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Spine > Acquired Stenosis > Flashcards

Acquired Stenosis Flashcards

1
Q

Spinal Stenosis is:

A

a narrowing of the spinal canal or of the intervertebral foramina through which the nerve root exits.

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2
Q

Causes of SS are classified as:

A

congenital and acquired

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3
Q

SS is one of the most ______ causes of ______

A

SS is one of the most common causes of lumbar dysfunction.

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4
Q

Narrowing can be ______ or ______

A

narrowing can be localized at one level or generalized involving many levels

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5
Q

Congenital stenosis is:

A

a spinal canal that did not reach adequate dimensions during development

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6
Q

Acquired stenosis is:

A

when the dimensions of the spinal canal have been narrowed

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7
Q

Acquired stenosis is comonly the result of:

A

degenerative changes

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8
Q

The 3 primary areas where the lumbar nerve roots can be compressed or irritated are:

A

1 - The central spinal canal
2 - The lateral recess, where the root passes anterior to the superior articular process just before exiting the spinal canal
3 - The intervertebral foramen, through which the root exits the spinal canal

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9
Q

Spinal stenosis becomes symptomatic when:

A

nerve roots are compressed or irritated.

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10
Q

Degenerative changes which can cause narrowing of the lumbar spine can occur in:

A

the intervertebral discs, the facet joints, and the ligamentum flavum

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11
Q

It is believe that the 1st event in lumbar disc degeneration is:

A

a circumferential tear in the annular fibers of the disc

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12
Q

Loss of disc space height can result from:

A
  • more circumferential tears, weakening the annulus fibrosis, allowing the disc to bulge
  • loss of proteoglycan and water content in the gelatinous nucleus pulposus
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13
Q

Loss of disc space height can cause:

A
  • further bulging of the annulus
  • narrowing of the intervertebral foramen
  • bulging of the ligamentum flavum, which narrows the spinal canal
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14
Q

The spinal canal can be narrowed as a result of:

A
  • bulging of the ligamentum flavum secondary to lost disc height
  • bulging of the annulus
  • osteophytes at the edges of the facet joints
  • degenerative spondylolisthesis
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15
Q

__________ can form at the _____ of lumbar facet joints, intruding into _____________
These changes are considered:

A

Hypertrophic spurs called osteophytes can form at the edges of the facet joints, intruding into the central spinal canal. These changes are considered degenerative or osteoarthritis

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16
Q

______ of the superior articular process narrow the _________, compressing the exiting nerve root against the _____ of the _______ body or ______

A

Osteophytes of the superior articular process narrow the lateral recess, compressing the exiting nerve roots against the back of the vertebral body or disk.

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17
Q

Degenerative processes of the intervertebral disc and facet joints alters the _______ properties of the segment ______, which can cause ______ to develop, which results in ______ and __________

A

Degenerative processes of the intervertebral disc and facet joints alters the biomechanical properties of the segment motion, which can cause instability to develop, which results in abnormal motion and malalignment.

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18
Q

__________ is the most frequently encountered example of malalignment due to the degenerative process, commonly occurring at _________

A

Degenerative spondylolisthesis is the most frequently encountered example of malalignment, commonly occurring at the L4-L5 level

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19
Q

With degenerative spondylolisthesis, the ________ of ____________ results in further narrowing of the spinal canal

A

With degenerative spondylolisthesis, the anterior translation of one vertebra on the next results in further narrowing of the spinal canal

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20
Q 
Flexion of the lumbar spine: 
\_\_\_\_ bulging of the discs
\_\_\_\_ the diameter of the central canal
and
\_\_\_\_ the diameter of the intervertebral foramina

Extension of the lumbar spine:
____ the lumbar spinal canal

Axial loading of the spine results in:

A

Flexion of the lumbar spine:
- increases bulging of the discs
- increases the diameter of the central canal
and
- increases the diameter of the intervertebral foramina

Extension of the lumbar spine:
- narrows the lumbar spinal canal

Axial loading of the spine results in:
- bulging or the discs

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21
Q

A symptomatic spinal stenosis pt. with pain in an upright position may obtain relief by:

