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NYCC Bone & Joint > (2,3) Intervertebral Disc Herniation > Flashcards

(2,3) Intervertebral Disc Herniation Flashcards

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1
Q

How are disc herniations classified?

A
  • morphology (type)
  • location
  • neurologic involvement
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2
Q

What are the types of disc herniations?

A
  • contained: protrusion
  • uncontained: extrusion & sequestered fragment
    (bulge is NOT a herniation)
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3
Q

What is a contained disc herniation?

A

nucleus contained by at least 1 annular layer

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4
Q

What is an uncontained disc herniation?

A

nuclear material violates annulus

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5
Q

What is a disc bulge?

A
  • disc loses height, expands outward (associated w/ degen.)
  • disc extends beyond body margin generally <3mm (2mm = bulge)
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6
Q

A disc bulge involves how much of the disc circumference?

A

> 25%

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7
Q

What MRI weighting and view can be used to visualize a disc bulge?

A

T2
axial view

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8
Q

Disc bulges can be ____ or ____

A

symmetric or asymmetric

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9
Q

What is the shape of the intervertebral discs in the cervical spine?

A

oval

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10
Q

What is the shape of the intervertebral discs in the upper thoracic spine?

A

D-shaped

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11
Q

What is the shape of the intervertebral discs in the lower thoracic spine?

A

kidney bean-shaped

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12
Q

What is the shape of the intervertebral discs from T12 to L4?

A

kidney bean-shaped

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13
Q

What is the shape of the intervertebral disc at L4-L5?

A

flat across back

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14
Q

What is the shape of the intervertebral disc at L5-S1?

A

oval

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15
Q

A focal extension of disc beyond the vertebral body margin, indenting the thecal sac is called a ____

A

disc protrusion

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16
Q

Nuclear material that is not contained by the outer 1/3 annular fibers but maintains continuity with the parent disc is called a ____

A

disc extrusion

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17
Q

Uncontained disc material that is not connected to the parent disc is called a ____

A

sequestered fragment

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18
Q

Describe the appearance of a disc protrusion.

A

base is wider than the depth in both sagittal and axial dimensions

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19
Q

What are the clinical findings of a disc protrusion?

A

often ASx (1-2/3 of ASx population has one)

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20
Q

Describe the appearance of a disc extrusion.

A
  • base is narrower than the depth in either sagittal or axial dimensions
  • acute cases may show ^T2 and postcontrast T1 d/t surrounding granulation tissue
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21
Q

If a disc appears to be protruded on a sagittal view, but extruded on an axial view, what type of herniation is it?

A

disc extrusion

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22
Q

What is the prognosis of disc protrusions and extrusions?

A
  • shown to reduce in size with time
  • 90% with radiculopathy managed conservatively with good outcome
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23
Q

Pain from a disc extrusion is more likely from ____ causes than ____

A
  • chemical
  • mechanical compression
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24
Q

What 2 questions should you ask every patient with low back pain?

A
  • problems w/ urination (starting/stopping, incontinence)
  • problems w/ bowel movements (starting/stopping, incontinence)
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25
What are the clinical findings of a sequestered disc fragment?
- can migrate into spinal canal = painful - can affect multiple nerve roots
26
What clinical signs would suggest that a sequestered disc fragment has migrated significantly?
changes in neuro symptoms
27
What is the treatment for a sequestered disc fragment?
open procedure to clean out all fragments (minimally invasive surgery is less than optimal)
28
What are the possible locations used to classify disc herniations?
- central - subarticular - foraminal - extraforaminal
29
What are the 2 more common location classifications of disc herniations?
central subarticular
30
What are the most common spinal levels for disc hernitations?
- L4/L5 - L5/S1 - C5/C6 - C6/C7
31
In general, what nerve roots are affected by central, subarticular, and foraminal cervical disc herniations?
exiting roots
32
What nerve root is affected by a C5/C6 subarticular disc herniation?
C6
33
What nerve root is affected by a C6/C7 central disc herniation?
C7
34
What nerve root is affected by a C4/C5 foraminal disc herniation?
C5
35
In general, what nerve roots are affected by central and subarticular lumbar disc herniations?
transiting nerve root (in lateral recess)
36
In general, what nerve roots are affected by foraminal lumbar disc herniations?
exiting nerve roots
37
What nerve root is affected by a L4/L5 subarticular disc herniation?
L5 (transiting)
38
What nerve root is affected by a L4/L5 foraminal disc herniation?
L4 (exiting)
39
In the lumbar spine, the upper segment level corresponds to the ____ nerve root, while the lower level corresponds to the ____ nerve root.
- upper = exiting - lower = transiting
40
What is the motor distribution of C5 nerve root?
- deltoid - **biceps brachii**
41
What is the motor distribution of C6 nerve root?
- biceps brachii - **wrist extensors**
42
What is the motor distribution of C7 nerve root?
- wrist flexors - finger extensors
43
What is the motor distribution of C8 nerve root?
- finger flexors/ABductors - interossei
44
What is the motor distribution of T1 nerve root?
finger ABductors & ADductors
45
What is the motor distribution of L4 nerve root?
tibialis anterior
46
What is the motor distribution of L5 nerve root?
- **EHL** - toe extensors
47
What is the motor distribution of S1 nerve root?
peroneus longus/brevis
48
What is the deep tendon reflex for C5 nerve root?
biceps brachii
49
What is the deep tendon reflex for C6 nerve root?
brachioradialis
50
What is the deep tendon reflex for C7 nerve root?
triceps
51
What is the deep tendon reflex for C8 nerve root?
none
52
What is the deep tendon reflex for T1 nerve root?
none
53
What is the deep tendon reflex for L4 nerve root?
patellar
54
What is the deep tendon reflex for L5 nerve root?
medial hamstring
55
What is the deep tendon reflex for S1 nerve root?
achilles
56
What is the probability of having an asymptomatic disc herniation?
roughly equal to age
57
What is the sensory distribution for C5 nerve root?
58
What is the sensory distribution for C6 nerve root?
59
What is the sensory distribution for C7 nerve root?
60
What is the sensory distribution for C8 nerve root?
61
What is the sensory distribution for T1 nerve root?
62
What is the sensory distribution for L4 nerve root?
63
What is the sensory distribution for L5 nerve root?
64
What is the sensory distribution for S1 nerve root?
65
What is the location of this disc abnormality/herniation? What nerve roots are most likely to be involved?
Central L5 nerve root (transiting)
66
What is the location of this disc abnormality/herniation? What nerve roots are most likely to be involved?
Central S1 nerve root (transiting)
67
What is the location of the disc abnormality/herniation? If this were located at L5/S1, what nerve roots are most likely to be involved?
Foraminal L5 nerve root (exiting)
68
What is the location of this disc abnormality/herniation? If this is at C6/C7 disc, what nerve roots are most likely to be involved?
Central C7 nerve root (exiting)

NYCC Bone & Joint (71 decks)

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