prognosis

Central Cord Syndrome

Epidemiology

 

Most common pattern cord injury

 

Hyper-extension injury in middle aged man with osteoarthritic spine

 

Usually C3/4 and C4/5

 

Mechanism

 

Most common type / in older patient with pre-existing spondylosis / OPLL

- hyperextension injury

- compression of the cord

- anteriorly by osteophytes

- posteriorly by infolded ligamentum flavum

 

Whiplash

Definition

 

Isolated posterior ligament injuries

- PLL / Posterior interspinous ligament / Paraspinal muscles

 

Excludes fracture / dislocation / HNP

 

Aetiology

 

MVA

Sport

Hyperflexion injuries

 

Symptoms

 

Large spectrum clinical presentation

- neck ache 

- nausea & vomiting 

- headache 

- visual symptoms

Spinal Tuberculosis

Epidemiology

 

Most common site for skeletal TB

- usually haematogenous spread

- can be direct from lung

 

3 patterns

 

1.  Peridiscal (50%) - originating in metaphyseal region

2.  Central - high incidence of vertebral collapse

3.  Anterior - instability less common with less bony destruction

 

Pathology

 

Affects multiple contiguous vertebrae

Nerve Injury

Epidemiology

 

Primary THR 1%

Revision THR 3%

DDH  5%

 

Sciatic nerve 90% of nerve palsy

 

Other

- femoral nerve

- CPN

- ulna / radial nerve from positioning

 

Aetiology

 

Direct 

 

Laceration

- exposure / sciatic and superior gluteal nerve

- drill reamer / obturator nerve

- spike of cement / obturator nerve

Congenital scoliosis

Definition

 

Lateral curvature of the spine 2° to vertebral anomaly

- causes an imbalance in longitudinal spine growth

 

Epidemiology

 

True incidence unknown

 

F > M

 

Typically Thoracic

 

Inheritance

 

No association in twins / suggests not inherited

5% risk in family if complex multi-level

 

Aetiology

 

Background

Definition

 

Idiopathic condition of the immature femoral capital epiphysis involving varying degrees of osteonecrosis

 

AKA

- Legg-Calve-Perthes disease

- coxa plana

 

Described in separate publications in 1912 by

- Legg (Boston)

- Calve (France)

- Perthes (Germany)

 

Epidemiology

 

M: F    4:1

 

1 in 740 males

 

Synovial Sarcoma

Epidemiology

 

4th most common STS

- 10-35% of STS

 

Peak age 3rd-4th decade

- rare in children

 

Pathology

 

Cellular characteristics suggest tumour arises from primitive synovial cells

- rarely actually occurs within joint

 

Characteristic

 

Occasionally metastasis to lymph nodes (5-7%) 

- like Epitheloid Sarcoma 

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