Isthmic spondylolisthesis is caused by a defect in the pars interarticularis that results in the anterior displacement of one vertebra on another. It commonly occurs at L5-S1 due to repetitive extension stresses. While often asymptomatic, it can cause back pain and radiculopathy. Diagnosis involves imaging like CT or MRI to view the pars defect. Treatment begins conservatively with rest, medication, and physical therapy. Surgery with fusion and instrumentation may be considered for persistent or progressive symptoms. Key factors like pelvic incidence correlate with severity and influence biomechanical stresses on the lumbar spine.
This document discusses spondylolisthesis, including its anatomy, classification, natural history, and management. Some key points include:
- Spondylolisthesis is the forward translation of one vertebra on another, often caused by a defect in the pars interarticularis. It is classified by its cause and severity.
- Symptoms range from low back pain to neurological deficits depending on grade. Imaging helps assess severity and complications.
- Conservative care focuses on symptom relief but surgery may be needed for progressive slippage, deformity, or neurological problems.
- Surgical options include decompression with or without fusion to improve stability. Fusion techniques include posterolateral, anterior, or circumferential
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
SPONDYLOLISTHESIS: DIAGNOSIS, CLASSIFICATION, EVALUATION AND MANAGEMENTBenthungo Tungoe
Spondylolisthesis is the forward slippage of one vertebra on another. There are several classifications including developmental, isthmic, degenerative, traumatic, and postsurgical types. Developmental spondylolisthesis is usually asymptomatic and rarely progresses after adulthood. Isthmic spondylolisthesis has a risk of progression over 25% slippage or in symptomatic cases. Degenerative spondylolisthesis results from sagittal facet orientation or disc degeneration and increases in older females. The natural history depends on factors like age, gender, slip severity and progression.
1. Athletic pubalgia, also known as sports hernia or core muscle injury, is a chronic lower abdominal and groin pain in athletes without a true hernia.
2. It results from an injury to structures like the pubic aponeurosis from opposing forces of the adductor longus and rectus abdominus muscles at the pubic symphysis during athletic activities.
3. Physical examination findings include tenderness over the pubic tubercle and pain with resisted hip adduction or sit-ups reproducing the symptoms. Diagnostic imaging includes pelvic x-rays to evaluate for injuries or conditions like femoroacetabular impingement that may be associated with athletic pubalgia.
Spondylolisthesis is the forward or backward slipping of one vertebra over another. This document discusses various types and classifications of spondylolisthesis. The key classifications discussed are the Wiltse, Newman, and Macnab classification (which categorizes spondylolisthesis based on its location and cause), the Meyerding classification (which grades the severity of slip based on percentage of vertebral translation), and the Marchetti-Bartolozzi classification (which categorizes spondylolisthesis as developmental or acquired based on etiology). Risk factors for progression include young age at presentation, female gender, high slip angle, and high grade slip.
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- SCFE involves slippage of the femoral epiphysis posteriorly and inferiorly due to weakness of the growth plate.
- It most commonly affects obese adolescent boys and girls during periods of rapid growth.
- Clinical features include pain in the groin or knee and limited range of motion of the hip.
- Treatment involves closed or open reduction and internal fixation using pins or screws to stabilize the slip.
- The goals of treatment are to prevent further slippage and allow healing to occur without complications like avascular necrosis.
This document summarizes the pathogenesis and treatment of Legg-Calve-Perthes disease, a childhood hip condition caused by interrupted blood supply to the femoral head. The disease leads to bone death and deformity of the femoral head. Treatment options are controversial but generally involve either nonoperative casting or operative procedures like osteotomies, depending on the age, stage of disease, and extent of involvement. Current evidence suggests operative treatments may slightly increase the chance of a spherical femoral head developing, but the effect is modest and more research is still needed to develop more effective therapies.
Pes cavus and pes planus are foot deformities characterized by high and low arches, respectively. Pes cavus, or a high arched foot, can be congenital or acquired and results in clawing of the toes. Pes planus, or a flat foot, is caused by the collapse of the medial longitudinal arch. Both conditions can cause foot, ankle, and leg pain and abnormal shoe wear. Treatment involves orthotics, physical therapy, and sometimes surgery to correct muscle imbalances and bony deformities.
This document discusses spondylolisthesis, including its anatomy, classification, natural history, and management. Some key points include:
- Spondylolisthesis is the forward translation of one vertebra on another, often caused by a defect in the pars interarticularis. It is classified by its cause and severity.
- Symptoms range from low back pain to neurological deficits depending on grade. Imaging helps assess severity and complications.
- Conservative care focuses on symptom relief but surgery may be needed for progressive slippage, deformity, or neurological problems.
- Surgical options include decompression with or without fusion to improve stability. Fusion techniques include posterolateral, anterior, or circumferential
Legg - Calve - Perthes disease is a self-limiting disorder of the hip caused by reduced blood flow and necrosis of the femoral head. It most commonly affects boys ages 4-8 and is characterized by pain and limping. While the exact cause is unknown, factors such as blood clotting disorders, abnormal arterial or venous blood flow, growth delays, trauma, genetics, and environmental influences may play a role in reducing blood supply to the femoral head. Treatment aims to allow the femoral head to remodel itself through non-weight bearing or minimal weight bearing methods.
SPONDYLOLISTHESIS: DIAGNOSIS, CLASSIFICATION, EVALUATION AND MANAGEMENTBenthungo Tungoe
Spondylolisthesis is the forward slippage of one vertebra on another. There are several classifications including developmental, isthmic, degenerative, traumatic, and postsurgical types. Developmental spondylolisthesis is usually asymptomatic and rarely progresses after adulthood. Isthmic spondylolisthesis has a risk of progression over 25% slippage or in symptomatic cases. Degenerative spondylolisthesis results from sagittal facet orientation or disc degeneration and increases in older females. The natural history depends on factors like age, gender, slip severity and progression.
1. Athletic pubalgia, also known as sports hernia or core muscle injury, is a chronic lower abdominal and groin pain in athletes without a true hernia.
2. It results from an injury to structures like the pubic aponeurosis from opposing forces of the adductor longus and rectus abdominus muscles at the pubic symphysis during athletic activities.
3. Physical examination findings include tenderness over the pubic tubercle and pain with resisted hip adduction or sit-ups reproducing the symptoms. Diagnostic imaging includes pelvic x-rays to evaluate for injuries or conditions like femoroacetabular impingement that may be associated with athletic pubalgia.
Spondylolisthesis is the forward or backward slipping of one vertebra over another. This document discusses various types and classifications of spondylolisthesis. The key classifications discussed are the Wiltse, Newman, and Macnab classification (which categorizes spondylolisthesis based on its location and cause), the Meyerding classification (which grades the severity of slip based on percentage of vertebral translation), and the Marchetti-Bartolozzi classification (which categorizes spondylolisthesis as developmental or acquired based on etiology). Risk factors for progression include young age at presentation, female gender, high slip angle, and high grade slip.
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- SCFE involves slippage of the femoral epiphysis posteriorly and inferiorly due to weakness of the growth plate.
- It most commonly affects obese adolescent boys and girls during periods of rapid growth.
