DDD / Spondylosis

Question 0

what are the 2 types of herniated discs?

Answer 0

Extruded: Protruding portion remains attached to the disc.

Sequestrated: Protruding portion detaches from the disc.

Question 1

What are the 3 phases of the intervertebral disc’s Degenerative Cascade?

Answer 1

Phase 1—Dysfunction:
small tears in the annulus of the disc.

Phase 2—Instability:
multiple annular tears, nucleus disruption and loss of disc height. Disc herniation occurs in this phase

Phase 3—Stabilization: further nucleus/disc deterioration, disc space narrowing, endplate destruction and osteophyte formation.

Question 2

What are the three locations for this disc herniations?

Answer 2

1. Central Herniation
2. Far Lateral Herniation
3. Paracentral Herniation

Question 3

Schmorl’s Node

Answer 3

When a disk herniates through the end plate.

Question 4

Spinal Stenosis

Answer 4

Narrowing of the Vertebral Foramen

Question 5

Paresthesia

Answer 5

Intermittent pain, numbness, and tingling

Question 6

Spondylolisthesis

(Also, Laterolisthesis or Retrolisthesis)

Answer 6

The forward movement / displacement of one vertebrae over another

Question 7

What are the 5 types of spondylolisthesis?

Answer 7

1. Congenital: from birth
2. Isthmic: caused by a defect in the pars interarticularis most common
3. Degenerative: caused by changes in the disc & facet
4. Traumatic
5. Pathologic: caused by a pre-existing disease

Question 8

Spondylolysis

Answer 8

A complete fracture of the pars interarticularis

Question 9

Sinuvertebral nerve

Answer 9

Nerves that live on the outer 1/3 of the annulus

Question 10

Discs make up ____% of overall height of the spine.

Answer 10

25%

Question 11

The intervertebral discs have three primary functions:

Answer 11

1. Spacer
2. Distribute Load
3. Accommodate Movement

Question 12

What factors can accelerate disc degeneration?

Answer 12

1. Mechanical stresses (repetitive vibrations, lifting, bending)
2. Aging (The endplates, which deliver the disc its nutrients become calcified over time. Also, the amount of proteoglycans in the disc decreases, which reduces the ability of the nucleus to take in water & the distance becomes malnourished.)

Question 13

Proteoglycans

Answer 13

Water attracting proteins

Question 14

Hypertrophy

Answer 14

Enlarged

Question 15

Neurogenic Claudication

Answer 15

Paresthesia in the legs that is brought on by walking or standing, and relieved by sitting or lying down.

Question 16

Cauda Equina Syndrome

Answer 16

A condition caused by the compression of multiple spinal nerves within the cauda equina

Question 17

Pars Interarticularis

Answer 17

Junction between the lamina and the pedicle.

Question 18

Spondyloptosis

Answer 18

When the vertebral body falls off the anterior edge of the vertebral body below.

Question 19

Radicular Symptoms

Answer 19

Indication of impingement on a spinal nerve. Symptoms include numbness, tingling, weakness, and/or paresthesia.

Question 20

Dermatome

Answer 20

SPECIFIC REGIONS on the skin that CORRESPOND to the ORIGIN of INDIVIDUAL spinal nerves.

Question 21

How are dermatomes used?

Answer 21

To diagnose the level of a spinal injury.

Question 22

Ridiculous symptoms indicate ___________

Answer 22

Impingement of a spinal nerve.

Question 23

Myelopathic symptoms indicate ___________

Answer 23

Impingement of the spinal cord.

Question 24

Ridiculous symptoms:

Answer 24

Numbness, tingling, weakness, and/or paresthesia.

Question 25

Myelopathic symptoms:

Answer 25

Gait disturbances, bowel and bladder dysfunction, and/or generalized weakness.

Question 26

Imaging tools used to diagnose DDD

Answer 26

1. Radiograph (X-Ray) - Used to view bones, disc height, and intervertebral disc height (lateral). Also used to show osteophytes and changes to the endplates that are characteristic of DDD. Can't see discs on x-ray. 2. CT Scan: Used for axial, lateral & coronal SLICES. Can also be used for 3-D imaging. Used to assess the patency, or open-ness, of the vertebral and intervertebral foramina, as well as the condition of the facet joints. 3. MRI - Magnetic resonance imaging uses magnets and radio waves to create an image based on water content of the tissues. Used to examine the soft tissues of the body. In spine its used to assess the health and water content of the disc. As well as to examine any constriction of the neural elements. 4. Discography - This technique is used to identify the spinal segment that is causing the patient’s symptoms by injecting radiopaque dye into multiple discs. Dye leaking from the disc space is indicative of tears in the annulus.

Question 27

Decompression

Answer 27

The removal of bone or soft tissue that is putting pressure onto the neural elements.

Question 28

2 types of decompression

Answer 28

1. Direct - the removal of bone or soft tissue putting pressure onto the neural elements (disc herniation, osteophyte). 2. Indirect - increasing the amount of room for the neural structures by increasing or restoring the height of the disc space (graft into the interbody space).

Question 29

Foraminotomy (for Radiculopathy caused by Herniation or osteophytes)

Answer 29

Removing the sections of the lamina and also the facet to increase the volume of the intervertebral foramen. Decompresses the neural elements without fusion. (ADVANTAGE).

Question 30

Laminotomy

Answer 30

The removal of part of the lamina. Often done in conjunction with a foraminotomy, microdiscectomy or posterior lumbar interbody fusion.

Question 31

Microdiscectomy

Answer 31

The removal of the herniated portion of a disc. Lumbar disc herniation with radicular symptoms or cauda equina syndrome. To access the herniation, surgeons may remove portions of the lamina or facet.

Question 32

Laminectomy

Answer 32

The removal of the lamina. Indication is Spinal Stenosis. Commonly done on more than one level which destabilizes the spine - necessitating a need for hardware.

Question 33

Liminoplasty

Answer 33

Reshaping the lamina to increase the volume of the vertebral foramen. Indicated for cervical and upper thoracic spinal stenosis. A laminoplasty achieves the same goal as a laminectomy - providing more room for the cord, without removing the protective function of the lamina.

Question 34

Discectomy

Answer 34

Removal of disc.

Question 35

Discectomy Approaches

Answer 35

In the cervical spine - an anterior approach is generally used; the thoracic spine - a lateral approach, lumbar spine - anterior, anterolateral, lateral, posterolateral, and posterior approaches are all performed. A patient’s specific pathology as well as surgeon preference may determine which approach is used.

Question 36

What are the 5 basic steps for a discectomy?

Answer 36

1. Removal of the disc 2. Placement of a spacer in the disc space 3. Graft augmentation of needed (If a posterior or poster- olateral approach is used, bone graft is often also applied to the “lateral gutters” of the spine to create a fusion in the posterior aspect as well). 4. Stabilization - using instrumentation. (It is important for the instrumentation not to shield the bone from load, but rather share it with the bone. This, via Wolff’s Law, will allow for a strong, solid fusion to develop). 5. Fusion. (A fusion takes approximately 6 - 9 months to become stable. However, it may take up to 7 years for all of the bone to be completely remodeled).

Question 37

Motion Preservation

Answer 37

Treatment of DDD without a fusion. Disc replacement is a common option today.

Question 38

What is Scoliosis?

Answer 38

Any lateral deviation from midline in coronal plane