes closed

Question 8

what are the signs seen on examination of the legs?

Answer 8

if cervical cord compression(cos it would act like an UMN lesion):

• Increased tone
• Weakness
• Hyper-reflexia
• Extensor plantar response
• Reduced vibration and joint position sense

Question 9

what are the 2 signs that are seen in spondylosis?

Answer 9

Lhermitte’s Sign- neck flexion causes crepitus (grating sound) and/or paraesthesia down the spine

Hoffman’s sign: flexion of terminal thumb phalynx when rapidly extending the terminal phalanx of 2nd or 3rd fingers - UMN sign