Cervical Spine Product

Dorn Spinal Therapy

Dorn Spinal Therapy has been in uses in the past 40 years. The credit of this method goes to Dieter Dorn, who has made a significant impact in the medical field. DORN- Method has been used on various patients where results could get witnessed instants. Due to the impact, this method has brought in the country. It has been declared the standard practice in treating Pelvical Disorders, Spinal, and Back pain. Dieter Dorn first used this method on his family, which was a sign of confidence in a method, which later gained much attention from different people in the country and also globally. Every day Dorn was able to offer treatment to 15- 20 patients in a day. His services were purely free which attracted attention both in the local and also global. The primary treatment that DORN-Method which could be treated using this method include spine healing therapy, misalignments of the spine, resolving pelvis and joints, and also solving out significant problems which could get attributed to vertebrae.

Dorn Spinal Therapy Summary


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Articulating Processes And Spinal Movement

Intervertebral Foramen Mri

The articulating processes in the cervical region are oriented in nearly a coronal plane, and permit flexion extension, rotation, and lateral bending. The articulating processes in the thoracic region are arranged on an arc that has its center in the vertebral body. Rotation and lateral bending are permitted. Flexion is prohibited both by the orientation of articulating processes and by attachment of the thoracic vertebrae to the rib cage. Articulating processes in the lumbar region are oriented in the sagittal plane, permitting flexion extension and prohibiting rotation. The anterior view of the articulated spine shows the consistent increase in size of the vertebral bodies from superior to inferior. The space between adjacent vertebrae is occupied by the intervertebral discs that collectively contribute approximately one fourth to the height of the spine. The uncovertebral joints are lateral and posterolat-eral between the C3-C7 vertebral bodies. The...

Anterior Muscles Of The Spine

Anterior Scalene Mri

The anterior muscles of the spine are less well developed because they are assisted in their primary action of flexion by gravity. In the cervical region, the anterior spinal muscles include the longus colli, longus capitis muscles, and the rectus capitis anterior and lateralis muscles. The lateral attachments of these muscles overlie the transverse processes of cervical vertebrae and must be considered during an anterior approach to the intervertebral discs, the uncovertebral joints, or the vertebral artery in the transverse canal (8,9). As a group, they produce flexion of the head and neck if acting bilaterally, and lateral flexion if acting on one side only. All receive motor innervation from anterior primary rami of cervical spinal nerves. The scalene muscles attach directly to the cervical spine, and when acting from their inferior attachment on the ribs can flex the spine. When the spine is fixed, the scalene muscles raise the ribs in inspiration. These muscles are critical...

Spinal Autonomic Reflexes

The afferent arm of these reflexes originates in the internal organs and terminates on the sympathetic preganglionic neurons in the interme-diolateral and intermediomedial cell columns of the spinal cord at levels T1 through L2 (p. 140). Typical examples are the viscerovisceral reflex (causing meteorism in colic and anuria in myo-cardial infarction), the viscerocutaneous reflex (a visceral stimulus leads to sweating and hyper-emia in the corresponding zone of Head), the cutivisceral reflex (reduction of colic, myogelosis, etc., by warm compresses or massage), the visceromotor reflex (defensive muscle contraction in response to visceral stimulus), and the vasodilatory axon reflex (dermographism). Any abnormality of these reflexes may be an important sign of impaired autonomic function (cardiovascular, gastrointestinal, thermoregulatory, or urogenital), particularly in patients with spinal cord disorders.

The spine anatomical features

Movements between the vertebrae are possible in several planes, and the axes of these movements pass through the approximate centres of the intervertebral discs. At all levels of the spine, flexion (F) and extension (E), and lateral flexion (LF) to both sides are possible. In the thoracic spine, the plane of the facet joints lies in the arc of a circle which has its centre in the nucleus pulposus (CNP) as a result, (axial) rotation (AR) is possible in this part of the spine. In contrast, the orientation of the facet joints (FJ) in the lumbar region is such that rotation is blocked, i.e. virtually no vertebra rotation occurs in the lumbar spine. As a result of the elasticity of the annulus the nucleus pulposus is under constant pressure, and may (uncommonly) herniate into a vertebral body anteriorly (A), or centrally (Schmorl's node) (SN). A much more common occurrence is for the annular fibres to tear (as a result of trauma or degenerative changes) so that the nucleus can bulge...

Spinal Cord Compression

Spinal stenosis and neurogenic claudication Spinal hemorrhage Intramedullary, subarachnoid, subdural, and - Primary spinal neoplasms Multiple myeloma Noncompressive myelopathies simulating spinal cord compression Spirochetal disease of the spinal cord - Myelopathy due to in- Penicillin, methylene blue, spinal anesthetics, trathecal agents intrathecal chemotherapy with methotrexate, - Spinal arachnoiditis Spinal cord infarction

Facet Joints in Spinal Pain

Facet Joint Injection Side Effects

Posterior view diagram of the lumbar spine depicting the typical course of the facet nerve or medial branch dorsal ramus. In the lumbar spine, the nerve takes a very typical course along a groove at the junction of the superior articular process and transverse process of a vertebra. Note that each facet joint is supplied by smaller branches arising from the two adjacent medial branches. To block one facet joint, two medial branch injections are typically performed. Figure 11.6. Posterior view of the cervical spine depicting the course of the medial branch. In the cervical spine, the medial branch stereotypically courses along a small groove in the midportion of the lateral mass of a vertebra, before coursing along the bone to innervate the joint. As in the lumbar spine, each joint is supplied by medial branches from levels above and below the joint. Figure 11.6. Posterior view of the cervical spine depicting the course of the medial branch. In the cervical spine, the...

Cervical Spine Injuries

In one study11 cervical spine injuries in patients 60 years of age and older accounted for 12 percent of the injuries. The pattern of cervical spine injuries in the elderly is very different than in younger patients. Ryan and associates11 found that the incidence of C1 and C2 fractures rose as the population aged. This rise in upper-level fractures was due to a significant increase in the incidence of odontoid fractures in the elderly. When the elderly trauma patient presents with neck pain or a potential mechanism for spine injury (fall, mvc), emergency physicians need to place special emphasis on maintaining cervical immobilization until the cervical spine is properly assessed. Because underlying cervical arthritis may obscure fracture lines, the elderly patient with persistent neck pain and negative plain radiographs should undergo CT scanning of the neck, and flexion-extension views if imaging is negative but symptoms or suspicion for injury persists.

Anesthesia and the Cervical Spine

Several anesthetic problems may occur during cervical spine surgery. The pathology for which the patient is receiving surgical treatment may, in itself, render normal techniques for securing the airway difficult or hazardous to the patient. For the anesthesiologist, access to the airway and the tracheal tube is difficult once surgery has started, so the possibility of tube dislodg-ment or disconnection from the breathing circuit is a real hazard. Trauma to, or ischemia of, the cervical cord or damage to the phrenic nerves may lead to respiratory paralysis or severe compromise post-operatively. Partial or complete airway obstruction may occur post-operatively as a result of edema of the tissues of the airway, recurrent laryngeal nerve palsy, or hemorrhage into the neck. Many conditions are associated with restricted movement or instability of the cervical spine. The list includes degenerative osteoarthritis and spinal canal stenosis, anky-losing spondylosis, Down's syndrome,...

Degenerative Disease of the Cervical Spine

Osteoarthritis, the most common member of this group, affects men more often than women. Not well understood is its tendency to worsen abruptly and to induce symptoms of radicular disease. This suggests trauma or an inflammatory joint change, but evidence for either is usually lacking. The usual symptoms are cervical aching pain radiating into the occiput, shoulder, and upper arms and restriction of movement of the head. With advanced disease and the formation of bony ridges (ossification of protruded disc material), the spinal cord may be compressed (cervical spondylosis), resulting in spastic weakness and loss of position and vibratory sense in the legs. Osteophytic spur formation in and around the vertebral foramina may cause symptoms and signs of root compression. In patients with congenital narrowing of the cervical spinal canal (less than 10 to 11 mm in anteroposterior diameter), relatively mild trauma or osteoarthritic changes may result in cord and root compression....

Introduction clearing the cervical spine

The cervical spine has been traditionally divided into an upper segment (skull base, C1 and C2), and a lower segment comprising C3-C7. This is not arbitrary and is actually based on specific embryological, morphological and physiologically distinct differences. The characteristics of these two segments become particularly relevant when considering the effects of traumatic events. The most common level is C2 which accounts for 24 of fractures. The cervical spine attains an importance to the anaesthetist as proper head position is important for successful orotracheal intubation. The oral, pharyngeal and laryngeal axes must be aligned for direct laryngoscopy. The head needs to be elevated at least 10 cm above the shoulders to align the pharyngeal and laryngeal axes. Also the atlanto-occipital joint needs to be extended to achieve the straightest possible line from the incisors to the glottis 1 . A difficult airway is characterised by a limited range of motion at the cervical spine or...

The Cervical Spine and Spinal Cord

Cervical spine disease and its neurologic risk is well recognized in rheumatoid arthritis and ankylosing spondylitis. In RA, pannus formation and destruction of ligamentous supporting structures may lead to atlantoaxial subluxation an atlantodental distance in excess of the normal 3.5 mm seen in a lateral flexion view suggests instability (in children under 12, 4 mm of widening is normal). Cord compression may occur acutely following a trivial injury or be more insidious. Subtle clues include a change in bowel or bladder function, new weakness, numbness, or paresthesias. Instability may lead to cranial migration of the odontoid. Complaints relating to vertebral insufficiency (e.g., vertigo) may be reported. Lhermitte sign, an electric shock sensation radiating down the back on neck flexion, is a classic indication of cervical spine instability. Strength may be difficult to assess in an RA patient, so subtle differences in reflexes are particularly informative. Lateral cervical spine...

