Spondylolysis and spondylolisthesis. Congenital anomalies of the spine. Scheurmann’s disease and its treatment. Degenerative changes of the spine. Spinal stenosis. Disc generation and prolapse. Sciatica. Ankylosing spondylitis.
University of Debrecen Department of Orthopaedic Surgery 1 Anatomy
DE OEC 2 Ortopédiai Klinika Vertebrae
• 7 Cervical • 12 Thoracic • 5 Lumbar • 5 Sacral • 4-6 Coccygeal • Same structure, but different localisation, shape and function! • Anatomical – functional segment
3 Joints of the vertebrae
ALL JOINT TYPES CAN BE FOUND
• SYNDESMOSIS (ligamentous) • SYNCHONDROSIS (fibro cartilage) • SYNOSTOSIS (bone) • REGULAR JOINT (joint capsule, hyalin cartilage, synovial membrane, synovial fluid)
4 DE OEC 5 Ortopédiai Klinika SYNDESMOSIS
• Anterior and posterior longitudinal ligament • Yellow ligament • Interspinous ligament • Intertransversal ligament
6 DE OEC 7 Ortopédiai Klinika SYNCHONDROSIS
INTERVERTEBRAL DISC (anulus fibrosus, nucleus pulposus)
8 SYNOSTOSIS SACRUM
9 REGULAR JOINTS
FACET JOINTS
Joint capsule, hyaline cartilage, synovial membrane and fluid! 10 DE OEC 11 Ortopédiai Klinika Movements of the spine
• Anteflexion • Retroflexion • Lateralflexion (left and right) • Torsion (left and right) • Pairs of wertebrae –anatomical and functional segment
12 Functions of the vertebral disc
• Stability - Stabilizing role (Keeps the ligaments tight by keeping the distance between the vertebrae constant) • Flexibility - Buffer role.
13 Degenerative changes
• CAUSE: disc prolapse and protrusion. • Disc flattening causes pain. • Bone growth at the edge of the vertebrae • Stability of spine – tension of ligaments • „Vicious cycle”.
14 Degenerative changes
DE OEC 15 Ortopédiai Klinika DISEAESES OF THE VERTEBRAL DISCS • PROTRUSION -anulus fibrosus intact • HERNIA -anulus fibrosus not intact - nucleus pulposus leaks out • RUPTURED HERNIA- small amount nucleus pulposus leaks out and loses connection with remaining
16 RUPTURED HERNIA
DE OEC 17 Ortopédiai Klinika Foraminal herniation
18 Foraminal herniation
DE OEC 19 Ortopédiai Klinika Imaging
DE OEC 20 Ortopédiai Klinika Imaging
DE OEC 21 Ortopédiai Klinika Symptoms
L4-L5 – 90% L5 and S1 symptoms
DE OEC 22 Ortopédiai Klinika Degenerative changes
DE OEC 23 Ortopédiai Klinika Definition
• SPONDYLOSIS: degenerative changes between two vertebral bodies with spondylophyte formation. • SPONDYLARTHROSIS: degenerative changes in the facet joints between two vertebrae. Spondylosis
DE OEC 25 Ortopédiai Klinika DE OEC 26 Ortopédiai Klinika CLINICAL SIGNS (lumbago) • The mobility of the affected vertebrae decreases • The affected area is tender • The spinous processes are sensitive to touch • Spastic paravertebral muscle • Antalgic posture • Pain on axial loading
27 CLINICAL SIGNS (sciatica) • The mobility of the affected vertebrae decreases • The affected area is tender • The spinous processes are sensitive to touch • Spastic paravertebral muscle • Antalgic posture • Pain on axial loading • + SIGNS OF NERVE ROOT IRRITATION!!!(radiating pain, sensory loss, paresis, reflex difference) 28 DE OEC 29 Ortopédiai Klinika RADIOLOGICAL SIGNS
• Decreased intervertebral space. • Degenerative bone deposits on the edge of the vertebrae (spondylophytes). • Degenerative facet joint changes. • Stenosis of intervertebral foramen • Spinal stenosis.
30 DE OEC 31 Ortopédiai Klinika TREATMENT
• BEDREST (IN KYPHOSIS) • PHYSICOTHERAPY • NSAID, MUSCLE RELAXANTS!! • LOCAL STEROID • BRACE • SURGERY: stabilization,discectomy, etc.
32 Spinal stenosis
• Narrowing of the spinal canal causing ischemia in the cauda equina. • reason: spondylophyte, facet joint arthrosis, discus hernia…etc.
33 Spinal stenosis
• Symptoms: Pain during standing or walking radiating into the lower extremities, which disappears after sitting or bedrest= neurologic claudication. • Treatment:conservative (see above) or surgical decompression
34 Ankylosing spondylitis Bechterew’s disease
DE OEC 35 Ortopédiai Klinika Ankylosing spondylitis Bechterew’s disease • Chronic inflamation of the entire spine and sacroiliac joints, which characterized by calcification of ligaments and joint capsules (regular joints!)
36 DE OEC 37 Ortopédiai Klinika DE OEC 38 Ortopédiai Klinika DE OEC 39 Ortopédiai Klinika Mennel test
DE OEC 40 Ortopédiai Klinika Spondylolysis, spondylolisthesis
DE OEC 41 Ortopédiai Klinika Spondylolysis - a defect in the pars interarticularis of the vertebral arch
Spondylolisthesis - is the forward or backward displacement of a vertebra
DE OEC 42 Ortopédiai Klinika DE OEC 43 Ortopédiai Klinika Meyerding Classification
44 Wiltse Classification
DE OEC 45 Ortopédiai Klinika Imaging – Dittmar view
DE OEC 46 Ortopédiai Klinika Imaging – CT
DE OEC 47 Ortopédiai Klinika Treatment
DE OEC 48 Ortopédiai Klinika Disorders of segmentation
Sacralisation – partial or total fusion of fifth lumbar vertebra and sacrum. Lumbarization – lack of the fusion inside the sacrum.
DE OEC 49 Ortopédiai Klinika DE OEC 50 Ortopédiai Klinika Scheuermann disease
• Juvenile osteochondrosis • 10% occurrence in adolescence • Blood supply problems to the end plate results in disc herniation -SCHMORL- nodes
DE OEC 51 Ortopédiai Klinika Imaging
• X-RAY: uneven endplate, Schmorl nodes, increased kyphosis, anterior wedging of vertebrae.
DE OEC 52 Ortopédiai Klinika Imaging
MRI
DE OEC 53 Ortopédiai Klinika Scheuermann disease
CLINICAL SIGNS: • fixed increased thoracic kyphosis • centre descend from V-VII to VII-IX
Treatment
DE OEC 55 Ortopédiai Klinika Thank you for your attention!