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From Flashcardlet > Spinal Pathologies > Flashcards

Spinal Pathologies Flashcards

1
Q

Spondylolisthesis

A

Slippage forward of a superior vertebra on an inferior vertebra

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2
Q

Wiltse’s Classification

A
  • Dysplastic
  • Spondylolytic
  • Degenerative
  • Traumatic
  • Pathologic
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3
Q

Dysplastic

A
  • Congenital abnormality of upper sacrum
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4
Q

Spondylotlytic

A
  • a pars lesion
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5
Q

Degenerative

A
  • pars-facet instability
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6
Q

Traumatic

A
  • non-pars fracture
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7
Q

Pathologic

A
  • cause my disease
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8
Q

Causes of Pars breaks

A
  • repetitive forced lumbar hypertension
  • sudden growth spurt
  • abrupt increase training intensity and freq.
  • improper technique
  • unsuitable sports equipment or playing surface
  • leg length discrepancy
  • poor posture
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9
Q

Meterding’s Spondylolisthesis Classification

A 
Grade 0 = no movement
Grade 1 = 1/4 length of body
Grade 2 = 1/2 length of body
Grade 3 = 3/4 length of body
Grade 4 = whole length of body
Grade 5 = way too far!!
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10
Q

Diagnosing spondylolisthesis

A
  • History
  • Hor. muscle bands standing
  • Painfree FB, but pain return from FB
  • Painful ext, rot, and SB
  • step deformity
  • referred pain
  • shortened stride
  • Neuro involved >,= grade 2
  • image tests
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11
Q

Single Leg Stance Test

A
  • Stand on leg of same side of pain
  • back extension
  • good indicator of spondylolisthesis
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12
Q

Treatment of Pars Stress

A
  • restricted to pain free motion
  • antilordotic bracing 8-12 weeks
  • Min. of 4-6 weeks conditioning post bracing
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13
Q

Order of Pars stress conditioning

A
  • Flexion ROM
  • Local cor training (TrA and Mult), the obliques
  • Global core - glutes, lats
  • work back in extension ROM
  • Gradual return to GRF’s
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14
Q

Treatment for Grades I and II slippage

A
  • immobilization witha torso brace followed by same conditioning as pars stress
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15
Q

Treatment for Grades III and IV

A
  • Bracing first if tere are minimal neurological Sx and Sy

- spinal fusion if spinal cord needs to be decompressed or if instability is too great

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16
Q

Spinal stenosis

A
  • narrowing of spinal canal, nerve root canals, or vertebral foramen
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17
Q

Central spinal stenosis

A
  • results in myelopathy or cauda equina syndrome (UMNL)
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18
Q

Lateral spinal stenosis

A
  • results in radiculopathy (LMNL)
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19
Q

Combined spinal stenosis

A
  • UMNL and LMNL
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20
Q

Forms of “acquired stenosis”

A
  • osteophytes
  • hypertropic or buckled ligamentum flavum
  • hypertrophied facets
  • central herniated disc
  • tumor
  • iantrogenic (caused by illness)
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21
Q

Lumbar stenosis diagnosis

A
  • history
  • claudicant pain
  • relief in flexion, pain in ext.
  • hyper or hypo DTR
  • lower extremity sensory loss and weakness
  • possible bowel/bladder problems
  • saddle area numbness
  • imaging
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22
Q

spinal stenosis treatment

A

Goal: increase mobility/decrease spinal compression

  • stretching, massage
  • increase flexion ROM
  • distraction to open lumbar facets
  • maybe traction
  • endurance exercises that dont compres or extend the spine (swimming, not jogging)
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23
Q

Lumbar Nerve Root Impingement

A
  • Lumbar radiculopathy: nerve irritation from compression
  • L5/S1 most common
  • mainly caused by disc herniation or rupture
  • other causes: facet arthritis, local inflammation, tumor
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24
Q

Cause of disc injury

A
  • poor posture
  • obesity
  • smoking
  • occupation
  • improper lifting
  • vibration
  • repetitive compression and rotation
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25
Q

Causes of LBP from smoking

A
  • coughing (increase disc pressure)
  • decrease bone density
  • fibrin deposition and scar formation
  • reduce blood flow to vertebral body
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26
Q

Lumbar radiculopathy diagnosis

A
  • history
  • Neuroscreen: dermatomes, myotome weakness, low DTR, SLR test
  • possible lateral shift and image tests
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27
Q

SLR and Well SLR test

A
  • 35-70 degrees of hip flexion produces leg pain, paresthesias, burning sensation
  • well 95% specific
  • SLR high sensitivity
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28
Q

4 Types of Disc Dysfunction

A
  • Protrusion
  • Prolapse
  • Extrusion
  • Sequestered
29
Q

Protrusion

A

Slight outstretching of posterior aspect of annulus and neurovascular capsule

30
Q

Protrusion Sx & Sy

A
  • instability
  • ligamentous pain behavior
  • occasional leg pain
31
Q

8 Causes of disc dysfunction

A
  • posture
  • obesity
  • smoking
  • occupation
  • lifting sport
  • vibration
  • repetitive compression and rotation
32
Q

