13: Degenerative & Neuroplastic Spine Disorders

Question 1

Intervertebral disc degeneration (IDD):

Answer 1

• multifactorial disorder
• Not single spine disease -> common complex disorder -> multiple riskfactors
• Leading condition of disability globally
• 20% of adolescents have mild IDD (esp. 50-60)

Compressed nerve roots

Question 2

Pathogenetic mechanisms

Answer 2

• inflammation
• Oxidative stress
• Telomerase shortening
• Nutrient deprivation
- mitochondrial dysfunction
- ECM degradation
- Epigenetic changes
- abnormal mechanical load

Question 3

Risk factors

Answer 3

• modifiable (smoking, obesity, repetitive microtrauma, diabetes, sedentary lifestyle)
• non modifiable (collagen mutation, polymorphisms)

Question 4

Dybalance

Answer 4

Dysbalance btw nutrient supply and demand -> degeneration
• demands: inflammation/cytokines, increase in cell density
• impaired supply: calcified cartilogenous endplates, marrow occlusion , sclerosis, …

Question 5

Macroanatomy

Answer 5

compressed nerve root
• anulus fibrosus around the nucleus pulposus is weaker than in healthy (cannot hold nucleus pulposus)
-> nucleus prolapse
• Later: nucleus pulposus extrusion
• Later: sequestration (cannot go back)

Question 6

Intact vs degenerated

Answer 6

• vessels less represented
• Bone sclerosis
• Loss of disc hight
• CEP (cartilageneous endplate) calcification and erosion
• -> inflammation and pain

Question 7

Endogenous scar tissue formation after annular tear formation

Answer 7

-> scar tissue less functional
• transverse tear (involves nucleus pulposus)
• Bilateral tears along fibres (makes it less elastic)
• Small tears involving annulus fibrosis

Question 8

Treatment

Answer 8

pharmacology to decrease need of supply and increase support

Question 9

Timing of surgery:

Answer 9

• cauda equina syndrome -> emergency surgery
• High grade motor deficits -> urgent surgery, consider infiltration
• Motor deficit -> intensive nonsurgical treatment, infiltration, steroids
• Low grade motor deficit -> non surgical therapy 2-3 weeks, analgetics, physio
• No motor deficit -> non surgical therapy at least 6weeks

Question 10

Spinal tumor

Answer 10

• rather rare
• Localization: proximity to spinal cord important
• Localization drives treatment strategy
- Intramedullary-intradural
- extramedullary-intradural
- extradural

Tumor rates: va meningomas

Question 11

Novel diagnostic imaging strategies: mixed reality:

Answer 11

• surgical planning
• Surgical rehersal and risk assassment
• Surgical training