Pathologies

Question 1

which bacteria causes TB

Answer 1

mycobacterium tuberculosis

Question 2

how does TB spread to the spine

Answer 2

blood stream
lymphatics

Question 3

what does TB form

Answer 3

caseating granulomas

Question 4

tx for TB

Answer 4

6 months antibiotics

Question 5

describe vascular spinal TB

Answer 5

initial appearance in anterior inferior region

Question 6

describe venous spinal TB

Answer 6

batson’s venous plexus
increased spread when venous pressure increased
causes central lesions (Singh, 2020)

Question 7

describe the lesions types seen in spinal TB

Answer 7

paradiscal - arterial cause w/ narrowing disc space
central - minimal disc space loss but vertebra plana
anterior- spread from above types, along ALL, gibbus formation
appendiceal - affects S, T processes and lamina, rare @ 3-5% of all spinal cases

Question 8

describe cold abscesses in TB

Answer 8

bacterium bony debris and caseous material
travel along ALL
surgical drainage req
may cause neural deficit

Question 9

describe kyphotic deformity

Answer 9

destruction of epiphyseal cortex, IV disc and adjacent vertebrae
causes anterior wedging or vertebra plana
palpable gibbus forms

Question 10

describe neurological deficit seen in spinal TB

Answer 10

due to cord compression/stretch
leads to paraparesis or paraplegia

Question 11

describe Scheuermann’s deformity

Answer 11

developmental deformity
osteochondritis affects growth CEP
0.4-10% IR
equal sex distribution

Question 12

describe the aetiology of Scheuermann’s deformity

Answer 12

genetic predisposition
hormonal imbalances
VIt A deficiency -> disordered endochondral ossification

Question 13

describe the clinical findings of Scheuermann’s deformity

Answer 13

thoracic/lumbar hyperkyphosis
back pain and muscle tightness
neurological deficit

Question 14

what is seen on MRI in Scheuermann’s deformity

Answer 14

wedging over 5 degrees in 3 or more vertebrae - Sorenson’s criterion
kyphosis over 50 degrees total
endplate irregularities

Question 15

describe classifications of Scheuermann’s deformity

Answer 15

typical - T7-9 with lumbar hyper-lordosis

atypical - T11-12, athletes/weight lifters,

narrow disc space in both

Question 16

describe Ankylosing spondylitis

Answer 16

chronic autoimmune spondyloarthropathy
affects axial skeleton
SI joints first
0.4-1.4% europeans affected
young males, 20-30 in 80% cases

Question 17

what gene is involved in Ankylosing spondylitis

Answer 17

HLA-B27

Question 18

describe common clinical features of Ankylosing spondylitis

Answer 18

sacroiliitis - back pain
spinal stiffness
enthesitis
anterior uveitis

Question 19

how long is diagnosis of Ankylosing spondylitis typically delayed

Answer 19

5-7 years (Weber et al, 2007)

Question 20

describe diagnosis criteria for Ankylosing spondylitis

Answer 20

2+ of:
morning stiffness >30 mins
improvement with exercise but not rest
pain awakening in2nd half of night
alternating buttock pain

in young-middle aged adult

Question 21

what blood tests diagnose Ankylosing spondylitis

Answer 21

HLA-B27
ESR
CRP

Question 22

what biologic treatments are considered in AS

Answer 22

TNF inhibitors and IL-17 inhibitors (infliximab etc)

Question 23

which 4 patient reported questionnaire’s are used to determine secondary treatment need in Ankylosing spondylitis

Answer 23

metrology index (BASMI)
functional index (BASFI)
disease activity index (BASDAI)
global score (BAS-G)