DDD, herniations part 1 Flashcards
1
Q
radiology of DDD
A
decreased disc height osteophyte formation endplate sclerosis vacuum phenomenon subluxation (retrolisthesis)
2
Q
spondylosis deformans are marked by what?
A
osteophytes
3
Q
what part of the disc is associated with spondylosis deformans
A
outer disc
4
Q
intervertebral chondrosis is marked by what?
A
reduced IVD space
5
Q
what part of the disc is associated with intervertebral chondrosis?
A
inner disc
6
Q
what is intervertebral disc osteochondrosis?
A
primary degeneration of the nucleus pulposus
loss of disc height with minimal osteophytes
7
Q
intervertebral disc osteochrondrosis has what radiographic feature?
A
Knutson’s vacuum phenomenon
8
Q
what is knutson’s vacuum phenomenon?
A
radiolucent collections of nitrogen gas within annular fissures
9
Q
where is vacuum phenomenon best seen?
A
anterior margin of IVD on extension films
normally seen in synovial extremity joints under slight distraction
10
Q
what is spondylosis deformans?
A
degeneration of the annulus with prominent osteophytes
11
Q
what is osteophytosis due to?
A
breakdown at the site of attachment of the outer annular fibers, including Sharpey’s fibers to the vertebral margin
12
Q
in osteophytosis, how do the osteophytes grow?
A
develop at the stressed areas of the ALL and keep going horizontally
13
Q
what ligaments does osteophytosis sterss?
A
vertebral attachment of ALL
14
Q
does osteophytosis fuse?
A
not usually
15
Q
what are the common signs and symptoms of cervical spondylotic myelopathy?
A
clumsy or weak hands leg weakness or stiffness neck stiffness pain in shoulders or arms unsteady gait atrophy of hand musculature hyperrefleia lhermitte's sign sensory loss
16
Q
what are intercalary ossicles?
A
annulus degeneration
NOT fractured osteophytes
17
Q
what does endplate sclerosis indicate?
A
infraction, compression and necrosis of stressed subchondral bone trabeculae
18
Q
modic type 1 (which MRI? what does it indicate?)
A
dark T1
bright T2
indicates inflammation (bone marrow edema)
19
Q
modic type 2 (which MRI? what does it indicate?)
A
bright T1
bright T2
indicates fat
20
Q
modic type 3 (which MRI? what does it indicate?)
A
dark T1
dark T2
indicates sclerosis
21
Q
what needs to be present to be considered modic changes?
A
DDD
22
Q
what does it indicate when no modic changes to modic type 1?
A
more likely hypermobile
23
Q
what does it indicate when modic type 1 goes to modic type 2?
A
more stable
24
Q
modic type 2 going to modic type 1 or modic type 2 going to no modic indicates what?
A
unstable or infection
25
type one modic changes are more common in what part of the spine?
cervical
26
type 2 modic changes are more common in what part of the spine?
lumbars
27
Schmorl's nodes
abrupt, focal, radiolucent IVD displacement into the cancellous bone of the adjacent vertebra
28
who do schmorl's nodes typically occur in?
young children, little significance
| if in adults, could represent clinically significant endplate infractions/fractures
29
criteria to be scheuermann's disease
at least 3 vertebra with disc space narrowing
endplate irregularity
wedging of 5 degrees or more
30
who normally gets scheuermann's disease?
adolescent onset (13-17)
31
what disease may result in pain, cosmetic deformity and premature DDD?
scheuermann's disease
32
what is juvenile discogenic disease?
thoracolumbar scheuermann's disease
33
what is the etiology of juvenile discogenic disease?
appears to be failure of embryologic vascular channels, centrum defects, and notochord clefts to disappear, leaving endplate defects
34
juvenile discogenic disease produces what pathologies?
early degeneration
segmental dysfunction
associated pathology in facet joint
35
posterior subluxations are primarily associated with what?
DDD (principally the annulus)
36
anterior subluxation are primarily associated with what?
posterior joint arthrosis (degenerative spondylolisthesis
37
describe degeneration of the cervical spine
```
most common at C5/6
decreased disc height
posterior and anterior vertebral body osteophyte formation
posterior joint arthrosis
uncovertebral arthrosis
intercalary ossicles
```
38
describe uncovertebral degeneration
```
within 3-7th cervical levels
most commonly middle to lower cervical spine
bulbous osteophytes (frontal projection)
pseudofracture (lateral projection)
may encroach IVF
```
39
describe zygapophyseal degeneration (facet arthrosis)
where?
x ray findings
where is neurological involvement demonstrated?
MC lower lumbar, middle cervical and upper throacic spine
xray is characterized by increased radiodensity and irregularity, hypertrophic changes, and osteophytes
neurological involvement is demonstrated on axial imaged of CT and MRI
40
baastrup's disease
when the spinouses can touch (kissing spine disease)
41
how can chiro help in degeneration?
assist function
42
how can pharma help in degeneration?
decrease inflammation
43
how can surgery help in degeneration?
joint replacement
44
how can social support help in degeneration?
decrease stress, increase social function
45
how can physiotherapy help in degeneration?
increase circulation, decrease pain
46
where is the source of pain in degeneration?
