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OMM > Congenital Lumbar Anomalies > Flashcards

Congenital Lumbar Anomalies Flashcards

1
Q

Aplasia

A
  • Failure of bone to form
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2
Q

Hypoplasia

A
  • Failure to grow to normal size
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3
Q

Dysplasia

A
  • Abnormal growth
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4
Q

Supernumerary Part

A
  • Extra vertebra/ fingers
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5
Q

Arrested Development

A
  • Spina bifida
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6
Q

Neural Tube Defects

A
  • Result from failure of the neural tube to close normally during the 3rd and 4th weeks after conception (5th and 6th weeks of gestation)
  • 2nd most prevalent congenital anomaly worldwide, second only to cardiac malformations
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7
Q

Neural Tube Defect Risk Factors

A
  • Inadequate folate intake
  • Use of folic acid antagonists (methotrexate)
  • Genetic factors causing abnormal folate metabolism
  • Antiepileptic drugs (Valproate; Carbamazepine)
  • Diabetes (maternal)
  • Amniotic bands; disrupt neural tube development
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8
Q

Spinal Dysraphism

A
  • Incomplete fusion or malformation of bone and neural structures of the spine region by errors in the closure of the neural tube
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9
Q

Spina Bifida Aperta

A
  • Open spinal dysraphism
  • Meningocele- herniation of the meninges through the defect
  • Meningomyelocele- herniation of the meninges and nerve roots through the defect
  • Characterized by a cleft in the spinal column, w/ herniation of the meninges (meningocele) or meninges and spinal cord (myelomeningocele) through the defect
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10
Q

Spina Bifida Occulta

A
  • Closed (Occult) spinal dysraphism
  • No herniation of the meninges through the defect
  • Characterized by failure of fusion of the vertebral bodies due to abnormal fusion of the posterior vertebral arches, w/ unexposed neural tissue; the skin overlying the defect is intact.
  • More common and least severe forms consist of isolated vertebral bony defects
  • Often see an area of skin over the segment w/ course hair and perhaps some discoloration
  • Can occur w/o any external manifestation
    • may see skin change, dimple, hairy patch, hemangioma
  • Detectable only by x-ray, CT-scan, etc
  • Occurs in ~10% of the pop.
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11
Q

Spina Bifida

A
  • Most common congenital abnormality of the spine
  • May occur at any level, but mot frequently at L5-S1 (last part of vertebral column to close)
  • Major defects which are obvious at birth have incidence of 2 per 1,000 births
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12
Q

Tethered Cord Syndrome

A
  • Stretch-induced dysfunction of the caudal spinal cord and conus
  • Symptoms: back pain, bladder dysfunction, leg weakness, calf muscle atrophy, diminished or absent deep tendon reflexes, and dermatomal sensory loss
  • Orthopedic signs include progressive scoliosis and various foot deformities
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13
Q

Tethered Cord Syndrome Symptoms

A
  • Toddlers and children present w/ progressive motor and sensory dysfunction, which may include gait abnormalities and loss of bladder control
  • Progression of symptoms such as motor and bladder problems
  • Children begin to stumble after they have learned to walk normally, then they start dribbling urine after having achieved successful toilet training
  • Older children and adolescents are more likely to complain of back pain exacerbated by exercise
  • Later, they develop musculoskeletal signs and symptoms: common findings include foot drop (weakness of ankle dorsiflexion) and scoliosis
  • Adults may develop back pain, leg pain and scoliosis which may be difficult to distinguish from other more common causes of chronic back pain
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14
Q

Spina Bifida Physical Effects

A
  • Will more often be treating pts w/ spina bifida occulta
  • Ligamentous asymmetry and mal-loading stress is a common cause of pain
  • Some reports of sacral base unleveling
    • therefore evaluate for heel-lift, sacral dysfunctions, innominate dysfunctions
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15
Q

Spina Bifida Treatment

A
  • Most OMT will be myofascially oriented
    • soft-tissue
    • myofascial release
    • counterstrain
    • facilitated positional release
  • Referral to neurologist (if not done yet) for co-management is recommended
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16
Q

Spondylolysis

A
  • Represents fracture or anomalous development (defect) of the pars interarticularis, usually of the 5th lumbar vertebra
  • Rarely occurs <5
  • More common at age 7 or 8
  • History of minor trauma is common
  • Injury is seldom severe
17
Q

Spondylolisthesis

A
  • Usually due to stress or fatigue fractures of the pars interarticularis of the named vertebrae
  • Roughly 5% of the pop. has this and half will be symptomatic w/ it
  • Usually L5 on S1, or L4 on L5
  • X-ray in weight-bearing is more accurate
  • LBP is usually an ache in back, butt, leg
18
Q

Spondylolisthesis Classifications

A

6 types

  • Dysplastic (congenital)
  • Isthmic (A and B)
  • Degenerative
  • Traumatic
  • Pathologic
19
Q