Development of spinal hyperexcitability during peripheral inflammation

In the course of joint or muscle inflammation, spinal cord neurons with deep input develop a state of hyper-excitability, which is also called central sensitization (see Figure 2.1). Central sensitization is characterized by typical neuronal changes (1) Spinal cord neurons with high threshold show a decrease of their excitation threshold, such that they are activated by innocuous stimuli applied to the inflamed tissue. (2) Both high threshold and wide dynamic range neurons show a marked increase of their responses to noxious stimulation of the inflamed tissue. This increased responsiveness to stimuli applied to inflamed tissue contributes to primary hyperalgesia at the site of inflammation. (3) With a similar time course, the neurons also show enhanced responses to mechanical stimuli applied to adjacent and even remote healthy tissue, and the total receptive field may expand.80,88,89 These changes indicate that the sensitivity of the spinal cord neuron is increased so that previous...

Molecular mechanisms of spinal sensitization

Concerning molecular mechanisms of central sensitiza-tion, several points must be made. First, an important basis for central sensitization is the potential of nocicep-tive spinal cord neurons to undergo neuroplastic changes. The latter can, for example, be shown with defined protocols of electrical nerve stimulation. Electrical stimulation of C-fibers can induce wind-up of the responses to and ventral horn.104 This is likely to result from an up-regulation of spinal COX-2, that is already present at three hours after induction of knee joint inflammation.104 Thus, as a presynaptic mechanism, a cocktail of transmitters and or modulators is released in the spinal cord under inflammatory conditions that is likely to influence the synaptic processing. Glutamate activates AMPA kainate (non-N-methyl-D-aspartic acid (NMDA)) receptors and NMDA receptors. Both glutamate receptor types have been implicated in the generation and maintenance of inflammation-induced spinal hyperexcitability....

Plasticity In Supraspinal Delta Opioid Systems Involved In Nociceptive Modulation

Of equal interest, delta receptor blockade in the RVM produced hyperalgesia in the uninflamed paw in these studies and evoked other behaviors indicating a general hyperalgesia 59 . This observation demonstrates an ongoing delta-mediated antinociceptive tone in the chronically inflamed animals. Again, this delta-mediated process is recruited over a period of several weeks, and is not seen in normal animals or at early time points after inflammation in the CFA 59 or arthritis models 38 . The ongoing delta modulation may reflect increased release of endogenous delta ligands in the brainstem with inflammation. Met-enkephalin release is increased in the PAG after inflammation 83 , and met-enkephalin levels are increased in several brainstem areas, including the RVM 59 . An additional possibility, complementary to an increase in available ligand, is that there is an increase in the targeting ofthe delta receptor to the cell membrane, as has been demonstrated in the dorsal horn of the spinal...

Assessing the injury and immobilizing the spine

Spinal cord injury must be suspected in patients with neck pain, sensory and motor deficits, unconsciousness, intoxication, spondylitis or rheumatoid arthritis, head injury, and facial fractures. If spinal cord injury is suspected or cannot be excluded, the patient must be placed on a spine board with the head and neck immobilized in a neutral position using a rigid collar to reduce the risk of neurological deterioration from repeated mechanical insults. Total neck immobilization should not interfere with maintenance of the airway, and inadequate respiratory function must be avoided.

Other Disorders of the Skull and Spine Dwarfism

Clinically, there are short limbs, a narrow thorax with short ribs, a short spine with flat vertebral bodies, and a large-appearing cranium with a flat nasal bridge. There are two subtypes the more common variety (type I) with bowed bones but rarely a cloverleaf skull, and a second form (type 2) with straight bones but with a complex craniosynostosis giving rise to the cloverleaf skull. Hydrocephalus is common with the second type of craniosynostosis. Both forms are associated with mutations in FGFR3. Achondroplasia can be associated with a number of neurological complications. y Stenosis at the level of the foramen magnum can cause a high cervical or lower medullary myelopathy. In case of lower medullary myelopathy, apneic spells or respiratory insufficiency can result high cervical myelopathy can give rise to long tract symptoms, including frank quadriparesis. Stenosis of the spinal canal with myelopathy or radiculopathy can occur at any level. Careful assessment for...

Types Of Spinal Procedures

Cages Types Spine

This chapter will deal with postoperative imaging in patients with degenerative disc disease, the most frequent spine pathology requiring surgery. Lumbar Spine There are several main categories of surgical procedures for treating degenerative lumbar spine conditions There are two types of interbody fusion procedures posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF) (Figure 17-1). Fusion procedures are performed with autogenous bone graft or with allograft and are usually combined with spinal instrumentation (pedicle screws that are connected to rods or plates). Interbody cages are also used and may be implanted through a posterior or anterior approach. The most frequent conditions that need to be evaluated in symptomatic patients after discectomy laminectomy procedures are persistent or recurrent disc herniation, epidural hematoma, epidural fibrosis, spinal stenosis, instability, pars fracture, arachnoiditis, spinal infection, and dural tears....

The Mechanics of the Spine and the Force Lines of the Body

Compressive and tensile forces play an important role in physics. The same holds true in human physiology. Cell metabolism depends on pressure conditions (see the formation of arthritis, supply of intervertebral disks and cartilage, and so on). Kapandji74 writes about the significance of spinal column curvatures for its stability (R N2 + 1 R resistance N number of curvatures). There is another physical law that states that an arch that is bent to one side has the tendency to rotate with the convex side into the newly formed convexity (see neutral position-sidebending-rotation NSR in Chapter 3). Littlejohn described six force lines with which he tried to explain the behavior of the spine under the strain of gravity, as well as the formation of dysfunctions in constantly recurring patterns

Spinal cord stimulation

Spinal cord stimulation was based on the gate control theory of pain, and is now linked to many mechanisms. It is thought to activate spinal inhibitory circuits, mainly those concerned with g-aminobutyric acid (GABA)-ergic mechanisms, V , and may have a suppressive action on dorsal horn neuronal hyperexcitability.124 Before permanent implantation of a stimulation device, a trial period with temporary external stimulation is strongly recommended. Spinal cord stimulation has been shown to have long-term benefit in various conditions associated with neuropathic pain, including diabetic painful neuropathy, complex regional pain syndromes, and failed back syndrome.125 III , 126 III , 127 III , 128 III , 129 III , 130 III , 131 Postherpetic pain and intercostal neuralgia seem to respond less favorably over the long term,126 III as do pain due to cauda equina injury and phantom limb 9. Wall PD, Woolf CJ. The brief and the prolonged facilitatory 27. effects of unmyelinated afferent input on...

The cervical spine

Most Prominent Spinous Process

Cervical spondylosis (cervical osteoarthrosis Osteoarthritis of the cervical spine 34 Barre-Lieou syndrome 36 Rheumatoid arthritis in the cervical spine 37 Osteitis of the cervical spine 37 nspection and palpation of cervical spine 38 Examination of cervical spine movements 39 In the 20-35-year age group, and often before there is any radiological evidence of arthritic change in the spine, a sudden movement of the neck may produce severe neck and arm pain accompanied by striking protective muscle spasm and limitation of cervical movements. In some cases these symptoms are produced by an acute disc prolapse similar to those occurring more familiarly in the lumbar region. In others, with identical symptoms, investigations including MRI scans may be quite negative some disturbance of the facet joints or related structures is often thought responsible. Most cases respond to a period of rest in a cervical collar, or physiotherapy in the form of traction. In a few resistant cases gentle...

Spinal Stenosis

Spinal stenosis can be a cause of back and lower extremity pain. It is defined as any narrowing of the lumbar spinal canal, nerve root canal, or intervertebral foramina, the predominant etiology being degenerative changes. Diagnosis is usually by CT or MRI. Incidence and prevalence as the primary source of pain is difficult to establish as it can also be found in asymptomatic individuals. The clinical presentation is usually that of an older individual with a long history of back pain. Ninety percent also have leg pain, as the key sign is lower extremity pain exacerbated with walking and relieved with sitting (neurogenic claudication). However, this still has a broad differential, including osteoarthritis of the hip and vascular claudication due to peripheral vascular disease. Ambulation producing lumbar, gluteal, or calf pain may be a manifestation of peripheral vascular disease, but it is also indistinguishable from that of lumbar spinal stenosis. Both vascular insufficiency and...


Lumbar Spine Ray Women

Rheumatoid arthritis is not common in the thoracic and lumbar spine. However, the high incidence in the cervical spine is well known. One of the most recent studies has indicated the radiographic prevalence rate of rheumatoid arthritis in the cervical spine to be 88.5 (Zik-ou et al. 2005). In contrast, a random sampling study showed rheumatoid arthritis to involve the lumbar spine in only 5 of men and 3 of women (Lawrence et al. 1964). Rheumatoid ar- Fig. 10.40A, B Rheumatoid arthritis in the uppermost cervical spine and skull base. A Anteroposterior conventional X-ray tomogram of the uppermost cervical spine in a 70-year-old woman with rheumatoid spondylitis shows erosions involving the dens (arrowheads) with subluxation to the right (open arrow). The occipitoatlantal joints are markedly narrowed bilaterally (arrows). B Posterior pinhole scintigraph shows intense tracer uptake in both occipitoatlantal joints (arrows) as well as the dens (open arrow). Compare with the normal anatomy...

Clinical Presentation

In spite of the fact that the spine is the second most common area affected by PD the majority of patients with PD remain totally asymptomatic. Some patients present with axial pain, which may be constant and does get better with rest. The pain may be ill-localized and of dull, boring character. Occasionally it may have a mechanical nature and increase on weight bearing. Other patients may present with facet arthropathy or spinal stenosis. In the former group, as pagetic bone is formed next to the facet joint, it frequently leads to the development of osteoarthritis in that joint. This leads to pain that increases on weight bearing, may radiate to the buttock (never below the knee), and can be unilateral or bilateral. In the latter group, new bone formation leads to spinal stenosis, resulting in neurogenic claudication, radicular pain, and, at times, cauda equina syndrome or frank myelopathy. Acute back pain may develop when a fracture occurs in the pagetic bone.

