Ch87 Differential Diagnosis Spine Flashcards
(14 cards)
What are the causes of atlantoaxial subluxation with increased ADI?
Rheumatoid arthritis (erosion of the entry point of the transverse ligament) Trauma Congenital laxity (Downs / NF) Retropharyngeal infection (Grisel syndrome) Chronic steroid use
What are the causes of atlantoaxial subluxation with normal ADI?
Odontoid fracture Os odontoideum (orthotopic type) Erosion of the odontoid due to Rheumatoid arthritis Neoplastic erosion of the odontoid Morquio syndrome - hypoplasia of the odontoid Transoral / endonasal odontoidectomy
What are the features of morquio?
Type 4 mucopolysaccharidosis
Short stature
Odontoid hypoplasia resulting in atlanto-axial instability
Platyspondyly of the vertebra (flattened)
Radial hypoplasia / curvature
Short metacarpals
Pectus carinatum
Scoliosis
Oar shaped ribs
Cox valga deformity secondary to dysplastic femoral heads
Which condition causes calcified intervertebral discs?
Ankylosing spondylitis (spares the nucleus pulposus)
What primary bone tumours affect C2?
Chondroma
Chondrosarcoma
Osteoblastoma
Osteoid osteoma
Osteosarcoma
Chordoma
Giant cell tumour
Aneurysmal bone cyst (see picture)
What is vertebra plana?
Completely collapsed vertebral body, sparing the discs and neural arches. No kyphosis.
Secondary to LCH, collapsed fracture, TB and haemangiomas
Which conditions cause posterior scalloping of the vertebral bodies?
Mnemonic = AMEN
Acromegaly Achondroplasia
Marfan’s Morquio
Ehlers-Danlos
Neurofibromatosis
**Also think nerve sheath tumours if at the neural foramen
(Note: anterior scalloping is caused by TB and lymphoma!)
Which infection spares the vertebral disc?
TB (also think metastases and multiple myeloma)
What causes presacral teratomas?
Sequestered cells from Hensen’s node in the caudal embyro. May be associated with Curarinho syndrome (sacral dysgenesis, pre-sacral mass and dysraphism)
Where does ankylosing spondylitis effect (by definition)?
The sacroiliac joint (based on the modified New York criteria is sacroilitis + one other feature in a patient with >3 months of back pain and onset <45 years)
What causes sacral agenesis?
Caudal regression syndrome. The associated spinal cord abnormalities are due to failure of secondary neurulation.
What causes diffuse nerve root enhancement in the spinal cord?
Tumours = lymphoma / leptomeningeal carcinomatosis
Infection = CMV, meningitis
Inflammatory = GBS / arachnoiditis / sarcoid (look for hilar lymphadenopathy!)
What causes nodular nerve root enhancement in the spinal cord?
NF
Drop mets
Neurofibroma
Schwannoma
What are the causes of a cystic lesion in the spine?
Meningeal cyst
Arachnoid cyst
Cystic schwannoma
Ependymoma with capping cyst
Syrinx
Dilated central canal
