Pathology Related To Spine 2022 - Feryanda

Polytechnic of Health Sciences Jakarta I
Ministry of Health of Republic of Indonesia

Department of Prosthetics & Orthotics
Spinal Orthotics Course Handout 2020

Pathology Related to Spine
Intake 13
2022
Leaning Outcomes
• The students will be able to explain each of

spinal pathology
2 SO/JSPO/2022/Intake13
Contents
Type of Spinal Pathology 9) Spondylolisthesis
1) Fracture 10) Spondylolysis
1. Compression Fracture 11) Intervertebral Disc Herniation
2. Burst Fracture 12) Ankylosing Spondylitis
3. Tear Drop Fracture 13) Ossification of the Posterior
4. Jefferson Fracture Longitudinal Ligament (OPLL)
5. Hangman’s Fracture 14) Thoracic Outlet Syndrome
6. Facet joint Fracture 15) Low Back Pain
7. Seat belt (Chance) Fracture 16) TB spine
2) Atlanto-Occipital Dislocation (AOD) 17) Neurofibromatosis
3) C1/2 Dislocation 18) Charcot spine
4) Whiplash Injury 19) Paget’s disease
5) Spondylosis 20) Spine hematoma
6) Spinal osteoarthritis 21) Deformity
7) Spinal stenosis 1. Torticollis
8) Degenerative disc disease 2. Scheuermann’s Kyphosis
3. Scoliosis (*another chapter)
Type of Spinal Pathology
Causes Regions
• Trauma • Cervical
• Non Trauma (Disease) • Thoracic
• Congenital • Lumber
• Unknown Idiopathic
Structures
• Bone
• Ligament
• Nerve
[1] Fracture
• A fracture is a broken bone

• It can range from a thin
crack to a complete break
• A bone can fracture
crosswise, lengthwise, in
several places, or into many
pieces
• Typically, a bone becomes
fractured when it is
impacted by more force or
pressure than it can support
Fracture
• Causes for trauma
– Traffic accident
– Fall down
– Sports
– Violence
For any trauma forces are required to fracture the bone

• Compression force
• Flexion force
• Extension force
• Rotation force
• Causes for non trauma

– Diseases
Fracture
• The vertebral column is divided into three columns
1. Anterior
2. Middle
3. Posterior
Fracture
Posterior column :
• Neural arch (Vertebral arch)
• Ligamentum flavum
• Facet joint
• Interspinous ligaments
Fracture
Middle column :
• Posterior longitudinal ligament
• Posterior half of the vertebral

body
• Posterior aspect of
Intervertebral Disc
Fracture
Anterior column :
• Anterior longitudinal ligament
• Anterior half of the vertebral

body
• Anterior aspect of
Intervertebral Disc
Fracture SUPER IMPORTANT
• Fracture stable versus unstable

– Spinal injury is considered
UNSTABLE if normal
physiological load cause
further neurological damage,
chronic pain and deformity
when under normal physiologic loading, the spinal
column can maintain its normal pattern without
displacement creating any additional neurologic deficit,
incapacitating pain or deformity (Panjabi and White)
– Instability exists if any of two

columns are disrupted
– If middle column is intact –
usually stable
Fracture
• Major Injuries
• Compression
• Burst
• Fracture – Dislocation
• Seat belt type
• Minor Injuries
• Transverse processes
• Spinous processes
• Articular process
Compression Fracture (1)
Overview
• Vertebra breaks and collapses
• Failure of anterior column
• The middle column is intact as a hinge
• Can put pressure on the spinal cord and nerves by compression
itself or protrusion of bone into spinal canal in the worst cases
Compression Fracture
Causes
• Trauma
– A fall, a forceful jump, a car accident,
etc.
– Downward pressure when spine
bending position
With some underlying cause

• Osteoporosis
• Cancer
Osteoporosis
• Bone is getting weaker
• Bones become brittle and fragile
from loss of tissue, typically as a
result of hormonal changes, or
deficiency of calcium or vitamin
D
• Common in old generation
people (usually old women)
• Tend easy to fracture, and tend
to get compression fracture
Causes by
Osteoporosis
• Fall on the buttocks

