L8: Spinal Degenerative Diseases Flashcards
(97 cards)
1
Q
A
2
Q
Pathology in Degenerative Disease of the Spine
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3
Q
Symptoms of Spinal Degenerative Diseases
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4
Q
Red Flags of Spinal Degenerative Diseases
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5
Q
Red Flags of Spinal Degenerative Diseases
- Cauda Equina Syndrome
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6
Q
Red Flags of Spinal Degenerative Diseases
- Myelopathy
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7
Q
Red Flags of Spinal Degenerative Diseases
- Radiculopathy
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8
Q
Red Flags of Spinal Degenerative Diseases
- Others
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9
Q
RF for Spinal Degenerative Diseases
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- Aging.
- Genetic predisposition.
- Smoking, diet, weight.
- Occupational (heavy lifting).
- Sedentary lifestyle.
10
Q
Types of Spinal Degenerative Diseases
A
A) Disc bulge.
B) Annular tear.
C) Herniation.
11
Q
Def of Disc Bulge
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12
Q
Types of Annular Tear
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13
Q
Def of Disc Herniation
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14
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Types of Disc Herniation
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Notes
15
Q
Types of Disc Herniation
- Protrusion
A
The base of the herniated disc material is broader than the apex.
16
Q
Types of Disc Herniation
- Extruded Disc Herniation
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The base of the herniation is
narrower han the apex (toothpaste sign)
17
Q
Types of Disc Herniation
- The Third Type?
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18
Q
Regions Affected by Disc Herniation
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19
Q
Epidemeology of Lumbar Disc Prolapse
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20
Q
Classification of Lumbar Disc Prolapse
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- According to Location
- According to Anatomy
21
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Classification of Lumbar Disc Prolapse
- Acoording to location
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22
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Classification of Lumbar Disc Prolapse
- Central Prolapse
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- Often associated with back pain only
- May present with Cauda equina syndrome (surgical emergency)
23
Q
Classification of Lumbar Disc Prolapse
- Posterolateral Prolapse (Paracentral)
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24
Q
Classification of Lumbar Disc Prolapse
- Foraminal Prolapse (Far Lateral, Extraforaminal)
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Classification of **Lumbar Disc Prolapse**
- Axillary Prolapse
Can affect Both exiting and descending nerve roots
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Classification of **Lumbar Disc Prolapse**
- According to Anatomy
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Dx of **Lumbar Disc Prolapse**
- Physical Examination
- Imaging
- Neurophysiological
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Dx of **Lumbar Disc Prolapse**
- Imaging
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Symptoms of **Lumbar Disc Prolapse**
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Def of **Cauda Equina Syndrome**
Serious neurologic condition in which damage to the cauda equina
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Symptoms of **Cauda Equina Syndrome**
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**Lumbar Disc Prolapse**
- L4
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**Lumbar Disc Prolapse**
- L5
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**Lumbar Disc Prolapse**
- S1
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Provocative Tests in **Lumbar Disc Prolapse**
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DDx of **Lumbar Disc Prolapse**
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Management of **Lumbar Disc Prolapse**
1) Conservative (Non operative)
2) Selective nerve root corticosteroid injections
3) Surgical
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Management of **Lumbar Disc Prolapse**
- Conservative
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Conservative Management of **Lumbar Disc Prolapse**
- Indications
1) First line of treatment for most patients with disc herniation
2) 90% improve without surgery
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Conservative Management of **Lumbar Disc Prolapse**
- Methods
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Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse**
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Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse**
- Indication
Second line of treatment if therapy and medications fail
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Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse**
- Methods
- Epidural
- Selective nerve block
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Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse**
- Outcome
- Leads to long lasting improvement in 50% compared to ~90% with surgery)
- Results best in patients with extruded discs is opposed to contained
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Surgical TTT of **Lumbar Disc Prolapse**
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Surgical TTT of **Lumbar Disc Prolapse**
- Indications
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Surgical TTT of **Lumbar Disc Prolapse**
- Methods
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Complications of **Surgical TTT of Lumbar Disc Prolapse**
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Symptoms of **Cervical Disc Prolapse**
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Symptoms of **Cervical Disc Prolapse**
- Sites Affected
1) Back of the skull
2) Neck
3) Shoulder girdle
4) Scapula
5) Arm and hand.
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Symptoms of **Cervical Disc Prolapse**
- Examples
1) Pain (neck, shoulder, arm, hand).
2) Radiculopathy.
3) Numbness.
4) Muscle weakness.
5) Paresthesia.
6) Severe cases: myelopathy + sphincteric disturbance (urinary incontinence and loss of bowel control).
