4) Spine & Neck

Question 1

What should healthy discs have a lot of?

Answer 1

Water

Question 2

Spine-Related Problems

Answer 2

• Fx
• Inflammation
• Radiculopathy
• Myelopathy
• Stenosis
• Discogenic Pain
• PN
• Double Crush Syndrome
• Metabolic
• Tumor
• Infection
• Spondylolisthesis

Question 3

Myelopathy

Answer 3

Pressure on the spinal cord itself

Question 4

Spondylolisthesis

Answer 4

Benign developmental defect where one vertebral body slips on another; Common in pre-adolescent female gymnasts

Question 5

Non-Spine Related Problems

Answer 5

• Visceral Issues
• Endocrine Issues
• Hematologic Issues
• Vascular Claudication
• MS or ALS
• Hip Problems
• ST jt pain
• Psychogenic Pain
• Steroid Use
• Cholesterol Meds

Question 6

Cauda Equina Syndrome

Answer 6

Pt loses B&B fxn, sexual fxn, etc

Question 7

Anterior Lumbar Interbody Fusion (ALIF)

Answer 7

Done for painful degenerative lumbar disc disease; Often combined w/posterior approach for better stabilization

Question 8

Advantages of ALIF

Answer 8

• Doesn’t disturb lumbar musculature
• Graft is placed anteriorly so there’s less compression
• Wide exposure is good for multi-level fusion
• Don’t need to retract nerve roots so there’s less chance of nerve damage
• Higher fusion rate than PLIF

Question 9

Kyphoplasty

Answer 9

Uses a balloon to reduce vertebral compression fx’s

Question 10

Vertebroplasty

Answer 10

Inserts cement into a fx from trauma, tumor, or osteoporosis

Question 11

Posterior Lumbar Interbody Fusion (PLIF)

Answer 11

Done for spondylolisthesis, discogenic LBP, or radicular pain

Question 12

Sx’s of saddle anesthesia

Answer 12

B&B or sexual dysfunction

Question 13

True or false: Saddle anesthesia is a red flag & a medical emergency?

Answer 13

True

Question 14

PT Goals

Answer 14

• Relieve sx’s
• Prevent progression & recurrence of sx’s
• Emphasize independence

Question 15

What part of the spine is the most common place to see degenerative disc changes?

Answer 15

Lumbar Spine

Question 16

Pattern of degenerative disc changes in 20y/o

Answer 16

Genetics or Athletes

Question 17

Pattern of degenerative disc changes in 30y/o

Answer 17

Macroscopic changes

Question 18

What part of the intervertebral disc sees changes? What are the changes & why are they a problem?

Answer 18

• Nucleus Pulposus

* Can’t hold on to H20 anymore so it gets dehydrated, thicker, & fibrotic so the disc doesn’t shock absorb anymore

Question 19

Other things that happen w/disc degeneration

Answer 19

• Annulosis fibrosis tear
• Disc collapse
• Vertebral compression

Question 20

Risk factors for disc degeneration

Answer 20

• Age
• BMI
• Genetics
• Smoking
• Atherosclerosis
• Psychosocial Factors

Question 21

What 3 conditions are associated w/disc degeneration?

Answer 21

Spinal Stenosis, Spondylolithesis, & Cauda Equina Syndrome

Question 22

Spinal Stensosis

Answer 22

Narrowing of spinal & central canal

Question 23

Neurogenic Spinal Stenosis

Answer 23

Spinal stenosis w/radiating pain, parasthesia, numbness, & tingling

*Its important to know what exacerbates the pt’s sx’s

Question 24

Vascular Spinal Stenosis

Answer 24

Spinal stenosis exacerbated by physical activity

Question 25

Where is the most common place for spondylothesis to occur?

Answer 25

L4-L5

Question 26

Sx’s of cauda equina syndrome

Answer 26

Pain in upper sacrum, butt, or genetalia parasthesia