- Clinical features include pain in the groin or knee and limited range of motion of the hip.
- Treatment involves closed or open reduction and internal fixation using pins or screws to stabilize the slip.
- The goals of treatment are to prevent further slippage and allow healing to occur without complications like avascular necrosis.
This document summarizes the pathogenesis and treatment of Legg-Calve-Perthes disease, a childhood hip condition caused by interrupted blood supply to the femoral head. The disease leads to bone death and deformity of the femoral head. Treatment options are controversial but generally involve either nonoperative casting or operative procedures like osteotomies, depending on the age, stage of disease, and extent of involvement. Current evidence suggests operative treatments may slightly increase the chance of a spherical femoral head developing, but the effect is modest and more research is still needed to develop more effective therapies.
Pes cavus and pes planus are foot deformities characterized by high and low arches, respectively. Pes cavus, or a high arched foot, can be congenital or acquired and results in clawing of the toes. Pes planus, or a flat foot, is caused by the collapse of the medial longitudinal arch. Both conditions can cause foot, ankle, and leg pain and abnormal shoe wear. Treatment involves orthotics, physical therapy, and sometimes surgery to correct muscle imbalances and bony deformities.
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
The document provides information on patellar dislocation, including:
- Anatomy of the patella and patellofemoral joint.
- Causes of patellar instability including anatomical abnormalities, trochlear dysplasia, and injury mechanisms.
- Evaluation of patients with patellar instability focusing on the integrity of the medial patellofemoral ligament and examining for patella alta.
- Imaging techniques used to assess patellar instability including x-rays, MRI, and CT which evaluate trochlear morphology, patellar height, and tracking.
Legg Calve Perthes disease, also known as osteochondritis of the femoral capital epiphysis, is characterized by idiopathic avascular osteonecrosis of the femoral head in young children, typically ages 4-8 years. It progresses through four stages - initial, fragmentation, reossification, and healed. Common symptoms include limping, hip or thigh pain, and limited range of motion. Imaging such as x-rays, ultrasound, CT, MRI, and bone scans can detect signs like femoral head flattening, sclerosis, fragmentation, and joint effusion that correspond to the disease stages. While the cause is unknown, it is more common in boys and low socioeconomic groups.
This document discusses congenital pseudarthrosis of the tibia (CPT), a rare condition where the tibia fails to heal after fractures at an early age. CPT is often associated with neurofibromatosis type 1. The etiology is unclear but is thought to involve periosteal fibrosis. Imaging can help evaluate the extent of disease. Surgical treatment aims to achieve union, prevent refracture, and correct deformities. Common approaches include intramedullary nailing, vascularized fibular grafting, and external fixation. Prognosis remains poor due to risks of nonunion, refracture, limb length discrepancy, and ankle deformity. Close long-term monitoring is needed.
This document provides an overview of common hip deformities and surgical procedures used to treat hip issues in cerebral palsy patients. It discusses flexion, adduction, and subluxation/dislocation deformities and treatments like adductor tenotomy, iliopsoas recession/release, and varus derotational osteotomy. Flexion deformities are addressed with procedures like psoas lengthening while adduction issues are treated with soft tissue releases like adductor tenotomy. More severe cases may require bony procedures such as varus derotational osteotomy. Post-operative care focuses on physical therapy and positioning to improve hip range of motion.
This document discusses congenital convex pes valgus (CVT), a rare rigid flatfoot condition present at birth. CVT is caused by genetic syndromes or abnormal muscle fibers/tendon contractures. Clinically, it presents as a rigid flatfoot with the talus medially displaced. Imaging can classify the deformity and assess reducibility. Nonoperative treatment with casting is rarely effective. The preferred surgical treatment is a single-stage correction using approaches like Cincinnati to release tissues and reduce/fix the talonavicular joint. Complications include recurrence, stiffness, and avascular necrosis of the talus. Later presentations may require more extensive fusions.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
SLIPPED CAPITAL FEMORAL EPIPHYSIS - By Dr. Lokesh SharoffLokesh Sharoff
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- Incidence is highest in obese boys aged 13-15 and girls aged 11-13.
- Presentation includes hip or knee pain that increases with activity, limping, and limited range of motion.
- Treatment aims to prevent further slipping, reduce the degree of slippage, and provide salvage options.
- Methods include hip spica casting, pinning or screwing, closed manipulation, and osteotomies depending on stability and severity.
- Complications include osteonecrosis from reduced blood flow and chondrolysis from joint damage.
This document discusses longitudinal deficiency of the femoral partial (LDFP), which is a congenital absence of part or all of the femur associated with other lower limb abnormalities. It can be unilateral or bilateral. The etiology is unknown but may involve vascular or infection issues. Clinical presentation includes a shortened lower limb, thickened thigh, foot deformities, and abnormal limb positioning. Treatment options include surgical procedures like ankle disarticulation or femoral-pelvic fusion, or non-surgical approaches like prosthetics tailored to the specific classification and severity of the LDFP. Prosthetic fittings aim to address limb length discrepancy, joint instability, muscle inadequacy, and functional needs.
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
This document discusses tuberculosis of the knee joint. It begins by providing background on skeletal tuberculosis and noting that the knee joint is the third most common site. It then describes the typical 3 stage progression of knee joint tuberculosis over 3-5 years from synovial involvement to joint destruction to repair. Key diagnostic signs and symptoms at each stage are outlined. Treatment approaches are also summarized, including use of antitubercular drugs, drainage of abscesses, traction, synovectomy, and arthrodesis.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
This document discusses genu varum (bow legs), genu valgum (knock knees), and genu recurvatum (back bending knees). It covers the normal development and alignment of the lower limbs from birth through childhood. It describes the causes, presentations, and treatment options for physiological and pathological genu varum, genu valgum, and genu recurvatum, including observation, bracing, hemiepiphysiodesis (guided growth), and osteotomy. The goal of treatment is typically correction of the alignment through non-surgical or surgical means depending on the severity and cause of the deformity as well as the age and skeletal maturity of the patient.
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
This document discusses Perthes disease, which results from loss of blood supply to the femoral head, typically affecting children ages 3-10 years old. It covers the stages of the disease from initial avascular necrosis to healing. Diagnosis involves examining radiographic changes over time as well as using imaging modalities like MRI, CT, bone scans and arthrography. Treatment aims to contain the femoral head within the acetabulum during healing to prevent deformity. Differential diagnoses and related conditions are also reviewed.
This document provides an overview of pes planus (flat foot) including the anatomy of the foot arches, definition and causes of pes planus, and discussions of common causes such as flexible flat foot, congenital vertical talus, tarsal coalition, and posterior tibial tendon disorder. Flexible flat foot is usually asymptomatic in infants and children. Congenital vertical talus is a rigid deformity characterized by dorsal dislocation of the talonavicular joint. Treatment involves serial casting or surgery to gradually correct contractures and restore normal anatomy.
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
Lumbar spinal stenosis is a narrowing of the spinal canal that causes compression of the nerves and blood vessels in the lower back. It most commonly presents with leg pain that worsens with standing and walking due to nerve compression. Physical examination may reveal reduced range of motion, reproduction of symptoms with extension, and occasionally motor or sensory deficits. MRI is the preferred imaging method to visualize the soft tissue compression causing the stenosis. Treatment involves conservative measures but may require surgery if conservative options fail.
