Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Rheumatoid arthritis

1 What is rheumatoid arthritis? Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disorder of uncertain etiology that affects the synovium of joints. It is an immunologically mediated systemic disorder that affects articular and nonarticular organ systems. The articular involvement is a symmetrical peripheral joint disease affecting large and small joints. Axial involvement predominantly affects the cervical region, especially the upper cervical spine. The extraarticular involvement…

Spinal infections

1 How are spinal infections classified? Host immune response: Pyogenic versus granulomatous Anatomic location: Vertebral body, disc, epidural space, subdural space, facet joint, paraspinous soft tissue Infectious route: Hematogenous, local extension, direct inoculation Host age: Pediatric versus adult Duration: Acute versus chronic spinal infection Pyogenic infections Pyogenic vertebral osteomyelitis 2 What are the three most frequent routes by which bacterial infection spreads to the spinal column?…

Treatment options for osteoporotic vertebral compression fractures

1 What is the incidence of osteoporotic vertebral compression fractures? Vertebral compression fractures are the most common fractures due to osteoporosis. Vertebral fractures are two to three times more prevalent than hip or wrist fractures. It is estimated that a vertebral fracture due to osteoporosis occurs every 22 seconds worldwide in men and women over age 50. In the United States alone, an estimated 700,000 new…

Metabolic bone diseases of the spine

Bone basics—structure, function, and homeostasis 1 What are some major functions of bone? Major bone functions include: Mineral storage (i.e., calcium, phosphorus, magnesium) Protection of internal organs from injury (i.e., brain, spinal cord, viscera) Provide support to the body by serving as a framework for tissue attachment Facilitate movement including locomotion by serving as an attachment for muscles Hematopoiesis 2 Describe the two major types of…

Metastatic spine tumors

1 What is the most common tumor of the spine? Metastatic lesions are the most common tumors of the spine. Metastatic lesions account for over 90% of all spinal column tumors. Spine metastases are the most common type of skeletal metastases. 2 What percentage of spinal metastases result in spinal cord compression? Spinal cord compression occurs in 20% of patients who develop spinal metastases. 3 Which…

Primary spine tumors

1 What types of tumors arise in the spine? Primary tumors and secondary tumors. 2 What is the difference between primary and secondary tumors of the spine? Primary tumors of the spine arise de novo in the osseous, cartilaginous, neural, or ligamentous structures of the spine. They may be classified as extradural or intradural. Secondary tumors are either metastatic to the spine from distant origins or…

Disorders of the spinal cord and related structures

Spinal cord tumors 1 How does one describe the anatomic location of a spine tumor? Spine tumors are localized according to the anatomic compartment in which they occur: extradural , intradural-extramedullary , or intramedullary ( Figs. 61.1 and 61.2 ). Certain tumors may invade multiple anatomic planes. Extradural tumors may be primary spinal tumors (benign or malignant) or secondary tumors (due to metastatic disease). Intradural-extramedullary tumors…

Spinal injuries in athletes

Cervical spine injuries 1 What sports are associated with the highest risk of head and neck injuries? The organized sports with the highest risk of head and neck injuries are football, gymnastics, wrestling, and ice hockey. Football is associated with the highest risk of such injuries. Head and neck injuries also occur in a variety of nonorganized sports activities, including diving, skiing, surfing, and trampoline use.…

Sacral fractures

1 Describe the important anatomic features and functions of the sacrum. The sacrum is located at the junction between the pelvis and spinal column and functions as a keystone between the iliac crests. The sacrum is formed by the coalescence of five vertebral segments (S1–S5) and is attached to the caudal lumbar spine and posterior pelvic ring through broad, well-developed ligamentous structures. The sacrum transmits load…

Thoracic and lumbar spine fractures

General 1 How does regional spinal anatomy influence the characteristics and distribution of thoracic and lumbar spine fractures? The thoracic and lumbar spinal fractures occur in three distinct anatomic regions: the thoracic (T1–T9), thoracolumbar (T10–L2), and low lumbar (L3–L5) regions. The thoracic region is aligned in kyphosis, has limited mobility except for rotation due to coronal orientation of the facet joints, and is stabilized by the…