```
distention of joint capsule
contracture of joint capsule
muscle spasms
periosteal elevation
direct pressure on subchondral bone
```
47
what are the consequences of degeneration?
```
loss of muscle strenght
decreased ROM
limited function
crepitus
joint effusion
depression/anxiety
```
48
what is DISH?
exuberant hypertrophic changes involving the anterior vertebral body margins
49
symptoms/signs of DISH
```
very common
males over 50
incidence among diabetics
may be asymptomatic
neck stiffness
dysphagia in 20%
hoarseness
```
50
where does DISH occur?
ALL of middle and lower thoracic, upper lumbar and lower cervical regions
51
define entheseopathy
pathological osseous proliferation at tendon or ligament insertion
it is degenerative and inflammatory
52
what are the radiographic signs you would see with DISH
flowing ossification of the anterior vertebral body margins with ankylosis
preservation of disc height (or minimal evidence of disease)
absence of sacroiliits (excludes AS)
53
what is OPLL?
ossification of the PLL, seen as a radiolucent line along the posterior aspect of the vertebral bodies
54
what can OPLL be associated with?
DISH, but doesn't have to
55
what can OPLLr result in?
loss of sagittal diameter of spinal canal, with resultant myelopathy
56
OPLL is present in __% of DISH patients.
40-50%
57
what are signs and symptoms of OPLL?
abnormalities are insidious
sensory and motor disturbances in the legs
progressive difficulty walking
paresthesias and diminished tactile senses over gradually increasing areas
58
what is a common treatment of OPLL?
laminectomy
59
if you see someone who has OPLL, what do you do?
send them for a neurosurgical consult
MR, CT
do NOT adjust
60
what are indications for imaging (MRI)?
```
true radicular symptoms
evidence of NR irritation
failed conservative treatment
surgical candidate
red flags
```
61
prevalence of disc herniations are similar in who?
low back pain and radiculopathy patients
62
radiculopathy patients are more likely to have what?
extrusions and nerve root compression
63
is there a correlation between severity of disease and function and apin?
no
64
who usually has a better sense of health?
patients who were blinded
65
red flags for potentially serious conditions
```
features of cauda equina syndrome
significant trauma
weight loss
history of cancer
fever
IV drug use
steroid use
patient age over 50 years
severe, unremitting night-time pain
pain that gets worse when patient is lying down
```
66
what aer the most common complaints of people with herniations?
back pain
| worse with sneezing, flexion, sitting and bowel function
67
only __% of back pain patients suffer from a disc herniation
5%
68
what is the prevalence of herniations among the asymptomatic patients?
20-35%
69
what are some predictive factors of herniations if they don't have symptoms?
lesion size and direction
canal size, ligamentum flavum hypertrophy
temporal/phase of herniation
70
what is the prognosis of a herniation?
good
71
what is the most serious complication of a herniation?
cauda equina syndrome
72
what is cauda equina syndrome?
one of the most serious complications of disc herniations
73
herniated discs do what to nerves that cause cauda equina syndrome?
compress multime nerve roots
74
what are the symptoms of cauda equina syndrome? what do you do?
```
altered bowel and bladder function
impotence
saddle paresthesia
progressive muscle atrophy
immediate neurosurgical consultation
```
75
what are some examples of aggressive management of disc herniations?
```
percutaneous discectomy
microdiscectomy
discectomy (MC)
laminectomy
chemonucleolysis
```
76
surgery foe a disc herniation is considered if...
there is cauda equina syndrome
lack of progress with conservative care
muscle atrophy
too much pain
77
what are some forms of conservative care for disc herniations?
```
chiropractic
limited bed rest
drugs
injections
physical therapy
acupuncture
```
78
midline disc herniations in the cervical spine cause what?
myelopathies
79
lateral disc herniations in the cervical spine cause what?
compresses the NR below
80
midline/paracentral herniations in the lumbar spine do what?
compress NR below
81
foraminal disc herniation in lumbars involve what?
compression of the nerve root at the same level
82
what is the best imaging for disc herniations?
MRI
83
what is the function of the IVD?
nucleus and annulus work together to dampen forces
84
what does proper function of the disc depend on?
integrity of the compoenets of the disc
stability of annulus
hydration of nucleus
separation offered by endplates
85
describe the pathway that leads to injury of the nucleus of a disc?
decreased oxygen-->decreased chondrocytes-->decreased proteoglycans-->decreased water-->increased annular stress-->increased annular fissures
86
the natural cohesion of the nucleus is denatured by what?
endplate fractures and blood exposure
87
what are the contents of the spinal canal?
```
thecal sac (cord, cauda equina)
epidural fat
internal vertebral plexus
ligamentum flavum
PLL
```
