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Flashcards in Spine Deck (52):
1

How many degrees of fredom are available in the spine?

6

2

Describe Fryette's laws of spinal biomechanics?

C-spine: side bend and rot occur to the same side; Lumbar and thoracic in neutral SB and Rot occur to the opposite side; Lumbar and thoracic in flex SB and rot same side; in reality spinal movement is highly variable in the thoracolumbar

3

Normal ranges for C0-C1

10-15 flex/ext, 8 degrees lateral flexion

4

Normal ranges: C1-2

10 flex/ext, 45 rot

5

Normal ranges: C3-7

64 flexion, 24 ext, 40 lateral flexion, 40 rot

6

Normal ranges: T1-S1

80 flex, 25 ext, 45 rot, 35 lat flexion

7

Angle of the facets for cerv, thoracic, lumbar:

Cerv: 45; thoracic: 60; lumbar vertical

8

Loads on the back when seated, standing forward bend, and seated forward bend?

145%, 150%, 180%

9

What level does the conus medullaris end?

L1-L2

10

How are facets innervated?

from one segment below and above

11

What happens during the straight leg raise test?

Neural movement: 0-30degrees slack is taken up, 35-70 the nerve root moves, 70-90 all structures are stretched

12

How effective are lumbosacral corsets for relief of spinal disk pressure?

Approximately 20-30% reduction in max disk load

13

What is the problem with supine situps in relation to the back:

high disk pressure therefore should be limited ~210% pressure

14

Chronic low back pain recruitment of erector spinae vs normal subjects shows what:

earlier and longer recruitment

15

What effect can a >3cm leg length discrepancy have on the lumbar spine?

Asymmetry in lateral bending during gait leading to accelerated degeneration

16

What is the role of bed rest in acute back pain

It should be limited, rest from activity but not from function except severe neurlogic involvement

17

Function of the intervertebral disk:

provides space and position; permits, guides, and restrains motion in all directions

18

What position facilitates disk nutrition?

sidelying or supine with knees bent

19

What is the source of diskogenic pain?

Healing response with vascularization and nerve growth causes pain

20

Describe stiffness in the low back

may occur after an acute injury with lack of movement resulting in collagen cross binging or fibrous adhesions

21

Describe mechanical block in the low back:

at L4/5 after stooping to pick up an object the joint may become locked in SB'ing; potentially related to a torn or seperated meniscoid or free fragment of articular cartilage

22

Describe painful capsule entrapment:

This is what is thought to happen in the C-spine after an awkward movement with one sided pain

23

Difference between protrusion and herniation?

Annular fibers are intact vs being disrupted

24

How quickly does disk disease resolve:

90-95% resolve in 3-4 months

25

Is intensive or mild exercise better after disk surgery?

Intensive 4-6 wks post surgery

26

Manual therapy and disk herniation, is it warranted?

yes, it can help increase movement and get the muscles to relax

27

What is spinal instability:

Osseoligamentous and neuromuscular components of the spine are unable to hold the spine against aberrant motions and slippage, leading to stress on soft tissues

28

What is the order of soft tissue disruption with forward flexion injury?

supraspinous lig, interspinous lig, facet capsule, and disk

29

What is spondylolisthesis?

anterior slippage of one vertebral body on an adj

30

What is sacral angle?

The angle of displacement of the scarum from the verticle, the scarum becomes more verticle with progressive listhsis

31

What is spondylolysis?

Defect in the vertebra, typically L5 that presents with fractures, especially in the par interarticularis

32

Does spondylolysis always progress to sponylolisthesis?

No

33

Should neurological comprimise be anticipated with spondylolisthesis?

Yes, it can occur with dysplastic and isthmic

34

What is functional scoliosis:

appearant scoliosis caused by a leg length discrepency or muscle spasm

35

When should be bracing be consider for scoliosis?

>20 degrees if progressing, >30 immediately

36

Red flags for metastatic cancer in the back?

History of cancer, night pain or pain at rest, unexplained weight loss, >50 years old or <17 years old, Failure to improve over the predicted time interval

37

Red flags for infection within the disk?

Immunosuppressed, prolonged fever >100.4, Hx of intravenous drug abuse, Hx of recent UTI, celluitis or pneumonia

38

Red flags for undiagnosed vertebral fx?

Prolonged use of corticosteroids, mild trauma age >50, age >70, known Hx of osteoperosis, recent major trauma at any age (fall greater than 5 ft or MVA)

39

Red flags for dangerous AAA

A pulsating mass in the abdomen, a hx of atherosclerotic vascular disease, a throbbing pulsing back pain at rest or with recumbency, > 60 y/o

40

Lumbar Manipulation CPR?

No symptoms distal to the knee, Current episode 35 degrees (4/5 24.38 LR)

41

Is a single red flag in the absence of serious disease worrisome?

No, red flags in isloation have little concern

42

What is lateral vs central stenosis?

Lateral: narrowing occurs within the lumbar intervertebral foramina and/or the nerve root canal, causing, encroachment; Central: narrowing that occurs within the spinal canal

43

What is primary vs secondary stenosis?

Primary: congenital malformation or defect in postnatal development; Secondary: narrowing resulting from aquired conditions such as degenerative changes

44

What are the most common structural changes associated with lumbar stenosis?

Facet joint arthrosis and hypertrophy, bulging, and thickening of the ligamentum flavum, loss of disk are the most common changes contributing to lumbar spinal stenosis

45

How will a lumbar stenosis patient typically present?

> 50 y/o long Hx of low back pain, pain and/or numbness in one or both legs; limited ROM especially ext and will often reproduce the symptoms; symptoms improve with flexion

46

Why does spinal stenosis worsen with standing?

Ext narrows the spinal canal as does axial compression

47

What is neurogenic cladication?

poorly localized pain, paresthesias, and cramping of one or both LE of a neurologic origin; symptoms are worsened with walking and relieved by sitting

48

Are there other conditions that might be confused with lumbar stenosis?

OA of the ihip, vascular claudication, unstable spondylolisthesis, and lumbar intervertebral disk herniation

49

Biggest differentiating factor for other condition from lumbar stenosis:

posture dependent pain with standing/ext vs no pain with sitting; bicycle test vs TM test

50

Most common surgery for lumbar stenosis?

decompression laminectomy; fusion is usually only performed in the presenece of spondylisthesis

51

Can an unweighted TM help patients with lumbar spinal stenosis?

Possible because it unloads the axial compression and may decrease the neurogenic claudication symptoms

52

Common presentation of cervical stenosis patient:

Hyporeflexia, motor weakness, sensory disturbances, Cspine ROM limited, ext may aggravate Sx, may reduced symptoms with traction; + spurlings