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Mechanical Derangement of the Spine: Spondylolysis; Spondylolisthesis and Spinal Stenosis

Spondylolysis – in spondylolysis there is a defect in the neural arch of the fifth lumbar vertebra.  Aching may be relieved by a surgical corset.  If pain is unusually troublesome an attempt may be made to close the defect in the pars interarticularis on each side by transfixing it with a screw and lying in slender bone grafts (Buck 1970); or alternatively, local fusion of the spine may be undertaken.

Spondylolisthesis – is the term applied to spontaneous displacement of a lumbar vertebral body upon the segment next below it; displacement is usually forwards, but may be backwards.

Spinal stensosis – (claudication of the cauda equine) – in the syndrome of spinal stenosis standing and walking beyond certain durations are associated with increasingly severe pain in the gluteal region and lower limb on one or both sides, ascribed to cramping of nerves and their blood vessels in a constricted spinal canal.  (Cauda equine – prolapsed inter-vertebral disc.)

Infections of the spine include: tuberculosis of the thoracic or lumbar spine and pyogenic infection of the thoracic or lumbar spine.

Arthritis of the spinal joints: rheumatoid arthritis; osteoarthritis and ankylosing spondylitis.

Osteochondritis includes:  Scheuermann’s vertebral osteochondritis and Calve’s vertebral osteochondritis.  Whereas in Scheuermann’s disease it is the vertebral ring epiphyses that are affected, Calve’s disease affects the central bony nucleus of a vertebral body.  It is generally confined to a single vertebra.  It is uncommon.

Extrinsic disorders simulating spinal disease:
(1)  The pain of a peptic ulcer is often felt in the back as well as in the epigastrium. 
(2)  Visceroptosis – dragging of pendulous viscera upon the posterior abdominal wall is a contributing cause of backache.

Tumours of the Spine
As in the cervical region, tumours involving the spine or related nerves may arise (1) in the spinal column itself; (2) in the meninges or rarely the spinal cord; (3) in the fibrous component of a peripheral nerve (neurofibroma); or (4) in adjacent soft tissues.

Tumours of the spinal column may be benign (for example: giant cell tumour; haemangioma and osteoblastoma) but are often malignant.  Such tumours may be primary (sarcoma and multiple myeloma) but metastatic tumours predominate.  A menigeal tumour (meningioma) is an occasional cause of compression of the spinal cord or cauda equine.  Nerve compression may also be a consequence of a neurofibroma growing within the spinal canal.

Acquired deformities of the spine include:
Torticollis; Scoliosis –postural, structural and idiopathic; Kyphosis – postural and senile; Lordosis –other than paralytic; Spondylolisthesis and Senile Osteoporosis.



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