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Y4R4 - Surgery II 👨‍⚕️ > L7: Spinal Degenerative Diseases > Flashcards

L7: Spinal Degenerative Diseases Flashcards

1
Q

Anatomical Overview of the vertebra

A
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2
Q

Pathology in Degenerative Disease of the Spine

A
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3
Q

Compression of the spinal Cord

A
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4
Q

Myelopathy

A
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5
Q

Most Common Myelopathy

A

Cervical spondylotic myelopathy (CSM)

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6
Q

Radiculopathy

A
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7
Q

Most Common Radicular Pain

A

sciatica - brachialgia

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8
Q

Stenosis

A
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9
Q

Spinal Degenerative Diseases

  • Arthritis
A
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10
Q

Spinal Degenerative Diseases

  • Bone Spurs
A
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11
Q

Symptoms of Spinal Degenerative Diseases

A
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12
Q

Red Flags of Spinal Degenerative Diseases

A
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13
Q

Red Flags of Spinal Degenerative Diseases

  • Cauda Equina Syndrome
A
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14
Q

Red Flags of Spinal Degenerative Diseases

  • Myelopathy
A
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15
Q

Red Flags of Spinal Degenerative Diseases

  • Radiculopathy
A
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16
Q

Red Flags of Spinal Degenerative Diseases

  • Others
A
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17
Q

RF for Spinal Degenerative Diseases

A
  • Aging.
  • Genetic predisposition.
  • Smoking, diet, weight.
  • Occupational (heavy lifting).
  • Sedentary lifestyle.
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18
Q

Types of Spinal Degenerative Diseases

A

A) Disc bulge.
B) Annular tear.
C) Herniation.

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19
Q

Def of Disc Bulge

A
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20
Q

Normal IVD

A
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21
Q

Classification of Disc Bulge

A
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22
Q

Def of Annular Tear

A

Disruption of concentric collagenous fibers comprising the anulus fibrosus.

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23
Q

Types of Annular Tear

A
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24
Q

MRI of Annular Tear

A
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25
Q

Def of Disc Herniation

A
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26
Q

Types of Disc Herniation

A

Notes

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27
Q

Types of Disc Herniation

  • Protrusion
A

The base of the herniated disc material is broader than the apex.

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28
Q

Types of Disc Herniation

  • Extruded Disc Herniation
A

The base of the herniation is
narrower han the apex (toothpaste sign)

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29
Q

Types of Disc Herniation

  • The Third Type?
A
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30
Q

Regions Affected by Disc Herniation

A
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31
Q

Epidemeology of Lumbar Disc Prolapse

A
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32
Q

Pathoanatomy of Lumbar Disc Prolapse

A
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33
Q

Prognosis of Lumbar Disc Prolapse

A
  • 90% of patients will have improvement of symptoms within 3 months with nonoperative care
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34
Q

Reabsorbtion in Lumbar Disc Prolapse

  • def
  • Mechanism
  • Type
A
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35
Q

Classification of Lumbar Disc Prolapse

A
  • According to Location
  • According to Anatomy
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36
Q

Classification of Lumbar Disc Prolapse

  • Acoording to location
A
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37
Q

Classification of Lumbar Disc Prolapse

  • Central Prolapse
A
  • Often associated with back pain only
  • May present with Cauda equina syndrome (surgical emergency)
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38
Q

Classification of Lumbar Disc Prolapse

  • Posterolateral Prolapse (Paracentral)
A
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39
Q

Classification of Lumbar Disc Prolapse

  • Foraminal Prolapse (Far Lateral, Extraforaminal)
A
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40
Q

Classification of Lumbar Disc Prolapse

  • Axillary Prolapse
A

Can affect Both exiting and descending nerve roots

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41
Q

Classification of Lumbar Disc Prolapse

  • According to Anatomy
A
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42
Q

Dx of Lumbar Disc Prolapse

A
  • Physical Examination
  • Imaging
  • Neurophysiological
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43
Q

Dx of Lumbar Disc Prolapse

  • Physical Examination
A
  • Neurological exam (sensory-motor-reflexes).
  • Provocative tests
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44
Q

Dx of Lumbar Disc Prolapse

  • Imaging
A
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45
Q

Imaging in Lumbar Disc Prolapse

  • MRI
A

MRI (Investigation of choice)

  • Most accurate assessment of lumbar spine area
  • There is a 29% prevalence of disc herniation in asymtomatic individuals.
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46
Q