- Lumbar spinal stenosis involves a narrowing of the spinal canal which causes compression of the nerves and blood vessels in the lower back. It is a common condition in aging individuals that results from degenerative changes in the spine over time.
- Patients with lumbar spinal stenosis often present with leg pain that takes the form of neurogenic claudication or radicular pain, as well as low back pain. Symptoms are typically exacerbated by standing and walking and relieved by sitting or flexion of the spine.
- MRI is the preferred imaging modality for evaluating lumbar spinal stenosis. While findings on imaging are common in asymptomatic older adults, clinical correlation is important. Conservative treatment is usually tried initially and surgery is considered if symptoms
This document discusses congenital vertical talus (CVT), a rare foot deformity. It begins by defining CVT and providing background information. It then describes the anatomy and pathoanatomy of CVT. Key points include that CVT results in an almost vertical talus bone and rigid flatfoot deformity. Treatment involves serial casting and manipulation to prepare for surgery, with the goal of restoring normal anatomical relationships in the foot. Surgical techniques described include open reduction and percutaneous fixation of the talonavicular joint with K-wires. Complications of surgery can include wound issues and stiffness.
The document provides information on patellar dislocation, including:
- Anatomy of the patella and patellofemoral joint.
- Causes of patellar instability including anatomical abnormalities, trochlear dysplasia, and injury mechanisms.
- Evaluation of patients with patellar instability focusing on the integrity of the medial patellofemoral ligament and examining for patella alta.
- Imaging techniques used to assess patellar instability including x-rays, MRI, and CT which evaluate trochlear morphology, patellar height, and tracking.
Legg Calve Perthes disease, also known as osteochondritis of the femoral capital epiphysis, is characterized by idiopathic avascular osteonecrosis of the femoral head in young children, typically ages 4-8 years. It progresses through four stages - initial, fragmentation, reossification, and healed. Common symptoms include limping, hip or thigh pain, and limited range of motion. Imaging such as x-rays, ultrasound, CT, MRI, and bone scans can detect signs like femoral head flattening, sclerosis, fragmentation, and joint effusion that correspond to the disease stages. While the cause is unknown, it is more common in boys and low socioeconomic groups.
This document discusses congenital pseudarthrosis of the tibia (CPT), a rare condition where the tibia fails to heal after fractures at an early age. CPT is often associated with neurofibromatosis type 1. The etiology is unclear but is thought to involve periosteal fibrosis. Imaging can help evaluate the extent of disease. Surgical treatment aims to achieve union, prevent refracture, and correct deformities. Common approaches include intramedullary nailing, vascularized fibular grafting, and external fixation. Prognosis remains poor due to risks of nonunion, refracture, limb length discrepancy, and ankle deformity. Close long-term monitoring is needed.
This document provides an overview of common hip deformities and surgical procedures used to treat hip issues in cerebral palsy patients. It discusses flexion, adduction, and subluxation/dislocation deformities and treatments like adductor tenotomy, iliopsoas recession/release, and varus derotational osteotomy. Flexion deformities are addressed with procedures like psoas lengthening while adduction issues are treated with soft tissue releases like adductor tenotomy. More severe cases may require bony procedures such as varus derotational osteotomy. Post-operative care focuses on physical therapy and positioning to improve hip range of motion.
This document discusses congenital convex pes valgus (CVT), a rare rigid flatfoot condition present at birth. CVT is caused by genetic syndromes or abnormal muscle fibers/tendon contractures. Clinically, it presents as a rigid flatfoot with the talus medially displaced. Imaging can classify the deformity and assess reducibility. Nonoperative treatment with casting is rarely effective. The preferred surgical treatment is a single-stage correction using approaches like Cincinnati to release tissues and reduce/fix the talonavicular joint. Complications include recurrence, stiffness, and avascular necrosis of the talus. Later presentations may require more extensive fusions.
This document discusses various osteotomies around the hip joint. It begins with defining osteotomy and providing a brief history of important developments. It then explains the biomechanics of the hip joint and why osteotomies are effective. Several types and classifications of osteotomies are outlined. Specific procedures like McMurray's displacement osteotomy, Pauwel's varus osteotomy, and Schanz angulation osteotomy are described in detail. Contraindications and postoperative care are also mentioned.
SLIPPED CAPITAL FEMORAL EPIPHYSIS - By Dr. Lokesh SharoffLokesh Sharoff
This document provides information on slipped capital femoral epiphysis (SCFE), including:
- Incidence is highest in obese boys aged 13-15 and girls aged 11-13.
- Presentation includes hip or knee pain that increases with activity, limping, and limited range of motion.
- Treatment aims to prevent further slipping, reduce the degree of slippage, and provide salvage options.
- Methods include hip spica casting, pinning or screwing, closed manipulation, and osteotomies depending on stability and severity.
- Complications include osteonecrosis from reduced blood flow and chondrolysis from joint damage.
This document discusses longitudinal deficiency of the femoral partial (LDFP), which is a congenital absence of part or all of the femur associated with other lower limb abnormalities. It can be unilateral or bilateral. The etiology is unknown but may involve vascular or infection issues. Clinical presentation includes a shortened lower limb, thickened thigh, foot deformities, and abnormal limb positioning. Treatment options include surgical procedures like ankle disarticulation or femoral-pelvic fusion, or non-surgical approaches like prosthetics tailored to the specific classification and severity of the LDFP. Prosthetic fittings aim to address limb length discrepancy, joint instability, muscle inadequacy, and functional needs.
Perthes disease, also known as Legg-Calve-Perthes disease, is caused by impaired blood flow in the femoral head that leads to bone death in children aged 3-12 years old, causing deformity of the femoral head; it is more common in boys and whites and symptoms include limping and hip pain that varies depending on the stage of bone regeneration. Genetic factors and growth abnormalities play a role in its development.
This document discusses tuberculosis of the knee joint. It begins by providing background on skeletal tuberculosis and noting that the knee joint is the third most common site. It then describes the typical 3 stage progression of knee joint tuberculosis over 3-5 years from synovial involvement to joint destruction to repair. Key diagnostic signs and symptoms at each stage are outlined. Treatment approaches are also summarized, including use of antitubercular drugs, drainage of abscesses, traction, synovectomy, and arthrodesis.
The document discusses developmental dysplasia of the hip (DDH), including: definitions; clinical detection from birth to 6 months using tests like Ortolani's and Barlow's; treatment from birth to 6 months using a Pavlik harness or closed reduction and hip spica casting; and treatment from 6 to 18 months also using closed reduction and hip spica casting, with the goal of obtaining and maintaining reduction without damaging the femoral head. Obstacles to reduction like hypertrophic soft tissues are also mentioned.
This document discusses genu varum (bow legs), genu valgum (knock knees), and genu recurvatum (back bending knees). It covers the normal development and alignment of the lower limbs from birth through childhood. It describes the causes, presentations, and treatment options for physiological and pathological genu varum, genu valgum, and genu recurvatum, including observation, bracing, hemiepiphysiodesis (guided growth), and osteotomy. The goal of treatment is typically correction of the alignment through non-surgical or surgical means depending on the severity and cause of the deformity as well as the age and skeletal maturity of the patient.
