Examination 2 Flashcards
What is spondylolysis?
Pathology to the pars interarticularis
Does unilateral or bilateral spondylolysis cause a higher risk for spondylolisthesis?
Bilateral (slower healing time as well)
Why is it important to catch a spondylolysis early?
Because fracturing 1 side of vertebral ring leads to increased stress on the other side and higher risk for fracture
What is a common clinical presentation of spondylolysis?
Activity related back pain, worse with extension, SL hop worse on side of defect
What is a solid battery of clinical test to use during a spondylolysis exam?
standing 1 leg hyperextension, SL hopping, and prone hip extension
What is the best form of imaging to use for a spondylolysis?
Oblique xray
What is the best form of xray to use for a spondylolosthesis?
Lateral
What is a CT scan good at visualizing?
Healing vs non-union
What is more accurate at discovering spondylolysis in youth athletes: CT or MRI?
CT
What is the telltale sign on an xray for a spondylolysis?
Scotty dog with collar
Briefly describe an intervention plan for a spondylolysis
Activity modification, bracing if pain is present at rest and persistent, return to sport once pain-free
What is the motion we are most concerned about with spondylolysis?
Repeated lumbar extension
What are some areas we want to work on in rehab for a spondylolysis patient
Posture (worried if they have excessive anterior L-spine tilt), gait (trendelenberg), strength (glutes and abs), movement coordination (breathing pattern, prone hip extension)
Why is it important to fix breathing pattern for a spondylolysis patient?
Lots of extension occurs through thoracolumbar junction with faulty breathing
What are some factors that could contribute to an anterior pelvic tilt?
Tight hip flexors, weak abdominals, weak glutes
Why is it common (25%) for spondylolysis fractures to not heal entirely?
Because of the direction of fracture. It’s not inline with body weight
How is spondylolisthesis graded?
1 - 25% slippage 2 - 50% slippage 3 - 75% slippage 4 - 100% slippage 5 - slips entirely forward
What are we worried about most with spondylolisthesis?
Neurlogic compromise. Normally irritates L5/S1 nerve root which leads to LE weakness, paresthesia with occasional dysfunction
What does treatment for spondylolisthesis look like?
Bracing for acute cases (3-6mo), LE flexibility program
Why is a little bit of hamstring tightness okay for spondylolisthesis patients?
Pulls pelvis posteriorly which helps with slippage
What is not indicated for spondylolisthesis patients?
Extension, lumbar lordosis
What are the indications for surgery for a spondylolisthesis patient?
Greater than 1 year persistant pain, lateral shift, progressive neurological deficits, slip beyond grade 2, high slip angle
What is the surgical technique that addresses spondylolisthesis?
In-situ fusion
What are some ways to distinguish the clinical presentation of spondylolysis and spondylolisthesis`
Potential radicular symptoms on spondylolisthesis. Tight hamstrings with lysis and palpable step off/positive dural tension sigh with lolisthesis
Define idiopathic scoliosis
Complex 3D deformity of the spine and trunk
when does idiopathic scoliosis generally occur?
During a period of rapid growth
What is the most common scoliosis pattern?
Right thoracic curve with a left lumbar curve
Is scoliosis more prevalent in males or females?
Females
What are some of the long term impacts of scoliosis?
> 80 degrees in T-spine = SOB, some decrease in QOL b/c it affects breathing and childbirth
Briefly describe the Cobb angle measurement (gold standard for measuring scoliosis)
ID upper and lower end vertebrae, draw lines extending alone vertebral orders, measure Cobb angle
How is scoliosis named?
For the convexity
When are patients with scoliosis braced?
When curve is <30 degrees and progresses >5 degrees in a year
How long does an average scoliosis patient wear a boston brace for?
Until they’re skeletally mature
What are some downsides of long term wearing of a boston brace?
Disuse atrophy, loss of spinal proprioception
What is one criticism of the Boston brace?
Fails to account for 3D control of the spine
What are the components of therapy for scoliosis?
Cognitive, sensory-motor, and kinesthetic
What are the current guidelines for treatment of scoliosis?
<25 degrees - observation
25-50 degrees - bracing
>50 degrees - surgery
What are some goals of rehab for scoliosis?
Improve curvature, improve strength and balance of muscle activation, decrease trunk asymmetry, decrease pressure on vital organs, increase lung function, arrest progression of curve
What is a Magnetic Expansion Control Growing Rod?
Used for children still going to grow a lot. Can lengthen rods with magnetic tool with no surgery
What is ankylosing spondylitis?
Inflammatory process
What is the classic clinical presentation of ankylosing spondylitis?
15-35yo, insidious onset of morning stiffness, LBP, insertional tendinitis, possible involvement of eyes, heart, lungs, pain worse with rest and better with activity
What are some general treatment principles for rehabing someone with ankylosing spondylitis?
Education, extension based exercises, NSAIDs
What is Scheuermann’s Disease?
Fixed rigid thoracic kyphotic deformity with or without pain
What is the clinical presentation of Scheuermann’s Disease?
Asymptomatic (occasional pain/fatigue), higher incidence in adolescent rowers/weightlifters, rare progression in late life
How is Scheuermann’s Disease diagnosed?
Lateral radiographs that show 3 consecutive T-spine vertebrae bodies with wedging > 5 degrees