Lumbar Spinal Stenosis

Lumbar spinal stenosis is a condition in which the foramina of the lumbar spine begin to narrow. This narrowing can occur in several places in the vertebra. In cases where the spinal canal is affected it is known as central stenosis; when the foramen are affected it is called foraminal stenosis. Spinal stenosis is most often caused by degenerative arthritis. Arthritis causes a loss of the cartilage in the joints. This arthritis can cause a loss in the spaces between the vertebra; this is known as degenerative disc disease. The degeneration will also cause an overgrowth of the ligament structures. All of these problems will reduce the pathways that the nerves normally travel through. This narrowing can cause pressure to the spinal nerves. Other causes of lumbar spinal stenosis are tumor, infections and other bone diseases such as Paget’s disease.
There are a number of symptoms that are associated with lumber spinal stenosis. These symptoms include numbness and loss of sensation in the lower legs. Pain in the lower back and legs is also common. It is common for the patient to have pain shoot down their legs when they are walking. This pain will lessen when the patient sits or rests. Patients will have an increase of pain if they bend backward while they are standing, however if they bend forward the pain will lessen. This is due to the fact that the disc spaces are larger when the patient bends forward which will take the pressure off the nerves. These symptoms most often worsen over time because arthritis is a progressive disease.
Diagnosis of lumber spinal stenosis is very important because there are several diseases that can cause similar symptoms. These include peripheral vascular disease, claudication of the blood vessels and diabetic neuropathy. The diagnosis process will begin with a thorough history and physical which will include a test of the patient’s range of motion. After the doctor has determined the duration and severity of the patients’ pain, the doctor will order x-rays that could include a CT or MRI scan. In cases where extensive damage to the nerves is possible the doctor may order an electromyogram (EMG) test. This will test the conductivity of the nerves to ascertain the level of damage that has occurred. This test will also determine the exact location of the nerves that are damaged.
Treatment for lumbar spinal stenosis can be done in a number of ways. Pain medicine and oral steroids are used to relieve the pain and inflammation. Certain medications such as Neurontin and Lyicra can be administered for the nerve pain. Surgery will become the next option of treatment for those patients that do not show improvements with the other treatments. The types of surgery that are typically done typically are laminectomy, foraminotomy, and, laminotomy. These types of surgery are done to remove the areas of the vertebrae that are compressing the nerves. These types of surgery are more commonly known as lumber decompression surgeries. Because lumbar spinal stenosis typically happens as a result of aging, there really isn’t any way to prevent this disease from occurring.

my information came from

http://www.medicinenet.com/lumbar_stenosis/article.htm

my picture came from

http://www.medscape.com/viewarticle/557944_2

Discitis of the cervical spine

Cervical discitis is a disease in which there is inflammation of the vertebral disk space. This inflammation is caused by an infection that has traveled from other parts of the body to the spinal column through the blood stream. It is very uncommon for the infection to start in the disk space. Discitis is not a very common disease, it will usually only affect 1 in every 100,000 people with death happening in only 2 to 12% of those affected. Death is usually a result of the spreading infection through either the nervous system or the organs. Discitis can affect both males and female but will affect males more often in usually a 2:1 ratio. Discitis can affect both children and adults but does not affect one race more than another
In adults this disease progresses very slowly which can cause the diagnosis to be delayed for months. Most individuals have beginning complaints of tenderness and or pain in the neck or back. In those individuals that are already chronically ill, there will be a higher occurrence of epidural extension of the infection. This can cause those individuals to have weakness in their legs and feet. Patients who have just had surgery will have symptoms similar to those with an acute discitis but can expect their symptoms to appear within a day or two after having surgery. IN some cases of post op discitis the symptoms may not appear for a week or two. In children the disease will present itself much faster. The more common symptoms are sudden back pain, irritability and possibly the child refusing to walk. In both children and adults there have also been instances of fever and chills being reported. In most cases the most common physical symptom is having tenderness over the affected area and spasms of the paraspinal muscles
Discitis is usually caused by the spread of infection through the blood stream from a systemic infection such as a kidney infection. The most common infections to cause discitis are pneumonia, soft tissue infections and urinary tract infections. This type of disk infection has also been known to be caused by an infection at the site of a surgical procedure of the spine such as a discectomy. However infections caused by this a very rare, usually only resulting in about .5% of cases.
Because of its slow progression it can be difficult to diagnose discitis in its early stages. X-ray can be used to diagnose discitis by showing the narrowing of the disk space but this is only after the disease has been present for weeks. CT scans are able to identify discitis earlier by highlighting the decrease in the density of the disk itself. The best way of detecting discitis is the use of MRI. BY using a T-1 weighted image, an MRI has the ability to show the narrowing of the disk space and the edema associated with the infection. MRI will also help the technologist to distinguish between an infectious discitis and other pathologies such as tuberculosis.
In some cases the doctor will do a biopsy using a needle to determine if the disease is discitis or something more. In other cases surgical biopsy may be used because it is believed by some to be a more conclusive way of diagnosing discitis. Treatment of discitis is the use of an antibiotic to keep the infection from spreading. I.V. antibiotics are the best course of action and they are given for around six to eight weeks. During the first few weeks of treatment it is recommended that the patient be on bedrest. After this period of bedrest the patient should have external immobilization in pace in the form of a brace. This bracing will allow the vertebrae that are affected to fuse in an aligned position. The patient must wear this brace for a period of 3 to 6 months. If all treatment steps are followed most discitis cases will be resolved. In rare cases (usually only 15%) permanent neurological deficits may occur. The image I have below is a T-1 wieghted image showing discitis of the lumbar spine.

