Category Archives: Degenerative

Background  L5S1 most common  Recurrent torsional stain of outter annulus  Annulus – Type 1  Pulposus – Type 2  Herniation nucleus pulposus  Location  Cental  Paracentral (most common)  Foraminal / far lateral  Morphologies  Protrusion – bulge through intact anulus  Extrrusion – though anulus still continuous with disc space  Sequestered – free fragment  Presentation  Sclerotomal pain  Low back, buttock, posteior thigh  Radicularr  Worse with valsavla Continue reading “Lumbar Disc Herniation”

Background  Narrowing of lumbar spinal canal due to bony or soft tissue structures  Most common cause of lumbar spine sugery in patinets >65  L45  RF  White  Increase BMI  Congenital spine anomalies  Failure of posterior elements to develop – leading to short pedicles and laminae  Pathophys  Due to  Disc bulge/ herniation  Flavum hypetrophy/ buckling  Facet cysts/ hypertrophy/ osteophytes  Uncinate spurs (posteriorContinue reading “Lumbar Stenosis”

Background  Unilateral am pain in dermattomal, weakness in myottomes  Non works in 75-90%  Nerve root below  C67 disc affects C7 (as that is the one that exits)  Nerve root exits above that named vertebra  Lumbar roots are vertical   Paracentral affects traversing, foraminal affects exiting root  Cervical roots are horizontal  Paracentral and foraminal disc will affect same root Continue reading “Cervical Radiculopathy”

Spine  AAOS Clinical Practice Guidelines  Strong  AGAINST vetebroplasty  Moderate  Calcitonin 4w for acute and neuro intact  Limited  Kypho is option for symptomatic compression fractures  L2 nerve block forr L34 fractures  Ibandronate and strontium ranelate vs future  Maximize outcomes in spine surgery  Prevent osteoporosis most important  Preop optimization from endo  Longer fusion construct, don’t star tor end at junction  3 points aboveContinue reading “Osteoporosis”

Backgound  Idiopathic anomaly  Asian  Dx lateral X, CT to quantifyy  C4-C6  RF  DM  Obesity  Asian  Hyperparathyroidism  Hypophophatemic rickets  hyperinsulinemia  High salt low meat diet  Mechanical stress oon PLL  RF for Developing Myelopathy  >60% stenosis (occupancy ratio)  <6mm SAC  Increase cervical ROM  OPLL laterally deviated in spinal canal  K Line  Developed for OPLL oiginally  If OPLL is behind K line, thenContinue reading “OPLL “

Background  Neurologic impairment caused by cord compression  Causes  Spondylosis  Congenital stenosis  OPLL  Tumour  Epidural abscess  Trauma  Kyphosis  Associated  Tandem stenosis in 20%  DDx  Stroke  Multiple Sclerosis  Autoimmune, female, age 30  MRI brain and spine – other lesions  Vision loss, brainstem – cranial neve including Diplopia, cerebellar, spinal cord  Amyotrophic Lateral Sclerosis  Anterior horn of SC – UMNContinue reading “Cervical Myelopathy  “

Background  Natural degenerraiotn  Starts age 40  85% of asymptomatic patientst >65 have spondylotic changes  C56  RF  Excessive driving  Lifting  Athletes  Smoking  Pathophys  Natural aging  Degeneration  Disc:  Dessication, height loss, bulding, herniation  Joints: Uncinate spurring, facet arthrosis  Ligamentum flavum: thicken, infold due to disc height loss  Deformity: kyphosis – disc height loss, shift load to uncinates and facets-> worsens joints  Associated:  Radiculopathy  Myelopathy  Discogenic neckContinue reading “Cervical Spondylosis”

Background  Natural degenerraiotn  Starts age 40  85% of asymptomatic patientst >65 have spondylotic changes  C56  RF  Excessive driving  Lifting  Athletes  Smoking  Pathophys  Natural aging  Degeneration  Disc:  Dessication, height loss, bulding, herniation  Joints: Uncinate spurring, facet arthrosis  Ligamentum flavum: thicken, infold due to disc height loss  Deformity: kyphosis – disc height loss, shift load to uncinatesContinue reading “Cervical Spondylosis”