Psoriatic Spondyloarthropathy

Psoriatic arthropathy usually involves the cervical spine and the upper extremities. Up to 30 of psoriatic patients develop spondyloarthropathy, especially of the cervical region. Many have unilateral or bilateral sac-roiliitis as well. Not infrequently the spinal changes remain asymptomatic and are discovered only incidentally. This occurs more frequently in males. The spinal changes may be attributed to psoriasis only when cutaneous, nail, or joint changes consistent with the disease develop. The spinal changes consist of multiple asymmetrical syndesmoph-ytes that fuse adjacent vertebrae. A large region, mostly in the cervical spine, may be totally fused. The vertebral bodies as well as the facet joints may be fused. These changes are best seen on plain X-rays and CT scans and, in some cases, may be indistinguishable from those seen in AS.

Figure 317

Sagittal T2WI showing a massive herniation at the L4-L5 level filling the spinal canal, compressing the dural sac, and abutting the posterior aspect of the spinal canal. MRI, the procedure of choice, or CT myelography will reveal a very large disc herniation compressing or totally obliterating the thecal sac (Figures 3-16 and 3-17). At times, the herniated disc is very large, fills the whole spinal canal, and may, superficially, resemble the thecal sac on axial CT images. Unlike a normal thecal sac it does not contain any neural elements within it it pushes the thecal sac posteriorly. This finding is referred to as empty sac syndrome. Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, KostuikJP Cauda equina syndrome secondary to lumbar disc herniation A meta-analysis of surgical outcomes. Spine 25 1515-1522, 2000. Anderson DG, Albert TJ, Fraser JK, Risbud M, Wuisman P, Meisel HJ, Tannoury C, Shapiro I, Vaccaro AR Cellular therapy for disc degeneration. Spine 30 (17 Suppl) S14-S19,...

Figure 614

(A) Sagittal and (B) axial T2WI of the thoracic spine showing multisegmentary epi-duritis behind the spinal cord with Note the increased cord signal indicating edema and myelopathy. Almeida A Tuberculosis of the spine and spinal cord. Eur J Radiol 55 193-201, 2005. Bezer M, Kucukdurmaz F, Aydin N, Kocaoglu B, Guven O Tuberculous spondylitis of the lumbosacral region. Long term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech 18 425-429, 2005. Campi A, Filippi M, Comi G, Martinelli V, Baratti C, Rovaris M, Scotti G Acute transverse myelopathy Spinal and cranial MR study with clinical follow-up. Am J Neuroradiol 16 115-123, 1995. Desai SS Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg Br 76 863-869, 1994. Govender S Review article Spinal infections. J Bone Joint Surg Br 87 1454-1458, 2005. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ Hematogenous pyogenic spinal infections and...

Figure 912

Lateral plain film of the cervical spine showing subaxial instability from C2-C3 through C4-C5 (arrows). The challenges posed by the cervical spine in rheumatoid patients are complex and require vast knowledge and expertise. In the last two decades the medical management of RA has changed with the rather early administration of disease-modifying agents. Early utilization of drugs such as sulfasalazine, methotrexate, or leflunomide is expected to suppress synovial pathology and postpone or reduce irreversible bony structural changes. It is hoped that earlier administration of these agents will eventually result in decreased cervical spine involvement in RA patients. Boden SD, Dodge LD, Bholman HH, Rechtine GR Rheumatoid arthritis of the cervical spine. J Bone Joint Surg Am 75 1282-1297, 1993. Breedveld FC, Algra PR, Vielvoye CJ, Cats A Magnetic resonance imaging in the evaluation of patients with rheumatoid arthritis and subluxations of the cervical spine. Arthritis Rheum 30 624-629,...

Figure 1018

Oostveen JCM, Van de Laar MAFJ Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. Semin Arthritis Rheum 30 52-69, 2000. Orr RD Treatment of osteoporotic vertebral compression fractures with vertebral augmentation Vertebroplasty and kyphoplasty Contemp Spine Surg 5 27-32, 2004. Soubrier M, Dubost JJ, Boisgard S, Sauvezie B, Gaillard P, Michel JL, Ristori JM Insufficiency fracture. A survey of 60 cases and review of the literature. Joint Bone Spine 70 209-218, 2003. Sugita M, Watanabe N, Mikami Y, Hase H, Kubo T Classification of vertebral compression fractures in the osteoporotic spine. J Spinal Disord Tech 18 376-381, 2005. Togawa D, Lieberman IH, Bauer TW, Reinhardt MK, Kayanja MM Histological evaluation of biopsies obtained from vertebral compression fractures Unsuspected myeloma and osteomalacia. Spine 30 781-786, 2005. Vaccaro AR, Kim DH, Brodke DS, Harris M, Chapman J, Schildhauer T, Routt C, Sasso RC Diagnosis and management of sacral spine...

Figure 1827

Procedure Use of fluoroscopy is fundamental for the proper execution of this procedure. The target for the needle tip is in close proximity to the spinal nerve and its vessels and other vital structures, such as the pleura or the spinal cord, depending on the spinal segment. In the cervical spine the target point is the midpoint of the dorsal aspect of the intervertebral foramen in a lateral view and the midfacet pillar line in an anterior-posterior view. In the thoracic spine the target point for the location of the needle tip is the intervertebral foramen medial to the pleural lines. In the lumbar spine the target point for the location of the needle tip is the midpoint of the infrapedicle area in the so called six o'clock position in the safe triangle (Figures 18-26 and 18-27). The safe triangle is the area limited between the lateral border of the vertebra, the spinal nerve, and the pedicle. Selective Spinal Nerve Sleeve Steroid Injection Deposition of a steroid and local...

Figure 122

Bone pain or symptomatic spinal stenosis should be started on anti-pagetic therapy. Several classes of drugs are presently available for the treatment of Paget's disease. The bisphosphonates have been used for quite some time with positive results. These drugs can eliminate symptoms and suppress disease activity for an extended period of time. Alendronate (Fosamax) and Risedronate (Actonel) can be given orally. The former should be administered weekly for a period of three to six months (70 mg qweek), whereas the latter, the more effective of the two, should be administered daily (30 mg qd) for a period of two months. Pamidronate, a more potent biphosphonate, can be intravenously administered. Sixty milligrams are mixed in saline and given over a few hours for two to three consecutive days. This drug, which may bring a rather dramatic clinical improvement, is reserved for patients with extensive PD. In severe symptomatic spinal stenosis that does not respond to medical treatment, and...

Figure 422

MRI of the lumbosacral spine. (A) Sagittal T1WI showing the dural sac severely compressed and narrowed from L4 downward. Note that it is pushed away from the spino-laminar line and the vertebral bodies by an abundant high-intensity fatty tissue. (B) On the axial cut the compressed dural sac (low-intensity signal) is of Y-shaped form. Arnoldi C, Brodsky A, Cauchoix H, Crock HV, Dommisse GF, Edgar MA, Gargano FP, Jacob-son RE, Kirkaldy-Willis WH, Kurihara A, Langenskiold WH, Macnab I, McIvor GW, Newman PH, Paine KW, Russin LA, Sheldon J, Tile M, Urist MR, Wilson WE, Wiltse LL Lumbar spinal stenosis and nerve root entrapment syndromes Definition and classification. Clin Orthop 115 4-5, 1976. Atlas SJ, Keller RB, Robson D, Deyo RA, Singer DE Surgical and nonsurgical management of lumbar spinal stenosis. Spine 25 556-562, 2000. Epstein NE Ossification of the yellow ligament and spondylosis and or ossification of the posterior longitudinal ligament of the thoracic and lumbar spine. J Spinal...

Diagnosing Osteoporosis

There are many ways to diagnose osteoporosis, some very accurate and some of questionable value. Dual-energy x-ray absorptiometry, also called DXA or DEXA, is the most accurate. Not only can it diagnose full-blown osteoporosis, but it can identify those at high risk before the disorder manifests. Of great value is its ability to measure density of bones that are most at risk for osteoporosis, such as the hip, lower spine and bones of the forearm. Other methods, such as simple x-ray absorption and SXA (single-energy x-ray absorptiometry) have little value, except as a screening tool for follow-up.

Potential Therapeutic Uses of Creatine

Creatine and creatine phosphate are involved in numerous metabolic processes. Creatine synthesis deficiencies and abnormal availability of creatine and PCr have been reported to cause a number of medical problems. For this reason, the potential medical uses of creatine have been investigated since the mid-1970s. Initially, research focused on the role of creatine and creatine phosphate in reducing heart arrhythmias and improving heart function during ischemia events (i.e., lack of oxygen).12 Initial studies also evaluated the effects of treating various medical populations who had creatine deficiencies (i.e., gyrate atrophy,69-72 infants and children with low levels of PCr in the brain,73-75 etc.). Interest in the potential medical uses of creatine has increased over the last 10 years. Researchers have been particularly interested in determining whether creatine supplementation may reduce rates of atrophy or muscle wasting, speed the rate of recovery from musculoskeletal and spinal...

Secret of the Inner Smile

Inner Smile

Back Line Smile down the inside of the vertebrae of your spine, one by one. Direct the smile to your two kidneys, in your lower back just below the rib cage on either side of the spine. The adrenal glands sit on top of them. Smile at your adrenals, and they may send you a burst of adrenalin. The kidney is the lower transformer of the veins and arteries. Smile to the kidneys and fill them with love. Like the heart, this will increase the flow of chi circulating through your system. Back Line Spine Now bring your focus back to your eyes. Smile into your eyes, your tongue, then begin to smile down the inside of your spinal column. Make sure your posture is straight with shoulders slightly rounded forward. Descend one vertebra at a time, smiling into each until you have reached the coccyx. The spinal column protects your central nervous system and is crucial in increasing your chi circulation. Starting from the neck there are seven cervical vertebrae, twelve thoracic vertebrae, and five...

