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E&M Musculoskeletal System > Disc Lecture > Flashcards

Disc Lecture Flashcards

1
Q

How much bigger should the IVF be in comparison to the nerve root that traverses it?

A

5-6x larger

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2
Q

What are the first trabeculae to go away when you lose vertebral bone density?

A

Horizontal trabeculae

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3
Q

What do the discs rely on for nutrition?

A

Diffusion

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4
Q

What is the distribution of blood supply to the disc?

A

50% from vessels of annulus

50% from vertebral endplates

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5
Q

What ensures that an even distribution of compressive stress acts on the vertebral bodies generating a tensile “Hoop Stress” in the surrounding annulus?

A

Nucleus Pulposus

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6
Q

What grade of the nucleus pulpous is a young, non-degenerated nucleus. There is a large “functional nucleus” in which the horizontal and vertical stresses are equal?

A

Grade 1

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7
Q

What grade of the nucleus pulpous is a mature disc indicative of 35-70 year olds in which the hydrostatic region shrinks?

A

Grade 2

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8
Q

What grade of nucleus pulposus is moderately degenerated with irregular stress profile indicating variable resistance to compression with a small or absent central hydrostatic region?

A

Grade 3

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9
Q

What grade of nucleus pulpous has a highly irregular and variable stress profiles and by an overall reduction in compressive stress and may have osteophytes?

A

Grade 4

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10
Q

What is the composition of the Nucleus Pulposus?

A

70-85% water, 20% collagen, 50% proteoglycan

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11
Q

What is the composition of the Outer Anulus?

A

50% water, 70% collagen, 10% proteoglycan

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12
Q

What type of collagen is typical of tensile structures like ligaments and is HIGHEST in the outer anulus?

A

Type I collagen

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13
Q

What type of collagen is typical of compressed tissues like articular cartilage and is HIGHEST in nucleus and ABSENT in outer anulus?

A

Type II collagen

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14
Q

How much fluid does the disc lose in the first hour of the morning?

A

90%

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15
Q

T/F: With normal aging, fibrous tissue replaces nuclear mucoid matrix, but the disc height is preserved and the disc margins remain regular

A

True

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16
Q

What is found in 100% of skeletons with individuals over 40?

A

Anterior and lateral margin vertebral body osteophytes

17
Q

What are knobby excresences of the vertebral bodies indicative of?

A

Degenerative osteoarthritis

18
Q

Who is most at risk for osteoporosis?

A

Post-menopausal women

19
Q

T/F: Genetics may play a role in 60% of “back pain”

A

True

20
Q

What are the 3 entities that describe primary disc pain?

A

Discitis
Torsion Injuries
Internal disc disruption (IDD)

21
Q

What is a disc that is infected by bacteria introduced by needles used for discography?

A

Discitis

22
Q

Axial rotation movements of the lumbar spine is limited to how many degrees?

A

1 degree

23
Q

No evidence of torsional damage to the disc can be detected in how many degrees?

A

1-9 degrees

24
Q

What actually tears during a torsional injury?

A

Circumferential tears of the anulus

25
Q

What does 50Nm of extension, lateral flexion, and rotation do to lumbar compression?

A

extension = 800Nm of compression
Lat. Flexion = 1400Nm of compression
Rotation = 3000 Nm of compression

26
Q

What is the cardinal pathological basis for discogenic pain?

A

Internal Disc Disruption

27
Q

What percent of patients with LBP are suffering from Internal Disc Disruption?

A

40%

28
Q

What is the definition of Internal Disc Disruption?

A

Degradation of the nucleus and the development of radial fissures that extend into the anulus

29
Q

What is the weak link of the lumbar spine during compression?

A

Vertebral endplate

30
Q

What are the criteria for diagnosing IDD?

A

Saline must reproduce pain

Grade 3 annular fissure on a CT

31
Q

What are the Radial Fissure Grades?

A

Grade 0: no fissure
Grade 1: Fissure penetrates into inner 1/3 of annulus
Grad 2: Fissure penetrates into the middle of the annulus
Grade 3: Fissure penetrates into the outer 1/3 of the annulus
Grade 4: a Grade 3 fissure that spreads circumferentially around the annulus

32
Q

What are a family of degradative enzymes in the nuclear matrix that chew up collagen?

A

Metalloproteinases

33
Q

What induces the activity of metalloproteinases?

A

Vertebral Endplate fractures

34
Q

What type of herniation involves less than 25% of disc circumference?

A

Focal Herniation

35
Q

What type of herniation involves between 25% and 50% of disc circumference?

A

Broad-Based Herniation

36
Q

T/F: The lower the pH, the more inflammation and fibrosis, and the greater the degree of pain

A

True

37
Q

What is an inflammatory condition of the nerve root due to rupture of the annulus fibrosus and dissemination of disk fluid along the nerve root sheath

A

Chemical radiculitis

E&M Musculoskeletal System (32 decks)

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