This document defines and describes cavus foot, including its causes, clinical features, diagnosis, and treatment options. A cavus foot has an abnormally high arch and accompanying toe deformities. Causes include neuromuscular conditions like Charcot-Marie-Tooth disease and polio. Clinical features include a high arch and clawing of the toes. Diagnosis involves physical exam and x-rays. Treatment depends on flexibility and severity but may include tendon lengthening, osteotomies, and joint fusions to correct deformities in the forefoot, midfoot, and hindfoot. The goal is to create a plantigrade foot.
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
This document discusses Perthes disease, which results from loss of blood supply to the femoral head, typically affecting children ages 3-10 years old. It covers the stages of the disease from initial avascular necrosis to healing. Diagnosis involves examining radiographic changes over time as well as using imaging modalities like MRI, CT, bone scans and arthrography. Treatment aims to contain the femoral head within the acetabulum during healing to prevent deformity. Differential diagnoses and related conditions are also reviewed.
This document provides an overview of pes planus (flat foot) including the anatomy of the foot arches, definition and causes of pes planus, and discussions of common causes such as flexible flat foot, congenital vertical talus, tarsal coalition, and posterior tibial tendon disorder. Flexible flat foot is usually asymptomatic in infants and children. Congenital vertical talus is a rigid deformity characterized by dorsal dislocation of the talonavicular joint. Treatment involves serial casting or surgery to gradually correct contractures and restore normal anatomy.
This document provides an overview of hip deformities in cerebral palsy and various surgical procedures used to treat them. It discusses hip subluxation and dislocation, risk factors, and treatments like adductor releases and varus derotational osteotomies. It then describes the details of the combined one-stage correction procedure known as the "San Diego procedure", which involves a lateral femoral osteotomy and anterior pericapsular pelvic osteotomy to realign the hip. Diagrams illustrate the surgical steps of each approach. The goal of these interventions is to prevent progressive hip deformity and dislocation in cerebral palsy patients.
Lumbar spinal stenosis is a narrowing of the spinal canal that causes compression of the nerves and blood vessels in the lower back. It most commonly presents with leg pain that worsens with standing and walking due to nerve compression. Physical examination may reveal reduced range of motion, reproduction of symptoms with extension, and occasionally motor or sensory deficits. MRI is the preferred imaging method to visualize the soft tissue compression causing the stenosis. Treatment involves conservative measures but may require surgery if conservative options fail.
- Lumbar spinal stenosis involves a narrowing of the spinal canal which causes compression of the nerves and blood vessels in the lower back. It is a common condition in aging individuals that results from degenerative changes in the spine over time.
- Patients with lumbar spinal stenosis often present with leg pain that takes the form of neurogenic claudication or radicular pain, as well as low back pain. Symptoms are typically exacerbated by standing and walking and relieved by sitting or flexion of the spine.
- MRI is the preferred imaging modality for evaluating lumbar spinal stenosis. While findings on imaging are common in asymptomatic older adults, clinical correlation is important. Conservative treatment is usually tried initially and surgery is considered if symptoms
This document discusses spondylolisthesis, including:
- It defines spondylolisthesis as the forward slippage of one vertebra on its adjacent caudal segment.
- Several classification systems are described including the Wiltse, Newman and Macnab classification based on etiology and topography.
- Risk factors for slip progression include developmental spondylolisthesis with lysis, isthmic spondylolisthesis from repetitive loading, and increased pelvic tilt.
- Treatment involves conservative care with bracing or exercise initially. Surgical options include direct repair of pars defect, decompression with or without fusion and instrumentation depending on the grade of slippage.
This document provides information on spondylolisthesis, including its definition as the forward slippage of one vertebra on another, most commonly at L5-S1. It discusses relevant anatomy and classifications including developmental, isthmic, degenerative, and traumatic types. Imaging findings like the "scotty dog" sign are described. Management involves conservative options like rest and physical therapy or surgical decompression and fusion depending on symptoms and etiology.
This document discusses hip-spine syndrome, which describes patients with coexisting osteoarthritis of the hip and degenerative lumbar spinal stenosis. Determining whether lower extremity pain originates from the hip or spine can be challenging. A hip injection with bupivicaine can help differentiate the source of pain. Treatment of the spine does not typically alleviate hip arthritis pain and vice versa. Femoroacetabular impingement, a cause of early hip osteoarthritis, involves abnormal contact between the femoral head-neck junction and acetabulum. History, physical exam, radiographs, and MRI can help diagnose impingement and determine whether it is cam, pincer, or mixed-type. Treatment involves activity modification, medications,
Dr. Mahak Jain presented on spondylolisthesis. Key points include:
1) Spondylolisthesis is the forward translation of one vertebra on another, commonly caused by defects in the pars interarticularis known as spondylolysis.
2) It is classified based on etiology, with dysplastic, isthmic, degenerative, traumatic, and pathological types.
3) Treatment depends on factors like grade, symptoms, and etiology, ranging from conservative care to surgical options like decompression, fusion, and instrumentation.
4) Studies show surgery with fusion has better outcomes for pain and function than nonsurgical treatment or decompression alone for degenerative
Diffuse idiopathic skeletal hyperostosis (DISH) is a common skeletal process of uncertain etiology found in 12 to 18% of Indian populations above 50 years. The primary manifestations of DISH are calcification and ossification of the spinal ligaments, as well as entheseal ossification within extraspinal sites
Developmental dysplasia of the hip is a condition where the femoral head does not properly fit into the acetabulum. It can present as hip dislocation or dysplasia. Risk factors include family history and breech presentation. Examination involves tests like Ortolani and Barlow. Treatment depends on age and severity, and may include casting, bracing, or surgery. Other congenital anomalies of the lower limbs discussed include congenital dislocation of the knee, clubfoot, and proximal femoral focal deficiency.
Ankylosing spondylitis is a type of inflammatory arthritis associated with the HLA-B27 gene. It typically causes stiffness and fusion of the spine over time. Diagnosis involves evidence of sacroiliac joint inflammation on imaging and a positive HLA-B27 test in most cases. Treatment focuses on exercises to maintain mobility, nonsteroidal anti-inflammatory drugs, and TNF inhibitors for severe cases. Surgery may be needed to correct spinal deformities or replace affected hips in advanced ankylosing spondylitis.
Spondylolisthesis is a condition where one vertebra slips over the vertebra below it. It can be caused by defects in the bone (congenital or acquired) or degeneration. Imaging like x-rays, CT, and MRI are used to classify and evaluate the spondylolisthesis. Patients experience back pain that worsens with activity and improves with rest. Treatment depends on the severity and cause of the spondylolisthesis.
1) Spondylolisthesis is the slippage of one vertebra over another, usually occurring at the L5-S1 level. It can be asymptomatic but sometimes causes back and leg pain.
2) The causes include dysplasia of the pars interarticularis, fractures from repetitive stress, and activities that increase lumbar lordosis. High grade spondylolisthesis affects over 50% of the vertebral body.
