IDD - Exam 2 Flashcards
what parts of the disc tear in acute IDD?
annulus
end plate
persistent IDD is disc changes that allow for herniations that develop ________
gradually over time
is acute or chronic IDD the most prevalent?
chronic
the layers of the annulus are more like a _______ which means the annulus and nucleus move ____(together or separate)___
gradient
together
the outer annulus has greater type _____ collagen and resists _______
type I
tension
the inner annulus has greater type _____ collagen and resists _______
type II
compression
true or false. from outer to inner annulus, it goes hyper to hyponeural
true
annulus:
- vascular or avascular?
- concentric rings w/ ________ fibers
- compression produces _______ and vice versa
- avascular
- perpendicular
- tension
nucleus:
- resists _______
- type ____ collagen
-high # of _______
- vascular or avascular?
- compression
- type II
-GAGs - avascular (depends on diffusion to get nutrients)
Vertebral endplate: “pipeline of body and disk”
-highly _____ and _______
-assists w/ ________ for disk
-covers the _____ and MOST of annulus with __________
-_________is (type?) toward the vertebral body
-_________is (type?) toward the disc
-innervated and vascularized
-nutrient diffusion
-nucleus; specialized connective tissue
-articular cartilage type II
-fibrocartilage type I
The __________ is the weakest link of the intervertebral joining, especially at the annular connection.
vertebral end plate
What is made up of type I collagen and 6x stiffer and 3x thicker than a disc?
bone
Is IDD more often times persistent or acute?
Rare in what spinal region?
persistent
thoracic spine
(most common in lumbar spine)
Why is it rare to have internal disc derangement (IDD) in the T-spine?
because the t-spine is the narrowest canal which means it has less room to accept change.
Why is it rare to have IDD in the C2-C6 region?
because of the additional stability from the UV jts.
-creates more stability
What portion of the disc is the MOST common area
-Why?
posterolateral
-weaker, thinner, with more vertical and, less oblique annular fibers
The transition of the annulus into _______is the weak spot
endplate
Acute IDD is more commonly _______ tear and _______ avulsion
Less commonly ______________ herniation
-annular and end plate
-nucleus pulosus
Does the immune system respond when disc structures are damaged? why?
Yes
large autoimmune inflammatory response occurs –> more water –> spinal nerve and disc swelled –> spinal nerve sensitized to pressure/tension –> radiculopathy/radicular S&S –> excess water has no where to go because poor drainage = extended inflammatory phase
typical postlat IDD acute symptoms:
dull/achy spinal pain
– annulus highly innervated
– less swelling due to less GAGs
radiculopathy
– segmental paresthesias within 24 hours into distal extremity because of additional water buildup
referred pain
decreased pain laying supine/unloaded
increased neck pain looking down (due to tension)
increased pain in morning
how does S&S of acute IDD differ from age related joint changes and lateral stenosis? (regarding flexion and extension)
age & stenosis = pain increased looking up
acute IDD = pain increased looking down
what are you going to find in a scan for postlat acute IDD?
ROM?
MMT?
stress test?
neuro?
ROM:
flx & contralateral SB/RT limited w/ increased extremity & spinal pain due to pressure toward spinal nerve
ext & SB/RT less limited w/ decreased extremity pain but may increase spinal pain due to increased hydrostatic pressure on disc
MMT:
variable
Stress test:
possible + with compression/distraction/PA pressures
neuro:
+ depending on severity and timing
myotomal fatigue
DTR- hyporeflexive
diminished dermatomes
+ dural mobility tests
what is centralization?
abolition of distal and/or spinal pain in a distal to proximal direction in response to repetitive motions or sustained positions
what are you going to find in a biomechanical exam for postlat acute IDD?
+ stability tests
central IDD (central vs postlat) is rare, but if found it would have what S&S? what would you do immediately after finding these S&S?
cord S&S
immobilize and emergency referral
the McKenzie method is based on the belief that most of the pain comes from ___
injuries to the disc
in the McKenzie method, the classification system is based on (2)
location of symptoms
positions that decrease symptoms
McKenzie method is more effective in ______ spine
least effective in ______ spine
lumbar
cervical
McKenzie’s method intends to put the patient in what position?
puts patient in positions that offset the symptoms
true or false. aggressive nonsurgical treatment is not effective in treating disc injuries
false - still very effective using:
- intermittent traction
- specific therex
- oral anti-inflammatory medication
- patient education
what are some Rx for acute IDD?
POLICED
intermittent traction may be helpful if no centralization
neural mobilizations
MET used for tissue proliferation and stabilization of local muscles –> targets deeper structures that help to handle stress better moving forward
what is persistent IDD also known as?
degenerative disc disease
age related disc changes
- no recent trauma
IDD is more commonly found in _____ spine
if in cervical, what segment is most common? why?
lumbar
C5-6 –> C6 spinal nerve
– most involved because it has the largest diameter in C spine due to many innervations from brachial plexus
what causes persistent IDD?
acute IDD
sedentary lifestyle / understressing (sitting all day)
genetics - can be modified by lifestyle changes
how does persistent IDD come about?
in growth of nociceptive fibers from acute IDD healing can lead to persistent inflammation and nociplastic pain
–> persistent inflammation brings excessive and destructive proteins and a low grade infection to the disc
what is happening to the disc in persistent IDD after the endplate is damaged from acute IDD?
persistent herniations gradually develop once changes occur with the disc
what are the categories of herniation?
what is the most common herniation?
- protrusion - bulge
** most common herniation - extrusion - nucleus migrates thru outer annulus
– hole in cheek, tongue poking out - free sequestration - nucleus breaks away from annulus
– tongue out of cheek and cut
what is likely to develop when the nucleus migrates into the vertebral body?
Schmorl’s nodes
what three things narrow with persistent IDD?
disc - instability may develop
increased load bearing on facets - age related joint changes may occur
foramen - stenosis may develop
quick or slow progression of symptoms with persistent IDD?
slower progression of symptoms because slow change allows tissues to adapt without symptoms
onset of persistent IDD symptoms are _____
gradual
may be like acute S&S
need to consider other conditions that may develop & their respective S&S
how would you treat persistent IDD?
possibly like acute IDD (POLICED) without inflammatory interventions
need to consider primary driver of symptoms from other conditions (instability, age related, stenosis)
what is the prognosis for IDD? (2)
mostly good
extended timeline of healing for ligament and cartilage
what is peripheralization? is it better or worse outcome than centralization?
sending more symptoms further down the extremity
worse outcome
what is peripheralization significantly associated with? (5)
mental distress
non organic signs i.e. tumor
pain behaviors
somatisation - anxiety into bodily symptoms
fear of work
what are MD treatment options for IDD? (5)
- antibiotics - to treat infection
- laminectomy (cut parts of the lamina to create space)
- partial discectomy (shave off a portion of disc)
- cervical fusion
- total disc replacement (TDR): safe and effective treatment more than 5 years postop
