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MSK Exam 1 - Spring > Acute to Persistent IDD - Done > Flashcards

Acute to Persistent IDD - Done Flashcards

1
Q

What is another name for persistent internal disc derangement?

A
  • Degenerative disc disease
  • Age- related disc changes (although not always due to age)
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2
Q

What is the incidence/ prevalence of persistent IDD?

A

1-3% of patients (directly related to the disc)

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3
Q

Disc changes that are formed by numerous variables allow for what to happen

A

Herniations (nuclear migration) to gradually develop over time

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4
Q

Chronic or persistent IDD is more or less common than acute IDD?

A

More common and is the most prevalent IDD and more often not the source of pain

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5
Q

Where is persistent IDD most commonly located and in what population?

A
  • Most commonly in the lumbar region (95% at L5-S1)
  • Only 1-3% of IDDs are symptomatic
  • Persistent IDD is the source of pain in less than 5% of LBP
  • Mostly 30-50 year olds
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6
Q

What is the etiology of persistent IDD?

A
  • Acute IDD
  • Mixed findings with age
  • Lower strength
  • Sedentary life style
  • Heavier occupational lifting
  • Smoking
  • Genetics
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7
Q

Lumbar IDD is associated with what other issue?

A

Age-related disc changes in the cervical region

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8
Q

65-85% of genes are from inheritance but can be modified by what?

A

Diet and lifestyle

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9
Q

What etiologies do not lead to IDD?

A
  • Not from routine loading/ physical activities
  • Routine loading was beneficial
  • Not from prolonged driving
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10
Q

What is the pathogenesis of the persistent IDD/ how are the disc and adjacent structures changing?

A
  • Inflammation
  • End plate changes
  • Less GAGs
  • Annulus break down
  • Fibrotic changes
  • Disc height loss
  • Foramen narrowing
  • Excessive stress that leads to hypermobility, stenosis, etc.
  • Infection in the disc
  • Fatty deposits
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11
Q

What is a gradual pathogenesis of persistent IDD (think getting sick)?

A

Persistent Inflammation

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12
Q

In- growth of nociceptive fibers from acute IDD healing can lead to what?

A

Nociplastic pain

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13
Q

What does persistent inflammation bring?

A

Excessive and destructive proteins (amyloidosis) and a low-grade infection likely enters the disc

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14
Q

What are the other gradual pathogenesis of persistent IDD?

A
  • Less GAGs so more fibrotic and dehydrated nucleus
  • More acidic disc that kills disc cells and limits proliferation
  • Annular disorganization
  • Thinning and loss of cartilage at the end plates
  • Increased inflammation and fatty deposits in vertebrae (modic changes)
  • Now persistent herniations and nuclear migration gradually developing per the miller classifications once changes occur with the disc
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15
Q

What are the categories of herniation?

A
  • Protrusion
  • Extrusion
  • Free Sequestration
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16
Q

What is protrusion?

A
  • Tongue pushing on cheek
  • Nucleus migrates but remains contained in annulus
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17
Q

What is extrusion?

A
  • Tongue pushing through hole in cheek
  • Nucleus migrates through the outer annulus
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18
Q

What is free sequestration?

A
  • Tongue getting cut off
  • Nucleus migrates and breaks away from annulus
19
Q

What is the most common type of herniation?

A

Protrusion

20
Q

Where do schmorl’s nodes typically develop?

A

Likely develop where the nucleus migrates into the vertebral body as well

21
Q

Narrowing is initially caused by what?

A

Changes related to loss of disc height and integrity

22
Q

What might you find with narrowing?

A
  • Instabiligy may develop
  • Joint hypermobility noted during sagittal and frontal plane motions but not in the transverse plane
23
Q

Joint space narrowing leads to what?

A
  • Contributes to initial instability
  • Greater load bearing on facets
24
Q

Neural foramen narrowing leads to what?

A

Stenosis potentially developing

25
Q

What are later changes that may come from narrowing?

A
  • Greater age-related joint changes
  • Can lessen prior instability due to associated stiffening of joint
26
Q

Slow changes allow for tissues to what?

A

Adapt without symptoms for some time as indicated by lack of symptoms with imaged changes in 2/3 of individuals

27
Q

Gradual onset with symptoms may be like what?

A

Acute signs and symptoms if inflamed … consider other conditions that may develop and other respective signs and symptoms

28
Q

Mechanical diagnosis and therapy is an Rx that provides what?

A
  • A short term benefit
  • Better than placebo for pain but not for function
29
Q

Mechanical therapy is not superior to what?

A
  • Education
  • Manual therapy and motion exercises
  • Stabilization exercises
30
Q

What do you need to consider when choosing an Rx for your patient with persistent IDD?

A

Need to consider primary driver of symptoms from the development of other conditions even if imaging shows disc changes (instability? stenosis? age related joint changes? combination?)

31
Q

What is the negative outcome predictor of both acute and persistent IDD?

A

Peripheralization

32
Q

Peripheralization has a significant association with what?

A
  • Mental distress/ depression
  • Pain behaviors
  • Somatisation (aka nociplastic pain) … conversion of anxiety into bodily symptoms
  • Fear of work
  • Non-organic signs (ex: tumor)
33
Q

There are worse outcomes for both acute and persistent IDD when symptoms present longer than what?

A

Six months prior to any treatment including surgery

34
Q

What oral medications might you see with IDD?

A

NSAIDS, Muscle relaxants, and acetaminophen

35
Q

Are oral medications beneficial for IDD?

A
  • Conflicting and unclear benefits
  • May be prescribed a steroid dose pack for large inflammatory response
36
Q

What is an epidural injection used for with IDD?

A

Short term but not long term relief or functional changes

37
Q

Why might antibiotics be used for IDD?

A

Antibiotic treatment benefits the potential infection source

38
Q

What is the benefit of surgery for IDD?

A
  • Waiting an average of 4.5 months on surgery did not minimize benefits of surgery
  • Some studies demonstrated earlier and improved benefit with surgery versus PT, particularly with severe acute IDD
  • Slower but the same overall outcomes without surgery after two years
39
Q

What kind of surgeries might be done?

A

Spinal decompression such as a laminectomy or a partial discectomy (you will lose stability with these!!)

40
Q

What are indications of spinal decompressions?

A
  • Persistent and/ or worsening radiculopathy
  • Use when symptoms are unresponsive to surgical treatments
41
Q

What surgeries can you preform when hypermobility/ instability is present?

A
  • Lumbar fusion
  • Total disc replacement (TDR) with persistent IDD
42
Q

Are lumbar fusions beneficial?

A
  • No difference versus PT in long term outcomes with pain, health status, satisfaction, or disability
  • Not additive to laminectomy or discectomy
  • May lead to adjacent joint hypermobility/ instability
43
Q

Are total disc replacements (TDR) with persistent IDDs beneficial?

A
  • Better load distribution across segments
  • Safe and effective treatment more than 5 years postoperatively
  • At 2 years follow up, no difference compared to PT alone without radiculopathy for in return to work, life satisfaction, fear avoidance behavior, drug use, back performance

MSK Exam 1 - Spring (9 decks)

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