immunolgical - endemic in parts east Europe and Asian Clinical - asymmetric appendicular arthritis especially knee - sacroiliitis & spondylitis may occur Inborn error of metabolism in which homogentisic acid can not be oxidised A form of HA - black deposit in tissues - deposited in connective tissue containing hyaline & fibrocartilage Most common spinal problem is spondylosis - deposits in disc with ossification & marginal syndesmophytes - SIJ usually unaffected Causes - tabes dorsalis - syrinx in cervical spine Clinically - deformity, instability, crepitation & hyper-mobility
In each spinal vertebra there are 2 joints composed of inferior and superior articular processes. These are called facet joints and are the main articulations between adjacent vertebrae. The facet joints are held in place by fibrous tissue called capsules. As part of the normal degenerative process, the facet capsules become thin and weakened. This results in a stretching of the capsule and a sliding of one vertebra on another. This sliding of one vertebra on another is called spondylolisthesis. As a result of this sliding, there is instability in the joint and the body responds via a thickening (hypertrophy) of the facets. This hypertrophy can sometimes compress the structures adjacent to the bony facets, such as the nerves or spinal canal. This results in spinal stenosis (pressure on the nerves in the low back). Spinal stenosis is commonly seen with degenerative spondylolisthesis and is a cause for the many symptoms seen with this disease.
Anterolisthesis in the cervical spine--spondylolysis
If slippage continues or if your pain doesn’t respond to conservative treatment, surgery may be necessary. Surgery can address both the instability of the spine and compression of the nerve roots. The surgeon may first perform a lumbar laminectomy to relieve pressure on the nerve root. Then a bone graft will be used to fuse the loose vertebrae and keep them from sliding out of place. In some cases metal plates, hooks, rods and screws may be used to support the fusion (Fig. 5). It may take a while for the two pieces of bone to grow together, so you should avoid extremes of motion while healing.