Dr. Rampersaud Teaching 11/14/2016

Rheumatoid Cervical  ADI = 3 (unstable), 10 (surgery)  SAC (PADI) = 13 (neurologic recovery) prognosis  Boden et al (JBJS 1993) (Spine 1994)  Look at Posterior laminar line  Rule  C1 arch – 1/3 dens 1/3 cord 1/3 posterior elements  Basilar invagination (lateral SKULL xray is the best XR for this)  Cardiac arrythmia/ arrest  Respiratory arrest  Ranawat  Clark Station Continue reading “Dr. Rampersaud Teaching 11/14/2016”

DISH 

Background  Diffuse idiopathic skeletal hyperostosis  Thoracic  Right side (due to Aorta)  Dx Criteria  Flowing ossification Anterolateral of 4 vert  Preseve dis height  No facet or SI akylosis  Findings  Cevical  Dysphagia, difficult intubation  OPLL myelopathy  Lumbar  Stenosis – flavum, hyperostosis  Fracture  Simialr to AS – long level arm  Enthesophyte  Increase HO afte THTA 

Ankylosing Spondylitis

Background  Seronegative  Others: Reiter (cant see pee or climb tree)  HLA b27  Pathophysiology  Enthesisitis, bony erosion, joint ankylosis  SI joints, facets, symphyses pubic  Disc space involved- bridging syndesmophyte  Dx Criteria  Bilateal SI  Uveitis  HLA B27 +ve  F -ve  Systemic  Uveitis  Heart disease  Pulmonary fibrosis  Renal amyloidosis  Ascending aota  Klebsielle pneumonia  Ortho Manifestations  Bilateral SI  Spine kyphotic  Hip and shoulder OA Continue reading “Ankylosing Spondylitis”

Rheumatoid Arthritis Cervical Spine

For background refer to: Rheumatoid Arthritis  Background  3 pattens of instability  Atlantoaxial  Basilar invagination (atlantoaxial impaction, cranial settling,)  Subaxial subluxation  Dx with flex ex and MRI  90% of people with RA, often missed  Pre-biologic agent data – incidence much lower now  Anti CCP is best marker for RA  Ranawat Class  1 – Pain, no neuro  2 –Continue reading “Rheumatoid Arthritis Cervical Spine”

Synopsis

2 Types  Rheumatoid Arthritis  Seronegative Spondyloarthropathy  Seronegative Spondyloarthropathy  Features  RF negative  Enthesopathy  Peripheral Arthridites  Different vs RA  Affect enthesis (bony insertions of tendons and ligamnets  Leads to reactive bone – eventually ankylosis  RA affects SYNOVIUM  Affects entire spine, but RA ist mostly C spine  Types  Ank Spond  Psoriatic Arthritis  Entereopathy Arthritis  Reiter syndrome