Lumbar, Thoracic, Cervical Spine (Exam 3)

Question 1

Second leading cause of all MD visits in U.S.

Answer 1

Lumbar Spine Problems

Question 2

Lordotic Curve

Answer 2

Concave Posteriorly

Question 3

Outer wall composed of concentric rings of fibrocartilage.

Answer 3

Annulus

Question 4

Gelatinous center.

Answer 4

Nucleus Pulposus

Question 5

Contains nucleus. Provides stability. Enhances movement b/w vertebral bodies. Shock absorption.

Answer 5

Annulus

Question 6

Transmit forces. Equalizes stress. Promotes movement.

Answer 6

Nucleus Pulposus

Question 7

Movement of spine from flexion to extension the nucleus moves _______.

Answer 7

Anteriorly

Question 8

Movement of spine from extension to flexion the nucleus moves ______.

Answer 8

Posteriorly

Question 9

Injury from sudden violent force or repeated stress.

Answer 9

Ligament Sprains

Question 10

Limited ability to heal and repair itself due to not having an intense vascular response to injury.

Answer 10

Vertebral Disk Injuries

Question 11

More common posteriorly. Due to weaker and narrower posterior longitudinal ligament (PLL).

Answer 11

Protrusions/Herniations

Question 12

Nucleus bulges against intact annulus.

Answer 12

Disk Protrusion

Question 13

Nucleus extend through annulus but nuclear material remains confined by PLL.

Answer 13

Extruded Disk

Question 14

Nucleus is free within the canal.

Answer 14

Sequestrated Disk

Question 15

More common in young to middle-aged adults.

Answer 15

Herniated Nucleus Pulposus (HNP)

Question 16

Not as common in older individuals due to changes with aging such as decreased water content and increased collagen.

Answer 16

HNP

Question 17

Symptoms are experienced further down the arm/leg.

Answer 17

Peripheralization

Question 18

Radiating pain originating from the spine and referred distally is made to move away from the periphery and toward the mid-line of the spine.

Answer 18

Centralization

Question 19

With a _____ shift, extension may increase pain, unless it is reduced prior to performing extension.

Answer 19

Lateral

Question 20

Reduce pain. Protect affected area from unwanted stress and forces while encouraging and promoting movement. Increase muscle strength, endurance, and flexibility. Counsel patient concerning correct body mechanics.

Answer 20

General Objectives of HNP

Question 21

Nucleases is reduced to a more anterior position and away from impingement.

Answer 21

Prone Extension Progression

Question 22

Prone Extension Progression Steps

Answer 22

Prone on pillow. Prone. Prone with pillow under chest. Prone on elbows. Prone press-ups. Press-ups with overpressure.

Question 23

Proper body mechanics. Sitting with lumbar roll. Avoid flexion positions.

Answer 23

Maintain neutral lordotic posture.

Question 24

Goal is to relieve pain and inflammation. Doesn’t fix the problem.

Answer 24

Epidural steroid injection.

Question 25

Remove the nonviable portion of the disk, thus decompressing the nerve root that is affected. Examples: Laminectomy, discectomy, fusion.

Answer 25

Surgical Intervention

Question 26

Men twice as common as women. Late middle age and older.

Answer 26

Spinal Stenosis

Question 27

Due to degenerative arthritic changes that encroach on canal, producing nerve root impingement.

Answer 27

Spinal Stenosis

Question 28

Common with extension. Especially walking. Radicular ache into thighs and calves. Paresthesias into LE. Feels better with walking in flexion with cart, walker.

Answer 28

Spinal Stenosis Symptoms

Question 29

Treatment of Spinal Stenosis

Answer 29

Avoid extension. Patient education on body mechanics and posture. General conditioning. Flexion exercises (William's Flexion). Posterior pelvic tilt, knee to chest, and partial sit-ups.

Question 30

Osteophytes formation at the superior and inferior margins of vertebral bodies.

Answer 30

Spondylosis

Question 31

Bony defect in the pars interarticularis of the posterior spine.