Lyme Disease and Rickettsia

In the nervous system, the organism can cause a condition called neuroborreliosis, which appears to involve the glutamate neurotransmitter system. In fact, viral infection acts through the same mechanism. It has been shown that the bacteria or virus activates microglia in the nervous system, which move around within the brain and spinal cord seeking out the spirochetes. When it encounters them, the microglia are activated and begin to pour out large amounts of free radicals and immune chemicals (cytokines). Together, these two block the uptake mechanism for the glutamate neurotransmitter.535

Alternatives To Animal Experiments

Human cell and tissue cultures, sometimes combined with silicon-chip technology and fluorescent dyes, are replacing animals in medical research and vaccine production. Cancer, Parkinson's disease, diabetes, asthma, colitis, spinal injury, and multiple sclerosis are all being researched in the ''test tube.'' In the Netherlands, scientists have replaced lethal vaccine tests on guinea pigs with cell-culture alternatives. Sometimes, microscopic organisms such as bacteria and yeasts are simple analogues of a human system. For example, tests with bacterial cultures have partly replaced the use of rats and mice to determine whether chemicals cause cancer. As a result, many thousands of animals have been spared from chemical-induced tumors. Volunteer studies provide direct information about human health and disease. Cancer, heart disease, muscle disorders, epilepsy, arthritis, and psychiatric illness can be researched with new scanning and imaging techniques. Lasers and ultrasound probes can...

Importance of the Microcosmic Orbit

By opening up this Microcosmic Orbit and keeping it clear of physical or mental blockages, it is possible to pump the life-force energy up the spine. If this channel is blocked by tension, then learning to circulate the Microcosmic Orbit is an important step to opening up the blocks in the body to circulate and revitalize all parts of the mind and body. Otherwise, when intense pressure builds in the head, taking such forms as headaches, hallucinations, and insomnia, much of the life-force energy escapes through the eyes, ears, nose and mouth and is lost. This is like trying to heat a room while all the windows are open. The way to open the Microcosmic Orbit is by sitting in meditation for a few minutes each morning as you practice the Inner Smile. An essential Taoist technique, described in detail in Taoist Ways to Transform Stress into Vitality, the Inner Smile is a means of connecting visual relaxation and the ability to concentrate. Allow your energy to complete the loop by letting...

Clinical applications of polymerase chain reaction

The AMPLICOR had a similar sensitivity, and the specificity of both assays remains high in nonrespiratory samples. The assays perform different based on the type of sample (spinal fluid, pleural fluid, ascitic fluid). Multidrug resistance in tuberculosis is a major public health problem. Coupling assays that detect gene mutations, such as line probe assays and molecular beacons, to PCR allows rapid detection of the drug-resistant mutations from smear-positive samples or from culture samples. Although not FDA approved, PCR can identify different species of Rick-ettsia, such as R rickettsii, Ehrlichia sp, Bartonella henselae (bacillary angio-matosis), and spirochete in late secondary and tertiary cutaneous syphilitic lesions. Among viral pathogens that can be detected by PCR in addition to the ones already mentioned are HSV-1 and -2 from saliva and serum of patients with acute herpes labialis and from spinal fluid PCR permits detection of either HSV serotype...

Joints Of The Vertebral Arch

Disc Bulge

The joints of the vertebral arch are the paired zygapophyseal joints between opposed superior and inferior articular processes (Greek zygon, yoke). They are sometimes referred to as apophyseal joints to indicate that they are outgrowths, or offshoots, of the arch (Greek apophysis, an offshoot). Clinically, they are the facet joints (Fig. 10). As synovial joints, they are subject to all of the degenerative changes associated with synovial joints, such as osteoarthritis. The fibrous capsules of the facet joints are sufficiently lax to allow movement of the spine, but they can be easily strained. The laxity of the capsule can allow its fibers to be pinched between the articular surfaces of the facet joint and produce pain. The joint capsules are innervated by twigs from the medial branches of the posterior primary rami of the spinal nerves (Fig. 11). Fig. 10. Spine model showing the formation of the facet joint by the superior articular process (SAP) and inferior articular process (IAP)....

Effect of Scoliosis Osteoarthritis Osteophytes Surgery and Fracture on BMD in the Proximal Femur

Structural changes and artifacts that interfere with DXA proximal femoral BMD measurements occur less often than at the spine. Osteoarthritic change in the hip joint may cause thickening of the medial cortex and hypertrophy of the trabeculae in the femoral neck, which may increase the BMD in the femoral neck and Ward's area (36). The trochanteric region is not apparently affected by such change and has been recommended as the preferred site to evaluate in patients with osteoarthritis of the hip (37). Osteophytes in the proximal femur are apparently much less common than osteophytes in the lumbar spine (19). They also appear to have little effect on the bone densities measured in the proximal femur. In patients with scoliosis, however, lower bone densities have been reported on the side of the convexity (38). If a worst-case measurement is desired, the bone density in the proximal femur should be measured in the femur on the side of the convexity. Proximal femur fracture and surgically...

Radionuclide scanning

The radiation exposure from a bone scan is similar to that from a roentgenographic series of the lumbar spine. MRI has a similar and in some cases better sensitivity than radionuclide bone scanning for early diagnosis of many bony and joint problems and in most cases has a better specificity. However, bone scanning is less expensive and has the advantage of being able to survey the entire skeleton during one examination.

Peripheral Nervous System

Stiens SA, Fajardo NR, Korsten MA. The gastrointestinal system after spinal cord injury. In Lin VW, ed. Spinal Cord Medicine Principles and Practice. New York Demos Publishing, 2003 321-348. 39. Stiens SA, Bergman SB, Goetz LL. Neurogenic bowel dysfunction after spinal cord injury clinical evaluation and rehabilitative management. Arch Phys Med Rehabil 1997 78(3 suppl) S86-102. 40. Stone JM, et al. Chronic gastrointestinal problems in spinal cord injury patients a prospective analysis. Am J Gastroenterol 1990 85(9) 1114-1119. 42. Krogh K, et al. Colorectal function in patients with spinal cord lesions. Dis Colon Rectum 1997 40(10) 1233-1239. 43. Cameron KJ, et al. Assessment of the effect of increased dietary fibre intake on bowel function in patients with spinal cord injury. Spinal Cord 1996 34(5) 277-283. 44. Nino-Murcia M, et al. Colonic transit in spinal cord-injured patients. Invest Radiol 1990 25(2) 109-112. 45. Krogh K, et al. Colorectal transport during defecation in...

Facet Joint Degeneration

Ligamenta Flava Mineralization

Disc protrusion extrusion (which may have both a mechanical and chemical irritation effect), spinal stenosis, facet arthropathy, osteophytic nerve root compression, spondylolysis (with or without spondylolisthesis), vertebral compression fracture, sacral insufficiency fracture, discitis osteomyelitis, spinal tumor (either primary or metastatic), arachnoiditis, and postoperative scar. The clinical differential diagnosis may also include causes of back pain unrelated to the spine, such as abdominal aortic aneurysm, retroperitoneal lymphadenopathy, or renal colic. A detailed discussion of the neurophysiologic basis of back pain and radiculopathy is beyond the scope of this text. The reader is referred to an excellent review of the complex relationship between the somatic and autonomic nervous system and the nature of referred pain by Jinkins et al. (13). Facet arthropathy is one of the many causes of back pain with or without radiculopathy. Facet disease degeneration can result in nerve...

MRI of the Painful Hip in Athletes

Female Hip Mri

Avulsive injuries at pelvic muscle insertions represent another mechanism of injury. Depending on the site, muscle may insert directly onto bone, or attach via tendon. Although not involving the hip per se, some muscle insertions are in close proximity to the hip joint, and these avulsions are a differential consideration in patients who have unilateral hip or groin pain following injury. Commonly encountered muscle avulsions include the relatively broad-based musculotendinous insertions of the rectus femoris (anterior inferior iliac spine) (Fig. 6), sartorius (anterior superior iliac spine), iliopsoas (hip lesser trochanter), and at the symphysis, the adductor group 26 . The hamstring origins are composed of tendons only injuries may be confined to the conjoined sem-itendinosus biceps femoris or to the semimembranosus 25,27 .

Miscellaneous Seated Tai Chi Exercises

Lowering the Spine The motions of this exercise are intended to strengthen the legs, improve the circulation throughout the body, and open the joints through which the circulation flows to and from the legs. This exercise can also begin to increase the flexibility of the spine.

Focal And Multifocal Limb Neuropathy

Segmental Demyelination

Isolated involvement of peripheral nerve of the limbs including radial, median, and ulnar nerves in the upper limbs and of the peroneal nerve for the lower limbs, occurs in patient with diabetes. It is sometimes, difficult to know whether it is a manifestation of increased liability of nerves to pressure palsy in common sites of entrapment in patients with diabetes, or a specific diabetic neuropathy. In other cases development of a senso-rimotor deficit in the territory of one or several nerve trunks occur without evidence of a superimposed cause for neuropathy. Such cases are extremely rare considering the frequency of distal symmetrical diabetic neuropathy and should always be investigated as in patients without diabetes. In particular, it is necessary to perform electrophysiological testings to enable a more accurate localization of the lesions, and when clinical and electrophysiological data point to spinal root lesions, magnetic resonance imaging of the spine has to be performed,...