A

bending forward at the waist

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22
Q

SS Imaging:
X-rays can measure __ diameter
__ diameter of ___ or less = stenosis (Verbiest)

____ x-rays in _____ and ______ postures can capture _____ and ______

A

SS Imaging:
X-rays can measure AP diameter
AP diameter of 10 mm or less = stenosis (Verbiest)

Lateral x-rays in flexed and extended postures can capture abnormal motion between vertebrae and malalignment

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23
Q

Plain x-rays are insensitive for:

A

identifying the contribution of soft tissue or facet hypertrophy to spinal canal stenosis

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24
Q

Axial scans allow measurement of:

A

the spinal canal cross-sectional area

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25
Q

Cross-sectional areas of less than ___ are ___

A

less than 100 mm are defined as stenotic

26
Q

____ provides better images of the bony architecture

A

CT provides better images of the bony architecture

27
Q

____ provides better images of soft tissues

A

MRI provides better images of soft tissue (intervertebral discs, neural elements)

28
Q

The primary complaint of the typical SS pt seeking medical attention is:

A

Pain

29
Q

The age of pt.s with SS is usually:

A

fifties, sixties, or older

30
Q

Pain from SS can be:

A
  • in the lumbar region or radiate down one or both legs

- may or may not follow a specific nerve root problem

31
Q

If pain from SS does follow a specific nerve root, it will:

A

be consistent in reflex, dermatome, myotome pattern

32
Q

If pain from SS does not follow a specific nerve root pattern, pt. may c/o of:

A
  • funny feelings in the legs
  • legs feeling rubbery
  • no pain but progressive weakness in LEs
33
Q

Most consistent finding in pt.s with SS:

A

Their symptoms increase with:

  • lumbar extension
  • walking
34
Q

An important symptom that must be sought out through specific questioning is:

A

bowel and bladder function

35
Q

Neurogenic claudication is:

that usually occurs with:

A
  • c/o pain, numbness, tingling, weakness, or cramping in one or both LE and a common symptom of SS

that usually occurs with
- walking or standing for a long period of time

36
Q

Differentiating neurogenic claudication vs. vascular claudication:

A
  • pt.s with N. claudication can exercise vigorously on a stationary bike without difficulty - they may be able to cont. walking after onset of pain by stooping forward
  • Pt.s with V. claudication have problems with prolonged LE activity, regardless of position
37
Q

Common findings of SS pt.s upon Exam:
- they may be able to ______ easily
- ____ causes pain and may be limited
- frequently a ______ of physical findings
- Ms. spasm is ____
- Sensation/Strength are frequently ____
- reflexes are _____ or _____
- n. root tension signs are usually ____
- weakness suggests ____________
- active reflexes should alert PT to possibility of coexisting __________
(present in __%-__% of lumbar stenosis pt.s)
- pt.s with normal neurological exams may develop neurological deficits if examed after ____________

A
  • they may be able to bend fwd easily
  • Ext causes pain and may be limited
  • frequently a paucity of physical findings
  • Ms. spasm is rare
  • Sensation/Strength are frequently normal
  • reflexes are normal or diminished
  • n. root tension signs are usually absent
  • weakness suggests severe disease
  • active reflexes should alert PT to possibility of coexisting cervical stenosis (present in 15%-20% of lumbar stenosis pt.s)
  • pt.s with normal neurological exams may develop neurological deficits if examed after walking a distance
38
Q

Common findings of SS pt.s upon Exam:

10 thing

A
  • they may be able to bend fwd easily
  • Ext causes pain and may be limited
  • frequently a paucity of physical findings
  • Ms. spasm is rare
  • Sensation/Strength are frequently normal
  • reflexes are normal or diminished
  • n. root tension signs are usually absent
  • weakness suggests severe disease
  • active reflexes should alert PT to possibility of coexisting cervical stenosis (present in 15%-20% of lumbar stenosis pt.s)
  • pt.s with normal neurological exams may develop neurological deficits if examed after walking a distance
39
Q

The number of people who will develop SS is likely to ______ because:

A

increase because this dysfunction is found primarily in older people and the number of older people is steadily increasing.