• Lift up light object
• Sneeze
• Twist the body
Symptom
• Traumatic accident
– Severe pain at back
• Osteoporosis
– No symptom at first
– Back pain start slowly and get worse with walking
• Numbness or weakness if fracture injures nerve
• Common at T12-L2
Treatment
• Traumatic accident
– Stable → Conservative treatment
– Unstable → Surgical treatment
• Osteoporosis
– Conservative treatment would be a
first choice
– BKB (balloon Kyphoplasty)
Orthotic Treatment
• Orthotic Goal?
• Biomechanical principle?
• Conservative treatment? Or surgical treatment?
Traumatic accident Osteoporosis
Burst Fracture (2)
Overview
• More severe than
compression fracture
• Occur from;
– Compression force
– Flexion force
– Extension force
– Rotation force
• Failure of anterior column
and middle column
• Most common junction T/L
Burst Fracture
SO/JSPO/2022/
22 Intake13
Tear Drop Fracture (3)
• Flexion Teardrop
– Extreme flexion and
axial loading at cervical
– Most severe – dive into
pool
– Vertebral column shift
posteriorly
Risk of SCI
C1 Fracture “Jefferson fracture” (4)
• is a bone fracture of the
anterior and posterior
arches of the vertebra
• commonly results from
axial load to the head
combined with
hyperextension of the
cervical part
• commonly results from
diving into shallow
water
C1 Fracture “Jefferson Fracture”
1. Burst Fracture
• Most common
• Compression (axial load force)
2. Posterior arch Fracture
3. Lateral mass fracture
4. Anterior arch fracture
5. Transverse Process fracture
C1 Fracture
“Jefferson fracture”
Video:
https://www.youtube.com/watch?v=XyLW
Hangman Fracture (5)
Fracture
caused by
extension and
compression
at C2
Fracture at
pars
interarticularis
There are type I, II, IIa and type III
• Stable
• Unstable
Video: https://www.youtube.com/watch?v=BuonvKW7Uxo
Facet Joint Fracture (6)
• The injury usually results from forced flexion

of the cervical spine. However, where there is
a degree of rotation, the facet dislocation
may only occur to one facet joint:
• unilateral facet fracture: stable

• bilateral facet fracture: unstable
Unilateral Facet Joint Fracture
Bilateral Facet Joint Fracture
Radiographic features:
(best seen on lateral view)
1. Complete anterior dislocation of
affected vetebral body by half or
more of the vertebral body AP
diameter.
2. Disruption of the posterior
ligament complex and the anterior
longitudinal ligament
Unstable
(7)
Seat belt Injury or Chance Fracture
Failure of middle and posterior columns

With tear of the anterior annulus fibrous, and
stripping of the anterior longitudinal ligament
Anterior
Longitudinal
Ligament
Annulus Fibrous
Flexion distraction or Seat Belt type Injury or
Chance fracture
Type A Type B Type C Type D

Flexion distraction One level ligament Across two levels Two levels middle
(Chance Fracture) and disc disrupted middle column column disrupted
Bone only anterior fractured
longitudinal
ligament intact
[2] Atlanto-Occipital dislocation (AOD)
Alar Ligament
[2] Atlanto-Occipital dislocation (AOD)
Hyperextension distraction
and rotation of cranio-
cervical junction
Can caused by hyper force

to the carnio-cervical
junction (CCJ)
Causing disruption of
carnio-cervical ligament:
Alar ligament
Atlanto-Occipital dislocation (AOD) - Type
Type 1 Head displaced anteriorly
Type 2 Distraction
Type 3 Head displaced posteriorly
[3] C1-C2 Dislocation
Atlanto-Axial Dislocation and
Fracture
Displaced fracture or dislocation of

the Atlanto-axial joint may cause
life-threatening complications.
Causes :
- Direct Trauma (Flexion
extension injury Traction or
rotation
- Bone Disorders
[3] C1-C2 Dislocation
[4] Whiplash Injury
• Non-medical term describing a range of injuries to the neck caused
by or related to a sudden distortion of the neck associated with
extension, although the exact injury mechanism(s) remain unknown.
• Usually it occurs in cases of car accident.
• No always visible on x-ray or scan
• Cervical pain, ringing in the ear, and dizziness.
• Stretching of ligaments. Rupture of ligaments
General Symptoms of Whiplash
• Neck pain and stiffness
• Worsening of pain with neck movement
• Loss of range of motion in the neck
• Headaches, most often starting at the base of the
skull
• Tenderness or pain in shoulder, upper back or
arms
• Tingling or numbness in the arms
• Fatigue
• Dizziness
[5] Spondylosis
• Spondylosis refers to degeneration (progressive diseases)
of the spine
• It is not a pathology but a term to describe pain caused
from degenerative conditions of the spine
• Pathologies
– Spinal osteoarthritis
– Spinal stenosis
– Degenerative Disc Disease
[6] Spinal Osteoarthritis
• Cartilage breaks down

