Benign Bone Lesions  

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  “

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 “