Degeneration of the Spinal Column

Question 1

What type of arthritis can you get in ages 0-20?

Answer 1

Juvenile Chronic arthritis
Septic arthritis

Question 2

What type of arthritis can you get in ages 20-40?

Answer 2

Anklylosing Spondylitis (AS)
Osteitis Condensans Illii (OCI)
Systemic Lupus Erythematosis (SLE)
Psoriatic Arthritis
Reiter’s syndrome
Rheumatoid Arthritis (RA)
Progressive Systemic Sclerosis (PSS)
Synoviochondrometaplasia (SCM)

Question 3

What type of arthritis can you get in ages 40+?

Answer 3

Osteoarthritis (OA)
Gout
Disseminated Idiopathic Skeletal Hyperostosis (DISH)
Hypertrophic osteoarthropathy (HOA)
Calcium pyrophostate deposition disease (CPPD)

Question 4

What are the anatomical classifications of joints?

Answer 4

Fibrous
Cartilaginous
Synovial

Question 5

What is Monoarticular?

Answer 5

Number of joints involved - affecting only one joint of body

Question 6

What is Oligoarticular?

Answer 6

Number of joints involved - affecting a few joints

Question 7

What is Polyarticular?

Answer 7

Number of joints involved - affecting many joints

Question 8

What are the 3 categories of joint disease?

Answer 8

INFLAMMATORY
DEGENERATIVE
METABOLIC

Question 9

What are symptoms of inflammatory joint disease?

Answer 9

soft tissue swelling -oedema
juxta-articular osteoporosis
uniform loss of joint space
may be symmetric if polyarticular
> likelihood of bony ankylosis with inflammatory arthritis
may have periostitis (sero negative)
POORLY DEFINED EROSIONS
E.g. Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS)

Question 10

What are symptoms of Degenerative joint disease?

Answer 10

nonuniform loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
Asymmetric

Question 11

What are symptoms of Metabolic joint disease?

Answer 11

“lumpy bumpy”; soft tissue masses
well marginated bony erosions
preservation of joint space - initially

Question 12

What are the signs of Arthritis?

Answer 12

Tenderness around the joint margin
Firm swellings of the joint margin (probably d/t the soft tissue, cartilage & bony outgrowths at the rim of joint) eg. Heberden’s nodes
‘Bony’ swelling & crepitus (one of the best signs in the clinical differentiation of OA from other disorders)
Signs of mild inflammation (cool effusions)
Decreased ROM

Question 13

What are the symptoms of Arthritis?

Answer 13

Pain and tenderness
Stiffness (‘gelling’) after inactivity (early morning stiffness, usually <30min)
Restricted, painful movements (difficulty with certain tasks), often accompanied by pain
Feelings of insecurity (feels unsafe) or instability
Functional limitations and handicap

Question 14

What are the red flags for Arthritis?

Answer 14

Malignancy, Infection, Inflammation
Fever
Night sweats
Unexpected weight loss
Night pain
Objective neurological deficit
Drop attacks

Question 15

What is the Epidemiology of Degeneration of the Spinal Column:a) Cervical Spine

Answer 15

Changes predominate in the lower C-spine (C5 – C7):
- Cervical disc spaces:
- M/C at C5/6 then C6/7
- Uncovertebral joints:
- Same levels often involved - Apophyseal joints:
- M/C at C4/5 and C6/7
Single or multiple levels involved
Rare in <40yoa
Common >40yoa
70% of patients >70yoa
M=F – increases in female with age

Question 16

What are the affected components of Degeneration of the Spinal Column:a) Cervical Spine?

Answer 16

Articular cartilage
Synovium
Uncovertebral joints
Facet joints
Intervertebral discs
Cervical plexus
Intervertebral ligaments

Question 17

What is the clinical presentation of Degeneration of the Spinal Column:a) Cervical Spine?

Answer 17

Pain
Stiffness
Crepitus
Limited ROM
Joint instability
Mild synovitis

Question 18

What are the Facet Arthrosis findings in Apophyseal Joints?