Arthritis And Rheumatism

Backache usually manifests as pranic depletion. Scan the spine thoroughly. Apply localized sweeping on the entire spine with emphasis on the affected part. Apply energizing on the affected part. The relief is usually very fast. Repeat these treatments for the next few weeks. This is necessary to make the healing permanent.

Dancing and Bone Chi Kung

By pressing the ground and swinging the hips, the kua opens and as the Chi from the earth runs up, the sexual organ and the whole pelvic floor are stimulated and the life force starts to fill the belly. It then begins to tremble and vibrate and the Chi moves to the sacrum, up the spine and around and through the whole body, filling the reservoirs, path routes, organs and glands.

Radiographic Synopsis

Synovial and cartilaginous articulations involved preferential involvement of the joints in the axial skeleton (sacroiliac, apophyseal, discovertebral, and costovertebral articulation) characteristic pattern of spinal ascent involvement of entheses joint space narrowing and erosion marginal sclerosis bone formation within joint capsule, tendons, and ligaments joint ankylosis (ankylosing spondylitis) 6. Bilateral short hallux short thumbs (less common) heterotopic ossification of striate muscles 'pseudoexostoses' at insertion points of tendons, ligaments, fasciae, and aponeuroses ankylosis of spine, shoulders, hips, temporomandibular joints, etc. (fibrodysplasia ossificans progressiva syndrome)

Supplemental Reading

Adachi Y, Shiota E, Matsumata T, et al. Osteoporosis after gastrectomy bone mineral density of lumbar spine assessed by dual-energy X-ray absorptiometry. Calcified Tissue International 2000 66 119-22. Buckley LM, Leib ES, Cartularo KS, et al. Calcium and vitamin D3 supplementation prevents bone loss in the spine secondary to low-dose corticosteroids in patients with rheumatoid arthritis. Ann Intern Med 1996 125 961-8. Haderslav KV, Tjellesen H, Sorensen HA, Staun M. Alendronate increases lumbar spine bone mineral density in patients with Crohn's disease. Gastroenterol 2000 119 639-46.

Who gets osteoporosis

When I went for my annual gynecology check-up at around the age of 52, my gynecologist asked me, as usual, if my family history of medical conditions had changed. His ears perked up when I told him that my mother had been diagnosed with spinal stenosis. When I looked back, I remembered My doctor said that I should have a bone density test to determine if I had osteoporosis in my hip or spine. My test did show some bone loss in my hip. I was angry because I had no symptoms whatsoever and believed that I was taking good care of my health.

Are there any medications that I should adjust or stop taking while Im being treated for osteoporosis

Recent research studies showed that DHEA, when taken in conjunction with traditional lupus therapies, may improve bone density at the hip and spine, and may reduce lupus flares in women. Whether DHEA actually reduces flares of lupus, allows prednisone dosages to be reduced, or increases your BMD, DHEA may be worth discussing with your rheumatologist.

Didronel etidronate is usually prescribed for Pagets disease Is it ever prescribed for osteoporosis

Didronel (etidronate) is another bisphosphonate. It is FDA-approved for Paget's disease, high calcium levels related to cancer, and rare bone conditions related to hip replacement surgery, but not for osteoporosis. Outside of the United States, Didronel is used for osteoporosis. It works a little differently from other bisphosphonates in that it kills off the osteoclasts (the cells that break down bone). Nonetheless, Didronel has been very effective in reducing osteoporosis-related fractures, particularly spinal ones, and safety has been established for 7 years or more use in postmenopausal women. Additionally, like other bisphos-phonates, some protective effects of Didronel on bone density have been shown to persist even after stopping the medication. Didronel is not FDA-approved Bone healing problems associated with hip replacement surgery and spinal cord injuries

Doctors Dilemma

Other intervention procedures are often discussed, fuelled by the general hope that as research progresses, more and more difficult operations will be carried out. It is probably time to take a hard look at some of the more fanciful operations which have been aired. One set of future procedures is concerned with the central nervous system. At present severe damage to the spinal cord often leads to loss of limb function. Although, minor nerve can regenerate to some extent, major nerves do not. This has lead to much discussion of the possibility of nerve regeneration in the future. However, it is not only a question of stimulating the growth of new nervous tissue, there is also the even more important problem of the specificity of nerve connections. Successful repair of a spinal cord involves perfect matching and rejoining of the many thousands of severed nerve endings. The enormity of the problem can be best illustrated by a consideration of the likelihood of eye transplantation in the...

Adverse Health Effects

Chronic infection or inflammation is associated with adverse health effects. MMPs play a role in the pathophysiology of experimental disease models. In animal models of rheumatoid arthritis, MMPs may contribute to cartilage and bone destruction, synovial proliferation, and periosteal bone formation (Firestein, 1992). In experimental allergic encephalomyelitis (EAE) in mice, MMPs appear in the spinal fluid and alter the normal permeability of the blood-brainbarrier (Goetzl etal., 1996).

Differential Diagnosis of the Painful

Neurovascular Supply The Pelvis

The differential diagnosis of hip pain must, in addition, include structures distant to the joint and periarticular tissues. The importance of referred pain from the lumbar spine, abdominal and pelvic viscera, genitourinary problems, sacroiliac problems, sporting hernias, osteitis pubis, and other pelvic conditions should also be considered. Similarly, pain from the knee and thigh may be referred proximally to the hip and vice versa. Persistent hip pain can also originate from intra-articular pathology such as synovitis, loose bodies, avascular necrosis (AVN), acetabular labral tears, or infection. Pain is usually the chief complaint of patients with hip problems. These patients may present with pain over the anterior or lateral aspect of the hip, in the groin, or more medially in the region of the adductors, corresponding to the obturator nerve distribution. (Figure 2.1) Pain may radiate distally to the knee. Pain referred to the hip may be secondary to spinal problems, which must be...

Atlantoaxial instability

The cervical spine is variably affected in 44-88 of patients, with conditions ranging from minor asymptomatic atlantoaxial subluxation to total incapacity due to severe and progressive myelopathy. Autopsies have shown that severe atlantoaxial dislocation and high spinal cord compression is the commonest cause of sudden death in patients with rheumatoid arthritis E.g., upper respiratory tract infections, mastoiditis, parotitis, tuberculosis

Scapular Abnormalities

Chest Xray Child Scapular

The most important and common anomaly of the scapula is congenital uni- or bilateral failure of descent, or Sprengel deformity. The scapula remains in an abnormally high position, sometimes anchored to the cervical spine by a bony (omovertebral bone), cartilaginous, or fibrous bridge (Baulot et al. 1998). Occasionally, an accessory ossicle is found at the insertion of the levator scapulae muscle (Gallien 1985). The point of tethering of the omovertebral connection is likely to determine the shape, rotation, medial migration, and superior displacement of the scapula (Leibovic et al. 1990). The scapula is smaller than normal, with a decrease in the height-to-width ratio. The degree of scapular rotation is inversely correlated to the superior displacement (Cho et al. 2000). Sprengel deformity can occur as an isolated anomaly Fig. 2.45. Campomelic dysplasia in a female newborn who died 2 h after birth. The scapulae are severely hypoplastic, each with unossified body and caudal portion....

Skeletal Fluorosis Making Us All Cripples

In stages, phase one presenting as arthritis-type pains and stage three as debilitating crippling. In countries with naturally high fluoride levels, skeletal fluorosis is quite common and considered a major medical disaster. Some villages have been described wherein every single resident has been afflicted with a twisted, bent spine leading to severe crippling. Death rates in such villages begin to skyrocket at about age fifty. In very advanced cases, the spine is so contorted and overgrown that the nerves and spinal cord are gradually crushed, leading to severe neurological injury. Those exposed at these levels for two-and-a-half years showed early stages of fluorosis, mainly arthritic pains. Those exposed for four-and-a-half years advanced to phase two bone changes, with increased stiffness and reduced range of motion in the joints. If the exposure continued for eleven years, there was a high incidence of crippling of the spine and other bones. Over the past thirty years of my...

Lymphoedema Armchair Legs

Lymphatic Papillomatosis Images

Verrucosis) develop in patients who sit in a chair day and night with their legs dependent. Patients with with cardiac or respiratory disease, stroke, spinal damage, or arthritis are predisoposed to this condition verrucosis) develop in patients who sit in a chair day and night with their legs dependent. Patients with with cardiac or respiratory disease, stroke, spinal damage, or arthritis are predisoposed to this condition

Sternal Abnormalities

Double Manubrial Ossification

Several acquired lesions may affect the sternum, which is a relatively common site of metastasis. Primary tumors are less common, and include lymphoma, chondrosarcoma, plasmocytoma, chordoma, and giant cell tumors (Martini et al. 1974). Fractures or dislocations of the sternum sometimes occur after direct trauma to the lower anterior part of the thoracic cage. Commonly, the site of fracture is the upper body of the bone near the manubriosternal junction. Cardiovascular, pulmonary, and tracheal injuries are serious complications of direct sternal trauma (Brookes et al. 1993). Indirect mechanisms, such as a blow to the upper thoracic spine, can also be responsible, although less commonly, for sternal fractures (Gkopalakrishnan and el Masri 1986). Osteomyelitis of the sternum and septic arthritis of the sternoclavicular and manubriosternal joint can result from direct hematogenous inoculation or secondary contamination attributable to local injury, surgery, or a therapeutic or diagnostic...

Extraintestinal Infections

Cases of endocarditis, urinary tract infections, pulmonary infections, arthritis, and osteomyelitis involving Aeromonas spp. occur (9,26,36-38). In patients of various age groups, Aeromonas hy-drophila and Aeromonas veronii, isolated from cerebral spinal fluid (CSF) and blood, have been connected with meningitis. Enhanced patient susceptibility might result from various underlying illnesses, such as liver disease and head trauma (39). Several Aeromonas-linked respiratory tract diseases, ocular infections, and peritonitis have occurred, and recently, Aeromonas veronii biotype sobria has been implicated as the cause of septic arthritis (39,40).

