prognosis
Central Cord Syndrome
Epidemiology
Most common pattern cord injury
Hyper-extension injury in middle aged man with osteoarthritic spine
Usually C3/4 and C4/5
Mechanism
Most common type / in older patient with pre-existing spondylosis / OPLL
- hyperextension injury
- compression of the cord
- anteriorly by osteophytes
- posteriorly by infolded ligamentum flavum
Whiplash
Definition
Isolated posterior ligament injuries
- PLL / Posterior interspinous ligament / Paraspinal muscles
Excludes fracture / dislocation / HNP
Aetiology
MVA
Sport
Hyperflexion injuries
Symptoms
Large spectrum clinical presentation
- neck ache
- nausea & vomiting
- headache
- visual symptoms
Spinal Tuberculosis
Epidemiology
Most common site for skeletal TB
- usually haematogenous spread
- can be direct from lung
3 patterns
1. Peridiscal (50%) - originating in metaphyseal region
2. Central - high incidence of vertebral collapse
3. Anterior - instability less common with less bony destruction
Pathology
Affects multiple contiguous vertebrae
Nerve Injury
Epidemiology
Primary THR 1%
Revision THR 3%
DDH 5%
Sciatic nerve 90% of nerve palsy
Other
- femoral nerve
- CPN
- ulna / radial nerve from positioning
Aetiology
Direct
Laceration
- exposure / sciatic and superior gluteal nerve
- drill reamer / obturator nerve
- spike of cement / obturator nerve
Aetiology & Classification
Definition
Idiopathic condition of the immature femoral capital epiphysis involving varying degrees of osteonecrosis
AKA
- Legg-Calve-Perthes disease
- coxa plana
Described in separate publications in 1912 by
- Legg (Boston)
- Calve (France)
- Perthes (Germany)
Epidemiology
M: F 4:1
1 in 740 males
Synovial Sarcoma
Epidemiology
4th most common STS
- 10-35% of STS
Peak age 3rd-4th decade
- rare in children
Pathology
Cellular characteristics suggest tumour arises from primitive synovial cells
- rarely actually occurs within joint
Characteristic
Occasionally metastasis to lymph nodes (5-7%)
- like Epitheloid Sarcoma
Rhabdomyosarcoma
Definition
Malignant tumour of striated muscle
Juvenile variety arises from mesenchyme
Epidemiology
Most common malignant ST Tumour in children (< 15 years)
Liposarcoma
Definition
STS composed of malignant lipoblasts
Epidemiology
Common
- 10% of STS
- second only to MFH
Occurs almost exclusively in adults
Males age 40-60
Can be multiple origin -> examine patient
Rarely arise from lipoma
Undifferentiated Pleomorphic Sarcoma
Definition
Malignant Fibrous Histiocytoma
Characterised by heterogenous population of pleomorphic spindle cells
- organised in a characteristic storiform or "starry night" pattern
Cell of origin unknown
- primitive mesenchymal cell
- allowing both features of a macrophage (hence histiocyte)
- and collagen producing cell (hence fibroblast)
Epidemiology