Objectives. Comprehension of the common spine disorder
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2 Objectives Comprehension of the common spine disorder Disc degeneration/hernia Spinal stenosis Common spinal deformity (Spondylolisthesis, Scoliosis) Osteoporotic fracture Destructive spinal lesions
3 Anatomy
4 Anatomy
5 Anatomy
6 Anatomy
7 Anatomy
8 Anatomy
9 Anatomy
10 Anatomy
11 Anatomy
12 Anatomy
13 Anatomy
14 Anatomy
15 Pathophysiology IVD Spinal motion segment. Two adjacent vertebrae. Three joint complex. Ligaments. Degeneration of IVD.
16 Pathophysiology IVD Degeneration of IVD. Loss of cellular material and hydration. Loss of disc height. Abnormal loading to the facet. Facet joints degeneration (Loss of height + facet OA). Spinal stenosis +/- instability.
17 Pathophysiology IVD
18 Clinical presentation Mechanical pain Degeneration +/- Instability Axial pain Activity related Neurological symptom Spinal cord: Cervical and Thoracic Nerve roots Cauda equina Spinal stenosis
19 Clinical presentation Neurological symptom Spinal cord: Cervical: Myelopathy (CSM) Spinal cord injuries: complete vs incomplete Nerve roots: Sciatica Cauda equina: Prevalence /LBP But Serious Spinal stenosis: Neurogenic claudication
20 Clinical presentation
21 Clinical presentation
22 Management Cervical spine (CSM) Lumbar spine Conservative always first Surgical indication Surgical procedures
23 Management Cervical spine: axial neck pain and radiculopathy, without neurological deficits Conservative: rest and short period of immobilization Physiotherapy: ROM and strengthening Pain management Neuropathic medication for radiculopathy
24 Management Cervical spine: Surgical indication: Cervical stenosis causing cervical myelopathy Disc hernia causing radiculopathy associated with weakness Failure of conservative managements
25 Management Cervical spine: Surgical procedures: Anterior cervical discectomy and fusion Posterior laminectomy +/- fusion Laminoplasty Cervical disc arthroplasty
26 Surgical procedure Anterior discectomy and fusion
27 Surgical procedure Laminectomy and fusion
28 Surgical procedure Laminectomy
29 Management Lumbar spine: Disc hernia Axial LBP Spinal stenosis
30 Management Lumbar spine (acute disc hernia): 90% resolved within 12 weeks Conservative: short period of rest, PT, Pain management (non-invasive and invasive) Surgical indication: Cauda equina, motor deficit and failure of 3 months conservative treatment Surgical procedure: Discectomy
31 Management
32 Management
33 Management Lumbar spine (Axial LBP): Conservative is the mainstay Conservative: PT, Pain management (non-invasive and invasive) Surgical indication: deformity, instability and failure of conservative treatment
34 Management Lumbar spine (Spinal stenosis): Conservative: PT, Pain management (non-invasive and invasive) Surgical indication: Motor deficit, severe neurogenic claudication and failure of 6+ months of conservative treatment Surgical procedure: Laminectomy is the commonest
35 Management
36 Management
37 Spinal deformities Common spinal deformities: Scoliosis (less common Kyphosis or combined) Spondylolisthesis
38 Spinal deformities Causes of scoliosis: Congenital Syndromic Neuromuscular Idiopathic: most common type
39 Spinal deformities Adolescent idiopathic scoliosis: Between 10 and 14 years Vertebral rotation Deformity without significant pain Normal neurological examination Surgical indication: 45 degrees or more Surgical procedure: instrumented PSF
40 Spinal deformities Adolescent idiopathic scoliosis:
41 Spinal deformities Spondylolysis Is a defect in the pars interarticularis Plan lateral radiograph 80%, oblique another 15% Single photon emission computed tomography
42 Spinal deformities Spondylolisthesis: Displacement of a vertebra in relation to a vertebra below Most people are asymptomatic Commonest causes are: Degenerative Isthmic Severity according to the degree of displacement Surgical indication: grade 3 or more, failed conservative Surgical procedure: according to severity. Instrumented PSF +/- interbody fusion is the commonest
43 Spinal deformities Spondylolisthesis Grade 5: spondyloptosis.
44 Spinal deformities Spondylolisthesis
45 Pathologic fractures Low-energy fractures Osteoporotic is common Usually due to infection or tumour X-rays: winking owl sign
46 Spine Pathology Red Flag Conditions Beware of: 1) Cauda Equina/severe neurologic injury (perianal numbness, decreased rectal tone, loss of movement in the extremeties) 2) Tumour weakening the vertebrae (causing cord compression or vertebral fracture) 3) Infection weakening bone (causing disc/vertebral destruction or cord compression) 4) Traumatic Spine Fracture (causing vertebral angulation, pain, or neuro compromise). Remember that spine fracture can occur without trauma
47 Destructive Spinal Lesions Present with pain at rest or at night Associated with constitutional symptoms Most common causes Infection Tumors Vertebral body and pedicle are the commonest sites of pathology
48 Spinal Tumors Primary Spinal tumors: Rare Benign (e.g. osteoid osteoma) or malignant (e.g. chordoma) Management depends on pathology Spinal metastasis Very common Biopsy required if primary unknown
49 Spinal infections Most common is TB and Brucellosis History of contact with TB patient, raw milk ingestion Potentially treatable diseases once diagnosis is established and antimicrobials administered
50 Osteoporotic fracture Pathological fractures Common injury post menopausal, if repetitive will result in loss of height and kyphotic deformity. Often missed Treatment: Underlying disease
51 Spinal Tuberculosis (with psoas abscess)
52 Pathologic feature
53 Questions
Comprehension of the common spine disorder.
Objectives Comprehension of the common spine disorder. Disc degeneration/hernia. Spinal stenosis. Common spinal deformity (Spondylolisthesis, Scoliosis). Osteoporotic fracture. Anatomy Anatomy Anatomy
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