University of Debrecen Department of Orthopaedic Surgery

Transcription

1 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. 1 University of Debrecen Department of Orthopaedic Surgery

2 Anatomy 2

3 Vertebrae 7 Cervical 12 Thoracic 5 5 Lumbar Sacral 4-6 Coccygeal Same structure, but different localisation, shape and function! Anatomical functional segment 3

4 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

5 5

6 SYNDESMOSIS Anterior and posterior longitudinal ligament Yellow ligament Interspinous ligament Intertransversal ligament 6

7 7

8 SYNCHONDROSIS INTERVERTEBRAL DISC (anulus fibrosus, nucleus pulposus) 8

9 9 SYNOSTOSIS SACRUM

10 REGULAR JOINTS FACET JOINTS 10 Joint capsule, hyaline cartilage, synovial membrane and fluid!

11 11

12 Movements of the spine Anteflexion Retroflexion Lateralflexion (left and right) Torsion (left and right) Pairs of wertebrae anatomical and functional segment 12

13 Functions of the vertebral disc Stability - Stabilizing role (Keeps the ligaments tight by keeping the distance between the vertebrae constant) Flexibility - Buffer role. 13

14 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

15 Degenerative changes 15

16 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

17 RUPTURED HERNIA 17

18 18 Foraminal herniation

19 Foraminal herniation 19

20 Imaging 20

21 Imaging 21

22 Symptoms L4-L5 90% L5 and S1 symptoms 22

23 Degenerative changes 23

24 Definition SPONDYLOSIS: degenerative changes between two vertebral bodies with spondylophyte formation. SPONDYLARTHROSIS: degenerative changes in the facet joints between two vertebrae.

25 Spondylosis 25

26 26

27 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

28 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

29 29

30 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

31 31

32 TREATMENT BEDREST (IN KYPHOSIS) PHYSICOTHERAPY NSAID, MUSCLE RELAXANTS!! LOCAL STEROID BRACE SURGERY: stabilization,discectomy, etc. 32

33 Spinal stenosis Narrowing of the spinal canal causing ischemia in the cauda equina. reason: spondylophyte, facet joint arthrosis, discus hernia etc. 33

34 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

35 Ankylosing spondylitis Bechterew s disease 35

36 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

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38 38

39 39

40 Mennel test 40

41 Spondylolysis, spondylolisthesis 41

42 Spondylolysis - a defect in the pars interarticularis of the vertebral arch Spondylolisthesis - is the forward or backward displacement of a vertebra 42

43 43

44 44 Meyerding Classification

45 Wiltse Classification 45

46 Imaging Dittmar view 46

47 Imaging CT 47

48 Treatment 48

49 Disorders of segmentation 49 Sacralisation partial or total fusion of fifth lumbar vertebra and sacrum. Lumbarization lack of the fusion inside the sacrum.

50 50

51 Scheuermann disease Juvenile osteochondrosis 10% occurrence in adolescence Blood supply problems to the end plate results in disc herniation -SCHMORL- nodes 51

52 Imaging X-RAY: uneven endplate, Schmorl nodes, increased kyphosis, anterior wedging of vertebrae. 52

53 Imaging MRI 53

54 Scheuermann disease CLINICAL SIGNS: fixed increased thoracic kyphosis centre descend from V-VII to VII-IX

55 Treatment 55

56 Thank you for your attention!