Disc Herniations

Question 1

What is the true definition of a disc herniation?

Answer 1

Projection of nuclear material through the annulus into the canal

Question 2

Are disc herniations common?

Answer 2

NO; only 5% of back pain patients suffer from disc herniation

Question 3

What is the gold standard imaging procedure to diagnosis a disc herniation?

Answer 3

MRI

Question 4

How does the pain typically present with a disc herniation?

Answer 4

IMMEDIATELY

Question 5

What is the most common complaint of patients with a disc herniation?

Answer 5

Back pain

Question 6

What kinds of activities make the pain of a disc herniation work?

Answer 6

Sneezing, flexion, sitting, bowel movement

Question 7

What is one of the most serious complications of a disc herniation?

Answer 7

Cauda Equina syndrome (1-16%)

Question 8

What is cauda equina syndrome?

Answer 8

Compression of multiple nerve roots leading to altered bowel and bladder function, saddle paresthesia, muscle atrophy, and impotence

Question 9

What neurological test can be used to assess for myelopathy?

Answer 9

Lhermitte’s

Question 10

What kind of canal can lead to asymptomatic herniations?

Answer 10

Increased canal size

Question 11

What is the most common treatment for a herniated disc?

Answer 11

Discectomy

Question 12

What is the most common age range for a disc herniation?

Answer 12

25-40 (which discs are juicy)

Question 13

A C5/C6 disc herniation would compress which nerve root?

Answer 13

C6

Question 14

What kinds of symptoms arise from a midline disc herniation in the cervicals?

Answer 14

Myelopathies

Question 15

What kind of directional disc herniation causes nerve route compression below in the cervicals?

Answer 15

Lateral

Question 16

What type of disc herniation in the lumbars will compress the nerve root BELOW? The nerve root at the same level?

Answer 16

BELOW = midline/paracentral

SAME LEVEL = foraminal

Question 17

A L5/S1 foraminal disc herniation will compress what nerve root?

Answer 17

L5 nerve root

Question 18

A L5/S1 midline disc herniation will compress what nerve root?

Answer 18

S1

Question 19

Which types of disc herniations in the cervicals is most significant due to the compressive of the nerve root below? Lumbars?

Answer 19

Cervicals = lateral
Lumbars = midline/paracentral

Question 20

What is the function of the IVD?

Answer 20

Dampen forces

Question 21

What three things must be intact and functional for the IVD to successful work to dampen forces?

Answer 21

1 stability of annulus
2 hydration of nucleus
3 separation offed by endplates

Question 22

What is the technique used by injecting a water-based or oil-based contrast into subarachnoid space to asses for disc herniations?

Answer 22

Myelography

Question 23

What is the technique used by injected radiopaque contrast into the nucleus pulpous to image morphology?

Answer 23

Discography

Question 24

How does discography show a present disc herniation?

Answer 24

Contrast will leak into spinal canal

Question 25

Why are discography and myelography considered inferior to CT or MRI?

Answer 25

Invasive due to injection

Question 26

If a disc herniation is visible on CT, what would be the FINDING?

Answer 26

Paracentral protrusion

Question 27

What are the contents of the spinal canal?

Answer 27

``` 1 thecal sac 2 epidural fat 3 internal vertebral plexus 4 ligamentum flavus 5 PLL ```

Question 28

What are the MRI findings of a disc herniation?

Answer 28

``` 1 focal bulge 2 obliterated epidural fat 3 deformed theca 4 displaced nerve roots 5 decreased MRI signal ```

Question 29

What are the four steps of classification for a disc herniation?

Answer 29

1 bulge 2 protrusion 3 extrusion 4 sequestration

Question 30

Which step of a disc herniation involves more than 25% of the disc diameter?

Answer 30

Bulge

Question 31

Which step of a disc herniation involves a free fragment of disc material with no connection to the disc?

Answer 31

Sequestration

Question 32

Which step of a disc herniation involves less than 25% of the disc diameter and the base is wider than the herniation?

Answer 32

Protrusion

Question 33

Which step of a disc herniation involves less than 25% of the disc diameter and the base is narrower than the herniation?

Answer 33

Extrusion

Question 34

Which step of a disc herniation is a true focal lesion and a complete disruption of the annulus?

Answer 34

Extrusion

Question 35

An area of high signal intensity on T2-weighted MRIs of a disc can indicate what?

Answer 35

Fissure or tear of the annulus

Question 36

Which congenital condition can lead to spinal stenosis?

Answer 36

Achondroplasia

Question 37

Spinal stenosis of the cervical spine is seen at what measurement? Lumbar spine?

Answer 37

``` Cervicals = less then 12 mm Lumbars = less than 15 mm ```

Question 38

How is the spinal canal measurement obtained?

Answer 38

Anterior line (through posterior aspect of vertebrae) to posterior line (through spinolaminar line)

Question 39

What imaging system is best used to determine spinal stenosis?

Answer 39

CT or MRI (X-rays are prone to distortion and only 2D)

Question 40

What are the three types of spinal stenosis?

Answer 40

1 central 2 neuroforaminal 3 lateral recess

Question 41

What are the general symptoms of spinal stenosis?

Answer 41

Radicular in nature