– Causing inflamed facet joint
– Can lead to development of
bone spur
– Pain if pinching on spinal
nerves, ligaments, muscles
– Can lead to
spondylolisthesis
[7] Spinal Stenosis
• Narrowing of the spinal canal
⇨ Compression of the spinal cord or spinal nerve
[7] Spinal Stenosis
Causes
• Degeneration in the spine
• Anatomical debris that has been created by the natural aging process
– Spinal osteoarthritis
– Degenerative disc disease
– Spondylolisthesis
– Calcification of the ligamentum flavum
– Bone spur
[7] Spinal Stenosis
(Foraminal Stenosis)
[7] Spinal Stenosis
Foraminal stenosis
• Compression of spinal nerve root when passing through
neural foramen
• Caused by bone spur, DDD
[7] Spinal Stenosis
Symptoms (Lumbar)
• Back pain
• Sciatica (due to irritation or compression of
sciatic nerve)
– Pain at buttock, thigh and leg
– Numbness and tingling at buttock and legs
– Muscle Weakness
• Bowel and bladder dysfunction
• Intermittent claudication
[7] Spinal Stenosis
Symptoms (Lumbar)
• Standing/walking • Patients lean • Sitting or bending

provokes symptoms forward while forward relieve
• Pain/weakness in walking to relieve symptoms
the legs symptoms
[7] Spinal Stenosis
Symptoms (Cervical)
• Myelopathy
– Compression of spinal cord
– Loss of function in upper and
lower extremities
– Bowel and bladder dysfunction
– Spasticity
• Radiculopathy
– Compression of nerve root
– Pinched nerve
– Pain at shoulder
– Muscle weakness, numbness,
tingling
[7] Spinal Stenosis
[8] Degenerative Disc Disease
• Inter vertebra discs starts to thin and break down

• Causes pain originated from disc itself or from the
change of biomechanics
[9] Spondylolisthesis
Overview
• Vertebra slips anteriorly
• May lead to your spinal cord or nerve roots being squeezed
(spinal stenosis)
• Common at L4/5 or L5/S1
Causes
• Can be caused by facet joint fracture (spondylolysis)
Causes
• Repetitive stress to the spine
– Stress fracture by sports (teens)
• Degenerative factor
– The joint of the vertebrae becoming worn and
arthritic
– DDD, osteoporosis, muscle weakness (older
adults)
• Trauma
• Congenital
Symptoms
• Back or buttock pain
• Pain that runs from lower back to down (one or both legs)
• Numbness or weakness in one or both legs
• Difficult to walk (intermittent claudication)
• Leg, back or buttock pain that gets worse when bend backward
or twist
• Loss of bladder or bowel control (in rare case)
⇨ Same symptoms as stenosis
[10] Spondylolysis
• Fracture of the Pars Interarticularis

