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BASIC TRAINING > DDD / Spondylosis > Flashcards

DDD / Spondylosis Flashcards

0
Q

what are the 2 types of herniated discs?

A

Extruded: Protruding portion remains attached to the disc.

Sequestrated: Protruding portion detaches from the disc.

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1
Q

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

A

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.

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2
Q

What are the three locations for this disc herniations?

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

Schmorl’s Node

A

When a disk herniates through the end plate.

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4
Q

Spinal Stenosis

A

Narrowing of the Vertebral Foramen

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5
Q

Paresthesia

A

Intermittent pain, numbness, and tingling

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6
Q

Spondylolisthesis

(Also, Laterolisthesis or Retrolisthesis)

A

The forward movement / displacement of one vertebrae over another

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7
Q

What are the 5 types of spondylolisthesis?

A
  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
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8
Q

Spondylolysis

A

A complete fracture of the pars interarticularis

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9
Q

Sinuvertebral nerve

A

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

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10
Q

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

A

25%

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11
Q

The intervertebral discs have three primary functions:

A
  1. Spacer
  2. Distribute Load
  3. Accommodate Movement
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12
Q

What factors can accelerate disc degeneration?

A
  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.)
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13
Q

Proteoglycans

A

Water attracting proteins

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14
Q

Hypertrophy

A

Enlarged

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15
Q

Neurogenic Claudication

A

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

16
Q

Cauda Equina Syndrome

A

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

17
Q

Pars Interarticularis

A

Junction between the lamina and the pedicle.

18
Q

Spondyloptosis

A

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

19
Q

Radicular Symptoms

A

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

20
Q

Dermatome

A

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

21
Q

How are dermatomes used?

A

To diagnose the level of a spinal injury.

22
Q

Ridiculous symptoms indicate ___________

A

Impingement of a spinal nerve.

23
Q

Myelopathic symptoms indicate ___________

A

Impingement of the spinal cord.

24
Q

Ridiculous symptoms:

A

Numbness, tingling, weakness, and/or paresthesia.

25
Q

Myelopathic symptoms:

A

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

26
Q

Imaging tools used to diagnose DDD

A
  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.
27
Q

Decompression

A

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

28
Q

2 types of decompression

A
  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).
29
Q

Foraminotomy (for Radiculopathy caused by Herniation or osteophytes)

A

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).

30
Q

Laminotomy

A

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

31
Q

Microdiscectomy

A

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.

32
Q

Laminectomy

A

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.

33
Q

Liminoplasty

A

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.

34
Q

Discectomy

A

Removal of disc.

35
Q

Discectomy Approaches

A

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.

36
Q

What are the 5 basic steps for a discectomy?

A
  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).
37
Q

Motion Preservation

A

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

38
Q

What is Scoliosis?

A

Any lateral deviation from midline in coronal plane

BASIC TRAINING (3 decks)

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