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PTRS 845 Midterm > Discs > Flashcards

Discs Flashcards

1
Q

Function and Composition: Nucleus Pulposus

A

F: accepts compressive forces; allows deformation under pressure

C: 70-90% water, 15-20% collagen type II, 65% proteoglycans (dry weight) < GEL like substance

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2
Q

Term: Causes nucleus pulposus to be viscose and thick

A

Collagen type 2

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3
Q

Function and Composition: Annulus Fibrosus

A

F: Resist distraction, shear, and torsional stresses

C: 60-70% water, 50-60% type I collagen, 20% proteoglycan (dry weight)

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4
Q

Term: sheets

A

Lamellae

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5
Q

Describe the arrangement of lamellae of the annulus fibrosus

A

Arranged in concentric rings with the fibers alternating 60 degrees from vertical in successive layers

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6
Q

Annulus Fibrosus Structure: Allows for flexion motion

A

Thin posterior fibers

  • While thin allows them to be more tightly packed thus can withstand flexion while remaining flexible
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7
Q

Annulus Innervation

A

Only the outer 1/3 is innervated (by recurrent sinuvertebral n.)

B/c the annulus is innervated it can be a source of LBP

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8
Q

Term: Outer annulus fibers that are attached to the vertebral bodies

A

Sharpey’s Fibers

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9
Q

Function: Vertebral end-plate

A

Hold disc in place

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10
Q

Describe the effect of nerve ending proliferation

A

increased pain

It has been found that those with DDD have more end plate innervation

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11
Q

Structure:

  • Transmits load form one vertebra to the next
  • Allows movement between vertebra
  • Proprioception
A

Intervertebral Disc

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12
Q

2 Normal Forces that Occur to Discs

A
  1. Compression
  2. Distraction
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13
Q

2 Pathologic Forces that Occur to Discs

A
  1. Rotation
  2. Shear
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14
Q

Describe the Mechanics: Compression

A

The vertebral bodies move towards one another deforming the nucleus and placing pressure on the annulus (radial bulging) and end plates (bulge into trabecular bone)

The annulus and trabecular bone resist the pressure, equilibrium is reached and the load is transfer through the spine

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15
Q

Term: Principle WB component of L-spine

A

Interbody joint

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16
Q

Term: movement caused by WB activities or muscle forces

A

Axial compression

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17
Q

Indicates: Pain with traction of the spine

A

Annulus tear or facet issue

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18
Q

Describe the Annulus’ response to rotation

A

Half of the fibers are on stretch and half are lax due to alternating directions of lamella

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19
Q

Motion: Causing lateral shearing and lateral rotation

A

Lift and twist

^ You should lift and pivot instead

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20
Q

Term: Anterior/Posterior bending

A

Rocking

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21
Q

Describe why those with posterior disc bulges flex or rock anteriorly

A

An anterior rock increases pressure on the anterior nucleus and decreases pressure on the posterior nucleus effectively relieving some of the pressure off the disc bulge

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22
Q

2 Ways the Disc recieves Nutrition

A
  1. Passively - imbibition/diffusion
  2. Actively - spinal motion
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23
Q

Term: avascular structure

A

Vertebral Disc

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24
Q

Describe the pattern of diffusion of nutrients (for the discs)

A

Bone marrow > vertebral body > end plate > nucleus

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25
Q

describe the blood supply/flow surrounding the discs

A

Blood supply to outer 1/3 of annulus from spinal arteries

Blood flow through endplate from bone marrow

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26
Q

Optimal Stimulus for Regeneration: Annulus

A

Modified tension in line of stress

Unload position out of pain range

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27
Q

Optimal Stimulus for Regeneration: Nucleus Pulposus

A

Intermittent compression and decompression

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28
Q

Describe Normal Disc Degeneration

A

Disc integrity decreases with age

The ability to retain water and distribute load across the disc decreases

All 3 structures under go change

PAIN is NOT a part of normal disc degeneration

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29
Q

4 Biochemical Disc Changes with Age

A
  1. Decreased proteoglycan (can’t hold water - dry out)
  2. Increased or change in collagen type (annulus > Type 2 = can’t accept tensile forces)
  3. Dead cell build up > lysozome activity > weakened collagen
  4. Amyloid build up in discs
30
Q

Changes in Disc Nutrition with Age

A
  1. Lack of movement > decreased diffusion
  2. Decreased fluid transport
  3. Injury or trauma
31
Q

Force: Most disruptive to a disc

A

Shear

32
Q

Condition:

  • M > F
  • 40-50
  • Occupation involves lifitng, sitting, oversure
A

Degenerative Disc Disease

33
Q

Condition:

  • Constant or Intermittent pain
  • Low grade ache
  • Leg sx rare
  • Morning stiffness/pain
  • Localized in low back, rare for pain to radiate
A

Degenerative Disc Disease

34
Q

Describe why those with DDD have morning stiffness

A

Over night discs rehydrate, making them highly hydrated in the morning. This increases their size, decreasing the space in the joint and contributing to morning stiffness

35
Q

Condition:

Aggravating factors include

  • Extending
  • Bending
  • Sitting
  • Sit to stand
  • sustained posutre
  • sudden motion
  • end ROM
A