• A kind of stress fracture of pedicle of
vertebral arch
• Common at L5, sometimes can be seen at
L3, L4
• Common in children and teens
– Participating in sports that place a lot of
stress on the lower back
– Cause a constant over-stretching
(hyperextending) of the spine
– Gymnastics, weightlifting, and football
– More often in males than in females
• Sometimes no symptoms
[10] Spondylolysis
Scottie Dog Fracture
QUICK REVIEW…..
• Spondylosis
• Spondylolysis
• Spondylolisthesis
[11] Intervertebral Disc Herniation
• Known as Spinal disc herniation, slipped disc, herniated disc…
• Nucleus pulposus comes out to posterior or side
• Common at L4/5, L5/S1, and C5/6 (C4/5, C3/4)
Causes
• Disc degeneration
– Gradual, aging-related wear and tear
• Risk factor
– Weight
• Excess body weight causes extra
stress on the disc
– Occupation
• Repetitive lifting, pushing, bending
sideways and twisting
• Driver
– Bad posture
– Smoking
– Genetics
Symptoms (Lumbar) Symptoms (Cervical)
• Back pain • Neck pain
• Pain at buttock, thigh and leg • Pain at shoulder and arm
• Numbness and tingling • Numbness and tingling
• Muscle Weakness • Muscle Weakness
• Bowel and bladder dysfunction • Bowel and bladder dysfunction
Symptoms (Radiculopathy) Symptoms (Myelopathy,
• Pain Cauda equina syndrome)
• Numbness and tingling • Dysfunction of motion
• Muscle Weakness – Difficult to walk, run, write, eat
• Unilateral • Bowel and bladder dysfunction

• Spasticity (severe case)
• Bilateral
• Straight Leg Raising Test (SLRT)
• Straight Leg Raising Test (SLRT)

– A positive result in a SLR test is the recreation
of a patient’s sciatica (with symptoms
extending below the knee) with or without the
presence of back pain. Generally, symptoms
between 30° and 60° to 70° of elevation are
considered significant.
– the BackLetter in 1992
– Positive in Lumber disc herniation
Spinal Stenosis vs Intervertebral Disc Herniation (1)
Spinal stenosis Intervertebral disc herniation
MRI diagnosis
Spinal stenosis vs Intervertebral Disc Herniation (2)
Spinal stenosis Intervertebral disc herniation
Pain Relief by bending forward Relief by bending backward
Intermittent
+ -
claudication
Low back Pain Not severe Severe
Age Common in over 50 Common in 20,30 and 40
Causes Aging Aging, sport, smoking
Leg pain From buttock to ankle From buttock to ankle
SLR - +
[12] Ankylosing Spondylitis
• Chronic Spinal Inflammation
• Unknown cause – genetic?
– Common in men, 10-30 years old
• Causes pain & stiffness
• Can lead to fusion (bamboo spine)
– Loss of mobility
[12] Ankylosing Spondylitis
[12] Ankylosing Spondylitis -
Treatment
• There's no cure for ankylosing spondylitis (AS),
but treatment is available to help relieve the
symptoms.
• Treatment can also help delay or prevent the
process of the spine joining up (fusing) and
stiffening.
– exercise
– physiotherapy
– medication
[13] Ossification of the Posterior Longitudinal Ligament
(OPLL)
• Abnormal calcification of
the posterior longitudinal
ligament
• Unknown cause – genetic?
– Common in men, elderly,
Asian
• Cervical region
• Myelopathy
[14] Thoracic Outlet Syndrome
• Compression / irritation of nerve or blood vessels

at thoracic outlet
• Pain / numbness / weakness in arm, shoulder,
neck
• Common in young women who has sloping
shoulder, or the person who work with upper
limb such as hairstylist, PC worker
• Test
– Morley
– Adson
– Wright
– Roos
– Eden
• Orthotic treatment
– Lift up clavicle and
scapula
– Positioning (reduce
kyphosis)
– Open thoracic outlet
[15] Low Back Pain
• Mechanical Low Back Pain
• Non specific pathology
• Not found obvious cause
– No any changes on X-ray
– No sciatica
• Either acute or chronic
– Muscle weakness
– Skeletal instability
– Acute Injury
• Common in men who are hard
workers, heavy weight, Driver or office
worker
[15] Low Back Pain
[15] Low Back Pain
[15] Low Back Pain
[16] Tuberculosis Spine (TB Spine)
• M.tuberculosis infection (primarily in lungs)
• Include: pulmonary, genitourinary, skeletal, pericardium,
meninges
• Skeletal TBPott’s disease (affects spine mostly but also
knee and hip)
• Synonim: tuberculosis spondylitis
• Symptoms
Fever and weight loss
Localized pain
Paravertebral abscess
 Neurological impact, eg: paraplegia
[16] TB Spine/ Pott’s Spine
Physical examination of the spine:

• Localized tenderness and paravertebral muscle spasm
• Kyphotic deformity (Pott’s disease)
• Cold abscess/swelling/sinus tract
• Pain and stiffness (common in lower cervical area)
[16] TB Spine / Pott’s Spine
Pathogenesis
Clinical Features of Pott’s Paraplegia

