surgical indications

Postoperative discitis

SymptomsT45 discitis

 

Period of pain relief after disc surgery

- followed by increasing back pain & occasional leg pain

 

Pain may be disproportionate to physical findings

 

Low grade fever common

 

SLR & femoral stretch tests elicit pain in some cases 

 

Bloods

 

Plantar Fibromatosis

Definition

 

Fibrous proliferative lesion in plantar fascia

 

Epidemiology

 

Male, white, middle age

 

May arise in isolation

 

Association Dupuytren's Diathesis

- aka Lederhosen disease

 

Pathology

 

Proliferative Fibroblastic lesion

- May resemble fibrosarcoma histologically

 

Thoraco Lumbar Fracture

Xray Assessment

 

A:  Alignment

B:  Bony

C:  Canal

D:  Disc

S:  Soft tissues

 

Goals of surgery

 

1.  Correct deformity

2.  Restore stability

3.  Decompress neural elements if required

 

MRI

 

Advantage

- defines level of conus

- may need anterior rather than posterior surgery if lesion above conus

Lumbar Stenosis

DefinitionLumbar Stenosis

 

Reduction of space available for neural elements in spinal canal or intervertebral foramina

- due to degenerative changes, congenital abnormalities or both

- involves compression of the thecal sac or nerve roots

 

Epidemiology

 

Onset 50 - 60's

- M = F

- associated with onset OA spine

Scheuermann's kyphosis

Definition 

 

Structural kyphosis of thoracic or thoracolumbar spine

- characterised by vertebral wedging & subsequent growth disturbance of vertebral end plate

 

X-ray Diagnostic Criteria Sorensen 1964

 

1.  Kyphosis > 45°

 

2. > 5° wedging 3 or more adjacent apical vertebrae

 

Other features

- Schmorl nodes

Cervical Myelopathy

DefinitionCervical Myelopathy MRI

 

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