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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
42
Q

Dx of Lumbar Disc Prolapse

A
  • Physical Examination
  • Imaging
  • Neurophysiological
43
Q

Dx of Lumbar Disc Prolapse

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

Dx of Lumbar Disc Prolapse

  • Imaging
A
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.
46
Q

Imaging in Lumbar Disc Prolapse

  • CT
A

…

47
Q

Imaging in Lumbar Disc Prolapse

  • X-ray
A

traction spurs & disc space narrowing

48
Q

Dx in Lumbar Disc Prolapse

  • Neurophysiological
A

EMG

49
Q

Symptoms of Lumbar Disc Prolapse

A
50
Q

Def of Cauda Equina Syndrome

A

Serious neurologic condition in which damage to the cauda equina

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
52
Q

Symptoms of Cauda Equina Syndrome

A
53
Q

Lumbar Disc Prolapse

  • L4
A
54
Q

Lumbar Disc Prolapse

  • L5
A
55
Q

Lumbar Disc Prolapse

  • S1
A
56
Q

Provocative Tests in Lumbar Disc Prolapse

A
57
Q

Provocative Tests in Lumbar Disc Prolapse

  • Straight Leg Raise
A
58
Q

Provocative Tests in Lumbar Disc Prolapse

  • Contralateral SLR
A

Crossed straight leg raise is less sensitive but more specifid

59
Q

Provocative Tests in Lumbar Disc Prolapse

  • Lassegue Sign
A

SLR aggravated byforced ankle dorsiflexion

60
Q

Provocative Tests in Lumbar Disc Prolapse

  • Bowstring Sign
A

SLR aggravated by compression on popliteal fossa

61
Q

Provocative Tests in Lumbar Disc Prolapse

  • Kernig Test
A

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

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
63
Q

Provocative Tests in Lumbar Disc Prolapse

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

DDx of Lumbar Disc Prolapse

A
65
Q

Prognosis of Lumbar Disc Prolapse

A
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
A
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
A
70
Q

Selective Nerve Root Corticosteroids Injections of Lumbar Disc Prolapse

A
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

A
75
Q

Surgical TTT of Lumbar Disc Prolapse

  • Indications
A
76
Q

Surgical TTT of Lumbar Disc Prolapse

  • Methods
A
77
Q

Complications of Lumbar Disc Prolapse

A
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
A

….

83
Q

Comlications of Lumbar Disc Prolapse

  • Discitis
A

……

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

A
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
A
89
Q

Symptoms of Cervical Disc Prolapse

  • C5/C6
A
90
Q

Symptoms of Cervical Disc Prolapse

  • C6/C7
A
91
Q

Symptoms of Cervical Disc Prolapse

  • C7/T1
A
92
Q

Dx of Cervical Disc Prolapse

A
  • Ex
  • Radiology
93
Q

Dx of Cervical Disc Prolapse

  • Ex
A
94
Q

Dx of Cervical Disc Prolapse

  • Cervical Compression Test & (Spurling’s test)
A
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
A
97
Q

Dx of Cervical Disc Prolapse

  • rads
A
98
Q

TTT of Cervical Disc Prolapse

A
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
A

Y4R4 - Surgery II 👨‍⚕️ (21 decks)

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