University of Jordan. Professor Freih Abuhassan -

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Lewis Hood
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1 Freih Odeh Abu Hassan F.R.C.S.(Eng.), F.R.C.S.(Tr.& Orth.). Professor of Orthopedics University of Jordan 1

2 A. Sacroiliitis History Trauma is very common Repetitive LS motion--lumbar rotation or axial loading Commonly y have LLD. 2

3 Differential Diagnosis: Traumatic A- Fracture Insufficiency y stress fractures: elderly patient with osteoporosis without t history of trauma Fatigue stress fractures: usually athletes / soldiers 3

4 B- Degenerative joint dis. C- Referred pain D- Spondyloarthropathies RA, AS. 4

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6 Diagnostic Tools X-rays: Up to 25 % of asymptomatic adults over 50 years can have abn. MRI / CT: Only if looking for tumor Bone scan: Good for fractures 6

7 Treatment Medications: NSAIDS Physical therapy Correct limb discrepancy Injection: Fluoroscopy-guided. 7

8 B. Cauda Equina Syndrome History: Sudden, partial or complete loss of voluntary bladder function due to massive disc impingement on spinal nerves Can C include loss of sensation as well as sphincter tone 8

9 54-year-old woman presenting with cauda equina.due to a massive L4-5 disk herniation 9

10 Urgent g decompression is mandatory for prevention of irreparable / irreversible bladder damage 12 hours is the maximum time prior to irreversible ibl changes. 10

11 C. DDD and Spondylosis: Clinical = Up to 75 % of involvement of the spine occurs at 2 levels: L5-S1 and L4-L5 11

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13 Treatment: t Medications Mdi Physical i l therapy 13

14 D. Spinal Stenosis: Clinical: Results from narrowing of spinal canal and / or neural foramina (CONG. OR DEGENERATIVE) Most common complaint is leg pain, limiting iti walking Neurogenic / Pseudo-claudication = ( pain in lower extremities with gait) 14

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17 Classification A- Congenital Developmental Achondroplasia B- Acquired Degenerative Spondylolisthesis Disc Herniation Degenerative & Disc Herniation Degenerative & congenital 17

18 C-Others: Paget's Spinal tumour Infection (TB) Post-surgery surgery Trauma 18

19 The L4-L5 segment is the most commonly affected,followed followed by the L3-L4. Men are more commnly affected than women, because their spinal canals are narrower at the L3-L5 levels. els 19

20 Pathophysiology Narrowing of the central canal and/or intervertebral foramina is due to: 1.Annular bulging 2.Bone spur formation 3.Facet joint enlargement 4.Ligamentous hypertrophy 20

21 =Relief can occur with: stopping activity sitting, stooping or bending forward =complaints of weakness and numbness of extremities 21

22 Diagnosis CT and MRI 22

23 Activity Walking Uphill Walking Rest Bicycling Lying Flat Vascular Claudication Distal- proximal pain; calf pain Symptoms develop sooner relief with standing Symptoms develop Relief Neurogenic Claudication Proximal- distal thigh pain Symptoms develop later relief with sitting or bending No symptoms May increase symptoms 23

24 Treatment Medications Physical therapy Surgical decompression Indications: 1. Severe neurological symptoms 2. failed conservative treatment + impaired ADL 24

25 E. Disc herniation Clinical: i l LBP associated leg symptoms Positions can induce radicular symptoms Posterolateral disc pathology why? = Area where annular fibers least protected by PLL = Greatest shear forces occur with forward or lateral bend 25

26 Central disc pathology Usually with LBP only without radicular symptoms, unless a large defect is present 26

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28 Treatment t Conservative treatment: > 90 % success rate of symptom resolution with non-operative management 28

29 Treatment Medications Mdi Physical i l therapy Injections SurgeryS 29

30 F. Pars Interarticularis Defects Spondylolysis: Anatomic defect in the bony pars interarticularis within the lamina May be uni- or bilateral Can be congenital or induced Usually without clinical symptoms with incidental findings on radiographs 30

31 Spondylolisthesis Progression of spondylolysis with separation»grades G d assigned di-iv IV»Most common levels are L5-S1 (70 %) L4-L5 (25 %) 31

32 Spondylolisthesis May ybe asymptomatic, but can result in»ddd»radiculopathyr l h 32

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35 Treatment Medication Physical Therapy Injections Surgery 35

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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