40
Q

The two primary courses of tx for pt.s with lumbar SS are:

A 
conservative = rehabilitation
aggressive = surgical intervention
41
Q

Pt.s with ______ should be managed surgically

A
  • significant neurological deficits

- bowel and bladder dysfunction

42
Q

The __ primary components of conservative management of pt.s with lumbar SS are:

A

the 5 are:

  • education
  • postural correction
  • increasing flexibility
  • increasing muscular strength
  • improving aerobic fitness
43
Q

The primary goals of Phase 1 (when the pt. is still in pain) of tx are:

A
  • education
  • posture
  • flexibility
44
Q

The primary goals of Phase 2 (commenced as pt.s pain decreases) of tx are:

A
  • ms. strengthening

- aerobic conditioning

45
Q

pt. education is critical to ensure:

A

compliance

46
Q

Pt. Education should cover:

A
  • the anatomic and biomechanical changes of their lumbar spine
  • how they can actively participate in their rehab to enhance the outcome
  • that prolonged bedrest has a deconditioning effect and is therefore harmful
  • exercise is important
  • awareness of their lumbar posture, esp. during functional activities
  • use of a flexion posture in the lumbar region
  • flexion exercise program (Williams, Dynamic Stabilization)
47
Q

Flexion exercises were developed by ______

Two of the goals of these ex.s are:

A

Williams

  • open up the intervertebral foramen, thus decreasing compression of the n. roots
  • strengthen the abdominal and gluteal musculature.
48
Q

_____ proposed the dynamic muscular stabilization concept for back rehabilitation

A

Saal

49
Q

Saal proposed:

A

the dynamic muscular stabilization concept for back rehabilitation

50
Q

Williams developed:

A

Flexion exercises

51
Q

Dynamic Stabilization uses contraction of the _______ musculature in unison to develop a ________ which encompasses the lumbar spine.

A

Dynamic stabilization uses contraction of the trunk musculature in unison to develop a muscular brace which encompasses the lumbar spine.

52
Q

Dynamic Stabilization creates a muscle held ________ of the lumbar spine that eliminates the _________ that occurs during activity

A

Dynamic Stabilization creates a muscle held stabilization of the lumbar spine that eliminates the repetitive microtrauma that occurs during activity

53
Q

Dynamic Stabilization is useful to lumbar SS because:

A

the ms. co-contraction can be used to decrease lumbar lordosis and maintain flexion of the lumbar spine with an isometric contraction

54
Q

control of lordosis is important to _________ through the spine

A

control of lordosis is important to distributing through the spine

55
Q

Pelvic tilt exercises help the pt:

A

learn how to adjust their lordosis to reduce compressive stress on the spine

56
Q

Systematic stretching is important to maintain:

and has been found to:

A

normal trunk ROM

help decrease pain and return LBP pt.s to functional activities when added to holistic rehab programs

57
Q

Ms.s that are essential to strengthen in a lumbar SS rehab program:

A
  • abdominals
  • paraspinals
  • LE musculature
58
Q

For LBP pt.s, ______ is considered more important than ________ or __________ when separating out the fitness variables

A

Strength is considered more important than aerobic capacity or flexibility

59
Q

______ and the ________ are common strength deficits of LBP pt.s

A

Trunk ms. strength and the endurance component are common strength deficits of LBP pt.s

60
Q

Who is less likely to suffer LBP and if they do, have shorter duration, less intense pain?

A

Physically fit people (Cady et al)

61
Q

Recommendations for aerobic exercise for pt.s with LBP:

A

20-40 minute sessions (with warm-up, cool-down)

3-5 sessions per week

62
Q

Reasoning behind recommending aerobic exercise to pt.s with LBP:

A
  • physically fit people get less LBP and get shorter, less intense LBP
  • aerobic conditioning:
    • combats the effects of deconditioning
  • aerobic conditioning combats many of the adverse effects of chronic pain by:
    • raising endorphins
    • combats depression
    • decreasing chemical dependency
  • aerobic conditioning promotes self-confidence

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