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Lecture 5 - finished Flashcards

(20 cards)

1
Q

IVD degeneration epidemiology

A

Common in adults, esp those 50+

Most common in the L4-L5 and L5-S1 regions

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2
Q

Pathology of IVD degeneration

A
Biochemical changes:
- With aging, several biochemical changes are observed in the IVD
- The IVD progressively becomes more desiccated, stiff and less able to resist mechanical forces 
= reduced proteoglycan synthesis
= reduction in proteoglycan size
= reduced water content
= increased collagen content
= reduced elastin content
Degeneration:
- Decreased ability to resist shear forces
    = fissures in annulus fibrosis
- Increased forces on endplates
    = Endplate micro-fractures may occur

** as a result of annulus fibrosis and end plate microfractures there is acute inflammation and healing

Fissures:
- Causes hernitations of nucleus pulposus, which can happen either in the
- vertebral end plate = schmorls nodes
OR
- CNS = Spinal nerve impingement or spinal cord impingement

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3
Q

What biochemical changes occur in IVD degeneration?`

A
= reduced proteoglycan synthesis
= reduction in proteoglycan size
= reduced water content
= increased collagen content
= reduced elastin content
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4
Q

What does a decrease in water content do to discs? What does this eventually lead to?

A

Decreased disc hydrostatic pressure
Decreased nucleus pulposus elasticity
Decreased disc height (i.e. flattening)

This eventually leads to altered biomechanical properties

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5
Q

What can fissures in the annulus fibrosis lead to?

A

Herniation of nuclear material into:

  • the spinal cord
  • the spinal nerves

Herniation into the intervertebral endplates causes:

  • Schmorls nodes
  • Reactive bone growth
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6
Q

When herniations into the intervertebral end plates cause reactive bone growth, how does this manifest?

What do these manifestations result in?

A

Osteophytes
Lipping

They result in spondylosis (= spinal degeneration)

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7
Q

How does disc degeneration result in facet joint spondylosis?

A

IVD degenerates and flattens
The facet joint becomes misaligned
The facet develops secondary OA
The facet develops spondylosis

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8
Q

How does spondyolsis worsen?

A
Increases osteophyte production
Narrowing of spinal canal
Narrowing of IV foramina
Nucleus pulposus becomes fibrocartilage
Fibrosis of affected structures
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9
Q

What is the main manifestation of chronic disc degeneration?

A

Pain

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10
Q

What can cause pain from chronic disc degeneration?

A
Facet misalignment
Facet joint arthritis
Vertebral instability
Root canal stenosis
Spinal canal stenosis
PLL tension and ossification
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11
Q

Is spinal spondylosis associated with back/neck pain?

A

No

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12
Q

Describe a partial herniation:

A

Fibrocartilagenous material extrudes/bulges posteriorly
The annulus usually bulges to one side of the PLL
The degree of the partial herniation gradually increases with successive injuries

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13
Q

Describe a posterolateral rupture:

A

May press on a nerve root proximal to its point of exit through the IV foramen
- e.g. L4/L5 herniation causes compression of the 5th lumbar root

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14
Q

Describe a large central herniation

A

Herniation of both the capsule (annulus fibrosis) and the nucleus pulposus
- may result in compression of the spinal cord or cauda equina.

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15
Q

Describe a complete herniation

A

Herniation where part of the nucleus may:

  • break free and lie free in the spinal canal
  • break loose and work its way into the IVF
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16
Q

What are some characteristic of cervical IVD herniation?

A

Neck pain
Neck stiffness
+/- upper limb neuro ssx
Spinal cord compression ssx

17
Q

What are some lumbar symptoms of IVD herniation?

A
Lumbar pain and tenderness
Lumbar muscle spasm
Lumbar stiffness and reduced ROM
\+/- sciatica
\+/- paraesthesia
18
Q

To what side will someones posture lean if they have a disc prolapse that is protruding medial to the spinal nerve?

A

They will lean/tilt towards the painful side

19
Q

To what side will someone posture lean if they have a disc prolapse that is protruding lateral to the spinal nerve?

A

They will lean away from the painful side

20
Q

Signs of posterolateral cervical IVD herniation

A
  • Limitations of certain neck movements (one movement will usually be free)
  • Full ROM in upper limb
  • Slight muscle wasting in the upper limb
  • Slight sensory impairment in the cervical nerve distribution
  • Abnormal tendon reflex in the corresponding cervical supply

** any variation and combination of the above might happen