Classification (Enneking) Latent HOOG Active HOOOGA Aggressive GO (GCT, Osteoblastoma) Lesions Osteoid Osteoma LATENT Age: 20 Location: pedicle, apex of scoliosis (on concavity) Size <2cm (>2cm is osteoblastoma) Presentation Pain +/- radiculopathy Worse at night Better with NSAIDs Imaging Early: sclerotic lesion in pedicle Later: Central nidus with Surrounding sclerosis Mx: Non Operative: observation +Continue reading “Benign Bone Lesions “
Category Archives: Topics
Metastatic Lesions
Common Mets to Bone BLT with Pickles on Rye Breast Lung Thyroid Prostate Renal Patchell 2005 RCT of Surgery + Rads vs Rads only Used fusion Outcomes Surgery + Rads > Rads Regaining ability to walk : 62% vs 19% Stopped trial early Conclusion: Aggressive treatment with Surgery along with Radiation *bone most common siteContinue reading “Metastatic Lesions”
Basics
Enneking Staging System Benign Lesions Latent lesion (HOOG) Hemangioma, Osteoid Osteoma, Osteochondroma, Granuloma Eosinophilic Observation Mx: intralesional excision +/- adjuvants (liquid nitrogen, phenol, PMMA) Active lesion (HOOOGA) Osteoid osteoma, osteochrondroma, hemangioma, eosinophilic granuloma, ABC Mx: en bloc resection vs intralesional excision +/- adjuvants (liquid nitrogen, phenol, PMMA) Aggressive lesion GCT, osteoblastoma Mc: wide excision (cuff of normal tissue) Continue reading “Basics”
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
Myelodysplasia
Background Common group of congenital disorders by various chromosomal anomalies that lead to failurre of closure of the spinal cord Anatomic anomalies Neurologic impairment Chromosomal abnormalities 10% T13, T18, triploidy, various single gene AFP 2nd trimester Risk Factors Folate deficiency Maternal hyperthermia Maternal diabetes Valproic acid Associated Conditions Ortho Path fractures (osteopenia) Spine Scoliosis – – PSIF toContinue reading “Myelodysplasia “
Atlantoaxial Rotatory Dis
Background C12 subluxation or facet dislocation Presents with kid with what looks like torticollis Congenital muscular torticollis – The spasm itself turns the head (so opposite side of chin) AARD The spasm is protective to prevent FURTHER rotation (so same side as chin) Pathophysiology Ligamentous laxity TL intact TL ruptured Causes Infection (25%) Grisel’s diseaseContinue reading “Atlantoaxial Rotatory Dis “
The Spine Book 