Degenerative Disc Disease, Acute Disc Herniation

Question 1

function of intervertebral discs

Answer 1

shock absorbers - allow more movement between vertebrae

Question 2

which part of the discs are innervated

Answer 2

posterior aspect of annulus

Question 3

neurological signs of herniation

Answer 3

motor weakness specific to level of lesion
dermatomal sensory changes

likely to occur with prolapse and sequestration changes

Question 4

degeneration of a disc

Answer 4

fibrous changes in nucleus and in organization of annulus fibrosis rings

disappearance of cartilaginous end plates

as early as 20 yo changes in lumbar discs are seen as vascular supply to disc becomes occluded

posterior portions of annulus become compressed and bulge from lordosis

posterior fibres are thinner and shorter

height of disc decreases

intervertebral foramen space is narrowed

Question 5

disc injury that results from rupture of annular fibres =

Answer 5

herniation

Question 6

what area on spine accounts for 98% of all low back disc injuries

Answer 6

L4-L5 , L5,S1

combination of flexion and torsional forces

Question 7

degenerative changes in facet joints and eventually ankylosing of the joint capsule =

Answer 7

spondyLOSIS

Question 8

3 stages of degeneration

Answer 8

1. dysfunction
2. instability
3. stabilization

Question 9

biomechanical changes over years –> weakness, bulging, minor tears in annulus, chronic facet joint irritation, joint effusion, mm spasm = what stage of degeneration

Answer 9

stage 1: dysfunction

Question 10

• posterior annular fibers and joint capsules become lax causing hypermobile vertebral segment
• nerve entrapment can occur
  -disc is secured by peripheral osteophytes
• tissue change in this stage is permanent
• spondylolisthesis may occur
  = what stage of degeneration

Answer 10

stage 2: instability

Question 11

• loss of disc material and decreased disc height
• intervertebral foramen narrows
• joint capsules and posterior ligaments fibrose
• osteophytes form causing decrease ROM
• stenosis
• degeneration may spread to other vertebral levels
  = what stage of degeneration

Answer 11

stage 3: stabilization

Question 12

most common acute herniation

Answer 12

posterolateral protrusion

Question 13

what does the pain feel like in acute disc herniation

Answer 13

sclerotic (deep, dull, achy pain)
poorly localized

Question 14

neurological signs are more likely to occur with _____

Answer 14

prolapse and sequestration

Question 15

large cervical posterolateral protrusion may cause

Answer 15

nerve root signs in upper limbs

Question 16

small lumbar posterolateral protrusion may cause pain ____

Answer 16

spreading across the back into glutes and thighs

Question 17

large lumbar posterolateral protrusion may cause ____

Answer 17

spinal cord compression w loss of bladder control

Question 18

which positions are less painful w an acute disc herniation posterolateral

Answer 18

standing and walking

Question 19

what movement would be the most restricted in DDD

Answer 19

spinal extension

Question 20

with posterolateral herniates that are contained by annular fibres - flexion is limited and symptoms ________ with movement

Answer 20

peipheralize

Question 21

with a complete annular rupture and sequestrated nucleus movement _________

Answer 21

cannot relieve symptoms

Question 22

Neurological myotomes associated w DDD

Answer 22

L4- ankle dorsiflexion
L5- big toe extension
S1- plantarflexion

Question 23

self care: reduce herniation through _____

Answer 23

maintaining lumbar lordosis