Imaging in Lumbar Disc Prolapse

  • CT
A

…

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47
Q

Imaging in Lumbar Disc Prolapse

  • X-ray
A

traction spurs & disc space narrowing

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48
Q

Dx in Lumbar Disc Prolapse

  • Neurophysiological
A

EMG

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49
Q

Symptoms of Lumbar Disc Prolapse

A
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50
Q

Def of Cauda Equina Syndrome

A

Serious neurologic condition in which damage to the cauda equina

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51
Q

Pathophysiology of Cauda Equina Syndrome

A
  • Loss of function of the lumbar plexus (nerve roots) of the spinal canal below the termination (conus medullaris) of the spinal cord (Lower motor neuron lesion
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52
Q

Symptoms of Cauda Equina Syndrome

A
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53
Q

Lumbar Disc Prolapse

  • L4
A
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54
Q

Lumbar Disc Prolapse

  • L5
A
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55
Q

Lumbar Disc Prolapse

  • S1
A
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56
Q

Provocative Tests in Lumbar Disc Prolapse

A
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57
Q

Provocative Tests in Lumbar Disc Prolapse

  • Straight Leg Raise
A
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58
Q

Provocative Tests in Lumbar Disc Prolapse

  • Contralateral SLR
A

Crossed straight leg raise is less sensitive but more specifid

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59
Q

Provocative Tests in Lumbar Disc Prolapse

  • Lassegue Sign
A

SLR aggravated byforced ankle dorsiflexion

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60
Q

Provocative Tests in Lumbar Disc Prolapse

  • Bowstring Sign
A

SLR aggravated by compression on popliteal fossa

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61
Q

Provocative Tests in Lumbar Disc Prolapse

  • Kernig Test
A

Pain reproduced with neck flexion, hip flexion, and leg extension

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62
Q

Provocative Tests in Lumbar Disc Prolapse

  • Nafziger Test
A
  • Pain reproduced by foughing
  • Instigated by lying patient supine & applying pressure on neck veins
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63
Q

Provocative Tests in Lumbar Disc Prolapse

  • Milgram Test
A
  • Pain reproduced with straight leg elevation for 3o seconds in the supine)position
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64
Q

DDx of Lumbar Disc Prolapse

A
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65
Q

Prognosis of Lumbar Disc Prolapse

A
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66
Q

Management of Lumbar Disc Prolapse

A

1) Conservative (Non operative)

2) Selective nerve root corticosteroid injections

3) Surgical

67
Q

Management of Lumbar Disc Prolapse

  • Conservative
68
Q

Conservative Management of Lumbar Disc Prolapse

  • Indications
A

1) First line of treatment for most patients with disc herniation

2) 90% improve without surgery

69
Q

Conservative Management of Lumbar Disc Prolapse

  • Methods
70
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

71
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Indication
A

Second line of treatment if therapy and medications fail

72
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Methods
A
  • Epidural
  • Selective nerve block
73
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

  • Outcome
A
  • Leads to long lasting improvement in 50% compared to ~90% with surgery)
  • Results best in patients with extruded discs is opposed to contained
74
Q

Surgical TTT of Lumbar Disc Prolapse

75
Q

Surgical TTT of Lumbar Disc Prolapse

  • Indications
76
Q

Surgical TTT of Lumbar Disc Prolapse

  • Methods
77
Q

Complications of Surgical TTT of Lumbar Disc Prolapse

78
Q

Comlications of Lumbar Disc Prolapse

  • dural Tear
A
  • If have tear at time of surgery then perform water-tight repair
  • Has not been shown to adversely affect long term outcomes
79
Q

Comlications of Lumbar Disc Prolapse

  • Recurrent HNP
A
  • Can treat nonoperatively initially - revision rate a 8-yr-FU is 15%
  • Outcomes for revision discectomy have been shown to be as good as for primary discectomy
80
Q

Comlications of Lumbar Disc Prolapse

  • Chronic Low Back Pain
A
  • Not completely understood but central sensitization may be a factor
  • Amplification of neural signaling within the central nervous system (CNS) that elicits pain
81
Q

Comlications of Lumbar Disc Prolapse

  • Vascular Catastrophe
A
  • Caused by breaking through anterior annulus and injuring vena cava/aorta
82
Q

Comlications of Lumbar Disc Prolapse

  • Instability
83
Q

Comlications of Lumbar Disc Prolapse

  • Discitis
84
Q

Epidemeology of Cervical Disc Prolapse

A
  • Most often between (C5/6) and (C6/7).
  • The nerves of the cervical plexus and brachial plexus can be affected
85
Q

Symptoms of Cervical Disc Prolapse

86
Q

Symptoms of Cervical Disc Prolapse

  • Sites Affected
A

1) Back of the skull
2) Neck
3) Shoulder girdle
4) Scapula
5) Arm and hand.

87
Q

Symptoms of Cervical Disc Prolapse

  • Examples
A

1) Pain (neck, shoulder, arm, hand).

2) Radiculopathy.

3) Numbness.

