Professional Documents
Culture Documents
1. Pott’s Diseas
2. Spondylosis
3. 3. Diffuse Idiopathic Skeletal Hyperostosis (DISH
1.Pott’s Diseas
Definition, Tuberculosis (TB) of the spine (Pott’s disease) is the most common site of bone
infection in TB; hips and knees are also often affected. The lower thoracic and upper lumbar
vertebrae are the areas of the spine most often affected.
Pott’s disease results from haematogenous spread of tuberculosis from other sites, often
pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining disc
space. If only one vertebra is affected, the disc is normal, but if two are involved the
intervertebral disc, which is avascular, cannot receive nutrients and collapses. The disc tissue
dies and is broken down by caseation, leading to vertebral narrowing and eventually to
vertebral collapse and spinal damage). A dry soft tissue mass often forms and superinfection
is rare.
Radiological features
Radiographic changes associated with potts disease present relative late
The following are radiographic changes characteristics of spinal tuberculosis on plain
radiography
Lytic destruction of anterior portion of vertebral body
Increased anterior wedging
Collapse of vertebral body
Reactive sclerosis of on progressive lytic process
Additional radiographic finding may include the following;
Vertebral end plate may osteoporotic
Intervertabral disks may be shrunk or destroyed
2. Spondylosis
Spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of
normal spinal structure and function. Although aging is the primary cause, the
location and rate of degeneration is individual. The degenerative process of
spondylosis may impact the cervical, thoracic, and/or lumbar regions of the spine
affecting the intervertebral discs and facet joints.
Spondylosis often affects the following spinal elements:
Pathology
The degenerative effects from aging may weaken the structure of the anulus fibrosus
causing the 'tire tread' to wear or tear. The water content of the nucleus decreases with
age affecting its ability to rebound following compression (e.g. shock absorbing
quality). The structural alterations from degeneration may decrease disc height and
increase the risk for disc herniation.
extension, flexion, and rotation. Like other joints, the bony articulating surfaces are
coated with cartilage. Cartilage is a special type of connective tissue that provides a
self-lubricating low-friction gliding surface. Facet joint degeneration causes loss of
cartilage and formation of osteophytes (e.g. bone spurs). These changes may cause
hypertrophy or osteoarthritis, also known as degenerative joint disease.
Bones and Ligaments
Osteophytes (e.g. bone spurs) may form adjacent to the end plates, which may
compromise blood supply to the vertebra. Further, the end plates may stiffen due to
sclerosis; a thickening/hardening of the bone under the end plates.
Ligaments are bands of fibrous tissue connecting spinal structures (e.g. vertebrae) and
protect against the extremes of motion (e.g. hyperextension). However, degenerative
changes may cause ligaments to lose some of their strength. The ligamentum flavum
(a primary spinal ligament) may thicken and/or buckle posteriorly (behind) toward the
dura mater (a spinal cord membrane).
The lumbar spine carries most of the body's weight. Therefore, when degenerative
forces compromise its structural integrity, symptoms including pain may accompany
activity. Movement stimulates pain fibers in the anulus fibrosus and facet joints.
Sitting for prolonged periods of time may cause pain and other symptoms due to
pressure on the lumbar vertebrae. Repetitive movements such as lifting and bending
(e.g. manual labor) may increase pain
Bilateral chronic sacroiliitis. Frontal radiograph shows complete fusion of both
sacroiliac joints.
The CT Scan may be used to reveal the bony changes associated with spondylosis. An
MRI is a sensitive imaging tool capable of revealing disc, ligament, and nerve
abnormalities.
Radiographic Appearance
Romanus lesions. Lateral radiograph shows anterior corner erosions at the T12
and L1 vertebral bodies. The typical shiny corner sign (or Romanus lesion) is
present (arrows).