Less common conditions we diagnose and rehabilitate

Osteomalacia: impaired bone mineralisation due to vitamin D deficiency, with diffuse pain and weakness of the proximal muscles.

Paget’s disease of bone: disordered bone remodelling with vertebral deformity and possible stenosis of the canal.

Primary hyperparathyroidism: loss of bone mass and fractures due to raised parathyroid hormone.

Calcium pyrophosphate deposition disease (CPPD): can affect the dens of the axis and cause acute neck pain and stiffness (crowned dens syndrome).

Gout of the spine: a rare cause of axial pain and radicular symptoms.

Ochronosis (alkaptonuria): calcification of the discs and early degeneration of the spine.

Acromegaly: vertebral hypertrophy and degenerative changes with back pain.

Reactive arthritis: spondyloarthritis following a bowel or urogenital infection.

SAPHO syndrome: synovitis, acne, pustulosis, hyperostosis and osteitis, with possible involvement of the spine.

Juvenile idiopathic arthritis: can affect the cervical spine, with stiffness and ankylosis.

Spina bifida: ranging from the asymptomatic occult form to the condition after surgery for myelomeningocele with a permanent neurological deficit.

Klippel-Feil syndrome: congenital fusion of the cervical vertebrae with restricted mobility and overload of the adjacent segments.

Chiari malformation and syringomyelia: descent of the cerebellar tonsils, or a cavity in the spinal cord, with neurological deficit and scoliosis.

Tethered cord syndrome: fixation of the lower spinal cord with progressive neurological symptoms.

Skeletal dysplasias and osteogenesis imperfecta: canal stenosis, deformities and a tendency to fractures.

Baastrup’s disease: contact and neoarthrosis between the spinous processes of the lumbar vertebrae.

Intercostal neuralgia: pain along an intercostal nerve, which must be distinguished from cardiac and pleural pain.

Quadratus lumborum syndrome: myofascial pain in the lower back and above the hip.

Increased lumbar lordosis: a postural or structural increase in lordosis with overload of the facet joints.

Multiple sclerosis, stroke and muscular dystrophies: neurological diseases with postural disorders, scoliosis and back pain.

Diabetes and chronic kidney disease: systemic diseases that contribute to osteopenia, DISH and neuropathy.