Pharmacologic Highlights

Teach the patient assistive techniques to manage joint pain, such as meditation, biofeedback, and distraction. When the pain is reduced and mobility improves, encourage the patient to assume more responsibility for self-care. Recommend a firm mattress or bed board for lumbar and sacral spine pain. Apply moist heat pads to relieve hip pain, and assist with gentle range-of-motion exercises. A total or partial hip replacement requires limited joint movement and restricted weight-bearing, depending on the type of prosthesis and surgical approach. Preventing dislocation of the hip prosthesis is extremely important. Keep the patient from lying on the affected side. Place three pillows between the patient's legs while she or he is sleeping and when you turn the patient. Avoid hip flexion. Keep the cradle boot in place, except for a brief period during a bath. Once the patient is allowed up, instruct her or him not to cross the legs while sitting and to avoid wearing shoes and stockings or...

Gas Chromatographic Model

The American psychologist Ronald Mel-zack (1929- ) and the American-based English biologist and anatomist Patrick D. Wall (1925- ) formulated the gate-control theory of pain, which states that the spinal cord contains a type of neurological gate that either blocks or allows pain signals to pass on to higher centers in the brain. The spinal cord contains small nerve fibers ( C-fibers ) that conduct most pain signals and larger fibers ( A-delta fibers ) that transmit most other sensory information. When some bodily tissue is injured, the small fibers activate and open the neural gate, and the person feels pain. Larger fiber activity, on the other hand, serves to close the pain gate and turns pain off. Thus, according to the gate-control theory of pain, one way to treat chronic pain is to stimulate (via small electrical currents or by acupuncture) the gate-closing activity in the large neural fibers. This is called the counterirri-tant method for...

News Prognostic Indicators Of Hospitalized Patients With Systemic Lupus Erythematosus A Large Retrospective Multicenter

Lupus Erythematosus Disseminatus

Lateral radiograph of the thoracic spine. There is loss of intervertebral disc space at T7-8 with loss of the endplate cortex anteriorly and little reactive bone formation (Courtesy of Robert Lopez-Ben, Division of Diagnostic Radiology, Department of Radiology, The University of Alabama at Birmingham, Birmingham, Alabama). Fig. 1. Lateral radiograph of the thoracic spine. There is loss of intervertebral disc space at T7-8 with loss of the endplate cortex anteriorly and little reactive bone formation (Courtesy of Robert Lopez-Ben, Division of Diagnostic Radiology, Department of Radiology, The University of Alabama at Birmingham, Birmingham, Alabama). Fig. 2. Magnetic resonance image of the thoracic spine. (A) Sagittal Tl-weighted MR image of the thoracic spine. There is marked marrow edema in T7 and T8 vertebral bodies. An epidural mass bulges the posterior longitudinal ligament and compresses the spinal cord at this level. (B) Sagittal Tl-weighted MR image of the thoracic...

Radionuclide infection scanning

Bilateral Fluid Signal Masses

CT provides axial sections for visualization of cross-sectional anatomy, which often facilitates the evaluation of abnormalities in the pelvis and spine. This is especially valuable in evaluating pelvic fractures and localizing osteoid osteomas. Sagittal and coronal images can be obtained by reformatting thin axial sections or images obtained by helical scanning. CT is useful in evaluating the extent of bony and soft-tissue tumors. It can be used to diagnose intervertebral disk herniation and spinal stenosis. CT performed after the injection of contrast material (e.g., after myelography, diskography, or arthrography) provides additional information in these studies. F. Magnetic resonance imaging (MRI) has the advantage of not using ionizing radiation. It provides multiplanar imaging capabilities without sacrificing image resolution. 2. Gradient echo techniques. Additional soft-tissue contrast is achieved through variation in pulse sequences. Gradient echo...

Paleopathology Findings Congenital Defects

Enchondral bone, that is bone formed first as cartilage. There is shortening of the bones of the extremities and the mandible and forehead appear prominent. The long bones are relatively thick and the head is larger than normal, with a prominent frontal region, small face, and depression of the bridge of the nose. The legs and spine are curved as well.

Surgical Technique

Frontal Sinus Surgery Instrument

The operator can get an indication whether they are in the frontal recess by placing an angled instrument, such as a ball probe , a Kuhn-Bolger curette, or an olive-ended sucker, in the area they believe to be the frontal sinus and then noting both the angle and length of the probe as it passes the maxillary spine. The instrument is then pinched next to the spine and then removed and placed on the external surface of the nose at the same angle and length from the spine.

Osteitis Condensans Ilii

Sacrum Acutum

Pinhole scintigraphy likewise shows symmetrical, club-shaped, or round areas of intense tracer uptake in the lower halves of both ilia along the sacroiliac joints (Figs. 7.1B and 7.2B). The shapes vary according to the sacral inclination. When the coronal plane of the sacrum is relatively flat the lesion looks like a spinnaker and when horizontally tilted the lesion appears round. In occasional cases, tracer uptake is asymmetrical and inhomogeneous, probably due to involutional change with age. It is well known that bilateral and more or less symmetrical tracer uptake may also occur in the lower sacroiliac joints in ankylosing spondylitis, but this is usually ill defined (see Ankylosing Spondylitis in Chapter 11) and mostly attended by the associated stigmata in the spine and other skeleton. It is to be remembered for differential diagnosis that unilateral sacroiliac joint uptake can occur in infection, trauma, metastasis, or seronegative spondyloarthropathies. Using pinhole scanning...

Comprehension Questions

22.4 A 22-year-old man presents with complaints of low back pain for 3 1 months and stiffness of the lumbar area, which worsen with inactivity. He reports difficulty in getting out of bed in the morning and may have to roll out sideways, trying not to flex or rotate the spine to minimize pain. A lumbosacral (LS) spine x-ray film would most likely show which of the following E. Diffuse osteonecrosis of the LS spine

All causes of acute and subacute low back pain as listed above Degenerative diseases

Spondylosis, spon- Spondylosis refers to osteoarthritis involving the ar-dylolysis, and spon- ticular surfaces (joints and disks) of the spine, often dylolisthesis with osteophyte formation and cord or root compres Lumbar spinal stenosis Multiple nerve roots are involved, and the pain in the spine is significantly greater than that in the limb. Symptoms develop when standing or walking. Impairment in the bowel, bladder, or sexual function may Lateral recess syndrome Single or multiple nerve roots on one or both sides become compressed. Pain in the limb is usually equal to or greater than that in the spine. Symptoms are brought on by either walking or standing, and are relieved with sitting. Testing by straight leg raising may be negative Clinical features include positive straight leg raising and radicular pain in the limb disproportionate to that in the spine. Loss of strength, reflex, and sensation occurs in the territory of the affected root

Further Along the Yoga Path Suggested Reading

Awakening the Spine. New York Harper Collins Publishers, 1991. lengthen your spine, 272-273 massage your spine, 274 mountain pose, 270-271 stretching and pulling, 272 warrior 2 pose, 271 pregnancy, yoga during, 284 child's pose, 286 corpse pose, 285 hero pose, 285 mountain pose, 284 sitting poses, 195 hero (virasana), 198-199 staff (dandasana), 196 spinal twists (maricyasana), 169 bound knee spinal twists, lying down spinal twists, bound knee spinal twists, 171 bound lotus (baddha padmasana), lacto ovo vegetarians, 253 lacto vegetarians, 252 leg lifts (uttanatavasan), 183 lengthen the spine pose, partner yama guidelines, 62 lying down spinal twists, 172 chanting, 221-222 Hari Om, 240 Om namah sivaya, 240 Om Shanti Shanti Shanti, 240 sample mantras, 240 maricyasana (spinal twists), 169 bound knee spinal twists, 171 lying down spinal twists, 172 Mars chakra, 232 actualization), 83-85 massage your spine pose, partner angle pose), 209 partner yoga, 269 poses (asanas),...

Hemophagocytic Lymphohistiocytosis Hemophagocytic Syndromes

Spinal fluid pleocytosis (mononuclear cells) Other abnormal clinical and laboratory findings consistent with the diagnosis are cerebromeningeal symptoms, lymph node enlargement, jaundice, edema, skin rash, hepatic enzyme abnormalities, hyperferritinemia, hypoproteinemia, hyponatremia, spinal fluid protein T, very low density lipoprotein (VLDL) T, high-density lipoprotein (HDL) 4, circulation soluble interleukin-2 receptor T.

Pyogenic Arthritis Pyarthrosis

Acetabulum And Hemorrhagic Fluid

Ordinary planar scintigraphy simply reveals intense tracer uptake in the joint. However, pinhole scintigraphy shows the intense uptake to be localized to markedly narrowed joint, reflecting the destruction of the articular cartilages and subchondral bones (Fig. 8.12). The articular narrowing tends to be conspicuous in the hips, the knees, and the spine that bear body weight. In contrast, the tracer uptake and articular narrowing are not so conspicuous in the glenohumeral joint (Fig. 8.13) and elbow, which are out of the main weight-bearing axis

Generalized Osteoarthritis

Whole Body Bone Scan

Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine Fig. 9.52 Value of whole-body bone scintigraphy in the diagnosis of generalized osteoarthritis. Anterior (left) and posterior (right) whole-body bone scans in a 56-year-old female show asymmetrical multiarticular involvement including the lower lumbar spine tive expected rates of 17 and 26 . Joints commonly involved include the apophyseal joints of the spine, the knees, the proximal in-terphalangeal joints of the finger, the first car-pometacarpal joint, and the first tarsometatar-sal joint (Kellgren and Moore 1952). The hips, wrists, and lateral metatarsophalangeal joints are also involved but less commonly. Whole-body scanning is ideally suited to the diagnosis of multiple joint involvement spread in the lumbar spine, knees,...