• Paraplegia
• Spontaneous muscle twitching in lower limbs
• Clumsiness while walking
• Extensor plantar response
• Exaggerated reflexes – sustained clonus of patella and ankle
• Motor affected first – then sensory
• Sense of pstition and vibration – last to disappear
Clinical Features
Active Stage
1. Constitutional symptoms 4. Deformity: Knuckle (1 or 2
• Malaise vertebrae) ; Gibbus (2 or 3
vertebrae) ; Kyphus
• Loss of weight/appetite (angular kyphosis > 3
• Night sweats vertebrae)
• Evening rise of 5. Cold abscess may be
temperature present
2. Back pain 6. Paraplegia (if neglected in
3. Spine stiffness: spasm of early stages)
para-vertebral muscle **Several of these signs and
symptoms may be absent
TB Spine
Healed Stage Healing is indicated by
Patient neither looks ill nor feel
ill  Decreased soft tissue
shadow
 No systemic features but the  Return of normal
deformity that occurred density
during active stage,  Bony ankylosis
however: persists.
 Erythrocyte sedimentation
rate (ESR) falls
 There is radiological
evidence of bone healing in
serial x-rays.
TB Spine
Radiological Investigations
Spine at risk sign

TB Spine
TYPE
1. Paradiscal Lesions
• Most common
• Narrowing of the disc
• Destruction of subchondral bone with
subsequent herniation of the disc
into the vertebral body
TB Spine
TYPE
2. Anterior Lesions
• More common in thoracic spine in children
• Both pressure and ischemia combine to produce anterior
scalloping
• Collapse of the vertebral body and diminution of the disc
space is usually minimal and occurs late
TB Spine
Posterior view
TB Spine of the pelvis
TYPE
3. Central Lesions
• Centered on the vertebral body
• Disc not involved
TB Spine
TYPE
4. Appendicial Lesions
• Uncommon (<5%)
• Radiographically- erosive
lesions, paravertebral shadows
with intact disc space
• Rarely, present as synovitis of
facet joints
TB Spine
Cervical tuberculosis (Cervical TB)

• Infection from primary sites via lymphatic route
• Uncommon (<1%)
• Presentation
Cervico-medullary compression
Cranial nerve deficits
Atlanto-axial instability
Abscess formation
TB Spine
Complications:
• Paraplegia • Secondary infection
• Cold abscess • Amyloid disease
• Spinal deformity • Fatality
• Sinuses
TB Spine
Staging of neurological deficit
TB Spine
Indication for surgery:

• No neurological recovery
• Recurrent of neurological complication
• Recurrent paraplegia
• Posterior spinal disease
• Spinal tumour resulting in cord compression
• Doubtful diagnosis & for mechanical stability after healing
• Cauda equina paralysis
[17] Spine Neurofibromatosis
• Genetic disorder that affects the development and growth of

nerve cell tissues (brain, nerve, spinal cord, skin)
• It causes tumor to grow on nerve (neurofibroma) that lie on
or under the skin anywhere in the body
• 2 types:
Neurofibromatosis type 1 (NF1)
Neurofibromatosis type 2 (NF2)
Spine Neurofibromatosis
Skeletal associations
 Generalized:  Focal:
• Osteoporosis • Spinal deformity
• Osteomalacia • Long bone and sphenoid wing dysplasia
• Chest wall and dental abnormalities
• Short stature
• Cystic osseous lesions
• Macrocephaly
Neurofibromatosis type 1 (NF1)
• Von Recklinghausen disease
• Mostly affects nerves of the outer parts of the body
(peripheral nervous system)
• Common sign: café-au-lait spots (>6)
• Lisch nodules in eyes
Neurofibromatosis type 1
Skeletal features
• Kyphoscoliosis
• Posterior vertebral scalloping
• Posterior hypoplastic elements
• Enlarged neural foramina
• Ribbon rib deformity, rib notching, dysplasia
• Dural ectasia
• Tibial pseudoarthrosis
• Severe bowing
Neurofibromatosis type 2 (NF2)