Answer 31

SpondyLOLsis

Question 32

Collar on "Scotty Dog"

Answer 32

SpondyLOLsis

Question 33

Forward slippage of one superior vertebra over inferior vertebra (usually L4-L5, L5-SI) due to instability caused by defect in pars interarticularis.

Answer 33

SpondyLOListhesis

Question 34

Grade I of Slippage

Answer 34

0-25%

Question 35

Grade II of Slippage

Answer 35

25-50%

Question 36

Grade III Slippage

Answer 36

50-75%

Question 37

Grade IV Slippage

Answer 37

75-100%

Question 38

Force producing fracture such as compression, flexion-rotation.

Answer 38

Lumbar Spine Fractures

Question 39

Elderly persons many thoracic and high lumbar fractures due to _____.

Answer 39

Osteoporosis

Question 40

Osteoporosis causes anterior wedging and creates kyphotic curve.

Answer 40

Thoracic Kyphosis

Question 41

Any lateral curvature of the spine.

Answer 41

Scoliosis

Question 42

Usually idiopathic.

Answer 42

75-85%

Question 43

Can also result from neuromuscular causes, degenerative disease, osteoporosis, trauma, and post surgical factors.

Answer 43

Scoliosis Causes

Question 44

Irreversible lateral curve with fixed rotation of vertebrae. Curve is not reversed by moving or changing position.

Answer 44

Structural Scoliosis

Question 45

Reversible curve. Lateral curve dissipates with positional changes.

Answer 45

Nonstructural Scoliosis

Question 46

Common among athletes and with MVA's.

Answer 46

Muscle Strains

Question 47

Muscles commonly involved in muscle sprains/strains.

Answer 47

SCM, traps, scalene, erectors, rhomboids, and levator scapulae.

Question 48

Mechanisms of Injury Muscle Sprains/Strains

Answer 48

Hyperflexion, rotation, lateral flexion (of head and C-spine).

Question 49

Chronic degenerative disk from wear and tear on WB structure of the C-Spine.

Answer 49

Cervical Spondylosis

Question 50

Most common in 40's, 50's. Men > Women. C5-C6, C6-C7 most common segments.

Answer 50

Cervical Spondylosis

Question 51

Compression of vascular or neurologic tissues as they exit the superior triangle opening of thorax. Compressed subclavian artery/vein, brachial plexus.

Answer 51

Thoracic Outlet Syndrome (TOS)

Question 52

Cervical rib, shortened or hypertrophied anterior scalene, maluninon of clavicle, sublimed 1st thoracic rib.

Answer 52

Causes of Compression TOS

Question 53

Chronic inflammatory auto-immune disease. Most common in Males.

Answer 53

Ankylosing Spondylitis

Question 54

Average at age 23 (20-40). Early symptoms are pain and stiffness. Eventually spinal joints fuse together.

Answer 54

Ankylosing Spondylitis

Question 55

Outer 2/3 of annulus innervated by _______.

Answer 55

Sinuvertebral Nerve

Question 56

Reduce inflammation, restore function, and protect affected area.

Answer 56

Treatment goals for muscle strains.

Question 57

Initial care for muscle strains.

Answer 57

Modalities, NSAIDS, protection.

Question 58

After acute healing for muscle strains.

Answer 58

Submax isometrics, stretching.

Question 59

Sub acute muscle strains.

Answer 59

Extensor exercises, abdominal stabilization exercises.

Question 60

Bed Exercises Post-Op

Answer 60

Ankle pumps, quad sets, glut sets, proper breathing. Avoid valsalva maneuver.

Question 61

Progression Post-Op

Answer 61

Extension (active), avoid flexion, pelvic tilts, ROM.

Question 62

Before general conditioning program.

Answer 62

Increased motion, controlled pain, improved endurance, strength.

Question 63

Stretching of PLL, muscle fatigue, postural syndromes, and neurological syndromes.

Answer 63

Pain of thoracic kyphosis is caused by.

Question 64

Posterior pevlic tilt, knee to chest, partial sit-ups.

Answer 64

Flexion Exercises (William's Flexion) Treatment for Spinal Stenosis