3) Sagittal balance and alignment of the pelvis and spine are important factors in determining treatment. Patients with altered sagittal balance or pelvic parameters may be more prone to spondylolisthesis due to increased mechanical stress at L5-S1.
This document summarizes three pediatric knee conditions:
1) Congenital dislocation of the knee joint, which presents at birth with hyperextension and can be treated non-operatively with casting or operatively with soft tissue releases.
2) Congenital dislocation of the patella, which is a lateral dislocation present at birth that can be treated with the Andrish surgical technique involving extensive soft tissue releases.
3) Bipartate patella, a normal variant where the patella fails to fuse during development, which is usually asymptomatic but can become painful and be treated initially with rest and physical therapy or later with fragment excision.
Alan moelleken-md-santa-barbara-spondylolisthesisAlan Moelleken
This document provides information about spondylolisthesis, including:
- It is the slippage of one vertebra over another, most commonly in the lumbar spine.
- It is usually caused by spondylolysis, a defect in the pars interarticularis.
- It is classified based on cause (isthmic, degenerative, etc.) and graded based on the percentage of slip.
- Symptoms vary but can include back pain and radiculopathy, with conservative care tried initially before considering surgery.
The document discusses congenital kyphosis, which is an abnormal curving of the spine present from birth that can progress with growth. It describes the types of congenital kyphosis, including failure of vertebral formation or segmentation. Surgery is usually recommended to prevent neurological complications from progression, with the procedure dependent on the deformity severity and age. Anterior release and fusion with posterior instrumentation is often used for more severe cases. Complications can include pseudarthrosis or further kyphosis without a combined approach.
This document provides a literature review on differential diagnosis of hip pain. It begins with an overview of hip structure and function. Common causes of hip pain are then discussed, including arthritis, traumatic injuries, vascular disorders, developmental issues, and other soft tissue injuries around the hip joint. For each condition, the document describes definitions, causes, clinical features, diagnosis methods where relevant. Case studies on osteoarthritis, rheumatoid arthritis, and developmental dysplasia of the hip are also summarized. The review provides a comprehensive guide to differential diagnosis of hip pain covering multiple pathologies.
Legg-Calve-Perthes disease is avascular necrosis of the femoral head that occurs in children aged 4-10 years. It has an insidious onset and is usually unilateral. The cause is unknown but it may result from trauma, infection, or coagulation disorders. Presentation includes limping, hip pain, and limited range of motion. Imaging shows changes in femoral head density and structure over time. Treatment depends on age, involvement of the lateral pillar, and femoral head deformity, ranging from observation to osteotomies. Complications include femoral head flattening or enlargement and degenerative arthritis.
This document provides information about spondylolisthesis, including:
- It is a condition where one vertebra slips out of position, usually involving L5 slipping forward on S1.
- It can be caused by a defect in the pars interarticularis that allows slippage.
- Treatment options include non-operative measures like bracing or injections, or surgical options like decompression or fusion to correct the slippage and stabilize the spine.
- Surgical treatment is generally recommended for severe slips over 50% or when non-operative treatment fails to relieve pain. Different procedures are used depending on the severity and characteristics of the spondylolisthesis.
imaging in intrauterine skeletal dysplasia Shail Padmani
diagnostic
algorithm for use in fetuses with severe limb shortening
and/or abnormal mineralization.
Skeletal dysplasias are a heterogeneous group of conditions associated with abnormalities of the skeleton that are caused by widespread disturbance of bone growth beginning in fetal development. Prenatal diagnosis of skeletal dysplasias is challenging due to overlapping features between conditions, lack of molecular diagnosis for many disorders, and variability in phenotypic presentation. Ultrasound evaluation involves systematic imaging of the long bones, thorax, hands, feet, skull, spine, and pelvis to assess for abnormalities in bone shape, size, mineralization and the presence of other phenotypic features. Accurate diagnosis requires a multidisciplinary approach including
This document discusses cubitus varus and cubitus valgus deformities of the elbow. Cubitus varus is a reduced carrying angle, most commonly caused by malunion of a supracondylar humerus fracture. Cubitus valgus is an increased carrying angle, most often due to non-union of a lateral condylar humerus fracture. Both conditions are typically corrected surgically through osteotomies if causing cosmetic issues, with cubitus valgus at risk of tardy ulnar nerve palsy requiring nerve transposition.
Rickets is a disease of growing bone caused by unmineralized bone matrix at the growth plates, occurring only in children before fusion of the epiphyses. It is caused by vitamin D disorders, calcium deficiency, renal losses, or phosphorous deficiency. Clinical features include failure to thrive, bowed legs, widened wrists and ankles, and bone pain. X-rays show widened growth plates and fraying and cupping of the metaphysis. Treatment involves high dose vitamin D and calcium supplementation.
The document summarizes information about the meniscus. It describes the meniscus' location and functions in the knee joint, including preventing impingement, distributing synovial fluid, and providing stability. It discusses patterns of collagen in the meniscus and its vascular supply. Common types of meniscal tears are described such as longitudinal tears in the posterior horn. Classification systems for tears and imaging appearances of normal and torn menisci are presented. Treatment options are covered including non-operative care for minor tears and operative procedures like meniscal repair and resection.
This document summarizes information about post-polio residual palsy. It discusses that polio is caused by enterovirus infection that affects motor neurons in the spinal cord. While most polio infections are asymptomatic, it can cause acute flaccid paralysis. After the initial infection, patients enter the residual palsy stage where muscles remain paralyzed and deformities develop over time due to muscle imbalance, spasm, growth issues, and lack of movement. The management of residual palsy involves physical therapy, orthotics, and sometimes surgery to address deformities and improve function and mobility.
The cervical spine is made up of 7 vertebrae. C3-C6 are typical vertebrae with bifid spinous processes and facets while C1-C2 and C7 have distinguishing features. The joints in the cervical spine include intervertebral joints between vertebral bodies, joints of Lushka between vertebral arches, and craniovertebral joints. Important ligaments like the atlantoaxial and zygohypophyseal joints allow flexion, extension, lateral flexion and rotation of the cervical spine.
Congenital pseudoarthrosis of tibia is a failure of normal bone formation in the distal half of the tibia, often leading to a segmental defect and bowing of the bone. It is most commonly caused by neurofibromatosis, which is present in 40-80% of cases. Pathology shows thickened periosteum and fibrous tissue surrounding the tibia, preventing callus formation and bone healing. Treatment aims to fully excise the soft tissue, correct angular deformity, stimulate bone healing, and properly fixate bone fragments, often through the Ilizarov technique or intramedullary nailing with bone grafting. Complications can include non-union, refracture, malalignment and
Screws and plates are commonly used implants in orthopedic surgery. There are different types of screws designed for either cortical or cancellous bone. Cortical screws have a finer pitch while cancellous screws have a coarser pitch. Plates can serve different functions, including as neutralization plates to bridge a fracture, compression plates to compress bone fragments, and buttress plates to strengthen weakened bone. Proper screw and plate selection depends on the bone type and fracture characteristics.
External fixation is a method of stabilizing fractures using pins connected to an external frame. It is indicated for open fractures with soft tissue injury, long bone and pelvic fractures, and in multiple trauma patients. The basic components are pins inserted through bones, clamps connecting pins to rods or rings, and external rods or rings. Proper pin placement and construct are important for stability. Complications can include pin site infections, loosening, and breakage. Care includes daily inspection and cleaning of pins.
