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Spinal Anatomy > Degenerative Disc Module > Flashcards

Degenerative Disc Module Flashcards

1
Q

Contains collagen fibers and proteoglycans

A

Nucleus pulposus

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2
Q

Water attracting proteins

A

Proteoglycans

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3
Q

What is the role of the annulus?

A

To contain the nucleus

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4
Q

True or false: intervertebral discs are avascular

A

True

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5
Q

How does the disc receive nutrients?

A

Vertebral route (through endplates from vessels in vert body)

Annular route (small vessels in outer third of annulus)

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6
Q

What are the nerve endings in the outer third of nucleus called?

A

Sinuvertebral nerves

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7
Q

Three major functions of disc

A

Spacer
Distribute Load
Accommodate movement

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8
Q

Phases of degenerative cascade

A

Dysfunction
Instability
Stabilization

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9
Q

Describe dysfunction phase of degen cascade

A

Small tears develop in annulus - acute or chronic back pain resolves with rest

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10
Q

Describe instability phase of degen cascade

A

Multiple annular tears, internal disc disruption, loss of height results in hyper mobility of motion segment

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11
Q

Describe stabilization phase of degen cascade

A

Further disc deterioration, disc space narrowing, endplate disruption, and osteophyte formation

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12
Q

Can result in general laxity in annulus

A

Bulging disc

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13
Q

Nucleus begins to protrude through a year in annulus in one area

A

Herniated disc

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14
Q

The type of herniation in which a portion of disc that has protruded through the annulus remains attached to remain material

A

Extruded disc herniation

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15
Q

Protruding portion of disc detached from remainder of disc

A

Sequestration disc herniation

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16
Q

Herniation towards midline putting pressure on spinal cord or cauda equina

A

Central herniation

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17
Q

Can result in weakness and numbness in lower extremities, bowel/bladder dysfunction, difficulty walking

A

Central herniation

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18
Q

May experience localized numbness, weakness, and tingling

A

Far lateral herniation

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19
Q

Generally affects spinal nerve

A

Far lateral herniation

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20
Q

When a herniation affect both spinal cord and spinal nerve

A

Paracentral herniation

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21
Q

When disc herniates through endplate

A

Schmorl’s Node

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22
Q

Condition that develops when the ligaments and posterior elements hypertrophy, enlarge, and the vertebral foramen narrows

A

Spinal stenosis

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23
Q

Numbness and tingling

A

Paresthesia

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24
Q

Intermittent pain or paresthesia in the legs that is brought on by standing and relieved by sitting

A

Neurogenic claudification

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25
Q

Compression of multiple spinal nerves within cauda equina

A

Cauda equina syndrome

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26
Q

Symptoms of cauda equina syndrome

A

Caused by lumbar stenosis or central herniation causing bilateral leg pain and parathesia, bowel and bladder dysfunction, and saddle anesthesia (loss of sensation restricted to area of buttocks and perineum)

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27
Q

Type of spondylolisthesis caused by abnormality in formation of Spine

A

Type 1 - Congenital

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28
Q

This type of spondylolisthesis is caused by a defect in pars articularis

A

Type 2 - Isthmic

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29
Q

Type of spondylolisthesis caused by degenerative changes in disc and facet

A

Type 3 - Degenerative

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30
Q

Type of spondylolisthesis secondary to severe injury that fractures any part of the vertebrae other than the pars interarticularis

A

Type 4 - Traumatic

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31
Q

Type of spondylolisthesis secondary to a general disease such as a tumor

A

Type 5 - Pathologic

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32
Q

Spondylo means what in Greek

A

Vertebra

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33
Q

Listhesis means what in Greek

A

To slide on an incline

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34
Q

What is spondylolysis

A

When the pars fractures completely

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35
Q

0-25 % slipped

A

Grade 1

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36
Q

25-50% slipped

A

Grade 2

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37
Q

50-75% slipped

A

Grade 3

38
Q

75-100% slipped

A

Grade 4

39
Q

Spondyloloptis (vb falls off the anterior edge of the vertebral body below)

A

Grade 5

40
Q

What are radicular symptoms

A

Numbness, tingling, weakness, and/or paresthesia

41
Q

Radicular symptoms typically correspond to what?

A

A dermatome

42
Q

What do myelopathic symptoms typically indicate?

A

Impingement of spinal cord

43
Q

What are myelopathic symptoms?

