UGANDA INSTITUTE OF ALLIED HEALTH AND

MANAGEMENT SCIENCES - MULAGO

P.O. Box 34025 Kampala-Uganda.Tel: +256 414 541180,540544,

S/NO NAME INDEX NUMBER SIGNATURE

1 KIISAKYE DERICK UA/OPM/031/16

2 SEMYALO DERRICK UA/OPM/024/15
Fax: +256 414 541180. Email:
3 AKEREJE BABRA Website:
UA/OPM/005/15

4 NASSOLO HAMIDAH UA/OPM/052/16

5 CANKURA SOLOMON UA/OPM/016/16

6 AKAO CLARA UA/OPM/003/16

PROGRAMME: DIPLOMA IN ORTHOPAEDIC MEDICINE

ACADEMIC YEAR: 2018/2019

SEMESTER: TWO

YEAR OF STUDY: THREE

COURSE UNIT: ADULT ORTHOPAEDICS.

COURSE CODE: OPM-320

TUTOR’S NAME: MADAM MUTUHE DIANAH

DATE OF SUBMISSION: 18/02/2019

Question;
Describe the following conditions in relation to orthopaedic medicine.
1. Spondylosis.
2. Ankylosing spondylitis.
3. Spondylolisthesis.
 4. spondylolysis

SPONDYLOSIS

Osteoarthritis and degenerative condition of the spine (intervertebral joints). Very

common to those used to heavy work.

CAUSE/ PREDISPOSING FACTORS

 Repetitive constant stress on the spine

 Previous injury to the spinal joints
 Previous disease involving the joint e.g intervertebral disc lesion and scheuermann’s
kyphosis.
NOTE: The cause of the degeneration is unknown but maybe the manifestation of the
ageing process in the cartilage tissue.

PATHOLOGY

The changes affect the central intervertebral joints (body to body) and the posterior
intervertebral joints (facet joint). One segement or several segments may be affected.
In the central and degenerative condition joint which is affected first, there is
degeneration with consequent narrowing of the intervertebral joints and hypertrophy of
the bone at the joint margins leads to the formation of osteophytes. In the posterior
intervertebral joints (facets) the changes are those of osteoarthritis in any diarthrodial
joints namely; attritional of the articular cartilage and osteophyte formation (spurring) at
the joint margins. The changes in the facet joints are probably the more important of
clinical part of view.

CLINICALFEATURES

 Spinal complain of aching pain in affected area worst on activity or after prolonged
standing or sitting in one position or lifting.
  Stiffness when raising from sitting position
 Narrowed interverbral foramen leading radiating in the distribution of the affected nerve
 Reduced range of motion
 Cervical spondylosis, aching at the back
 Stiffness initially intermittent and later persistent

INVESTIGATION

 X rays
 CT scan.

RADIOLOGICAL FEATURE

On x-ray, the following will be found;

 Narrowing of the intervertebral disc spaces

 Osteophytes at the vertebral margins anteriorly and posteriorly
 Narrowing of the intervertebral foramen

TREATMENT
 Depends upon the severity of the disability, in mild cases treatment is unnecessary,
explanation and reassurance surface.
 Thoracic spine: In osteoarthritis of thoracic spine symptoms are seldom and if treatment
is required a cost of active spinal exercise to strengthen the posterior muscles is usually
sufficient.
 Lumbar spine: In lumbar osteoarthritis of moderate arthritis a well fitted surgical corset
(orthitic brace) will usually afford adequate relief, physiotherapy mainly by exercises and
passivemobilization may also be helpful. Heavy lifting and similar strain to the back
should be strictly avoided
 If the pain from a localized lesion is bad enough to cause serious hardship, operative
fusion of the affected segment of the spine may be required.
 Decompression surgery.
ANKYLOSING SPONDYLITIS

There is chronic inflammation, progressing slowly to bony ankylosis of the joint of spinal

column and occasionally of proximal limb joints

It is also called mariestrumpell disease

CAUSE

o Unknown but may represent auto immune response to an infecting organizing.

o There is a strong hereditary link to the HLA-B27 gene which represent 80-90% of
patients.
o There is also a relationship with certain type of sero-negative chronic juvenile arthritis in
members of the family.