1) Intramedullary nailing has evolved over the past 75 years from early wooden and ivory implants to modern interlocking nails made of titanium.
2) Reaming improves nail stability and increases the use of larger nails but also disrupts endosteal blood supply, so newer reamer designs like the Reamer-Irrigator-Aspirator aim to minimize this.
3) Nail characteristics like diameter, length, curvature and interlocking screws influence stability, with larger diameter nails providing greater bending stiffness and interlocking screws enhancing torsional stability.
The Krukenberg surgery converts the forearm into a forceps-like structure by separating the radius and ulna into opposing rays that can act against each other like chopsticks. This allows amputees, especially in areas without modern prosthetics, to regain some hand function. The procedure involves longitudinally splitting the flexor and extensor muscles of the forearm into radial and ulnar groups and severing the interosseous membrane to separate the radius and ulna at their tips while maintaining motion at their proximal ends. Reconstructing the forearm in this way provides a more useful alternative to amputees than a mechanical prosthesis.
This document provides an overview of patellofemoral disorders, including the anatomy and biomechanics of the patellofemoral joint. It describes several common patellofemoral conditions such as patellar instability, excessive lateral patellar compression syndrome, chondromalacia patellae, bipartite patella, and patellofemoral arthritis. For each condition, it discusses symptoms, physical exam findings, imaging features, and treatment options both non-surgical and surgical. Surgical procedures discussed include lateral retinacular release, tibial tubercle elevation, drilling/abrasion techniques, and patellectomy.
Osteonecrosis is the death of bone tissue due to a lack of blood supply. It can be caused by trauma or other events that disrupt blood flow, such as fractures or dislocations. Imaging like x-rays and MRIs are used to stage osteonecrosis and monitor for signs of bone death and structural damage over time. The femoral head, humeral head, and scaphoid bone are particularly susceptible to osteonecrosis due to their vascular anatomy. Long term complications can include bone collapse and osteoarthritis. Prevention focuses on minimizing corticosteroid use and maintaining circulation for patients with conditions like sickle cell disease.
Osteochondroma is a benign bone tumor that presents as a cartilage-capped bony projection on the external surface of bones. It is caused by aberrant growth plate development and is associated with mutations in EXT1 and EXT2 genes. Osteochondroma typically presents in childhood as multiple lesions near joints and can cause deformities. Complications include fractures, bursa formation, arthritis and rare malignant transformation into chondrosarcoma. Diagnosis involves radiology and biopsy. Treatment involves surgery to remove painful or deforming lesions. It has an autosomal dominant inheritance pattern and carriers have a 50% risk of passing the condition to offspring.
Dupuytren contracture is a condition characterized by nodules and cords in the subcutaneous palmar tissue, resulting in progressive and irreversible finger joint flexion contractures. It is caused by increased proliferation of fibroblasts and deposition of type III collagen in the palmar fascia. The pathogenesis involves uncontrolled growth of the palmar fascia leading to flexion contractures. Treatment options include clostridial collagenase injections for mild contractures or surgical procedures like fasciotomy or fasciectomy for more severe contractures.
This document describes the Chopart amputation procedure, which removes the forefoot and midfoot while preserving the talus and calcaneus bones. It notes that this is an unstable amputation due to loss of tendon insertion points, often requiring a prosthesis extending to the patellar tendon level. The technique involves excising the Achilles tendon, creating skin flaps, disarticulating the transverse tarsal joints, and transferring the anterior tibial tendon for fixation. Post-op, the patient wears a splint and ankle-foot orthosis to prevent equinus deformity. Complications can include progressive equinovarus, which a modified procedure aims to address through additional steps like tendon transfers and flap
This document provides detailed information about the anatomy of the anterior cruciate ligament (ACL). It describes the ACL's embryology, histology, blood supply, nerve supply, measurements, biomechanics, and variations. It discusses ACL injuries and reconstruction procedures. Key points include that the ACL attaches to oval footprints on the femur and tibia, has a spiral arrangement that allows it to tuck under the intercondylar notch, and is most commonly reconstructed using a bone-patellar tendon-bone autograft.
The document discusses the innervation of the urinary bladder. It describes how the bladder develops from three sources and its anatomy. The bladder has a detrusor muscle layer and two sphincters. Micturition is controlled by higher cortical and brainstem centers that coordinate sympathetic, parasympathetic, and somatic nerve pathways. The sympathetic pathway relaxes the detrusor and contracts the internal sphincter during bladder filling. The parasympathetic pathway contracts the detrusor and relaxes the internal sphincter during voiding. The somatic pathway controls the external urethral sphincter voluntarily. Neurogenic bladder can occur due to nerve damage and is classified based on the lesion level.
This document provides information about Maduramycosis, also known as Madura foot or mycetoma. It is a chronic fungal or bacterial infection that enters through the skin, usually on the foot, and causes swelling, draining sinuses, and grain-like structures. It is most common in tropical areas and affects adult males. Diagnosis involves examining these grains microscopically and through cultures. Treatment involves long-term antifungal medications for fungal causes or antibiotic regimens for bacterial causes. Surgery may be needed for extensive or bone-involved cases. Prevention focuses on protecting the feet from minor skin trauma.
Adult-acquired flatfoot deformity is caused by posterior tibial tendon dysfunction and results in collapse of the medial longitudinal arch. It is classified into stages based on deformity severity and joint involvement.
Conservative management is recommended for stages 1 and 2, involving rest, orthotics, physical therapy and bracing to correct deformities. Surgery is considered if conservative measures fail for over 4-6 months. Joint-sparing procedures are preferred, such as posterior tibial tendon repair/transfer and medializing calcaneal osteotomy. For more severe stage 2 cases, lateral column lengthening procedures like calcaneocuboid fusion or Evan's osteotomy may be used. Stages 3 and
Strategies for Effective Upskilling is a presentation by Chinwendu Peace in a Your Skill Boost Masterclass organisation by the Excellence Foundation for South Sudan on 08th and 09th June 2024 from 1 PM to 3 PM on each day.
This presentation was provided by Steph Pollock of The American Psychological Association’s Journals Program, and Damita Snow, of The American Society of Civil Engineers (ASCE), for the initial session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session One: 'Setting Expectations: a DEIA Primer,' was held June 6, 2024.
How to Build a Module in Odoo 17 Using the Scaffold MethodCeline George
Odoo provides an option for creating a module by using a single line command. By using this command the user can make a whole structure of a module. It is very easy for a beginner to make a module. There is no need to make each file manually. This slide will show how to create a module using the scaffold method.
ISO/IEC 27001, ISO/IEC 42001, and GDPR: Best Practices for Implementation and...PECB
Denis is a dynamic and results-driven Chief Information Officer (CIO) with a distinguished career spanning information systems analysis and technical project management. With a proven track record of spearheading the design and delivery of cutting-edge Information Management solutions, he has consistently elevated business operations, streamlined reporting functions, and maximized process efficiency.