Protrusion Treatment

A
  • Correct posture (T-L spine and hip)
  • McKenzie exercises
  • Stabilize: core and dynamic stabilization
  • Endurance
  • correct mechanics
  • change behaviors
33
Q

Prolapse

A

Nucleus prolapsing but annulus intact

34
Q

Prolapse Sx & Sy

A
  • frequent leg pain
  • Maybe neurological signs (dermatome, myo, DTR)
  • FB or BB may increae symptoms
35
Q

Prolapse Treatment

A
  • Find movements that make pain better/worse
  • McKenzie exercises?
  • Centralized pain to back
  • Posture -> Stabilize -> Endurance -> change life style
36
Q

Extrusion

A
  • Annulus torn, nucleus starting to escape
37
Q

Extrusion Sx & Sy

A
  • LBP, worse in sitting
  • FB or BB may increase leg pain
  • Neuro Sx & Sy present
  • Possible lateral shift
  • Significant disability
38
Q

Acute Treatment of Extrusion

A

Rest (two weeks), Ice, Back brace

Goal: Allow annulus to heal

39
Q

Sub acute treatment of extrusion

A
  • Work on leg pain, sensory and motor problems via: positional distraction, manual traction, mechanical traction, pain modalities
40
Q

Chronic treatment of extrusion

A
  • continue to centralized pain
  • Correct posture
  • Stabilization (core -> dynamic exs)
  • Aerobic exs
  • Change life style
41
Q

Sequestered Nucleus

A

Free nuclear material

42
Q

Sequestered Sx & Sy

A

????

43
Q

what determines conservative treatment vs surgery?

A

????

44
Q

3 types of Surgery for sequestration

A

discectomy, laminectomy, fusion

45
Q

Facet syndrome

A

Pain in one or more facets due to:

- Synovitis or locked joint from trauma

46
Q

Diagnosing facet syndrome

A
  • history
  • palpate for malalignment or spasm
  • assess spinal segmental mobility
  • Rule out other pathologies
  • determine level and side of facet
47
Q

Facet Syndrome Treatment

A
  • ice, e-stim for spasm
  • joint manipulation
  • distraction (open facet)
  • Traction (open facet)
  • corrective exs once facet motion restored
48
Q

How to define CLBP

A

???

49
Q

Motor control and CLBP

A
  • change control of deep truck muscles

- increased stiffness and stability at the expense of spinal function

50
Q

Diagnosing CLBP

A
  • History: Present > 3 months

- Clinical Testing: other diagnoses ruled out, segment instability (manual test, EMG, videofluoroscopy)

51
Q

CLBP Treatment

A
  • NSAIDS
  • Counseling
  • Improve aerobic fitness, and core stabilization
52
Q

Acute low back pain (back strains)

A
  • Local muscle injury causing pain with palpation, limitation in bending
  • Rule out: disc herniation, stenosis, spondyl, infection, malignancy
  • most dont 100% recover -> CLBP
53
Q

ALBP treatment

A
  • distraction
  • mobilization
  • core stabilization
  • acupuncture
54
Q

After low back pain exam

A
  • treatment w/o MD? (simple LBP, facets, no neuro Sx & Sys)
  • safe for treatment w/ MD (w/ CLBP or mild disc injury)
  • defer treatment (exstruded or sequestered, stenosis)
55
Q

4 treatment classification groups

A
  • Specific exercise
  • mobilization
  • traction
  • immobilization
56
Q

Specific exercise

A

extension syndrome or flexion syndrome

57
Q

mobilization

A
  • unilateral LBP w/ segmental hypomobility
58
Q

traction

A
  • radiculopathy w/ or w/o lateral shift
59
Q

immobiliization

A
  • segmental hypermobility
60
Q

Extension syndrome

A
  • likes extension
  • symptoms worsen seated or FB
  • Use for: mild disc herniation w/o radicular pain
61
Q

Flexion syndrome

A
  • likes flexion
  • symptoms worsen standing and extending
  • Use for: spinal stenosis
62
Q

Five Criteria for Prediction Rule

A
  • Current LBP or = 1 lumbar hypomobile segment

- > or = 1 hip w/ > 35 hip IR

63
Q

Traction

A

For radiculopathy to decompress nerve

64
Q

Core strengthening

A

Stabile lumbar requires:

  • passive stiffness (osseous and ligaments)
  • active stiffness (muscle strength and sequence)
  • from inside>out (TA>OA>RA)
65
Q

Core

A

Pelvic floor, back muscles, diaphragm, abdominals

66
Q

TA facts

A
  • 1st muscle to be recruited with UE and LE movements

- important cause of attached at TL fascia

67
Q

impaired diaphragmatic breathing

A
  • disuse of lower abs -> lower resting diaphragm -> slump posture = restrict diaphragm breathing
  • upper chest breathing dominates, leads to shallow inspiration and chronic fatigue
68
Q

Prevent LBP injury

A
  • core stability
  • spine and hip flexibility
  • nutrition and exercise
  • walking or jogging
  • no smoking
  • decrease job injury

From Flashcardlet (22 decks)

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