Lecture on Pathology with a Focus on the Skeletal System

Overview of Pathology

• Introduction to Pathology: Overview provided last week.
• Focus Areas for Semester:
  • Neuropathology
  • Bony Pathology and Skeletal System
  • Spinal Pathology
  • Vascular Pathology

Skeletal System Pathology

• Importance: First exposure in surgery; impacts nervous system monitoring.
• Goals:
  • Discuss spinal column disorders and impacts on nervous system.
  • Characteristics and treatment of scoliosis.
  • Pathology of vertebrae and spinal ligaments.
  • Impact of degenerative spinal changes.

Scoliosis

• Definition: Curvature of the spine exceeding 10 degrees in the coronal plane.
• Causes:
  • Idiopathic (most cases)
  • Congenital (15%)
  • Secondary to neuromuscular diseases (e.g., cerebral palsy)
  • Other causes (CMT disease, Arnold-Chiari malformations, etc.)
• Treatment: Bracing and potentially surgical correction.

Surgical Correction and Instrumentation

• Historical Insight: Cottrell-Dubose instrumentation system.
• Example Case: Extensive scoliosis correction surgery in a 79-year-old woman.

Spinal Column Disorders

• Common Causes:
  • Vertebral fractures
  • Tumors
  • Modic changes
• Types of Fractures:
  • Compression, wedge, crush, burst fractures

Tumors

• Causes:
  • Often metastatic from other cancers (breast, lung, prostate)
  • Benign types include hemangioma, osteoid osteoma, osteoblastoma.

Modic Changes

• Types:
  • Type 1: Inflammation
  • Type 2: Fatty infiltration
  • Type 3: Bony sclerosis
• Spinal Stenosis Causes:
  • Ossification of ligaments (e.g., OPLL)
  • Thickening of ligamentum flavum

Myelopathy vs. Myopathy

• Definitions:
  • Myelopathy: Pathology of the spinal cord
  • Myopathy: Muscle-related conditions
• Causes of Myelopathy: OPLL, multiple sclerosis, etc.

Genetic Disorders

• Klippel-Feil Syndrome: Congenital fusion of cervical vertebrae.

Degenerative Spinal Disorders

• Spondylosis: Osteoarthritis of the spine
• Ankylosing Spondylitis (AS): Rheumatic disease affecting spine joints
• Spondylolysis vs. Spondylolisthesis:
  • Spondylolysis: Pars defect causing stress fracture
  • Spondylolisthesis: Vertebral slippage (graded 1-5)

Other Disorders

• Facet Syndrome: Degeneration of facet joints
• Synovial Cyst: Fluid-filled cysts forming in response to spine stress

Degenerative Bone Disorders

• Types:
  • Osteoarthritis
  • Osteoporosis
  • Osteophytes (bone spurs)

Disc Problems

• Common Causes for Neurological Deficits: Degenerative disc disease
• Herniation Types: Central, paramedian, foraminal, extraforaminal

Conclusion

• Understanding pathological terms in H&P for better surgical monitoring preparation.
• Will further explore next semester.