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NYCC Bone & Joint > Intervertebral Disc Herniation > Flashcards

Intervertebral Disc Herniation Flashcards

1
Q

How are disc herniations classified?

A
  • morphology (type)
  • location
  • neurologic involvement
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2
Q

What are the types of disc herniations?

A
  • contained: protrusion
  • uncontained: extrusion & sequestered fragment
    (bulge is NOT a herniation)
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3
Q

What is a contained disc herniation?

A

nucleus contained by at least 1 annular layer

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4
Q

What is an uncontained disc herniation?

A

nuclear material violates annulus

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5
Q

What is a disc bulge?

A
  • disc loses height, expands outward (associated w/ degen.)
  • disc extends beyond body margin generally <3mm (2mm = bulge)
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6
Q

A disc bulge involves how much of the disc circumference?

A

> 25%

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7
Q

What MRI weighting and view can be used to visualize a disc bulge?

A

T2
axial view

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8
Q

Disc bulges can be ____ or ____

A

symmetric or asymmetric

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9
Q

What is the shape of the intervertebral discs in the cervical spine?

A

oval

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10
Q

What is the shape of the intervertebral discs in the upper thoracic spine?

A

D-shaped

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11
Q

What is the shape of the intervertebral discs in the lower thoracic spine?

A

kidney bean-shaped

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12
Q

What is the shape of the intervertebral discs from T12 to L4?

A

kidney bean-shaped

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13
Q

What is the shape of the intervertebral disc at L4-L5?

A

flat across back

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14
Q

What is the shape of the intervertebral disc at L5-S1?

A

oval

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15
Q

A focal extension of disc beyond the vertebral body margin, indenting the thecal sac is called a ____

A

disc protrusion

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16
Q

Nuclear material that is not contained by the outer 1/3 annular fibers but maintains continuity with the parent disc is called a ____

A

disc extrusion

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17
Q

Uncontained disc material that is not connected to the parent disc is called a ____

A

sequestered fragment

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18
Q

Describe the appearance of a disc protrusion.

A

base is wider than the depth in both sagittal and axial dimensions

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19
Q

What are the clinical findings of a disc protrusion?

A

often ASx (1-2/3 of ASx population has one)

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20
Q

Describe the appearance of a disc extrusion.

A
  • base is narrower than the depth in either sagittal or axial dimensions
  • acute cases may show ^T2 and postcontrast T1 d/t surrounding granulation tissue
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21
Q

If a disc appears to be protruded on a sagittal view, but extruded on an axial view, what type of herniation is it?

A

disc extrusion

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22
Q

What is the prognosis of disc protrusions and extrusions?

A
  • shown to reduce in size with time
  • 90% with radiculopathy managed conservatively with good outcome
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23
Q

Pain from a disc extrusion is more likely from ____ causes than ____

A
  • chemical
  • mechanical compression
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24
Q

What 2 questions should you ask every patient with low back pain?

A
  • problems w/ urination (starting/stopping, incontinence)
  • problems w/ bowel movements (starting/stopping, incontinence)
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25
Q

What are the clinical findings of a sequestered disc fragment?

A
  • can migrate into spinal canal = painful
  • can affect multiple nerve roots
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26
Q

What clinical signs would suggest that a sequestered disc fragment has migrated significantly?

A

changes in neuro symptoms

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27
Q

What is the treatment for a sequestered disc fragment?

A

open procedure to clean out all fragments
(minimally invasive surgery is less than optimal)

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28
Q

What are the possible locations used to classify disc herniations?

A
  • central
  • subarticular
  • foraminal
  • extraforaminal
29
Q

What are the 2 more common location classifications of disc herniations?

A

central
subarticular

30
Q

What are the most common spinal levels for disc hernitations?

A
  • L4/L5
  • L5/S1
  • C5/C6
  • C6/C7
31
Q

In general, what nerve roots are affected by central, subarticular, and foraminal cervical disc herniations?

A

exiting roots

32
Q

What nerve root is affected by a C5/C6 subarticular disc herniation?

33
Q

What nerve root is affected by a C6/C7 central disc herniation?

34
Q

What nerve root is affected by a C4/C5 foraminal disc herniation?

35
Q

In general, what nerve roots are affected by central and subarticular lumbar disc herniations?

A

transiting nerve root (in lateral recess)

36
Q

In general, what nerve roots are affected by foraminal lumbar disc herniations?

A

exiting nerve roots

37
Q

What nerve root is affected by a L4/L5 subarticular disc herniation?

A

L5
(transiting)

38
Q

What nerve root is affected by a L4/L5 foraminal disc herniation?

A

L4
(exiting)

39
Q

In the lumbar spine, the upper segment level corresponds to the ____ nerve root, while the lower level corresponds to the ____ nerve root.

A
  • upper = exiting
  • lower = transiting
40
Q

What is the motor distribution of C5 nerve root?

A
  • deltoid
  • biceps brachii
41
Q

What is the motor distribution of C6 nerve root?

A
  • biceps brachii
  • wrist extensors
42
Q

What is the motor distribution of C7 nerve root?

A
  • wrist flexors
  • finger extensors
43
Q

What is the motor distribution of C8 nerve root?

A
  • finger flexors/ABductors
  • interossei
44
Q

What is the motor distribution of T1 nerve root?

A

finger ABductors & ADductors

45
Q

What is the motor distribution of L4 nerve root?

A

tibialis anterior

46
Q

What is the motor distribution of L5 nerve root?

A
  • EHL
  • toe extensors
47
Q

What is the motor distribution of S1 nerve root?

A

peroneus longus/brevis

48
Q

What is the deep tendon reflex for C5 nerve root?

A

biceps brachii

49
Q

What is the deep tendon reflex for C6 nerve root?

A

brachioradialis

50
Q

What is the deep tendon reflex for C7 nerve root?

51
Q

What is the deep tendon reflex for C8 nerve root?

52
Q

What is the deep tendon reflex for T1 nerve root?

53
Q

What is the deep tendon reflex for L4 nerve root?

54
Q

What is the deep tendon reflex for L5 nerve root?

A

medial hamstring

55
Q

What is the deep tendon reflex for S1 nerve root?

56
Q

What is the probability of having an asymptomatic disc herniation?

A

roughly equal to age

57
Q

What is the sensory distribution for C5 nerve root?

58
Q

What is the sensory distribution for C6 nerve root?

59
Q

What is the sensory distribution for C7 nerve root?

60
Q

What is the sensory distribution for C8 nerve root?

61
Q

What is the sensory distribution for T1 nerve root?

62
Q

What is the sensory distribution for L4 nerve root?

63
Q

What is the sensory distribution for L5 nerve root?

64
Q

What is the sensory distribution for S1 nerve root?

65
Q

What is the location of this disc abnormality/herniation? What nerve roots are most likely to be involved?

A

Central
L5 nerve root (transiting)

66
Q

What is the location of this disc abnormality/herniation? What nerve roots are most likely to be involved?

A

Central
S1 nerve root (transiting)

67
Q

What is the location of this disc abnormality/herniation? If this were at

68
Q

What is the location of the disc abnormality/herniation? If this were located at L5/S1, what nerve roots are most likely to be involved?

A

Foraminal
L5 nerve root (exiting)

69
Q

What is the location of this disc abnormality/herniation? If this is at C6/C7 disc, what nerve roots are most likely to be involved?

A

Central
C7 nerve root (exiting)

NYCC Bone & Joint (52 decks)

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