• Less common
• Mostly affect CNS, causing tumors of the brain and spinal
cord (eg: meningioma)
• Tumors along cranial nerves  8th cranial nerve and
vestibular nerve
• Hearing problems
• Muscle atrophy
[18] Charcot Spine
• Charcot spinal arthropathy

• Mostly traumatic (SCI)
• Rare but progressive and severe degenerative disease
that develops in the absence of deep sensation
• Combination of:
Spinal fusion
Loss of sensation below the fused area
Repeated excess stress below the fused area
Charcot Spine
Etiology
• SCI
• Diabetes mellitus neuropathy
• Multiple sclerosis
• Syringomelia
• Leprosy
• Etc
Charcot Spine
Degenerative Cascade
Charcot Spine
Symptoms
• Localized low back pain
• Loss or increase of spasticity
• Audible noise with motion of the spine
• Kyphosis or scoliosis
• Autonomic dysreflexia
[19] Paget’s Disease
• Other name: Osteoitis deformans

• Progressive bone deformation due
to problems in bone resorption and
remodelling resulted in deformity
• Second most common disorder in
elderly (after osteoporosis)
• Idiopathic
• Affects axial skeleton (spine, skull,
sacrum, pelvis, femur, etc)
Paget’s Disease
Symptoms:
• Bone pain (the most common symptom)
• Secondary osteoarthritis (when Paget disease occurs around a
joint)
• Bony deformity (most commonly bowing of an extremity)
• Excessive warmth (due to hypervascularity)
• Neurologic complications (caused by the compression of neural
tissues)
Paget’s Disease
Phases
• Lytic
Increase of bone turnover rate
• Mixed (lytic and blastic)
Rapid increase in bone
formation
• Sclerotic
Bone formation dominates
(woven bone)
Paget’s Disease
Paget’s Disease
Clinical features
• Localised pain and tenderness
• Local temp ↑  hypervascularity
• Bone size ↑ (changing hat size)
• Bowing deformities
• Kyphosis
• Decreased ROM
Paget’s Disease
Complications
• Optic and auditory nerve compression
• Heart failure
• Malignancies (eg: osteosarcoma)
• Deformity and fractures (eg: paraplegia, quadriplegia)
• hyperparatyroidism
[20] Spinal Hematoma
• Collection of blood in the potential space between the dura

and the bone, along the spinal canal.
• Other name: Hematomyelia

• Type
Traumatic
Spontaneous
Iatrogenic
Spinal Hematoma
• Traumatic spinal epidural hematoma

– Frequency unclear
– Typically will have concomitant spine fracture
• Spontaneous spinal epidural hematoma
– Associated with anticoagulation, coagulopathies,
thrombocytopenia, neoplasms, or vascular malformations
• Iatrogenic spinal epidural hematoma
– The risk of bleeding after procedures,
eg: multiple attempts at needle placement, and use of
anticoagulation or antiplatelet therapy
Spinal Hematoma
Spinal Hematoma
Association with:
• Vascular malformation
• Coagulopathies
(eg: congenital  hemophilia)
• Myelitis/vasculitis
(eg: tumor)
This T1-weighted sagittal MRI is from a 19-year-old man with

4-month history of progressive motor loss and an inability to
ambulate. He underwent spinal biopsy that confirmed an
intramedullary glioblastoma.
Spinal Hematoma
• Symptoms
– Sudden onset of severe back pain, or radicular pain,
depending on the location of the bleeding
– Pain may be exacerbated by percussion of the spine or by
movements that increase intraspinal pressure (coughing or
sneezing)
– Neurological symptoms may not develop until hours to days
after the onset of back pain, difficult for early diagnosis to
Spinal Hematoma
• Signs
– There may be tenderness to palpation of the spine
– Motor and sensory deficits depend on the level and size of the
hematoma
– Clinical presentation can range from focal weakness to

paraplegia or quadraplegia, and from paresthesias to complete
loss of sensation below a certain level
Spinal Hematoma
[21] Spine Deformities
TORTICOLLIS
Torticollis
• Latin word = Twisted neck
• It is disorders that exhibit

flexion, extension, or twisting
of muscles of the neck
beyond their normal position
• This condition can be

congenital or acquired
Congenital Muscular Torticollis
• The most common type

• Causes is unknown,
• It is present at birth and
normally discovered in
first 6 – 8 weeks
• Radiograph is necessary
to check any vertebral
anomalies
• Some is associated with
hip dysplasia
• Clinical Presentations
– Spasm of the sternocleidomastoid muscle on the
same tilt
– Head tilt toward the tightened muscle and chin
rotation to the opposite site
Courtesy of Texas Scottish Rite

