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University of Debrecen
Department of
Orthopaedic Surgery
Spondylolysis and spondylolisthesis. Congenital anomalies of the spine.
Scheurmann’s disease and its treatment. Degenerative changes of the spine. Spinal
stenosis. Disc generation and prolapse.
Sciatica. Ankylosing spondylitis.
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Anatomy
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Vertebrae
• 7 Cervical
• 12 Thoracic
• 5 Lumbar
• 5 Sacral
• 4-6 Coccygeal
• Same structure, but different localisation,
shape and function!
• Anatomical – functional segment
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Joints of the vertebrae
ALL JOINT TYPES CAN BE FOUND
• SYNDESMOSIS (ligamentous)
• SYNCHONDROSIS (fibro cartilage)
• SYNOSTOSIS (bone)
• REGULAR JOINT (joint capsule, hyalin
cartilage, synovial membrane, synovial
fluid)
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SYNDESMOSIS
• Anterior and posterior longitudinal
ligament
• Yellow ligament
• Interspinous ligament
• Intertransversal ligament
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SYNCHONDROSIS
INTERVERTEBRAL DISC
(anulus fibrosus, nucleus pulposus)
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SYNOSTOSIS SACRUM
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REGULAR JOINTS
Joint capsule, hyaline cartilage, synovial
membrane and fluid!
FACET JOINTS
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Movements of the spine
• Anteflexion
• Retroflexion
• Lateralflexion (left and right)
• Torsion (left and right)
• Pairs of wertebrae –anatomical and
functional segment
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Functions of the vertebral disc
• Stability - Stabilizing role
(Keeps the ligaments tight by keeping the
distance between the vertebrae constant)
• Flexibility - Buffer role.
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Degenerative changes
• CAUSE: disc prolapse and protrusion.
• Disc flattening causes pain.
• Bone growth at the edge of the vertebrae
• Stability of spine – tension of ligaments
• „Vicious cycle”.
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Degenerative changes
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DISEAESES OF THE
VERTEBRAL DISCS
• PROTRUSION -anulus fibrosus intact
• HERNIA -anulus fibrosus not intact -
nucleus pulposus leaks out
• RUPTURED HERNIA- small amount
nucleus pulposus leaks out and loses
connection with remaining
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RUPTURED HERNIA
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Foraminal herniation
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Foraminal herniation
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Imaging
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Imaging
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Symptoms
L4-L5 – 90%
L5 and S1 symptoms
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Degenerative changes
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Definition
• SPONDYLOSIS: degenerative changes
between two vertebral bodies with
spondylophyte formation.
• SPONDYLARTHROSIS: degenerative
changes in the facet joints between two
vertebrae.
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Spondylosis
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CLINICAL SIGNS (lumbago)
• The mobility of the affected vertebrae
decreases
• The affected area is tender
• The spinous processes are sensitive to touch
• Spastic paravertebral muscle
• Antalgic posture
• Pain on axial loading
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CLINICAL SIGNS (sciatica)
• The mobility of the affected vertebrae
decreases
• The affected area is tender
• The spinous processes are sensitive to touch
• Spastic paravertebral muscle
• Antalgic posture
• Pain on axial loading
• + SIGNS OF NERVE ROOT
IRRITATION!!!(radiating pain, sensory
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RADIOLOGICAL SIGNS
• Decreased intervertebral space.
• Degenerative bone deposits on the edge
of the vertebrae (spondylophytes).
• Degenerative facet joint changes.
• Stenosis of intervertebral foramen
• Spinal stenosis.
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TREATMENT
• BEDREST (IN KYPHOSIS)
• PHYSICOTHERAPY
• NSAID, MUSCLE RELAXANTS!!
• LOCAL STEROID
• BRACE
• SURGERY: stabilization,discectomy, etc.
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Spinal stenosis
• Narrowing of the spinal canal causing ischemia in the cauda equina.
• reason: spondylophyte, facet joint arthrosis, discus hernia…etc.
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Spinal stenosis
• Symptoms: Pain during standing or walking radiating into the lower extremities, which disappears after sitting or bedrest= neurologic claudication.
• Treatment:conservative (see above) or surgical decompression
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Ankylosing spondylitis
Bechterew’s disease
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• Chronic inflamation of the entire spine and
sacroiliac joints, which characterized by
calcification of ligaments and joint
capsules (regular joints!)
Ankylosing spondylitis
Bechterew’s disease
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Mennel test
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Spondylolysis, spondylolisthesis
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Spondylolysis - a defect in the pars
interarticularis of the vertebral arch
Spondylolisthesis - is the forward or
backward displacement of a vertebra
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Meyerding Classification
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Wiltse Classification
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Imaging – Dittmar view
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Imaging – CT
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Treatment
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Disorders of segmentation
Sacralisation – partial or total fusion of fifth lumbar
vertebra and sacrum.
Lumbarization – lack of the fusion inside the
sacrum.
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Scheuermann disease
• Juvenile osteochondrosis
• 10% occurrence in adolescence
• Blood supply problems to the end plate results in
disc herniation -SCHMORL- nodes
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Imaging
• X-RAY: uneven endplate, Schmorl nodes,
increased kyphosis, anterior wedging of
vertebrae.
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Imaging
MRI
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Scheuermann disease
CLINICAL SIGNS:
• fixed increased thoracic kyphosis
• centre descend from V-VII to VII-IX
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Treatment
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Thank you for your attention!