4) Muscle weakness.

5) Paresthesia.

6) Severe cases: myelopathy + sphincteric disturbance (urinary incontinence and loss of bowel control).

88
Q

Symptoms of Cervical Disc Prolapse

  • C4/C5
89
Q

Symptoms of Cervical Disc Prolapse

  • C5/C6
90
Q

Symptoms of Cervical Disc Prolapse

  • C6/C7
91
Q

Symptoms of Cervical Disc Prolapse

  • C7/T1
92
Q

Dx of Cervical Disc Prolapse

A
  • Ex
  • Radiology
93
Q

Dx of Cervical Disc Prolapse

  • Ex
94
Q

Dx of Cervical Disc Prolapse

  • Cervical Compression Test & (Spurling’s test)
95
Q

Dx of Cervical Disc Prolapse

  • Lhermitte Sign
A

Feeling of electrical shock with patient neck flexion

96
Q

Dx of Cervical Disc Prolapse

  • Hoffman Sign
97
Q

Dx of Cervical Disc Prolapse

  • rads
98
Q

TTT of Cervical Disc Prolapse

99
Q

TTT of Cervical Disc Prolapse

  • Conservative
A
  • Medications (NSAID).
  • Physical therapy and exercise.
  • Steroid injection.
100
Q

TTT of Cervical Disc Prolapse

  • Surgery
101
Q

Def of Spinal Canal Stenosis

A

Abnormal narrowing (stenosis) of spinal canal that may occur in any of the regions of the spine → restriction to the spinal canal → neurological deficit

102
Q

Symptoms of Spinal Canal Stenosis

A

1) Pain
2) Numbness, paraesthesia
3) Loss of motor control.

103
Q

Incidence of Lumbar Canal Stenosis

A
  • Most common reason for lumbar spine surgery in pts > 65 yrs old
  • seen in 20-25%
104
Q

Lumbar Canal Stenosis

  • Sex
  • Age
A
  • Sex: Slightly more common in males (D5:1)
  • Age: Average age at presentation 5 65 years old
105
Q

Location of Lumbar Canal Stenosis

A

Most commonly occurs at L4-5 (91%)

106
Q

Risk Factors for Lumbar Canal Stenosis

A

1) Caucasian race

2) Increased BMI

3) Congenital spine anomalies (20%)

4) Failure of posterior elements to develop, short pedicles and laminae

107
Q

Classification (Types) of Lumbar Canal Stenosis

A

1) Central stenosis
2) Lateral recess stenosis
3) Foramen stenosis
4) Extraforaminal Stenosis

108
Q

Symptoms of Lumbar Canal Stenosis

109
Q

Symptoms of Lumbar Canal Stenosis

  • Neurogenic Claudication
110
Q

Signs of Lumbar Canal Stenosis

111
Q

Signs of Lumbar Canal Stenosis

  • Kemp Sign
A
  • Unilateral radicular pain from foraminal stenosis
  • Worse by back extension
112
Q

Signs of Lumbar Canal Stenosis

  • SLR
A

Usually, negative

113
Q

Signs of Lumbar Canal Stenosis

  • Valsalva
A
  • Radicular pain not worsened by Valsalva as is the case with a herniated disc
114
Q

Signs of Lumbar Canal Stenosis

  • Neuro Exam
A
  • Patients may have no focal deficits
  • cAs exam often takes place with patient seated and symptoms may be reproducible or exacerbated only with lumbar extension or ambulation
115
Q

Radiology in Lumbar Canal Stenosis

116
Q

Management of Lumbar Canal Stenosis

A
  • Non-Operative
  • Operative
117
Q

Management of Lumbar Canal Stenosis

  • Non-Operative
118
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Modalities
A

Oral medications, physical therapy, and corticosteroid injections

119
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Indications
A

First line of treatmen

120
Q

Non-Operative Management of Lumbar Canal Stenosis

  • Modalities (Explained)
A

1) NSAIDS, physical therapy, weight loss and bracing:
- Preoperative opioid use associated with prolonged hospital stays and increased postoperative pain.

2) Steroid injections (epidural and transforminal):
- Found to be effective and may obviate the need for surgery

121
Q

Surgical Management of Lumbar Canal Stenosis

122
Q

Surgical Management of Lumbar Canal Stenosis

  • Wide PTP Decompression
123
Q

Surgical Management of Lumbar Canal Stenosis

  • Wide PTP Decompression with instrumented fusion
124
Q

Def of Spondylosis

A
  • Broad term meaning degeneration of the spinal column from any cause.
  • In the more narrow sense it refers to spinal osteoarthritis, age-related wear and tear of the spinal column (most common cause of spondylosis)
125
Q

Spondylotic osteoarthritis mainly affects ……..