PATHOLOGY

 The disease usually begins in the sacro-iliac joint, hence it usually extends upwards to
involve the lumbar, thoracic and often the cervical spine. In the worst cases the hip or
shoulder is affected

 The hip,knee and manubrio sternal joints are also affected.

 Initially synovitis occurs followed by cartilage destruction and bony erosion. Resultant
fibrosis ultimately leads to fibrous ankylosis and bony ankylosis

 The articular cartilage, synovium and ligaments show chronic inflammatory changes and
eventually they become ossified after several years of inflammatory process becomes
quiescent.
CLINICAL FEATURES

 Early aching pain in the lower back and the gluteal region.
 Increasing stiffness of the lower back.
 Later the pain migrates upwards.
 Diffuse radiating pain down one or more lower limbs is common.
 Chest expansion is markedly reduced if thoracic region is involved.

INVESTIGATION

1. RADIOLOGICAL
o Radiograph in early stages shows fuzziness and widening of both the sacro-iliac joints so
that the joint outline is no longer clearly defined.

o Later if the disease progresses the the intervertebral joint undergo bony ankylosis with
permanent anterior bridging of the vertebral bodies producing the so called bamboo
space
2. LABORATORY
o ESR and C-reactive protein levels are raised.
o In 90 % of the cases the test for gene HLA-B27 antigen is positive.

DIAGNOSIS

Should be distinguished from other causes of back ache in sciatica.

 There is marked limitation of the spinal movements.

 Reduced chest expansion.
 Raised ESR.

On xray of the pelvis the following will be found;

 Haziness of the sacro- iliac joint

 Sclerosis of the articulating surfaces of the sacro iliac joint
  Widening of the sacro iliac joint space
 Bony ankylosis of the sacro iliac joints
 Calcification of the sacro iliac ligament
 Irregular subchondralerosionsinsacro iliac joints

TREATMENT

1. CONSERVATIVE
o Treatment is unsatisfactory, in that no method is known by which the disease process can
be halted and spinal mobility preserved.
o NSAIDS.
o Rest should be prescribed(sleeping flat on a firm mattress in supine postion) with one
pillow to maintain normal spinal alignment.
o Special exercise should be practiced to make most of the spine movements remain.

2. SURGICALLY
o In severely deformed (flexion deformity) of spine where the hips are involved and
develop flexion contractures in addition to spinal deformity.
o Relief is obtained replacement arthroplasty of both hip to restore upright spine.
o Corrective wedge osteotomy of the lumbar spine is performed if the replacement
arthroplasty fails.

SPONDYLOLISTHESIS
This is a spontaneous forward displacement of the lumbar vertebral body upon the segment next
below it. Displacement is usually forward, only on rare cases does the backward displacement

Causes (predisposing factors)

 Congenital malformation of the articular process (rare).

 Spondylolysis( a defect in the pars interarticularis of the neural arch which may be
developmental or result of stress fracture)
 Osteoarthritis of the posterior (facet) joints.
CLINICAL FEATURES
 It depends to some extent upon the nature of the causative lesion and upon the degree of
displacement

 Chronic backache with or without sciatica.

INVESTIGATION.

o Lumbo-Sacral X-ray.
o CT-scan standard.

TREATMENT

If spondylolisthesis is symptomless treatment is not required.

o Non operative treatment-Well fitted surgical corset and should be tied before operation is
considered.
o Operative treatment is done when the disability is severe .it involve the release of
stretched or compressed nerve, followed by fusion of the affected segment of the spinal
column.

SPONDYLOLYSIS

Is a defect or stress fracture of the pars intercularis of the vertebral arch.

CAUSE

The cause of spondylolysis is unknown however, the following factors may contribute to:

o Hereditary
o Acquired

CLINICAL FEATURES

o Unilateral low back pain.

 o Pain radiating to the buttocks of the legs.
o Onset of pain can be acute or gradual.
o Pain aggreviate with lumbar hyper extension.
o Pain increase with strenuous exercise.

DIAGNOSIS

 X-ray-Oblique x-ray view can usually identify.

 MRI
 CT-SCAN

TREATMENT

 Bracing-antilorditic brace (Barton brace) for 6-12 weeks.

 Activity restriction
 Extension exercises
 Flexion exercises
 Deep abdominal strengthening.
 Physical therapy