Certified as an ISO/IEC 27001: Information Security Management Systems (ISMS) Lead Implementer, Data Protection Officer, and Cyber Risks Analyst, Denis brings a heightened focus on data security, privacy, and cyber resilience to every endeavor.
His expertise extends across a diverse spectrum of reporting, database, and web development applications, underpinned by an exceptional grasp of data storage and virtualization technologies. His proficiency in application testing, database administration, and data cleansing ensures seamless execution of complex projects.
What sets Denis apart is his comprehensive understanding of Business and Systems Analysis technologies, honed through involvement in all phases of the Software Development Lifecycle (SDLC). From meticulous requirements gathering to precise analysis, innovative design, rigorous development, thorough testing, and successful implementation, he has consistently delivered exceptional results.
Throughout his career, he has taken on multifaceted roles, from leading technical project management teams to owning solutions that drive operational excellence. His conscientious and proactive approach is unwavering, whether he is working independently or collaboratively within a team. His ability to connect with colleagues on a personal level underscores his commitment to fostering a harmonious and productive workplace environment.
Date: May 29, 2024
Tags: Information Security, ISO/IEC 27001, ISO/IEC 42001, Artificial Intelligence, GDPR
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How to Add Chatter in the odoo 17 ERP ModuleCeline George
In Odoo, the chatter is like a chat tool that helps you work together on records. You can leave notes and track things, making it easier to talk with your team and partners. Inside chatter, all communication history, activity, and changes will be displayed.
How to Fix the Import Error in the Odoo 17Celine George
An import error occurs when a program fails to import a module or library, disrupting its execution. In languages like Python, this issue arises when the specified module cannot be found or accessed, hindering the program's functionality. Resolving import errors is crucial for maintaining smooth software operation and uninterrupted development processes.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
3. Spondylolysis - considered to occur prior to appearance of
spondylolisthesis, as the anterior column of the vertebra is no longer in
continuity with the posterior column.
4. • Over time, vertebral body then displaces ventrally once disc &
supporting soft tissues are no longer able to maintain the structural
integrity & anatomic alignment of the vertebrae.
9. • .
Children < 6 yrs- incidence - lumbar spondylolysis - 4.4% & spondylolisthesis-2.6%
At adulthood- L. spondylolysis - 5.4% & spondylolisthesis - 4%.
- reported pars defects did not typically heal & slippage occurred throughout f/u
period
Fredrickson et al..
prospective, pop-based
study of 500
schoolchildren from
northern Pennsylvania in
1950s
10. Fredrickson also reported that 2/3rd of spondylolysis cases were
males, & > 90% occurred at L5–S1.
Spondylolisthesis-found in 74% of pts with b/l pars defects at L5–S1,
but not in Pts with unilateral defects or pars defects at other levels.
Females - lower incidence of defects but higher rate of slip
progression.
11. • A more recent study by Urrutia et al. found a similar incidence of isthmic
spondylolisthesis in a non-US adult population of 3.8% (range, 1.7–6.8%).
• Incidence appeared not to change into adulthood, & authors concluded
spondylolysis is more likely an acquired disorder.
12. Pathophysiology
• Isthmic spondylolisthesis is a defect in pars interarticularis, a critical
structural component of posterior element of the vertebra.
• The pars is the intersection of the lamina, inferior and superior
articular processes, and pedicle.
13.
14. • Etiologies for spondylolysis are numerous but many believe that the
vast majority are due to stress fractures of the pars interarticularis.
• Biomechanical studies have shown this region is exposed to the
highest extension forces in the lumbar spine.
15. It has also been suggested that this region of bone is the weakest
structural component of the posterior neural arch.
Repetitive lumbar extension loading appears to result in a
localized stress reaction in the vulnerable bone of the pars
region, and if the stress is sustained or excessive & if the bone is
unable to heal, then a spondylolysis develops.
16. Rosenberg et al. support this hypothesis, reporting their observation
that spondylolysis does not occur in nonambulatory individuals.
Additional support for the relationship b/w extension stress &
spondylolysis is the observation that a high incidence of pars defects
are observed in athletes such as wrestlers, football linemen, &
gymnasts—who frequently undergo repetitive hyperextension loads.
17. M/c level for spondylolysis is L5 &
- Isthmic spondylolisthesis at L5–S1 (90%)
- Due to previous data suggesting that sagittally oriented facet joints
predispose individuals to degenerative spondylolisthesis, they
analyzed facet joint orientation in an isthmic spondylolisthesis group.
18. • The group with isthmic spondylolisthesis had significantly more
coronal orientation of the facets of L3–L4 and L4–L5, that is, above
the affected level.
• They concluded that facet joints with more coronal—less sagittal—
orientation allow for less dorsal-ventral translation of cranial motion
segments, which leads to greater extension stresses on the L5 pars
and results in spondylolysis.
19. • Ward and Latimer evaluated the intrafacet distances of lumbar
vertebrae in individuals with & without spondylolysis & found an
increase in cranial-to-caudal intrafacet distance in nonaffected
individuals, which they concluded allowed for overlap of lamina
during lordosis.
22. Biomechanical environment at the lumbosacral
junction is a complex one that normally
functions as a harmonious linkage between the
trunk & pelvis.
During radiographic assessment of patients,
lumbar lordosis (LL), pelvic incidence (PI), sacral
slope (SS), and pelvic tilt (PT) are most
commonly measured.
26. PI is considered a fixed anatomic measurement & does not change for
any given individual through adulthood.
LL, SS, and PT are measurements of the relative position of lumbosacral
spine
Sagittal spinopelvic parameters have been found to correlate significantly
with spondyloptosis as well as the severity of isthmic spondylolisthesis.
27. • Labelle et al. - 214 young adults
(ages 10–40 years) that PI is
significantly greater in
individuals with isthmic
spondylolisthesis and correlates
linearly with higher (Meyerding)
slip severities.
28. • They also showed that PI strongly correlates with the other
parameters:
• LL, SS, and PT they concluded that individuals with isthmic
spondylolisthesis stand with increased SS, PT, and LL.
• Moreover, these increased values—in particular, LL—are an
important factor in the amount of shear stress on the L5 lamina and
pars.
29. Diagnosis
• History
• Most individuals with spondylolysis are asymptomatic.
• While it is the most common cause of LBP in children, the same does
not hold true in the adult population.
30. • Andrade et al.recently reported a review of observational studies on
the association of spondylolysis and isthmic spondylolisthesis with
LBP.
• They reported that only 1 of 15 eligible studies found an association
and 11 did not.
• In fact, they found that LBP was significantly more prevalent in
individuals without spondylolysis/isthmic spondylolisthesis.
31.
32.
33. • Moller and Hedlund reported on 201 patients with isthmic
spondylolysis and found that their patients presented with
- back pain only in 27%,
- back pain and sciatica in 65%,
- and sciatica only in 8% of individuals.
• Back pain may be positional & may be worsened with standing and/or
lumbar extension maneuvers, while it may be relieved with forward
flexion or sitting.
34. • Lower extremity pain can be radicular in nature, as it is often caused
by impingement of the exiting L5 nerve root due to frequent
occurrence of associated foraminal stenosis at L5–S1.
• Pain in lower extremities can often be positional, similar to typical
LBP complaints.