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Symptoms of **Cervical Disc Prolapse**
- C4/C5
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Symptoms of **Cervical Disc Prolapse**
- C5/C6
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Symptoms of **Cervical Disc Prolapse**
- C6/C7
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Symptoms of **Cervical Disc Prolapse**
- C7/T1
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Dx of **Cervical Disc Prolapse**
- Ex
- Radiology
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Dx of **Cervical Disc Prolapse**
- Ex
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Dx of **Cervical Disc Prolapse**
- Cervical Compression Test & (Spurling's test)
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Dx of **Cervical Disc Prolapse**
- Lhermitte Sign
Feeling of electrical shock with patient neck flexion
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Dx of **Cervical Disc Prolapse**
- Hoffman Sign
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Dx of **Cervical Disc Prolapse**
- rads
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TTT of **Cervical Disc Prolapse**
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TTT of **Cervical Disc Prolapse**
- Conservative
- Medications (NSAID).
- Physical therapy and exercise.
- Steroid injection.
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TTT of **Cervical Disc Prolapse**
- Surgery
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Def of **Spinal Canal Stenosis**
Abnormal narrowing (stenosis) of spinal canal that may occur in any of the regions of the spine → restriction to the spinal canal → neurological deficit
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Risk Factors for **Lumbar Canal Stenosis**
1) Caucasian race
2) Increased BMI
3) Congenital spine anomalies (20%)
4) Failure of posterior elements to develop, short pedicles and laminae
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Classification (Types) of **Lumbar Canal Stenosis**
1) Central stenosis
2) Lateral recess stenosis
3) Foramen stenosis
4) Extraforaminal Stenosis
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Symptoms of **Lumbar Canal Stenosis**
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Symptoms of **Lumbar Canal Stenosis**
- Neurogenic Claudication
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Signs of **Lumbar Canal Stenosis**
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Management of **Lumbar Canal Stenosis**
- Non-Operative
- Operative
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Management of **Lumbar Canal Stenosis**
- Non-Operative
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Non-Operative Management of **Lumbar Canal Stenosis**
- Modalities
Oral medications, physical therapy, and corticosteroid injections
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Non-Operative Management of **Lumbar Canal Stenosis**
- Indications
First line of treatmen
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Non-Operative Management of **Lumbar Canal Stenosis**
- Modalities (Explained)
**1) NSAIDS, physical therapy, weight loss and bracing:**
- Preoperative opioid use associated with prolonged hospital stays and increased postoperative pain.
**2) Steroid injections (epidural and transforminal):**
- Found to be effective and may obviate the need for surgery
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Surgical Management of **Lumbar Canal Stenosis**
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Surgical Management of **Lumbar Canal Stenosis**
- Wide PTP Decompression
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Surgical Management of **Lumbar Canal Stenosis**
- Wide PTP Decompression with instrumented fusion
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Def of **Spondylosis**
- Broad term meaning degeneration of the spinal column from any cause.
- In the more narrow sense it refers to spinal osteoarthritis, age-related wear and tear of the spinal column (most common cause of spondylosis)
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Def of **Spondylolishthesis**
An anterior displacement of a vertebra relative to the vertebra below.
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Grading of **Spondylolishthesis**
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Etiological Classification of **Spondylolishthesis**
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CP of **Spondoylolishthesis**
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Management of **Spondoylolishthesis**
- Non Operatice
- Operative
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Management of **Spondoylolishthesis**
- Non-Operative
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Non-Operative Management of **Spondoylolishthesis**
- Examples
Oral medications, lifestyle modifications, therapy
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Non-Operative Management of **Spondoylolishthesis**
- Techniques
1. Activity restriction.
2. NSAID.
3. Role of injections unclear.
4. Bracing may be beneficial especially in the acute phase.
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Non-Operative Management of **Spondoylolishthesis**
- Indications
Most patients can be treated nonoperatively
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Operative Management of **Spondoylolishthesis**
- L5-S1 Decompression & Instrumented Fusion +- Reduction
- L4-S1 Decompression & Instrumented Fusion +- Reduction
- ALIF
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Operative Management of **Spondoylolishthesis**
- L5-S1 Decompression & Instrumented Fusion +- Reduction
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Operative Management of **Spondoylolishthesis**
- L5-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
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Operative Management of **Spondoylolishthesis**
- L5-S1 Decompression & Instrumented Fusion +- Reduction (Reduction)
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Operative Management of **Spondoylolishthesis**
- L4-S1 Decompression & Instrumented Fusion +- Reduction
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Operative Management of **Spondoylolishthesis**
- L4-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
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Operative Management of **Spondoylolishthesis**
- ALIF
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Operative Management of **Spondoylolishthesis**
- ALIF (Indications)
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Operative Management of **Spondoylolishthesis**
- ALIF (Outcomes)
