Uganda Institute of Allied Health and Management Sciences - Mulago
Uganda Institute of Allied Health and Management Sciences - Mulago
Uganda Institute of Allied Health and Management Sciences - Mulago
SEMESTER: TWO
Question;
Describe the following conditions in relation to orthopaedic medicine.
1. Spondylosis.
2. Ankylosing spondylitis.
3. Spondylolisthesis.
4. spondylolysis
SPONDYLOSIS
PATHOLOGY
The changes affect the central intervertebral joints (body to body) and the posterior
intervertebral joints (facet joint). One segement or several segments may be affected.
In the central and degenerative condition joint which is affected first, there is
degeneration with consequent narrowing of the intervertebral joints and hypertrophy of
the bone at the joint margins leads to the formation of osteophytes. In the posterior
intervertebral joints (facets) the changes are those of osteoarthritis in any diarthrodial
joints namely; attritional of the articular cartilage and osteophyte formation (spurring) at
the joint margins. The changes in the facet joints are probably the more important of
clinical part of view.
CLINICALFEATURES
Spinal complain of aching pain in affected area worst on activity or after prolonged
standing or sitting in one position or lifting.
Stiffness when raising from sitting position
Narrowed interverbral foramen leading radiating in the distribution of the affected nerve
Reduced range of motion
Cervical spondylosis, aching at the back
Stiffness initially intermittent and later persistent
INVESTIGATION
X rays
CT scan.
RADIOLOGICAL FEATURE
TREATMENT
Depends upon the severity of the disability, in mild cases treatment is unnecessary,
explanation and reassurance surface.
Thoracic spine: In osteoarthritis of thoracic spine symptoms are seldom and if treatment
is required a cost of active spinal exercise to strengthen the posterior muscles is usually
sufficient.
Lumbar spine: In lumbar osteoarthritis of moderate arthritis a well fitted surgical corset
(orthitic brace) will usually afford adequate relief, physiotherapy mainly by exercises and
passivemobilization may also be helpful. Heavy lifting and similar strain to the back
should be strictly avoided
If the pain from a localized lesion is bad enough to cause serious hardship, operative
fusion of the affected segment of the spine may be required.
Decompression surgery.
ANKYLOSING SPONDYLITIS
There is chronic inflammation, progressing slowly to bony ankylosis of the joint of spinal
CAUSE
PATHOLOGY
The disease usually begins in the sacro-iliac joint, hence it usually extends upwards to
involve the lumbar, thoracic and often the cervical spine. In the worst cases the hip or
shoulder is affected
The articular cartilage, synovium and ligaments show chronic inflammatory changes and
eventually they become ossified after several years of inflammatory process becomes
quiescent.
CLINICAL FEATURES
Early aching pain in the lower back and the gluteal region.
Increasing stiffness of the lower back.
Later the pain migrates upwards.
Diffuse radiating pain down one or more lower limbs is common.
Chest expansion is markedly reduced if thoracic region is involved.
INVESTIGATION
1. RADIOLOGICAL
o Radiograph in early stages shows fuzziness and widening of both the sacro-iliac joints so
that the joint outline is no longer clearly defined.
o Later if the disease progresses the the intervertebral joint undergo bony ankylosis with
permanent anterior bridging of the vertebral bodies producing the so called bamboo
space
2. LABORATORY
o ESR and C-reactive protein levels are raised.
o In 90 % of the cases the test for gene HLA-B27 antigen is positive.
DIAGNOSIS
TREATMENT
1. CONSERVATIVE
o Treatment is unsatisfactory, in that no method is known by which the disease process can
be halted and spinal mobility preserved.
o NSAIDS.
o Rest should be prescribed(sleeping flat on a firm mattress in supine postion) with one
pillow to maintain normal spinal alignment.
o Special exercise should be practiced to make most of the spine movements remain.
2. SURGICALLY
o In severely deformed (flexion deformity) of spine where the hips are involved and
develop flexion contractures in addition to spinal deformity.
o Relief is obtained replacement arthroplasty of both hip to restore upright spine.
o Corrective wedge osteotomy of the lumbar spine is performed if the replacement
arthroplasty fails.
SPONDYLOLISTHESIS
This is a spontaneous forward displacement of the lumbar vertebral body upon the segment next
below it. Displacement is usually forward, only on rare cases does the backward displacement
INVESTIGATION.
o Lumbo-Sacral X-ray.
o CT-scan standard.
TREATMENT
o Non operative treatment-Well fitted surgical corset and should be tied before operation is
considered.
o Operative treatment is done when the disability is severe .it involve the release of
stretched or compressed nerve, followed by fusion of the affected segment of the spinal
column.
SPONDYLOLYSIS
CAUSE
The cause of spondylolysis is unknown however, the following factors may contribute to:
o Hereditary
o Acquired
CLINICAL FEATURES
DIAGNOSIS
TREATMENT