Epidemiology

80% cancer patients have spinal metastasis at autopsy 

Spine is number one site for bony metastasis (50%)

Cause

Hexagon: PBBLTK

                 Prostate    Breast

Epidemiology

M:F =2:1

30-40 years

20% diabetic

50-80% identifiable source

Site

Lumbar (50%) > Thoracic > Cervical (<10%)

Pathogenesis

1.  Haematogenous

- arterial rather than venous

Risk factors

- UTI (40% of all cases)

- IVDU

- elderly

Definition

Pus collection in the epidural space

Epidemiology

Usually haemotogenous seeding

Very rare

- 37 / 1 000 000 patients with LBP

- 1 /10 000 admissions

- most common in old men

Average age 68 years

3/4 males

Rare in paediatrics

Definition

Clinical diagnosis

- based on a sclerotomal distribution of motor &/or sensory symptoms or signs

Caused by impingement of exiting nerve roots

- HNP

- zygo-apophyseal / facet joint hypertrophy

- neuro-central joint hypertrophy

May be acute or chronic

Epidemiology

M>F

Peak age 50-54

C7 > C6

Definition

Spinal cord dysfunction
- extrinsic compression of the cord or its vascular supply
- caused by degenerative disease of spine

Epidemiology

Most common spinal cord dysfunction in patients > 55 years old
 

C5/6 commonest level

Definitions

Cervical spondylosis

- chronic disc degeneration & associated facet arthropathy

Cervical myelopathy

- spinal cord dysfunction

- secondary to extrinsic compression of cord or its vascular supply

Cervical radiculopathy

- sclerotomal distribution of motor &/or sensory symptoms or signs

- due to compression of nerve root

Epidemiology

Neck involved in 86%

- second most common site after hands and feet

- closely associated with MCPJ subluxation

Associations

Males / Steroid use / Seropositivity Nodules / Severe long standing disease

Conditions

Atlanto-axial subluxation

Subaxial subluxation

Superior migration ondontoid