Answer 18

Aka Facet joints or zygapophyseal joints
Facet Arthrosis findings:
Joint space narrowing (reduced height – space)
Osteophytes - marginal
Sclerosis - subchondral
Subluxation- misalignment

Question 19

What does Intervertebral Degeneration look like?

Answer 19

Decreased disc height
Vacuum phenomenon
Vacuum cleft
May indicate annular tearing
Osteophytes
Canal stenosis
Due to projecting posterior osteophytes

Question 20

What is Uncovertebral Joint?

Answer 20

Aka Luschka’s joints – formed between uncinate processes (C3-C7)
Uncovertebral Arthrosis
Hypertrophy
Initial Sharpening
Blunting
Bulbous appearance
Foraminal encroachment
Oblique views
Best to determine osseous encroachment into intervertebral foramen

Question 21

What is the radiological findings of spondylosis?

Answer 21

Osteophytes
Claw
Broad based
Vertically curvilinear
From shear forces on traction spurs/ osteophytes

Traction
Early phase
2-3mm from vertebral body endplate margin (corner)
Horizontal and taper
Suggest shear type translation loading forces – dysfunctional stage

Question 22

What are the Affected Components Degeneration of the Spinal Column:b) Thoracic Spine?

Answer 22

Thoracic Intervertebral Disc & Spondylosis:
Mid to lower thoracic spine
Less pronounced changes here than other spinal areas
Disc space narrowing, osteophytes, Minimal sclerosis
- Osteophytes tend to be right sided, (presumably d/t pulsations of the aorta)

Intervertebral osteochondrosis:
mid thoracic spine

Costovertebral & Costotransverse arthrosis:
Typically at T9 and T10
Often overlooked
Implicated in pain production which may simulate cardiac or upper gastro-intestinal (GI) disease

Question 23

What is the clinical presentation of Degeneration of the Spinal Column:b) Thoracic Spine?

Answer 23

Pain in back
Pain and tenderness at level of involved facet joints
Muscle spasm
Loss of motion
Joint stiffness
Localised swelling

Question 24

What are the facts and figures of Degeneration of the Spinal Column:c) Lumbar Spine?

Answer 24

M/C affected area - particularly lower L/S (L4/5 and L5/S1)
Symptoms:
- LBP
- Local tenderness
- Leg pain
Causes:
- Inflammation
- Micro trauma
- Injury
Risk Factors:
- Genetics
- Excessive strain
- Obesity
- Smoking

Question 25

What are complications of Degeneration of the Spinal Column:c) Lumbar Spine?

Answer 25

Segmental instability
Degenerative spondylolisthesis
Retrolisthesis
Senile kyphosis
Limbus vertebra
Hemispheric spondylosclerosis
Discal calcification
Spinal stenosis

Question 26

What is Intervertebral Osteochondrosis (Degenerative Disc Disease - DDD)?

Answer 26

Retrolisthesis – may be early sign
Decreased disc height (Intervertebral osteochondrosis)
Disc space narrowing to varying degrees
Endplate Sclerosis
Vacuum phenomenon - late stage
Nitrogen gas in nuclear and annular fissures
2-3% of general population
Subluxation

Question 27

What does facet arthrosis look like?

Answer 27

Loss of joint space
Subchondral sclerosis
Osseous overgrowth – osteophytes – bone spurs = (“proliferation”)
AP view
Unreliable due to facet orientation
Lateral view
Sclerosis
Caution IVF narrowing on this view - ? rotation
Obliques
Best radiographic view
Sclerosis, joint narrowing, osteophytes
CT – Study of choice

Question 28

What is Sacroiliac Joint Degeneration?

Answer 28

uni or bilateral
may/may not be symptomatic
- If so, pain & tenderness
patients are usually >40 years
Usually, joint space loss
sclerosis on the iliac side - common
Osteophyte formation usually at the anterosuperior or anteroinferior aspect
periarticular bridging osteophytes – causing joint ankylosis
no erosions of the subchondral bone plate