Kyphosis

Osteoporosis is low bone strength that raises fragility fracture risk, diagnosed by a hip or spine T-score of -2.5 or less or by a fragility fracture itself. First-line treatment is an oral bisphosphonate, alendronate or risedronate, alongside adequate calcium and vitamin D intake.

A vertebral compression fracture is a collapse of the anterior or middle vertebral body, most often from osteoporotic fragility with minimal or no trauma, presenting as acute focal spinal tenderness or, in up to two-thirds of cases, as an asymptomatic finding on imaging. Diagnosis is by spine radiograph confirming the fracture, which alone establishes a clinical diagnosis of osteoporosis, and first-line management is analgesia (acetaminophen 650 mg PO every 6 hours) with antiresorptive or anabolic pharmacotherapy to prevent further fracture.

Ankylosing spondylitis is the radiographic axial spondyloarthritis: a chronic, HLA-B27-associated inflammatory disease of the sacroiliac joints, spine, and entheses presenting with inflammatory back pain before age 45. Sacroiliitis on pelvic radiograph or MRI establishes the diagnosis. First-line treatment is continuous scheduled NSAIDs with active exercise, escalating to a tumor necrosis factor inhibitor, then an interleukin-17 inhibitor, when NSAIDs fail.

Tuberculosis, caused by Mycobacterium tuberculosis, remains a leading global cause of infectious death and presents as latent infection, primary/secondary pulmonary disease, or extrapulmonary and disseminated (miliary) disease. Diagnosis rests on AFB smear, NAAT, and mycobacterial culture (the gold standard), and drug-susceptible active disease is treated with a four-drug regimen (isoniazid, rifampin, pyrazinamide, ethambutol) for 2 months followed by isoniazid plus rifampin for 4 to 7 months.

Scoliosis is a lateral curvature of the spine greater than 10 degrees by Cobb angle on standing radiographs, most often adolescent idiopathic scoliosis detected on screening with the forward bend test. Treatment follows the Cobb angle and remaining growth: observation for 11-24 degrees, bracing for 25-49 degrees while growth remains, and surgical fixation at 50 degrees or more, with restrictive lung disease the main long-term risk of severe curves.

Marfan syndrome is an autosomal dominant connective tissue disorder from FBN1 (fibrillin-1) mutations, with skeletal, ocular, and cardiovascular features. The cardiovascular risk drives prognosis: aortic root dilation predisposing to dissection and rupture, managed with beta-blockers or ARBs, activity restriction, surveillance imaging, and prophylactic aortic surgery.

Osteoarthritis is a chronic progressive joint disorder of cartilage and subchondral bone degradation with low-grade synovitis, diagnosed clinically from age, activity-related pain, and exam findings, and managed with exercise, weight loss, topical or oral NSAIDs, and joint replacement for refractory disease.

Cauda equina syndrome is compression of the lumbosacral nerve roots below the spinal cord causing saddle anesthesia, bladder or bowel dysfunction, bilateral leg weakness with areflexia, and low tone, most often from a large central lumbar disk herniation. It is a surgical emergency diagnosed by emergent MRI of the lumbar spine and treated with urgent decompression.

Spinal cord compression is mechanical narrowing of the spinal canal by tumor, hematoma, abscess, disc herniation, or trauma that produces myelopathy; it is a neurologic emergency requiring urgent MRI of the affected level and immediate treatment of the cause, since surgical decompression rarely restores function once paraplegia develops.