Degenerative Disc Disease

36
Q

Condition:

History includes repeated micro trauma to annular fibers, trauma to disc, or bone spur formation

A

Degenerative Disc Disease

37
Q

Condition:

Objective

  • ROM limited in the acute phase
  • Pain with flex/ext, OP, sustained posture
A

Degenerative Disc Disease

38
Q

Condition:

Objective

  • SLR (-)
  • Thickened soft tissue
  • PAIVM increased, decreased mobility, min pain
A

Degenerative Disc Disease

39
Q

4-6 Goals for Degenerative Disc Disease

A
  1. Decrease compression
  2. Promote nutrition
  3. Improve mobility/flexibility
  4. Strengthen core
  5. Minimize faulty movement
  6. Promote function
40
Q

4 Components of Disc Rehydration

A
  1. Unloaded 90/90 positin or alternative reclined position
  2. Minimum mm activity
  3. Maintain unloaded position for 15-20 minutes
  4. Morning exercise prefered to DDD
41
Q

Term: displacement of nuclear material beyond normal confines

A

Disc Herniation

42
Q

4 Types of Disc Herniation

A
  1. Intra-spongy herniation
  2. Protrusion (contained herniation)
  3. Prolapse/Extrusion
  4. Sequestration
43
Q

Term: break in the end plate due to heavy lifting or compression that may or may not result in an inflammatory response

A

Intra-spongy herniation

44
Q

Defn: Schmorl’s Node

A

A hole in the vertebral body due to trabecular bone erosion

Erosion can occur following an intraspongy herniation due to nuclear material settling into trabecular bone

45
Q

Condition:

  • Occurs more commonly in the T-Spine
  • 20s-30s
  • Pt. unloads spine before getting up
A

Intra-Spongy Herniation

46
Q

Term: Nucleus material migrates outward through a tear but does not escape from the outer annulus fibrosus or the PLL

A

Protrusion

47
Q

Condition:

  • 20s-50s
  • Poorly localized dull ache in back
  • May have buttock pain
  • Increased pain in AM
  • Unloads spine from sit to stand
A

Protrusion

48
Q

Condition:

History includes sudden onset of localized back pain that may resolve with continued activity

A

Protrusion

49
Q

Describe why herniation is not longer possible after the age of 55

A

The nucleus losses its viscosity so doesn’t have a consistency that would make it easy for it to escape its confines

50
Q

Condition:

Objective

  • Lateral shift
  • Radicular pain +/–
  • flexion limited or painful
A

Protrusion

51
Q

Term: trunk deviation away from the pain

A

Lateral Shift

52
Q

Term: Nucleus material escapes the annulus fibrosus and the PLL but remains attached to the disc

A

Extrusion or Prolapse

53
Q

Term: A free fragment of the nucleus pulposus and may migrate to the spinal canal

A

Sequestration

54
Q

2 Disc Herniations that are likely to Impinge Nerve Tissue

A
  1. Extrusion/Prolapse
  2. Sequestration
55
Q

Term: Bulge lateral to the nerve root

A

Posterolateral Disc Herniation

56
Q

Term: Shift to opposite side to open up and allow pressure release

A

Protective Scoliosis for Posterolateral Disc Herniation

57
Q

Term: Most common disc herniation

A

Posterolateral Disc Herniation

58
Q

Term: Bulge medial to the nerve root

A

Posteromedial Disc Herniation

59
Q

Term: Shift to the same side to open up and allow pressure release

A

Protective Scoliosis for Posteromeidal Disc Herniation

60
Q

Condition:

  • 20-55 yo
  • LBP, back and leg pain
  • Associated muscle spasms +/-
A

Posterolateral Disc Herniation

61
Q

Condition:

Aggravating factors include: flexion, sitting, sit to stand, walking, sneezing, coughing

A

Posterolateral Disc Herniation

62
Q

Condition: Those with Posterolateral Disc Herniation are at high risk

A

Cauda Equina

63
Q

Condition

  • Severe back pain
  • SLR +
A

Possible Cauda Equina

64
Q

Condition:

History includes: sudden onset but usually due to repetitive bending, lifting or frequent lifting, recurrent episodes

A

Posterolateral Disc Herniation

65
Q

Condition:

  • Slight flexed posture
  • Lateral Shift +/-
  • Limited ROM/Gaurded movement
  • Centralization of pain
A

Posterolateral Disc Herniation

66
Q

4-6 Goals for (Posterolateral) Disc Herniation

A
  1. Decrease Inflammation/mm gaurding
  2. Protect Disc
  3. Centralize Pain
  4. Correct shift if present
  5. Decrease compressive forces and tension
  6. Promote pain free mobility/activity
67
Q

Describe how lateral shift is named

A

Named in the direction of shoulder displacement

A left shift will relieve sx on the right

68
Q

Describe how a lateral shift is correct

A

By moving the hips under the shoulders

69
Q

Describe what will be damaged first with pure compression

A

Vertebral bodies and end plate before disc damage

70
Q

Term: most frequent site of disc degeneration

A

Lumbosacral joint - L4/L5; L5/S1

PTRS 845 Midterm (13 decks)

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