Journal articles on the topic 'Spinal osteophytosis'

Spondylosis deformans is a type of spinal claw osteophytosis which can be found on the anterolateral vertebral bodies of any region, and which consists of protrusions of intervertebral disc tissue covered by a bony shell. We report here a case of thoracic spondylosis deformans and multilevel instrumented fusion found during routine dissection of a cadaver. Theories of the etiology of this condition are reviewed in general, and with respect to this specific case and the potential interaction of the presenting comorbidities. The clinical implications of these osteophytes, including musculoskeletal and visceral sequelae, are also discussed.

Spinal stenosis and degenerative spondylolisthesis share many symptoms and the same treatment, but their causes remain unclear. Bone mineral density has been suggested to play a role. The aim of this study was to investigate differences in spinal bone density between spinal stenosis and degenerative spondylolisthesis patients. 81 patients older than 60 years, who underwent DXA-scanning of their lumbar spine one year after a lumbar spinal fusion procedure, were included. Radiographs were assessed for disc height, vertebral wedging, and osteophytosis. Pain was assessed using the Low Back Pain Rating Scale pain index.T-score of the lumbar spine was significantly lower among degenerative spondylolisthesis patients compared with spinal stenosis patients (−1.52 versus −0.52,P=0.04). Thirty-nine percent of degenerative spondylolisthesis patients were classified as osteoporotic and further 30% osteopenic compared to only 9% of spinal stenosis patients being osteoporotic and 30% osteopenic (P=0.01). Pain levels tended to increase with poorer bone status (P=0.06). Patients treated surgically for symptomatic degenerative spondylolisthesis have much lower bone mass than patients of similar age treated surgically for spinal stenosis. Low BMD might play a role in the development of the degenerative spondylolisthesis, further studies are needed to clarify this.

Spinal synovial cysts are benign protrusions of facet joint capsules caused by degenerative spondylosis, most frequently involving the L4–5 level, and commonly lead to symptoms of back pain, radiculopathy and neurogenic claudication. Although percutaneous treatment via facet joint steroid injection with cyst rupture can provide significant symptom relief, cyst rupture is not always achievable via an indirect trans-facet approach due to limited access from severe degenerative changes. In this case, we describe a successful approach to direct cyst access using a laser-guided navigational software in a patient with severe facet joint osteophytosis. We provide a brief review of literature.

CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6%, osteophytes in 33.3% and calcifications of the aorta in 30.2%. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively), despite the fractured vertebrae having greater bone mineral density (P < 0.02). Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04). Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01). CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry results should be carried out together with the interpretation of a simple lumbar spine x-ray in elderly women.

Abstract Dysphagia secondary to osteoarticular disorders is a rare entity. In this report, we present the case of a 76-year-old female patient with progressive dysphagia and recurrent aspiration pneumonia caused by large anterior cervical osteophytes. Osteophytectomy was performed without spinal fusion. The patient reported significant improvement post-operatively, and no recurrence was detected at the 1-year follow-up. Cervical osteophytosis should be suspected as a cause of dysphagia, especially in elderly patients with degenerative osteoarthritic disease when other causes have been excluded.

Background: Cervical Spondylosis, commonly known as Cervical Osteoarthritis, is a kind of degenerative osteoarthritis of the joints between the spinal vertebrae's and the neural foramina. It's a condition characterized by changes in the cervical bones, discs, and joints as a result of regular aging wear and tear. Spondylosis of the cervical spine is most common in 40s and 50s. Case Presentation: A 65 years old male came to physiotherapy department with complaints of pain in left upper limb and neck and weakness in his left upper back muscles and unilateral since 2 months. Clinical impression showed cervical non radiculopathy. X-ray of cervical spine revealed osteophytosis and narrowed inter- vertebral space, seen in C6 and C7 cervical vertebral bodies with straightening of cervical spine. Cervical Distraction and compression test was positive. Conclusion: A well planned physical therapy intervention has shown significant improvement in cases with cervical spondylosis in relieving the symptoms and improving quality of life.

Abstract Introduction SAPHO is a rare syndrome of osteoarticular disorders with associated skin manifestations. The classic constellation of symptoms includes synovitis, acne, pustulosis, hyperostosis and osteomyelitis. Estimated prevalence is 1-4/10,000, but the syndrome is underdiagnosed due to its variable presentation and lack of formal diagnostic criteria. SAPHO is a diagnosis of exclusion and conditions such as infectious osteomyelitis and bone tumours must be eliminated first. We present a case of SAPHO, mistaken for spinal tuberculosis (TB). Case description A 67-year-old Caribbean man with a history of type 2 diabetes mellitus and multiple prolapsed discs requiring surgical fixation presented in 2014 with severe back pain, swinging fevers and weight loss. A CT scan showed sclerosis of T9/10 vertebrae with corresponding bone oedema on an MRI spine. He commenced induction treatment for TB based on radiological features and travel history. Two months later, an MRI spine showed progressive inflammation at T10/11. Blood and tissue samples were negative for acid fast bacilli. Mycobacterium cultures, Interferon-gamma release assay (IGRA) and PCR were negative. However, treatment for TB was continued for a further ten months. Three months later, he re-presented with thoracic back pain and night sweats. MRI showed new inflammation at T6/7 and L3/4 reported as probable osteomyelitis. IGRA, blood and tissue cultures remained negative. Meanwhile, the patient suffered nine episodes of synovitis affecting knees and wrists. Knee X-rays showed end-stage hypertrophic osteoarthritic changes with severe osteophytosis. Synovial biopsies showed inflammatory changes but no evidence of TB. The patient re-presented in 2018 with back pain, sternoclavicular (SC) joint tenderness, painful knee swelling, night sweats and weight loss. Blood and synovial fluid cultures were negative, with calcium pyrophosphate crystals detected in synovial fluid. USS scan of the SC joint showed floridly active right-sided synovitis and synovial thickening on the left. CRP was 350 and he was treated with broad spectrum antibiotics for two weeks for presumed septic arthritis. Rheumatology review was requested when he failed to improve. His constellation of symptoms (synovitis, hyperostosis, osteitis and a history of a pustular rash) suggests a diagnosis of SAPHO. He commenced a weaning prednisolone regime and given zoledronic acid to good effect. Recurrence of symptoms occurred at low dose prednisolone, so he was given IM steroids and commenced on methotrexate. Discussion SAPHO is underdiagnosed due its variable presentation and the need to first exclude infection and malignancy. The patient’s radiological features consistent with spinal TB and risk of TB exposure delayed diagnosis, despite negative serology and cultures. It is important to be aware that the full constellation of symptoms may not be evident at the time of presentation, or indeed at all in the course of the condition; our patient reported a prior history of a pustular rash on the soles of his feet, although there was no clinical evidence of this at the time of review. Involvement of classically affected joints, including anterior chest wall and thoracic spine, or skin involvement should increase clinical suspicion of SAPHO. NSAIDs and corticosteroids are first line therapy, with DMARDs, biological agents and bisphosphonates used to maintain remission. Key learning points Practitioners must consider the possibility of SAPHO, particularly in those with symptoms of osteomyelitis but no identifiable pathogen or who do not respond to antibiotic therapy. High inflammatory markers or high fevers do not preclude its diagnosis. As such, it is important to exclude infection, including osteomyelitis and septic arthritis, and malignancy prior to making a diagnosis. Clinicians should also be aware that the patient may not present with the full SAPHO syndrome; close review of past medical history and questioning about unreported episodes of synovitis or rash may be required to make the diagnosis. Conflicts of interest The authors have declared no conflicts of interest.