척 추 병 변
Anatomy
a. primary kyphotic, 2ndary cervical lordosis (2-3 months old) & lumbar lordosis (1-2 yrs old)
b. C7, T12, L5, S5, C4 vert. body, 2 pedicles 2 laminae, spinous process, 2 transverse process, sup. & inf. articular process
c. Intervertebaral disc : annulus fibrosus, nucleus pulposus
d. end plate is no fibrous connection to collagen fiber of subchondral bone -> weak by shearing force
e. Articular facet joint: Thoracic; coronal plane ->able to flexion, extension rotation, limited in lateral bending
Lumbar; saggital ->able to flexion, extension, lateral bending, limited in rotation
f. Ligament : ALL, PLL, supraspinous & interspinous ligament, ligamentum flavum
g. 3 column of spine :
anterior column --> ant. longitudinal ligament, ant. 1/2 of
vertebral body and annulus fibrosus
middle column --> PLL, post 1/2 of vert. body and anulus
fibrosus
post. column --> 2 pedicles, 2 laminae, spinous process,
ligamentum flavum, 2 facet joints, inter- &
supraspinous ligaments
<Cervical disc herniation>
1. soft disc herniation : rare,
nerve root or cord compression due to herniated or protruded disc
30-40 yrs old
2. hard disc : common,
compressed by osteophyte in degenarative spodylitis
over 50 yrs old
3. Sx & Sign : neck pain, stiffness, shoulder pain, rad pain to arm, hypothesia of fingers, Spurling test
4. C5-6 HIVD : most common, C6 root compression
weakness of biceps, decreased biceps tendon reflex,
hypothesia & pain on radial side of forearm, 1st & 2nd fingers
5. C6-7 HIVD : C7 root compression
weakness of triceps & decreased triceps tendon reflex,
hypothesia on 2nd & 3rd fingers, pain on dorsal forearm
6. Dx : Hx taking, P.E. plain x-ray, EMG, myelogram, CT or MRI
7. DDx : frozen shoulder, thoracic outlet syndrome, carpal tunnel syndrome, spinal cord tumor
8. Tx :
a. conservative ; bed rest, halter traction, analgesics, cervical brace
b. operative ; posterior laminectomy and discectomy
anterior decompression and fusion
<Scoliosis>
1. Def. : lateral deviation & curvature of spine usually with vertebral body rotation
2. Cardiopulmonary dysfunction in severe case
* structural scoliosis vs. nonstructural scoliosis
3. Classification of scoiosis
Idiopathic : infantile (1-3 yrs old)
juvenile (4-9 yrs old)
adolescent (over 10 yrs old)
Congenital : failure of formation
failure of segmentation
Neuromuscular : neuropathic
myopathic
Scoliosis with neurofibromatosis
Miscellaneous : tumor, infection, D.A. etc
<1> Iiopathic scoliosis
a. most common in scoliosis
b. 3 type : infantile, juvenile, adolescent
c. Adolescent type : over 10 yrs old, female, Rt thoracic curve is common
d. Sx : slow progression, shoulder or pelvis elevated, scapula or buttock prominent
e. Dx : foreward bending -> prominent hump, standing x-ray
f. Tx : close observation
brace (TLSO, Milwakee brace)
corrective op.
<2> Congenital scoliosis
a. classification : Formation failure -> wedge vert.
hemivert.
Segmentation failure -> unilateral unsegmented bar
block vert.
b. Associated cong. anomaly ; U-T anomaly in 20 %, congenital heart disease in 15-20 %, intraspinal anomaly(syringomyelia, thetered cord, diastematomyelia) in 10 %
c. Rigid, progressive curve
severe in unsegmented bar or unilateral multiple hemivertebrae or wedge vertebrae
d. Tx. : Early treatment is important,
Milwaukee brace,
posterior fusion with/without correction
<3> Neuromuscular scoliosis
a. Def. : 2ndary scoliosis due to nerve or muscle disease
b. Causes :
(1) Neuropathic -> spinal cord injury
poliomyelitis sequelae
syringomyelia
C.P.
2. Myopathic -> m. dystrophy
arthrogryposis
miscellaneous
c. rapid progress, long curve, pelvic obliquity
d. Tx. : observation
brace
operation
usually operative Tx.
<4> Neurofibromatosis scoliosis
a. Def. : scoliosis as manifestation of bony lesion of neurofibromatosis
b. 20-25 % in neurofibromatosis
c. short(5-8 vert.), large curve with kyphosis
d. dystrophic type : scalloping vertebrae,
severe rotation of apical vertebra
rib penciling
enlargement of intervertbral foramen
e. non-dystrophic type
f. Tx. : brace
usually operation in dystrophic type
<Kyphosis>
1. Def. : increased state of posterior curve due to disorders of vertebral body, disc or muscle
2. Cause : Scheuermann's disease
congenital
primary or 2ndary tumor
senile
Tbc sequelae
post-traumatic
post-laminectomy
3. Cx. : back pain, cardiopulmonary dysfunction, near vision
<Lower back pain>
1. Cause :
(1)discogenic ; lumbar instability
HIVD
deg. disc disorders
spinal stenosis
(2)osseous ; congenital
developmental disorders of spine
spondylolysis or spondylolisthesis
infection, tumors, trauma
metabolic disorder, osteoporosis
(3)caused by abdominal organ
(4)caused by N. system
(5)vascular origin
(6)psychiatric origin
<H.I.V.D.>
1. Def. : disorders caused by compression of root or dural sac by herniated nucleus pulposus
2. Grade : bulging -> protrusion -> extrusion -> sequestrated disc
3. 30-50 yrs male,
4. Incidence :L4-5 > L5-S1 > L3-4
5. Pathology : disc degeneration (decreased chondroitin sulfate & water content -> decreased elasticity of N. pulposus) -> tear of annulus fibrosus -> herniation of N. pulposus through post. or posterolat. part of PLL
6. repeated bending motion, heavy lifting, fall-down from height, sip-down, abrupt change of posture, unknown cause
7. Dx. : plain x-ray, CT, myelography, MRI, discography
8. Tx :
(1) Conservative Tx
bed rest, medications, P.T.
Brace (corset)
(2) Operative Tx.
open discectomy with/without fusion
chemonucleolysis
percutaneous discectomy
<spondylolysis>
1. Def. : unilateral or bilateral defect of the pars interarticularis (isthmus)
<spondylolisthesis>
1. Def. : anterior displacement of vertebral body with or wothout spondylolysis
2. Classification :
a. congenital
b. isthmic
defect type
elongated type
c. degenerative
d. post-traumatic
e. pathologic
f. postsurgical
3 Sx. : back pain with radiating pain to leg in adults
muscle weakness, decreased sensation
postural change
intermitent claudication in severe case
<Spinal stenosis>
1. Location : central, lateral recess, foramenal
2. Classification :
(1) congenital ;
1) idiopathic
2) achondroplastic
(2) acquired ; 1) degenerative
2) Mixed
3) spondylolisthetic
4) iatrogenic
5) traumatic
6) miscellaneous ;
Paget's disease, fluorosis
3. Sx : back pain with rad. pain to buttock
numbness, paresthesia during walking or standing
Neurologic claudication(DDx ;vascular claud)
SLRT ; usually (-)
muscle weakness in lower leg
decreased DTR
4. Tx : PT, medications, brace
Op. if severe Sx or not respond to conservative Tx.
post. decompression with/without fusion