Period of pain relief after disc surgery
- followed by increasing back pain & occasional leg pain
Pain may be disproportionate to physical findings
Low grade fever common
SLR & femoral stretch tests elicit pain in some cases
Fibrous proliferative lesion in plantar fascia
Male, white, middle age
May arise in isolation
Association Dupuytren's Diathesis
- aka Lederhosen disease
Proliferative Fibroblastic lesion
- May resemble fibrosarcoma histologically
1. Displacement > 4 mm
2. Angulation > 10o
3. Intra-articular
Zone 1
- avulsion fractures
A: Alignment
B: Bony
C: Canal
D: Disc
S: Soft tissues
1. Correct deformity
2. Restore stability
3. Decompress neural elements if required
Advantage
- defines level of conus
- may need anterior rather than posterior surgery if lesion above conus
Forward slip of one vertebra relative to inferior one
Wiltse "DID TIP"
Dysplastic
Isthmic
Degenerate
Traumatic
Iatrogenic
Pathological
Congenital Dysplasia of Upper Sacrum
- occurs at L5-S1
Reduction of space available for neural elements in spinal canal or intervertebral foramina
- due to degenerative changes, congenital abnormalities or both
- involves compression of the thecal sac or nerve roots
Onset 50 - 60's
- M = F
- associated with onset OA spine
Lateral deviation of the spine that develops after the age of 50
- minimal structural vertebral deformity
Lower lumbar
- convex left
Unknown
Structural kyphosis of thoracic or thoracolumbar spine
- characterised by vertebral wedging & subsequent growth disturbance of vertebral end plate
1. Kyphosis > 45°
2. > 5° wedging 3 or more adjacent apical vertebrae
Other features
- Schmorl nodes
Spinal cord dysfunction
- extrinsic compression of the cord or its vascular supply
- caused by degenerative disease of spine
Most common spinal cord dysfunction in patients > 55 years old
C5/6 commonest level