Application To Disease Diagnosis

The chemical composition of cerebrospinal fluid (CSF) gives a good indication of the health or otherwise of the central nervous system (CNS), and therefore biofluid NMR studies of CNS diseases have focused on CSF. Studies in this area include drug overdose, Reye's syndrome, and Alzheimer's disease.

History of rheumatic diseases

Specific associations include psoriasis with psoriatic arthritis or gout ulcerative colitis or Crohn's disease with inflammatory disease of the spine or peripheral or sacroiliac joints diabetes with neuropathic, septic joints, or osteomyelitis hemochromatosis with severe osteoarthritis endocrinopathies such as hypothyroidism (carpal tunnel syndrome, myopathy), hyperparathyroidism (pseudogout), and acromegaly (severe osteoarthritis). A complete medication list is essential, as well as an inquiry into prior medications. Important in this context is drug-induced lupus associated with the use of hydralazine and procainamide, Raynaud's phenomenon associated with the use of beta blockers, eosinophilia-myalgia syndrome associated with l-tryptophan, or myositis associated with the use of statin drugs for hypercholesterolemia.

Clinical manifestations

An increased prevalence of PsA has been clearly established with HIV infection, mostly in AIDS patients 13,30,46 . A variety of psoriatic manifestations may accompany HIV infection, with nail involvement present in most HIV-positive patients with inflammatory articular involvement. The articular pattern most frequently observed is polyarticular and symmetric with enthesopathy and dactylitis, but sacroiliac or spinal affection can also occur 46,47 . Of 702 new Zambian patients with inflammatory arthritis, 28 had PsA and 27 of these were HIV positive. At first consult, 16 patients (60 ) were in WHO clinical stage I. PsA is almost universally associated with HIV infection in black Zambians. The clinical features are similar to those described for whites with AIDS-associated PsA 48 . The course of psoriatic arthropathy during HIV infection is variable but tends to progress together with the decrease of CD4+ cell count and to be refractory to conventional treatment. In this regard, the...

Location of the Points of the Great Bridge and Great Regulator Channels

Dayan Qigong Meridian Points

Location On the back, halfway down from the lowest rib to the top of the hip bone, and halfway between the spine and the side of the body. Location On the back, between the fourth and fifth rib, between the spine and the left scapula. The point feels like a knot of muscular tension and is sensitive to pressure.

Intervertebral Osteochondrosis

Osteophyte Cervical Vertebrae

The spine has five different articulations the diskovertebral and apophyseal joints in throughout the spine, the costotransverse and costocorporeal joints in the thoracic spine, and the uncovertebral joints in the cervical spine. Of these, the diskovertebral joint is fibrocarti-laginous in type and others are synovial except for the uncovertebral joint that is mixed in type. Based on the principal site of involvement, diskovertebral degeneration can be divided into diskovertebral osteoarthritis and spondylosis deformans. The former osteoar-thritis affects the nucleus pulposus with diffuse condensation of peridiskal bones (endplate-based sclerosis) of the lower lumbar and lum-bosacral vertebrae and the latter the outer or Sharpey's fibers of the annulus fibrosus with osteophytosis. On the other hand, the degenerative change of the apophyseal and costoverte-bral joints is considered to be a classical osteo-arthritis since these joints are synovial. Fig. 9.37A, B Straightness of endplate...

Can A Lesion On The Pons Cause Hyperacusis And Opthalmoplegia

Motor Pathway For Smiling

Lesions at 1. (e.g. haemorrhage) cause ipsilateral VI and or VII nerve palsies and contralateral pyramidal signs. Lesions at 2. (e.g. basilar thrombosis) cause ataxia on the side of the lesion (damage to the cerebellar peduncles). There may also be impaired sensation on Ihe ipsilateral side of the face (spinal tract and n udeus of V nerve) and on the contralateral side of the body (spinothalamic tract) and xcasionally a VII nerve lesion. Lesions in the pons often cause internuclear ophthalmoplegia (p. 202) and ataxic nystagmus. Spinal tract and nucleus of V nerve Fig. 6.19 Lesions of the pons. Lesions at 1. (e.g. haemorrhage) cause ipsilateral VI and or VII nerve palsies and contralateral pyramidal signs. Lesions at 2. (e.g. basilar thrombosis) cause ataxia on the side of the lesion (damage to the cerebellar peduncles). There may also be impaired sensation on Ihe ipsilateral side of the face (spinal tract and n udeus of V nerve) and on the contralateral...

Conventional Tomography

Conventional Tomography

Conventional tomography of the spine in a patient who has S aureus endocarditis. A lateral tomogram of L4-L5 region shows a large osteolytic area involving the disc space and contiguous vertebral bodies, with surrounding sclerosis (arrow). Fig. 11. Conventional tomography of the spine in a patient who has S aureus endocarditis. A lateral tomogram of L4-L5 region shows a large osteolytic area involving the disc space and contiguous vertebral bodies, with surrounding sclerosis (arrow). used by bacteria for their growth, biotin forms a stable, high-affinity noncova-lent complex with avidin. Lazzeri and coworkers 65 explored the usefulness of this technique for the detection of early vertebral osteomyelitis in a series of 55 patients. Thirty-two of the patients underwent MRI and 24 underwent CT scan. DTPA-conjugated biotin was radiolabeled by incubating 500 mg of DTPA-biotin with 111 MBq of 111In-chloride. Two-step scintigraphy was performed by first infusing 3 mg streptavidin...

Acetabular Reconstruction Fixation Methods in Simple Fracture Patterns

Isolated anterior wall fractures are relatively rare, and these fractures are usually a part of a more complex pattern. Normally, the ilioinguinal approach will be used to operate on anterior wall fractures with the patient in supine position on a radiolucent table. Unlike the posterior wall, access and fixation of the anterior wall may be a bit more difficult. In 2002, Kloen et al. reported their favorable experience in treating 15 patients with a modified ilioinguinal approach, which was combined with a Smith-Petersen anterior approach. An anterior superior iliac spine (ASIS) osteotomy is a component of this modified approach, and it greatly enhances access to the anterior wall (Fig. 4). In some cases of femoral head lesions with anterior or superior wall lesions, this approach can be very useful (Fig. 5). Figure 4 Schematic illustration of modified anterior approach for treatment of anterior wall fractures. Note anterior superior iliac spine osteotomy and release of rectus femoris...

Simian Posture In Pagets Disease

Normal Spine Without Arthritis

In chronic cases there is often a long history of intermittent low back pain over a number of years. The cause is often obscure, although degenerative changes in the spine are not uncommonly present. Resistance to treatment is a frequent problem, and many are ultimately referred to pain clinics. Sometimes a change of employment to work of a lighter character may have to be contemplated. In patients with this complaint of pain in the coccygeal area there is often a history of a fall in the seated position on to a hard surface consequently, in a number of cases radiographs may reveal a fracture of the end piece of the sacrum, or show the coccyx to be subluxed into the anteverted position. Symptoms of pain on sitting and defecation are often protracted for 6-12 months, but tend to resolve spontaneously. It was formerly thought that if symptoms proved persistent either a disc lesion in the lumbar spine (with distal referral) or a functional problem was likely to be the problem, but this...

Disorders of the Joints

The symptoms of osteoarthritis include pain, tenderness, swelling, redness, and loss of motion or strength in the affected joint or joints. The pain tends to worsen toward the end of the day. In some people the joint may make cracking sounds when it is in motion. In osteoarthritis, joint cartilage gradually wears away, allowing adjoining bones to rub against each other. Painful outgrowths of bone (spurs) also may develop. Although symptoms usually do not appear until middle age, they can begin as early as between ages 20 and 30. Among adults under age 55, men and women are affected equally after age 55, the incidence of osteoarthritis is higher in women. Joints in the hips, knees, spine, big toe, and fingers are most commonly affected.

Phosphorylation and Membrane Recruitment of the NKCC1 Cotransporter and Referred Visceral Hyperalgesia

Recently, several studies have suggested a role for the NKCC1 cotransporter in nocicep-tive processing and in the generation and maintenance of hyperalgesic states. Disruption of the gene encoding NKCC1 causes an impaired behavioral response to the hot plate test (91) and a reduction in stroking hyperalgesia (touch-evoked pain or allodynia) evoked by capsaicin injections (92). NKCC1 is expressed in primary afferent neurons and in sensory neurons in the spinal cord and the induction of an experimental arthritis alters the expression of NKCC1 in these neurons (93). The process by which NKCC1 may be involved in pain processing involves the role of the cotransporter in the generation of presynaptic inhibition in the spinal cord (94), a mechanism proposed in the gate control theory of pain (95) to explain interactions between low- and high-threshold afferents in spinal nociceptive processing. The upregulation of NKCC1 during the generation of a visceral hyperalgesic state has been studied...

GDifficulty with activities of daily living ADL

Spinal and sacroiliac disease in ankylosing spondylitis and other seronegative spondyloarthropathies. Maintenance of an erect posture is critical for all ADL, including sitting, standing, walking, and sleeping. Patients should sleep in a prone or supine position on a firm mattress with one small pillow or no pillow. (Pillows under the knees should be avoided at all times to prevent flexion deformities.) Breathing and chest expansion exercises are extremely important. In addition, stretching exercises that facilitate extension of the neck, spine, and peripheral joints should be taught and diligently followed.

Evaluation Of Pregnant Woman

Diagram Igm Igg Rubella

The diagnosis of congenital rubella can be confirmed with virus isolation, which is the most reliable method of making the diagnosis. Unlike individuals who acquire rubella postnatally, infants with congenital rubella excrete the virus for months. Cultures are most sensitive for isolation of virus when done soon after birth because the quantity of virus present decreases over time. The nasopharynx and throat are probably the best sites for isolation of virus, but it may also be cultured from the urine, blood, feces, and cerebrospinal fluid (10).