35. Physical Examination
• There are no pathognomonic physical examination findings for
isthmic spondylolisthesis.
• Lumbar extension will often elicit LBP, lower extremity radicular
complaints, or both.
There can be a palpable or visible step-of in cases of highgrade slips.
The step-of occurs between the L4 and L5 spinous processes as the
posterior elements of L5 remain dorsal and in line with the S1 spinous
process
36. • Hamstring tightness is often described but difficult to assess
objectively.
• A positive straight-leg raise test will be present in approximately 50%
of patients.
• Sensory or motor abnormalities can be found due to associated
foraminal stenosis and exiting root compression.
37. Imaging
• Routine radiographic images can detect spondylolysis, especially if
spondylolisthesis is present, and slip severity can be measured on
lateral images.
• Additionally, standing images that include Flexion and extension
positioning should be evaluated.
38. • If spondylolysis is suspected but not visualized, oblique radiographic
images 45 degrees to the sagittal plane can be obtained that can
detect up to 96% of pars defects.
• Abnormalities in the “neck of the Scotty dog” is the hallmark
radiographic finding.
39. Complete defects are most common, but pars dysplasia & hypoplasia
can also be observed.
• Sagittal reformatted images best show the pars defect as being
distinct from facet joints and are the definitive finding in
spondylolysis.
• One limitation of CT is the lower sensitivity for soft tissue densities,
especially the internal anatomy of the neural foramen and the extent
of any associated nerve root compression.
40. - MRI is increasingly used as the primary imaging modality in patients
with LBP with or without radiculopathy.
• Sagittal T1-weighted images provide the greatest level of contrast
between hyperintense bone marrow and the signal void of bony
cortex at the pars defect.
41. • Single-photon emission computed tomography can be used in the
evaluation of suspected acute or impending spondylolysis.
• However, SPECT has been reported to have notable false-positive and
false-negative results in spondylolysis & thus should be used with
caution, although it may be of particular value in cases in which MRI
is contraindicated.
42.
43.
44. Differential Diagnosis
• The differential diagnoses for isthmic spondylolisthesis are those of its
clinical presentations: LBP and sciatica.
• First, spinal trauma, tumors & infections should be ruled out.
• Next, degenerative disc disease, spondylosis, spinal stenosis, or disc
herniation should be considered.
45. • Other causes include systemic diagnose-
- rheumatoid arthritis &
- spondyloarthropathies, and other
- nonspinal,
- musculoskeletal etiologies, such as sacroiliac joint arthrosis,
hip arthritis, & more.
Finally, abdominal/visceral considerations would include renal,
gastrointestinal, and vascular disorders.
46. Treatment
• Nonoperative Treatment
• Initial Rx for patients presenting with acute LBP should be
nonoperative.
• The mainstays are patient education, activity modification, and
medications - NSAIDS
• The addition of physical therapy and exercise can be considered when
early treatments fail and LBP becomes more long-standing.
• Other alternative pain management modalities—such as chiropractic
care, acupuncture, and massage—have been widely utilized, with
reported improvements in pain and function.
47. • Short-term use of narcotic analgesics should be considered with
caution.
• A minor neurologic deficit, such as radicular numbness or
paresthesias, but excluding severe motor weakness, can also be
managed nonoperatively but may benefit from corticosteroid
injection via injection therapies, such as Fluoroscopically guided
selective nerve root blocks.
48. Operative Treatment
• Indications-
• Severe, persistent back
• &/or lower extremity pain that is associated with functional
limitations or that significantly impacts quality of life—with or
without flexion–extension instability on radiographs, progressive
motor weakness, or cauda equina syndrome—are all generally
accepted indications for operative intervention.
• Patients should complete a rigorous course of nonoperative
treatment prior to considering surgery unless a signiicant neurologic
deficit exists.
49. Surgery
• Goals of operative intervention in isthmic spondylolisthesis are to
decompress neural elements & stabilize the affected motion segment.
• Uncommonly, decompression alone can be performed in certain
circumstances when fusion is not necessary.
• More typically, surgery involves stabilization traditionally performed
with posterior in situ fusion techniques with or without pedicle screw
instrumentation and sometimes without decompression.
50. • Supplemental anterior column support using interbody fusion
techniques approached posteriorly (posterior lumbar interbody
fusion [PLIF]) or anteriorly (anterior lumbar interbody fusion) has
been recently popularized and may currently represent the most
popular form of surgical treatment in the United States.
51. Decompression
• Decompression without fusion can be performed on individuals who
have only radicular symptoms & stable spondylolisthesis on dynamic
radiographs or a bony fusion seen on CT scans.
• Low-demand individuals or those with significant medical
comorbidities may be reasonable candidates.
• Gill laminectomy entails removal of the entire posterior arch and the
hypertrophied fibrocartilaginous tissue at the pars, as well as partial
facetectomies to decompress the nerve root.
• Long-term results of laminectomy alone have not been favorable,
leading most experts to believe that addition of fusion is required in
most cases to obtain good clinical outcomes.
53. PEARLS
Isthmic spondylolisthesis are rarely symptomatic, but those who do
develop severe back pain, radiculopathy, or both can be effectively
treated without surgery.
Significant evidence exists that isthmic spondylolisthesis develops in
adolescence as a result of an extension stress injury.
Spondylolisthesis develops as the soft tissues around the vertebral
motion segment become incompetent.
Symptomatic individuals who fail nonoperative treatment is commonly
treated with a spinal fusion.
Ideal treatment technique has not been agreed upon and often involves
use of pedicle screw instrumentation and interbody techniques.
54. PITFALLS
1. Failure to identify spondylolysis on imaging studies is common; if
high suspicion exists, further imaging should be considered.
2. Because spinal fusion is the mainstay of treatment, individuals
with high risk of nonunion should be approached with caution.
3. Decompression alone should be reserved in individuals who are
low demand and poor operative candidates.
4. Nerve root involvement occurs at the level of the foramen and
should correlate with clinical symptoms at presentation.
5. Reduction of high-grade slips can increase risk of nerve injuries.
- Spondylolysis is a defect in the pars interarticularis due to congenital, traumatic, dysplastic, or neoplastic etiologies.
It is measured as a percentage using the length of slip of the cranial vertebra compared to the length of superior endplate of the caudal vertebra.
grade 5, greater than 100% or spondyloptosis.
dysplastic,
isthmic,
degenerative,
traumatic,
and neoplastic types.
-
Axial computed tomographic image showing spondylolysis
(open triangles). Note the undulating course of lucency, making it distinct
from a facet joint.
a line is drawn from the center of the S1 endplate to the center of the femoral head
a second line is drawn perpendicular to a line drawn along the S1 endplate, intersecting the point in the center of the S1 endplate
the angle between these two lines is the pelvic incidence
sacral slope = pelvic incidence - pelvic tilt
a line is drawn from the center of the S1 endplate to the center of the femoral head
a second vertical line (parallel with side margin of radiograph) line is drawn intersecting the center of the femoral head
pelvic tilt = pelvic incidence - sacral slope
a line is drawn parallel to the S1 endplate
a second horizontal line (parallel to the inferior margin of the radiograph) is drawn