125 Hospital for Children
SO/JSPO/2022/Intake13
• Treatment
– Stretching ( success rate is 90%)
– Surgery  if deformity persistent more than 1 year
– Orthosis  TOT collar , Fillauer
SCHEUERMANN’S KYPHOSIS
Alignment of Spine
• Normal thoracic
kyphosis 20 - 40°
• Normal lumbar
lordosis 55 - 65°
Scheuermann’s Kyphosis
• It is a rigid thoracic
hyperkyphosis by >45°
• Unknown cause
• There are 2 forms:
– Thoracic SK  most
common form
– Thoracolumbar/Lumbar
SK
• Associated with
increased back pain
• No vertebral wedging
involved
Thoracic Scheuermann’s Kyphosis
• 12 – 15 years old , M > F
• Thoracic deformity with compensatory cervical lordosis
• The forward bending test to check the excessive of
kyphosis
• 30% associated with mild scoliosis
• Radiographs
– Excessive khyposis
– Vetebral wedging >5°
on 3 vertebrae
– End plates irregularity
– Narrowing of disc
space - anteriorly
• Indication for extension brace

– Curve 45 – 65 with 2 years
growth remaining
– Wedging >5°
• Apex at T9 or above –
CTLSO
• Below T9 – TLSO
• Indication for surgery
– Kyphosis >65°
– Wedging >10°
Thank you
Questions?

Pathology Related To Spine 2022 - Feryanda

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Pathology Related To Spine 2022 - Feryanda

Uploaded by

Copyright:

Available Formats

Polytechnic of Health Sciences Jakarta I

Ministry of Health of Republic of Indonesia

Spinal Orthotics Course Handout 2020

• The students will be able to explain each of

• A fracture is a broken bone

For any trauma forces are required to fracture the bone

• Causes for non trauma

• The vertebral column is divided into three columns

• Neural arch (Vertebral arch)

• Posterior longitudinal ligament

• Posterior half of the vertebral

• Anterior longitudinal ligament

• Anterior half of the vertebral

• Fracture stable versus unstable

– Instability exists if any of two

With some underlying cause

• Fall on the buttocks

• Numbness or weakness if fracture injures nerve

Traumatic accident Osteoporosis

• The injury usually results from forced flexion

• unilateral facet fracture: stable

Failure of middle and posterior columns

Type A Type B Type C Type D

Can caused by hyper force

Type 1 Head displaced anteriorly

Displaced fracture or dislocation of

• Cartilage breaks down

• Standing/walking • Patients lean • Sitting or bending

• Inter vertebra discs starts to thin and break down

⇨ Same symptoms as stenosis

• Fracture of the Pars Interarticularis

Scottie Dog Fracture

• Unilateral • Bowel and bladder dysfunction

• Straight Leg Raising Test (SLRT)

• Straight Leg Raising Test (SLRT)

– Positive in Lumber disc herniation

Spinal stenosis Intervertebral disc herniation

Pain Relief by bending forward Relief by bending backward

Low back Pain Not severe Severe

Age Common in over 50 Common in 20,30 and 40

Causes Aging Aging, sport, smoking

Leg pain From buttock to ankle From buttock to ankle

• Compression / irritation of nerve or blood vessels

Physical examination of the spine:

Clinical Features of Pott’s Paraplegia

Spine at risk sign

Cervical tuberculosis (Cervical TB)

Indication for surgery:

• Genetic disorder that affects the development and growth of

Neurofibromatosis type 2 (NF2)

• Charcot spinal arthropathy

• Other name: Osteoitis deformans

• Collection of blood in the potential space between the dura

• Other name: Hematomyelia

• Traumatic spinal epidural hematoma

This T1-weighted sagittal MRI is from a 19-year-old man with

– Clinical presentation can range from focal weakness to

• It is disorders that exhibit

• This condition can be

• The most common type

Courtesy of Texas Scottish Rite

• Indication for extension brace

You might also like