Lower cervical spine injuries

Injury classification 1 What are some criteria used to classify subaxial cervical spine injuries? Many different classification systems have been proposed for subaxial cervical spine injuries based on a range of criteria, including radiographic instability, mechanism of injury, and injury morphology. While recognition of instability based on radiographic parameters such as relative sagittal plane translation >3.5 mm or relative sagittal plane angulation >11° is useful in clinical…

Upper cervical spine trauma

1 What are the major types of injuries involving the upper cervical (occiput–C2) region? The major types of injuries can be classified based on anatomic location as: 1. Occipitocervical articulation Occipital condyle fractures Craniocervical dissociation 2. Atlas (C1) and atlantoaxial joints Atlas fractures Transverse atlantal ligament (TAL) injuries Atlantoaxial instabilities 3. Axis (C2) and C2–C3 joints Odontoid fractures Traumatic spondylolisthesis of the axis Axis body fractures…

Spinal cord injury

1 Which of the following terms are currently favored to describe impairment or loss of motor and/or sensory function due to damage of neural elements within the spinal canal: (1) tetraplegia, (2) paraplegia, (3) quadriplegia, (4) quadriparesis, and/or (5) paraparesis? Tetraplegia refers to the impairments resulting from damage to neural elements within the cervical spinal canal, whereas paraplegia refers to the impairments resulting from damage to…

Evaluation of the spine trauma patient

1 How many traumatic spinal column and spinal cord injuries occur in the united states each year? It is estimated that over 50,000 traumatic spinal column fractures occur per year in the United States. (1) According to the National Spinal Cord Injury Statistical Center, 17,730 new cases of spinal cord injury occur each year in the United States. This equates to approximately 54 cases per million…

Spondylolysis and spondylolisthesis in adults

1 What are the different types of spondylolisthesis and how are they classified? Spondylolisthesis refers to ventral displacement of the proximal spinal column in relation to the distal spinal column. The degree of slip is determined by measuring the amount of anterior translation of the displaced vertebra relative to the superior aspect of the inferior vertebra and is expressed as a percentage. The Meyerding Classification grades…

Sagittal plane deformities in adults

General principles 1 What is the “cone of economy” concept? The concept of the “cone of economy” was introduced by Dr. Jean Dubousset and describes a cone-shaped region extending from the feet upward around the trunk. When the body’s center of gravity is maintained within this region, energy expenditure is minimized. Deviation outside this cone increases the energy expenditure required to maintain an erect posture. Sagittal…

Adult idiopathic and degenerative scoliosis

1 Define adult scoliosis and describe the prevalence and incidence of this condition. Adult scoliosis is a spinal deformity characterized by a Cobb angle in excess of 10° in the coronal plane that is present in a skeletally mature patient. Recent estimates regarding the prevalence of scoliosis in adults range from 2.5% to 25% of the population, and increasing age is associated with higher prevalence rates.…

Disorders of the sacroiliac joint

Background 1 Why has the sacroiliac joint historically been neglected as part of the history, physical examination, and diagnostic workup of low back pain? As sacroiliac joint (SIJ) pain presents with symptoms similar to hip and lumbar spine pathology, the SIJ is often overlooked as a pain generator. Historically, poor outcomes have been reported with surgical intervention for SIJ pain due to high complication rates and…

Lumbar spinal stenosis

1 What is lumbar spinal stenosis? Lumbar spinal stenosis is defined as any type of narrowing of the spinal canal, nerve root canals, or intervertebral foramen. This narrowing can be caused by soft tissue, bone, or a combination of both. The resultant nerve root compression leads to nerve root ischemia and a clinical syndrome associated with variable degrees of low back, buttock, and leg pain. 2…

Discogenic low back pain

1 Define lumbar disc degeneration. Lumbar disc degeneration has been defined by the North American Spine Society Consensus Committee on Nomenclature in terms of morphologic changes involving the anatomic components of the lumbar disc. These changes may include: Desiccation, fibrosis, vacuum changes, or cleft formation in the nucleus Fissuring, mucinous degeneration, or calcification in the annulus Defects and sclerosis of the vertebral endplates Osteophytes at the…