Thoracic Spine

Question 1

Discuss discogenic pain (prolapse/herniation)

age
symptoms
where in T spine is it most common
what kind of pain/opathy can it cause?

Answer 1

relatively rare symptomatically
most commonly seen at T11-12, 75% of cases bt. T8-12
40-60 years most common
90% of cases non traumatic
generalised local symptoms common-dull ache, ‘band like pain’ around chest
central or lateral prolapses can produce myelopathy/radicular pain or radiculopathy/paraesthesia
DDx from visceral/neurological disorders v. impt.

Question 2

Discuss spondylotic change - what is it? Symptoms

Answer 2

common in t-spine as elsewhere
spondyloarthritic change commonly manifests as osteophytic growth
symptoms - periodic, dull and local

Question 3

Rib Lesions - describe inspiration & expiration type

Answer 3

Inspiration - rib ‘held’ in inspiration, draws up ribs below
pain felt in forced exhalation, cough
Expiration - rib ‘held’ in expiration, draws down ribs from above
pain felt in forced inspiration

Question 4

Discuss costochondritis

what is it? where is it most common?

Answer 4

inflam. process of costrochondral or costosternal joints that causes localised pain & tenderness
any of the 7 costochondral junctions may be affected, in 90% of cases more than 1 site affected, 2-5 CC most common

Question 5

Schmorls Nodes

Answer 5

Intrusion of disc into vertebral body
‘weak vertebral end plate vs.disc strength
gradual calcification/encapsulation of disc
often asymptomatic
1% develop in adolescence

Question 6

Scheuermann’s disease

Answer 6

self limiting skeletal disorder of childhood
aka juvenile kyphosis, 12-13 years old, M:F 2:1,
Structurally - thickened ALL, wedge shaped vertebral bodies, narrow IVD
50% ish feel pain, lower back & thoracic

Question 7

Scoliosis

Answer 7

common ‘normal’ variant of lateral curves
often relates to spinal adaptation for:
short lower extremity
pelvic assymetry - uneven sacral base
postural demands - uneven cranial base
Cobb angle measures severity - can be acquired, congenital or idiopathic, functional or structural

Question 8

Idiopathic Scoliosis

Answer 8

cause unknown…mulit gene?, not well understood
found in 2-4% of children aged 10-16 years
lateral curve greater than 10 degrees
can progress rapidly

Question 9

Kyphosis

Answer 9

Kyphosis can occur as a deformity solely in the sagittal plane, or it can occur in association with an abnormality in the coronal plane
In adults is caused by - degenerative diseases of the spine (such as arthritis or disk degeneration)
Fractures caused by osteoporosis (osteoporotic compression fractures)
Injury (trauma)
Slipping of one vertebra forward on another (spondylolisthesis)