Dysplastic/Congenital Spondylolisthesis

A

If severe displacement of L5 occurs there may be pressure on:

 * cauda equina
 * nerve roots - Back pain w/ or w/o sciatic may occur - Presents during childhood - May be assoc. w/ spina bifida
20
Q

Isthmic Spondylolisthesis

A
  • Most common type 51% of all sponylolisthesis
    • 2x greater in males but females 4-6x more symptomatic
  • Defect in pars interarticularis
    • spondylolytic spondylolisthesis
  • B/L or U/L
  • Most common type in pts. <50
  • Probably due to repeated micro-fractures
21
Q

Degenerative Spondylolisthesis

A
  • 25% of all spondylolisthesis
  • Secondary to degenerative changes in
    • facet joints
    • intervertebral discs
  • Due to long standing intersegmental instability
  • Occurs most commonly at L4
  • Seldom before age 40
  • Women:men = 4:1
  • African American:white = 3:1
  • Instability and chronic LBP
22
Q

Traumatic Spondylolisthesis

A
  • 1% of all spondylolisthesis
  • Fracture in vertebra other than pars
    • articular processes
    • pedicles
  • Slip occurs gradually
23
Q

Pathologic Spondylolisthesis

A
  • 2% of all spondylolisthesis
  • Very rare
  • Generalized or localized bone disease
    • osteogenesis imperfecta
    • infection
    • tumor
    • paget’s
24
Q

Spondylolisthesis Pain Presentation

A

Intermittent pain

  • Usually follows a stressful injury (strain, sprain)
  • Aggravated by activity (running, walking, standing)
  • Relieved by rest
25
Q

Spondylolisthesis Physical Presentation

A
  • B/L tight hamstrings
  • Secondary ‘thoracic’ and ‘lumbosacral’ kyphosis
    • loss of waistline
  • Spinous process step-off w/ grade II to III
    • usually easier to feel w/ non-spondylolytic type
26
Q

Spondylolisthesis Susceptible Populations

A
  • Most common cause of LBP and sciatica in children and adolescents
  • Gymnasts; have hypermobile spines that are subject to constant trauma
  • Dancers; have low body weight, develop amenorrhea, and become osteoporitic
  • Paratroopers; unknown if it causes spondylolisthesis or irritates an existing problem
27
Q

Radiographic Eval for Spondylolisthesis

A
  • AP and lateral views usually ordered for initial work-up
  • Oblique views for spondylolysis
    • U/L- collar on “scotty-dog”
    • B/L- collar or head/neck decapitated
28
Q

Spondylolisthesis Treatment

A
  • Usually conservative w/ pt education, controlled activities, med prn., sometimes a lumbar brace and OMM
29
Q

Spondylolisthesis Surgery

A 
Operative for spondylolisthesis
- Anterior fusion 
     *interbody
- Lateral fusion (in situ posterolateral)
     *intertransverse process
- Instrumental
     *immediate stability
Depends on case and choice of surgeon
30
Q

Spondylolisthesis OMM Treatment

A
  • Will generally be treating 1st or 2nd grade slips
  • Must not put undo stress directed ventrally thru unstable level (especially w/ pars defect)
    *therefore, prone soft-tissue techniques not indicated
  • DO NOT PUT IN EXTENSION
  • Lateral recumbent position is much safer
  • Most OMT will be myofascially oriented
    *Soft tissue
    +supine hip flexion and frog technique
    +lateral recumbent techniques
    *myofascial release
    +supine lumbar and sacral release and/or traction
31
Q

Facet Tropism

A
  • Unequal size and/or angling of the zygo-apophyseal joints of a vertebrae (also called facet asymmetry)
  • Can cause Hypo- or Hypermobility
32
Q

Facet Tropism Symptoms

A
  • Myofascial imbalance
  • Articular symptoms may be on hypo- or hypermobile side
  • Hypomobile side (sagittal)
    • HVLA w/ gapping techniques
    • muscle energy
  • Hypermobile side: avoid HVLA techniques
33
Q

Facet Tropism Treatment

A

On side of hypermobility

  • Counterstrain, Myofascial release
  • Facilitated positional release (FPR)
  • Probably not HVLA techniques
34
Q

Bertolotti’s Syndrome

A
  • Characterized by anomalous enlargement of the transverse process(es) of the most caudal lumbar vertebra which may articulate or fuse w/ the sacrum or ilium and cause isolated L4/5 disc disease
  • A cause of back pain in young ppl
35
Q

Transitional Segments Treatment

A
  • Techniques recommended are: soft tissue, myofascial release, muscle energy, FPR
  • Intended to assist the body in compensating for the abnormality that is present
36
Q

Management of Lumbar Anomalies

A

Conservative

  • Might what to start therapy in water
  • Rest or immobilization (bracing)
  • Stretching and therapeutic exercise
    • aquatics
    • CORE stabilization/ strengthening
  • Analgesics, NSAIDs, muscle relaxants
  • OMT
  • Avoidance behavior

OMM (6 decks)

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