Degenerative Disc Disease Flashcards
1
Q
What is degenerative disc disease?
A
- natural deterioration of the intervertebral disc structure
- become progressively weak and begin to collapse
2
Q
What is the Px of Disc degenration?
A
- Ageing - Progressive dehydration of the nucleus pulposus
- Daily activities - tears in the annulus fibrosis
3
Q
A
4
Q
What are the 3 stages of disc degenration?
A
- Dysfunction – outer annular tears and separation of the endplate, cartilage destruction, and facet synovial reaction
- Instability – disc resorption and loss of disc space height, along with facet capsular laxity, can lead to subluxation and spondylolisthesis
- Restabilisation – degenerative changes lead to osteophyte formation and canal stenosis
5
Q
What are the clinical features of DDD?
A
Early stage
- local spinal tenderness
- contracted paraspinal muscles
- hypomobility
- painful extension of back
Instable
- radicular leg pain
- paraesthesia
- positive Lasegue sign
- scoliosis
*assess for red flag signs of CE
6
Q
What is the Lasègue Test?
A
- straight leg raise
- assess for disc herniation in patients presenting with lumbago
7
Q
What are the differential diagnosis for DDD?
A
- cauda equina syndrome
- infection (such as discitis)
- malignancy
8
Q
What are the criterias for ordering imaging in DDD?
A
- Red flags present
- Radiculopathy with pain for more than 6 weeks
- Evidence of a spinal cord compression
- Imaging would significantly alter management
9
Q
What Ix would you order for DDD?
A
- Imaging
- xray - if >70, trauma or osteoporosis
- MRI - gold standard
10
Q
How would you mx DDD?
A
- Conservative
- progressive activity
- physiotherapy
- Pharmacological
- simple analgesics (first line)
- neuropathic analgesics (amitryptilline)
- nerve root corticosteroid injection
- refer to pain clinic if pain persist > 3months
- Surgical
- CES - decompression of spinal canal
- Laminectomy
- Discectomy
