Spinal pathology

• Describe osteoporotic spinal fractures

  -osteoporosis is diminished bone density, so vertebral wedge/compression fractures are seen for the spine, other wise known are fragility fracture.

  -These usually affect the anterior column

  -most common is mid thoracic spine and thoraco-lumbar junction

  -spinal stability is not a risk but can be painful and debilitating
• MOI for osteoporosis

  Cortical and trabecular bone loss with disruption of bne microachitecture. this causes the bone to become fragile, thus minimal flexion (bending over) and axial loading (carrying light bags) can cause fractures
• RA for osteoporosis

  Vertebral body is reduce in height, mostly on anterior side, influencing a wedge-like shape. This appears as reduced bony density. There is increased kyphosis (curvature/hump appearance) if multiple fractures evident
• treatment for osteoporosis

  it is usually a stable, benign fracture that will heal on its own without complications. treatment will often be pain medication use, active limitation, bracing, and physical therapy. only rate cases with middle or posterior common fractures require surgery. With ongoing management, use bi-phosphonates (reduce impact of bone density loss) and calcium supplements, DEXA scans, weight bearing exercises to monitor those at risk.
• Spinal metastases

  When primary cancer in its later stage spread to and grow in the vertebral column through the blood. Bones will erode or weaken causing a wedge or compression fracture, this can eventually compromise the spinal cord/nerves. 70% of symptomatic lesions are found in the thoracic region
• primary cancers that spread to the spine

  -lung 31

  -breast 24

  -GI tract 9

  -prostate 8

  –lymphoma 6

  -melanoma 4

  -kidney 1

  -thyroid
• MOI for spinal metastases

  Cancerous cells that grow in the vertebra disrupt the normal regulation of osteoblastic/osteoclastic activity causing osteoblastic/sclerotic lesions (increase density) or osteolytic lesions (reduced density=can lead to pathological fractures as bones weaken)
• symptoms of spinal metastases

  -bone pain

  -reduced range of movement

  -neurological symptoms in SC/nerves affected
• RA spinal metastases on xray

  -sclerotic areas shown as increased density/whiteness

  -lytic areas shown as decreased density/blackness e.g look at pedicels if they have eroded on AP view, visible as a ‘winking owl’
• spinal metastases RA in other modalities

  -NM showing hot spots for areas of increased radioisotope reuptake

  -CT showing pathological fractures from lytic lesion

  -MRI showing whether the metastases has extended to the spinal cord, compressing it. shown as darker/lower signal areas in the brighter/higher signal bone
• treatment for spinal cord metastases

  -metastases with fracture includes palliative care with pain relief, stabilisation of spine, reversal or stabilisation of neurological deficits (when SC is affected), brace to support the spine, or surgery with radiotherapy

  -spinal cord compression will need immediate attention, usually surgery or radiotherapy to prevent pemanent loss of nerve function and relieve pressure from SC/nerves

  -only metastases include steroids, anti-inflams, physiotherapy and radiotherapy
• Describe prolapsed/herniated/slipper intervertebral disc

  When pressure on the disc causes the nucleus pulposous to herniate posteriorly (can affect spinal cord/nerves=sciatica w/ pain in lower limb) or into one of the adjacent vertebral bodies. posterior, will cause acute weakness and pain
• MOI PID

  From overdue pressure. Common in lumbar region due to weight-bearing and flexing role.
• RA PID

  use MRI for soft tissue demonstration in sagittal and axial views. shown as bulging of nucleus pulpopsus
• PID treatment

  -rest, painkillers, gentle exercise

  -more severe: steroids, physiotherapy

  -surgery to decompress the disc
• describe scoliosis

  An abnormal lateral curvature of the vertebral coloumn
• cause of scoliosis

  combination of genetic and environmental factors. pt will usually present with uneven hips/shoulders, a more prominent scapula and may lean more towards one side
• symptoms of scoliosis

  includes chronic back pan, arthritis around the vertebrae joints, possible difficult in breathing. pt may also have numbness/weakeness in lower limbs due to nerve inpingement
• RA of scoliosis

  asymmetry of evident across intervertebral joints with medio-lateral narrowing or widening of joint spaces in the region of the curve. the trabecular pattern and cortical margin should be intact
• treatment for scoliosis

  analgesias, back brace, physiotherapay. surgery for more severe cases involving fusion of the vertebrae using metal rods and wires
• describe spinal fusion as surgery for scoliosis

  harvest bone elsewhere in the body and graft to the vertebrae. the vertebral column will become rigid fuse into one bone mass as part of healing process. use metal rods and wire to insert for correction of the curvature during the healing process. use CT for assessment and planning of treatment
• describe lordosis

  Abnormal exaggeration of curvature in cervical or lumbar vertebra that curves more anteriorly
• lordosis causes

  -bad posture

  -obesity

  -osteoporosis

  -discitis

  -kyphosis

  -spondylolisthesis

  -achondroplasia
• lordosis symptoms

  -pain

  -muscle spasms

  -tingling or numbness in limbs

  -bowl or bladder function issues due to nerve entrapment
• RA lordosis

  antero-posterior
• treatment for lordosis

  mild-analgesia, back brace, physiotherapy

  severe-surgery for vertebral fixation
• describe loss of lordosis

  Loss of natural antero-posterior curvature of the cervical or lumbar spine
• causes for loss of lordosis

  poor posture, obesity, osteoporosis
• symptoms for loss of lordosis

  pain, tingling/numbness of lower limbs due to nerve entrapment, muscle spasms
• RA of loss of lordosis

  antero-posterior
• treatment for loss of lordosis

  mild cases- traction and physiotherapy to correct posterior

  severe cases- spinal fusion but will lose spinal flexibility and elasticity
• describe kyphosis

  abnormal increase in curvature for thoracic spine
• causes for kyphosis

  TB, rickets, poor posture. for females, most common from advanced osteoporosis
• symptoms for kyphosis

  pain, muscle spasm, tingling/numbness in limbs due to nerve entrapment
• RA for kyphosis

  anterior-posterior
• treatment for kyphosis

  -mild: exercise and physiotherapy ton increase muscle strength, anti-inflammatories

  -severe: corrective surgery and bracing
• kyphosis in children

  -there is congenital kyphosis from incorrect foetal development of spinal curvature, thus this type of kyphosis is found at birth

  -scheuermanns disease = a form of osteoporosis-chondritis that affects vertebrae, mostly apparent in teens

  -these lead to impingement to the spinal cord that put pressure to internal organs

  -use back brace or surgery for correction
• Describe torticollis

  asymmetrical alignment of the neck from muscle spasms
• torticollis causes

  -trauma or twisting of neck muscles, causing head to be drawn to one side

  -or infections whereby glands and lymph nodes in neck will swell. muscles overlying these glands can go into spasm and cause torticollis
• torticollis symtpoms

  pain, stiffness, decrease range of movements