A

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

44
Q

Pain that is felt in the back itself

A

Axial back pain

45
Q

Theory as to why axial back pain occurs

A

Chemicals formed in the disc during degenerative process has irritated the sinuvertebral nerves

46
Q

Uses radiation to create a picture of the tissues of the body

A

Radiography

47
Q

Uses a computer to compile multiple views of the body

A

CT scan

48
Q

Uses magnets and radio waves to create an image based on water content of the tissues

A

MRI (magnetic resonance imaging)

49
Q

When radiopaque die is injected into multiple discs and the patient is prompted to notify the surgeon if they are experiencing concordant pain

A

Discography

50
Q

Can be used to assess disc height, volume of intervertebral foramen, osteophytes and changes to endplate

A

Radiograph

51
Q

Allows surgeon to assess patency (openness) of the vertebral and intervertebral foramina as well as condition of facet joints

A

CT Scan

52
Q

Allows surgeon to examine the health and water content of discs

A

MRI

53
Q

First step in treating DDD

A

Conservative therapy

54
Q

Success rate for treating severe lumbar radiculopathy with conservative therapy

A

50%

55
Q

% of back pain patient who never need surgery

A

90%

56
Q

Removal of bone or soft tissue putting pressure on neural elements

A

Decompression

57
Q

Physically removing the pieces of tissue that are exerting pressure onto a neural element

A

Direct decompression

58
Q

Increasing the amount of room for the neural structures by increasing or restoring the height of the disc space

A

Indirect decompression

59
Q

A procedure that increases the diameter of the intervertebral foramen

A

Foraminotomy

60
Q

A procedure in which sections of the lamina and the facet are removed

A

Foraminotomy

61
Q

Indications for foraminotomy

A

Radiculopathy caused by pressure on spinal nerve by disc herniation or osteophytes

62
Q

Advantages of foraminotomy

A

Decompress neural elements without fusion, relief of cervical radiculopathy in 90% of patients

63
Q

Disadvantages of foraminotomy

A

Not effective for myelopathy or pathology toward midline

May lead to spinal instability

64
Q

Removal of part of the lamina to relieve compression on a neural element or to gain access to other anatomical structures

A

Laminotomy

65
Q

Often done in conjunction with a foraminotomy, microdiscectomy, or posterior lumbar interbody fusion

A

Laminotomy

66
Q

Indications for laminotomy

A

Herniated disc, compressed nerve root

67
Q

Advantages of laminotomy

A

allows access to neural elements and disc from a posterior approach

68
Q

Disadvantages of laminotomy

A

Not often a stand alone procedure

69
Q

A procedure that involves the removal of the herniated portion of a disc, performed through a small incision, usually with the assistance of a microscope to enhance visualization

A

Microdiscectomy

70
Q

Indications for microdiscectomy

A

Lumbar disc herniation with radicular symptoms or cauda equina syndrome

71
Q

Advantages of microdiscectomy

A

Minimally invasive, small incision, no fusion

72
Q

Disadvantages of microdiscectomy

A

Simply removes herniation, does not repair the disc or restore lost height of the disc

73
Q

A procedure in which the lamina is removed

A

Laminectomy

74
Q

Commonly performed to decompress the spinal cord

A

Laminectomy

75
Q

Indications for laminectomy

A

Spinal stenosis

76
Q

Advantages of laminectomy

A

Increases volume of vertebral foramen

77
Q

Disadvantages of laminectomy

A

May destabilize the spine if performed over multiple levels, requiring instrumentation

78
Q

Contraindications for laminectomy

A

Contraindicated if kyphotic deformity is present

79
Q

A procedure that involves reshaping the lamina to increase the volume of the vertebral foramen and decompress the spinal cord without removing the protective function of the lamina

A

Laminoplasty

80
Q

Indications for laminoplasty

A

Cervical and upper thoracic spinal stenosis

81
Q

Advantages of laminoplasty

A

Increases the volume of the vertebral foramen over multiple levels without removing the protective function of the lamina or significantly destabilizing the spinal segment

82
Q

Disadvantages of laminoplasty

A

Technically more demanding than a laminectomy and limited to cervical and upper thoracic spine

83
Q

Contraindications for laminoplasty

A

Contraindicated if spine is in kyphosis

84
Q

Removal of the disc

A

Discectomy

85
Q

Inducing the body to grow a bridge of bone from one vertebra to another

A

Fusion

86
Q

Five basic steps of discectomy and fusion

A 
Removal of disc
Placement of spacer in disc space
Graft Augmentation
Stabilization
Fusion
87
Q

This device attempts to achieve the goals of a fusion (decompression, relief of symptoms) while maintaining motion at the spinal segment

A

Disc replacement

88
Q

Comprised of spinal instrumentation that may allow for controlled flexion, extension, lateral bending, and axial rotation while resisting unwanted shear motion of the spinal segment

A

Dynamic stabilization

89
Q

Limit extension in patients suffering from spinal stenosis

A

Interspinous spacer

90
Q

Replaces a diseased, painful facet

A

Facet replacement

Spinal Anatomy (12 decks)

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