A
  • Vertebral bodies.
  • Neural foramina
  • Facet joints (facet syndrome).
126
Q

Spinal Instability

127
Q

Def of Spondylolishthesis

A

An anterior displacement of a vertebra relative to the vertebra below.

128
Q

Retrolisthesis

A

“the reverse” the superior vertebra slips posterior to that below.

129
Q

Grading of Spondylolishthesis

130
Q

Etiological Classification of Spondylolishthesis

131
Q

Etiological Classification of Spondylolishthesis

  • Dysplastic
A

Congenital dysplasia of the articular processes.

132
Q

Etiological Classification of Spondylolishthesis

  • Isthmic
A

Defect in the pars articularis.

133
Q

Etiological Classification of Spondylolishthesis

  • Degenerative
A

Degenerative changes in the facet joints.

134
Q

Etiological Classification of Spondylolishthesis

  • Traumatic
A

Fracture of the neural arch other than the pars articularis.

135
Q

Etiological Classification of Spondylolishthesis

  • Pathological
A

Weakening of the neural arch due to disorders of the bone.

136
Q

Etiological Classification of Spondylolishthesis

  • Iatrogenic
A
  • Excessive removal of bone following spinal decompression.
137
Q

Isthmic Spondylolishthesis

  • AKA
A

Spondylolytic Spondylolisthesis

138
Q

Isthmic Spondylolishthesis

  • Incidence
A

Most common form

139
Q

Isthmic Spondylolishthesis

  • Pathology
A

A bilateral defect in the pars interarticularis is present

140
Q

What is Pars interarticularis (AKA Isthmus)?

A
  • Pars interarticularis (AKA Isthmus) is the part of the neural arch that joins the superior and inferior articular processes
141
Q

Degenerative Spondoylolishthesis

142
Q

Degenerative Spondoylolishthesis

  • Description
A

A lumbar spondylolisthesis without a defect in the pars

143
Q

Degenerative Spondoylolishthesis

  • Level
A

Most common is L4-L5

144
Q

Degenerative Spondoylolishthesis

  • INVx
A

Dynamic radiographs: Flexion-Extension X-rays

145
Q

CP of Spondoylolishthesis

146
Q

CP of Spondoylolishthesis

  • Axial Back Pain
A
  • Most common presentation.
  • Pain usually has a long history with periodic episodes that vary in intensity and duration.
147
Q

CP of Spondoylolishthesis

  • Leg Pain
A

Usually a L5 radiculopathy (foraminal stenosis at the L5-S1 level).

148
Q

CP of Spondoylolishthesis

  • Neurogenic Claudication
A
  • Caused by spinal stenosis.
  • Characterized by buttock and leg pain worse with walking.
  • N.B: Symptoms of neurogenic claudication rare because these slips rarely progress beyond Grade Il
149
Q

CP of Spondoylolishthesis

  • Cauda Equina Syndrome
A

Rare because these slips rarely progress beyond Grade II.

150
Q

CP of Spondoylolishthesis

  • L5 Radiculopathy
A

Physical Exam: Ankle dorsiflexion and EHL veakness

151
Q

Management of Spondoylolishthesis

A
  • Non Operatice
  • Operative
152
Q

Management of Spondoylolishthesis

  • Non-Operative
153
Q

Non-Operative Management of Spondoylolishthesis

  • Examples
A

Oral medications, lifestyle modifications, therapy

154
Q

Non-Operative Management of Spondoylolishthesis

  • Techniques
A
  1. Activity restriction.
  2. NSAID.
  3. Role of injections unclear.
  4. Bracing may be beneficial especially in the acute phase.
155
Q

Non-Operative Management of Spondoylolishthesis

  • Indications
A

Most patients can be treated nonoperatively

156
Q

Operative Management of Spondoylolishthesis

A
  • L5-S1 Decompression & Instrumented Fusion +- Reduction
  • L4-S1 Decompression & Instrumented Fusion +- Reduction
  • ALIF
157
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction
158
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
159
Q

Operative Management of Spondoylolishthesis

  • L5-S1 Decompression & Instrumented Fusion +- Reduction (Reduction)
160
Q

Operative Management of Spondoylolishthesis

  • L4-S1 Decompression & Instrumented Fusion +- Reduction
161
Q

Operative Management of Spondoylolishthesis

  • L4-S1 Decompression & Instrumented Fusion +- Reduction (Indications)
162
Q

Operative Management of Spondoylolishthesis

  • ALIF
163
Q

Operative Management of Spondoylolishthesis

  • ALIF (Indications)
164
Q

Operative Management of Spondoylolishthesis

  • ALIF (Outcomes)

Y4R4 - Surgery II 👨‍⚕️ (32 decks)

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