My information and image came from the following website

http:www.emedicine.com/Orthoped/topic77.htm

Bow Hunter's Syndrome

Bow Hunter’s syndrome is a stroke that is caused by turning the head to the side in a forcible way. Turning the head in this way puts pressure on the vertebral arteries in the neck; this pressure will cause the blood flow to be impaired. This will in turn cause a stroke. Strokes are caused by the blockage or bursting of a blood vessel. The damage to the blood vessels will cause a loss of blood to the brain, which will in turn cause the tissues to start to die. Diagnosis of Bow Hunter’s syndrome is done by using MRI imaging and MRI angiography.
Symptoms of Bow Hunter’s syndrome are typically the same as those of a regular stroke. Stroke symptoms include dizziness, vision disturbances, trouble speaking and walking, confusion and severe headache. These symptoms will usually occur on only one side of the body. The symptoms may develop or worsen over a period of minutes up to a matter of days. If any of these symptoms are present, medical treatment should be sought immediately by going to the emergency room. The faster treatment is obtained the better the chances for a full recovery. The damage starts immediately, the cells will start to die after 4 minutes without blood. The body will compensate for this loss by directing the blood to the other areas of the brain by using the other vessels that are not damaged. The damage that is caused can be temporary or permanent. Seeking treatment early may increase the chances of decreasing the permanent damage. Patients have the best chance of regaining their capabilities in the first few months. Some other symptoms can include changes in judgment, emotions and memory. Bow Hunter’s syndrome can be treated by two methods. These include using a neck brace for the cases that are not as severe and surgery for those cases that are more severe. The picture I chose is a CT image of a hemmorhagic stroke.
My information came from

http://www.revolutionhealth.com/condtions/brain-nerves/stroke/symptoms/bow-hunters-stroke

my pictures came from

http://en.wikipedia.org/wiki/stroke

Sjogren's Disease

Sjogren’s syndrome is a disease that affects the body’s autoimmune system. This means that this disease will cause an increase in antibodies. This increase will bring the antibodies to an abnormal level. These antibodies will then start to attack certain tissues in the body. The antibodies that are associated with this disease will begin to attack the tissues in certain glands in the body, most usually in the salivary, parotid, and, lacrimal glands. Ion 90% of cases Sjogrens disease affects mainly women. In most cases it is believed that this disease is inherited. It has also been found that people who suffer from other autoimmune diseases will be more likely to have the occurrence of Sjogrens disease in their family members. Other common autoimmune diseases are lupus, erythematosus, and juvenile diabetes.
Symptoms of Sjogrens disease depend on the gland that is affected. For example if is the lacrimal gland that is affected the patient can expect to have symptoms of dry eye and eye irritation due to a decrease in the tear production, this irritation can lead to abrasion on the cornea of the eye. If the salivary gland is affected then the patient will have complaints of dry mouth and swallowing difficulty. They may also develop gum disease and tooth decay. It may also lead to the development of stones or infection in the parotid gland. This disease may also affect the joints and blood vessels by causing inflammation. The inflammation of the blood vessels is called (vasculitis). Although this is a very serious complication of Sjogrens disease it is also very rare. Thyroiditis is another disease that is associated with Sjogrens disease. This can lead to thyroid hormone levels that are extremely elevated
This disease is diagnosed by the diagnosis of the symptoms. To test for dryness of the eyes they will perform a test called a Schirmer’s test. This is done by taking a small piece of paper and placing it under the eyelid to test the eyes ability to wet the paper. Problems with the salivary gland s are tested by using a technique called the salivary flow test. To follow up on this test they will perform a salivary gland biopsy. Unfortunately there is not a cure for Sjogrens disease. The only treatment for this disease is to treat the areas that have been affected. In the cases of dry eyes, eye drops are an effective treatment. Dry mouth can be treated by an increase in the patients’ fluid intake, using a humidifier to moisten the air, and have good dental hygiene to avoid problems with gum and tooth decay. When the nasal passage is dry a saline nasal spray is effective in relieving the discomfort of the dryness.
My information came from
http://www.medicinenet.com/script/main/art.asp?articlekey=477&pf=3&page=1