University of Debrecen

Department of

Orthopaedic Surgery

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.

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Anatomy

Vertebrae

• 7 Cervical

• 12 Thoracic

• 5 Lumbar

• 5 Sacral

• 4-6 Coccygeal

• Same structure, but different localisation,

shape and function!

• Anatomical – functional segment

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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)

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SYNDESMOSIS

• Anterior and posterior longitudinal

ligament

• Yellow ligament

• Interspinous ligament

• Intertransversal ligament

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SYNCHONDROSIS

INTERVERTEBRAL DISC

(anulus fibrosus, nucleus pulposus)

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SYNOSTOSIS SACRUM

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REGULAR JOINTS

Joint capsule, hyaline cartilage, synovial

membrane and fluid!

FACET JOINTS

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Movements of the spine

• Anteflexion

• Retroflexion

• Lateralflexion (left and right)

• Torsion (left and right)

• Pairs of wertebrae –anatomical and

functional segment

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Functions of the vertebral disc

• Stability - Stabilizing role

(Keeps the ligaments tight by keeping the

distance between the vertebrae constant)

• Flexibility - Buffer role.

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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”.

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Degenerative changes

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

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RUPTURED HERNIA

Foraminal herniation

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Foraminal herniation

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Imaging

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Imaging

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Symptoms

L4-L5 – 90%

L5 and S1 symptoms

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Degenerative changes

Definition

• SPONDYLOSIS: degenerative changes

between two vertebral bodies with

spondylophyte formation.

• SPONDYLARTHROSIS: degenerative

changes in the facet joints between two

vertebrae.

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Spondylosis

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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

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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

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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.

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TREATMENT

• BEDREST (IN KYPHOSIS)

• PHYSICOTHERAPY

• NSAID, MUSCLE RELAXANTS!!

• LOCAL STEROID

• BRACE

• SURGERY: stabilization,discectomy, etc.

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Spinal stenosis

• Narrowing of the spinal canal causing ischemia in the cauda equina.

• reason: spondylophyte, facet joint arthrosis, discus hernia…etc.

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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

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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!)

Ankylosing spondylitis

Bechterew’s disease

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Mennel test

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Spondylolysis, spondylolisthesis

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Spondylolysis - a defect in the pars

interarticularis of the vertebral arch

Spondylolisthesis - is the forward or

backward displacement of a vertebra

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Meyerding Classification

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Wiltse Classification

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Imaging – Dittmar view

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Imaging – CT

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Treatment

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Disorders of segmentation

Sacralisation – partial or total fusion of fifth lumbar

vertebra and sacrum.

Lumbarization – lack of the fusion inside the

sacrum.

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Scheuermann disease

• Juvenile osteochondrosis

• 10% occurrence in adolescence

• Blood supply problems to the end plate results in

disc herniation -SCHMORL- nodes

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Imaging

• X-RAY: uneven endplate, Schmorl nodes,

increased kyphosis, anterior wedging of

vertebrae.

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Imaging

MRI

Scheuermann disease

CLINICAL SIGNS:

• fixed increased thoracic kyphosis

• centre descend from V-VII to VII-IX

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Treatment

Thank you for your attention!