Lij clinical orthopaedic examination

Hemivertebra Pes

Pathology (18) The arrow inserted in this CT scan shows an abnormal encroachment on the spinal canal. Where treatment in childhood has been unsuccessful, or even where the condition has not been diagnosed, a patient may seek help during the third and fourth decades of life. Symptoms may arise from the hips or the spine. In the hips, secondary arthritic changes occur in the false joint that may form between the dislocated femoral head and the ilium with which it comes in contact. In the spine, osteoarthritic changes are a result of long-standing scoliosis (in the unilateral case), increased lumbar lordosis (in both unilateral and bilateral cases), or excessive spinal movements that occur in walking. In a few cases hip replacement surgery may be considered, otherwise the treatment follows the lines for the conservative management of osteoarthritis of the hips and spine. 1. The commonest cause of hip pain in the adult is pain referred from the spine, e.g. from a prolapsed...

Uncovertebral Osteophytes

Disc Osteophyte Complex

Radiographs (15) Normal oblique projection of the cervical spine (one of two). cervical myelopathy (I) (a) the Pavlov ratio. Normally, the depth (A) of the cervical canal, as seen in the lateral projection, is as great as that of its related vertebral body (B), giving a Pavlov ratio (A B) of 1.0, and more than adequate room for the spinal cord. A Pavlov ratio of 0.8 or less indicates a developmentally narrow cervical canal, with risk of cord compression. If the ratio is reduced check the lumbar spine, as there may well be an associated lumbar spinal stenosis. 3.45. Cervical spine radiographs examples of pathology (1) The cervical curvature is reversed there is wedging of the body of C6. represented by a solid bony mass. Diagnosis congenital fusion of cervical spine. 3.52. Pathology (8) There is marked loss of vertebral alignment, and the inferior articular processes of C6 are lying in front of the superior articular processes of C7. The spinous processes of C5 and C6 are...

Indications and Patient Selection for Bariatric Surgery

And become fertile unfortunately, their hirsutism will not go away with weight loss. It is recommended that women take contraceptive precautions for 1 year after bariatric surgery because of the potential risk of neural tube defects (spina bifida, etc.) with nutritional impairment during pregnancy. Pseudotumor cerebri has also been shown to resolve after surgically induced weight loss these patients no longer suffer from constant headaches and pulsatile tinnitus and their opening cerebrospinal fluid (CSF) pressures normalize. Patients with degenerative joint disease involving the hips, knees, ankles and lower back will usually claim a marked decrease in pain and improved mobility following marked weight loss, but there are no studies documenting this impression to date. It may obviate the need, either temporarily or longer, for artificial joint replacement. There are no data to date evaluating the effect of major weight loss on non-alcoholic steatohepatitis (NASH), although the...

Joint Manifestations Arthralgia Arthritis and Ankylosing Spondylitis

Symptomatic disease has a clinical pattern identical to that of idiopathic disease. Patients develop low back pain, especially during the night, followed by morning stiffness and buttock, chest or neck pain. The characteristic clinical signs are spine motility impairment and chest expansion. The main feature of axial involvement is that its onset and course are independent of the bowel disease. HLA-B27 has a high prevalence in ankylosing spondylitis (90 ) while in patients with IBD and spondylitis, its prevalence varies from 50-75 . The simultaneous presence of HLA-B60 and HLA-B44 seems to increase the patient's susceptibility to axial involvement 26 .

Mycoplasmas and ureaplasmas in human disease

M. hominis can be found in male urethritis in 19 of cases, and in the female genital tract as a commensal and as a member of the bacterial vaginosis family. Pelvic inflammatory disease, pyelonephritis, postpartum fever, posthysterectomy wound infection and fetal scalp abscesses may ensue from there. M. hominis has also been isolated from respiratory secretions of premature infants with pneumonia and in adult pharyngitis. In patients with reduced immunity, dissemination of genital mycoplasmas to other sites is possible, e.g. to the cerebrospinal fluid in premature infants, to the joints of hypogamma-globulinemic persons or nosocomially to operative wounds. M. hominis and U. urealyticum have recently been demonstrated in adenotonsillitis in children.

Current Treatments

Estrogen therapy (ET) or estrogen plus progesterone therapy, commonly referred to as hormone replacement therapy (HRT), are effective antiresorptive strategies in preventing menopause-associated bone loss and in reducing osteoporotic fractures reversal of bone resorption can occur within a month of treatment initiation. Whilst increases in the BMD of the spine, forearm, and hip were found in women treated with high-dose estrogen when compared with the placebo groups, lower-dose estrogen treatment is also bone-protective and may reduce side effects. Response to estrogen replacement depends upon patient age, the number of years since menopause, dose and type of estrogen, and whether or not progestins are included, length of treatment, supplementation with calcium and vitamin D, bone resorption rate at the start of treatment, baseline BMD, and other factors.62

Tuberculous Arthritis of Peripheral Joints

Tubercuiosis The Clavicle

Pinhole scintigraphy shows intense tracer uptake in the destroyed joint and periarticular bones (Figs. 8.22C and 8.23A). Articular narrowing is a constant feature, which is more severe in the weight-bearing joints of the spine, hip, knee, or ankle (Fig. 8.23) than in the non-weight-bearing glenohumeral or sternoclavicular joints (Fig. 8.24). The interphalangeal joints of the hand and foot are also affected as

Ankylosing spondylitis

See site code before M40 Rheumatoid arthritis of spine Includes arthrosis or osteoarthritis of spine degeneration of facet joints Anterior spinal and vertebral artery compression syndromes ( G99.2* ) Spondylogenic compression of spinal cord+ ( G99.2* ) Excludes vertebral subluxation ( M43.3-M43.5 ) Other spondylosis with radiculopathy Other spondylosis M48.0 Spinal stenosis M48.2 Kissing spine current injury - see injury of spine by body region. M48.8 Other specified spondylopathies Excludes psoriatic and enteropathic arthropathies ( M07.-* , M09.-* ) M49.0* Tuberculosis of spine ( A18.0+ )

Crosssectional imaging

Lupus Breast Ultrasound

The primary applications of CT to the evaluation of infections of the musculoskeletal system are the delineation of the osseous and soft tissue extent of the disease process, especially in areas of complex anatomy, such as the vertebral column, and the guidance of interventional procedures (biopsies and aspirations), particularly of the spine (Fig. 13) and sacroiliac joints. MRI is the modality of choice in cases of well-established osteomyelitis and in determining the extent of infection, especially of eventual epidural abscess or phlegmon, the intramedullary involvement, and consecutive neural compression 88 . In addition it is a useful tool in the evaluation of the presence of intraosseous abscess 78 , except when multiple lesions are suspected 11 . Furthermore, MRI helps the orthopedic surgeon to plan the optimal surgical management 93,94 , allowing better planning for open or percutaneous drainage of fluid collections and surgical debridement 95,96 . MRI also contributes to the...

Specific Arthropathies with CC

Paget's disease, or osteitis deformans, is a slowly progressing condition of bone structure that is characterized by increased and disorganized bone turnover. It affects approximately 4 of the U.S. population older than 40 years. The bones affected vary, but those most commonly involved are the femur, tibia, lower spine, pelvis, and skull. Initially, there is an increase in the number of osteoclasts, which leads to excessive bone resorption and a compensatory increase in osteoblas-tic activity to repair bone matrix. As a result, the bone is enlarged and distorted, with areas of poor mineralization that resemble a mosaic pattern. Consequently, the bone cannot adequately withstand stresses and strains and is weaker. Paget's disease causes bones to fracture easily, often after only a minor trauma these fractures heal slowly and often incompletely. If the spine is involved, the vertebrae may collapse, causing paraplegia. If the skull is involved, bony impingements on the cranial nerves...

Temporomandibular Joint

Median Atlantoaxial Joints

Fig. 10.41A, B Rheumatoid apophysitis in the lumbar spine. A Right posterior oblique radiograph of the lower lumbar spine in a 63-year-old woman with rheumatoid apophysitis of L3 and L4 vertebrae shows articular blurring and periarticular bone erosions (open arrows). B Posterior pinhole scintigraph reveals moderately increased tracer uptake in L3 and L4 apophyseal joint on the right (arrows). Note the typical astride position of the apophyseal joint at this level Fig. 10.41A, B Rheumatoid apophysitis in the lumbar spine. A Right posterior oblique radiograph of the lower lumbar spine in a 63-year-old woman with rheumatoid apophysitis of L3 and L4 vertebrae shows articular blurring and periarticular bone erosions (open arrows). B Posterior pinhole scintigraph reveals moderately increased tracer uptake in L3 and L4 apophyseal joint on the right (arrows). Note the typical astride position of the apophyseal joint at this level Fig. 10.42 Diskovertebral rheumatoid arthritis with apophyseal...

Clinical Characteristics of MPS I

The presentation of an MPS I patient for diagnosis can occur at any time from birth to adulthood, depending on the severity of the disease 1 . Most Hurler and Hurler-Scheie patients present with one or more of a variety of clinical problems within the first few years of their life. Patients can show signs of developmental delay and experience frequent respiratory and ear infections, cardiac disease, enlarged liver and spleen, joint stiffness, excessive head growth, hernias, and malformation of the spine. Within a few years time, the patients will usually manifest, to varying degrees, medical problems in every body system. The diverse problems are usually managed by symptomatic treatments, such as surgery to stabilize the spine, frequent antibiotics for infections, or oxygen therapy for respiratory insufficiency, but in general, these treatments do not prevent the inexorable decline and death of these patients. At the severe end of the spectrum, death occurs in almost all cases by age...