L8: Spinal Degenerative Diseases

Question 2

Pathology in Degenerative Disease of the Spine

Answer 2

Question 3

Symptoms of Spinal Degenerative Diseases

Answer 3

Question 4

Red Flags of Spinal Degenerative Diseases

Answer 4

Question 5

Red Flags of Spinal Degenerative Diseases

• Cauda Equina Syndrome

Answer 5

Question 6

Red Flags of Spinal Degenerative Diseases

• Myelopathy

Answer 6

Question 7

Red Flags of Spinal Degenerative Diseases

• Radiculopathy

Answer 7

Question 8

Red Flags of Spinal Degenerative Diseases

• Others

Answer 8

Question 9

RF for Spinal Degenerative Diseases

Answer 9

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

Question 10

Types of Spinal Degenerative Diseases

Answer 10

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

Question 11

Def of Disc Bulge

Answer 11

Question 12

Types of Annular Tear

Answer 12

Question 13

Def of Disc Herniation

Answer 13

Question 14

Types of Disc Herniation

Answer 14

Notes

Question 15

Types of Disc Herniation

• Protrusion

Answer 15

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

Question 16

Types of Disc Herniation

• Extruded Disc Herniation

Answer 16

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

Question 17

Types of Disc Herniation

• The Third Type?

Answer 17

Question 18

Regions Affected by Disc Herniation

Answer 18

Question 19

Epidemeology of Lumbar Disc Prolapse

Answer 19

Question 20

Classification of Lumbar Disc Prolapse

Answer 20

• According to Location
• According to Anatomy

Question 21

Classification of Lumbar Disc Prolapse

• Acoording to location

Answer 21

Question 22

Classification of Lumbar Disc Prolapse

• Central Prolapse

Answer 22

• Often associated with back pain only
• May present with Cauda equina syndrome (surgical emergency)

Question 23

Classification of Lumbar Disc Prolapse

• Posterolateral Prolapse (Paracentral)

Answer 23

Question 24

Classification of Lumbar Disc Prolapse

• Foraminal Prolapse (Far Lateral, Extraforaminal)

Answer 24

Question 25

Classification of **Lumbar Disc Prolapse** - Axillary Prolapse

Answer 25

Can affect Both exiting and descending nerve roots

Question 26

Classification of **Lumbar Disc Prolapse** - According to Anatomy

Answer 26

Question 27

Dx of **Lumbar Disc Prolapse**

Answer 27

- Physical Examination - Imaging - Neurophysiological

Question 28

Dx of **Lumbar Disc Prolapse** - Imaging

Answer 28

Question 29

Symptoms of **Lumbar Disc Prolapse**

Answer 29

Question 30

Def of **Cauda Equina Syndrome**

Answer 30

Serious neurologic condition in which damage to the cauda equina

Question 31

Symptoms of **Cauda Equina Syndrome**

Answer 31

Question 32

**Lumbar Disc Prolapse** - L4

Answer 32

Question 33

**Lumbar Disc Prolapse** - L5

Answer 33

Question 34

**Lumbar Disc Prolapse** - S1

Answer 34

Question 35

Provocative Tests in **Lumbar Disc Prolapse**

Answer 35

Question 36

DDx of **Lumbar Disc Prolapse**

Answer 36

Question 37

Management of **Lumbar Disc Prolapse**

Answer 37

1) Conservative (Non operative) 2) Selective nerve root corticosteroid injections 3) Surgical

Question 38

Management of **Lumbar Disc Prolapse** - Conservative

Answer 38

Question 39

Conservative Management of **Lumbar Disc Prolapse** - Indications

Answer 39

1) First line of treatment for most patients with disc herniation 2) 90% improve without surgery

Question 40

Conservative Management of **Lumbar Disc Prolapse** - Methods

Answer 40

Question 41

Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse**

Answer 41

Question 42

Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse** - Indication

Answer 42

Second line of treatment if therapy and medications fail

Question 43

Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse** - Methods

Answer 43

- Epidural - Selective nerve block

Question 44

Selective Nerve Root Corticosteroids Injections of **Lumbar Disc Prolapse** - Outcome

Answer 44

- Leads to long lasting improvement in 50% compared to ~90% with surgery) - Results best in patients with extruded discs is opposed to contained

Question 45

Surgical TTT of **Lumbar Disc Prolapse**

Answer 45

Question 46

Surgical TTT of **Lumbar Disc Prolapse** - Indications

Answer 46

Question 47

Surgical TTT of **Lumbar Disc Prolapse** - Methods

Answer 47

Question 48

Complications of **Surgical TTT of Lumbar Disc Prolapse**

Answer 48

Question 49

Symptoms of **Cervical Disc Prolapse**

Question 50

Symptoms of **Cervical Disc Prolapse** - Sites Affected

Answer 50

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

Question 51

Symptoms of **Cervical Disc Prolapse** - Examples

Answer 51

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).

Question 52

Symptoms of **Cervical Disc Prolapse** - C4/C5

Answer 52

Question 53

Symptoms of **Cervical Disc Prolapse** - C5/C6

Answer 53

Question 54

Symptoms of **Cervical Disc Prolapse** - C6/C7

Answer 54

Question 55

Symptoms of **Cervical Disc Prolapse** - C7/T1

Answer 55

Question 56

Dx of **Cervical Disc Prolapse**

Answer 56

- Ex - Radiology

Question 57

Dx of **Cervical Disc Prolapse** - Ex

Answer 57

Question 58

Dx of **Cervical Disc Prolapse** - Cervical Compression Test & (Spurling's test)

Answer 58

Question 59

Dx of **Cervical Disc Prolapse** - Lhermitte Sign

Answer 59

Feeling of electrical shock with patient neck flexion

Question 60

Dx of **Cervical Disc Prolapse** - Hoffman Sign

Answer 60

Question 61

Dx of **Cervical Disc Prolapse** - rads

Answer 61

Question 62

TTT of **Cervical Disc Prolapse**

Question 63

TTT of **Cervical Disc Prolapse** - Conservative

Answer 63

- Medications (NSAID). - Physical therapy and exercise. - Steroid injection.

Question 64

TTT of **Cervical Disc Prolapse** - Surgery

Answer 64

Question 65

Def of **Spinal Canal Stenosis**

Answer 65

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

Question 66

Risk Factors for **Lumbar Canal Stenosis**

Answer 66

1) Caucasian race 2) Increased BMI 3) Congenital spine anomalies (20%) 4) Failure of posterior elements to develop, short pedicles and laminae

Question 67

Classification (Types) of **Lumbar Canal Stenosis**

Answer 67

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

Question 68

Symptoms of **Lumbar Canal Stenosis**

Answer 68

Question 69

Symptoms of **Lumbar Canal Stenosis** - Neurogenic Claudication

Answer 69

Question 70

Signs of **Lumbar Canal Stenosis**

Answer 70

Question 71

Management of **Lumbar Canal Stenosis**

Answer 71

- Non-Operative - Operative

Question 72

Management of **Lumbar Canal Stenosis** - Non-Operative

Answer 72

Question 73

Non-Operative Management of **Lumbar Canal Stenosis** - Modalities

Answer 73

Oral medications, physical therapy, and corticosteroid injections

Question 74

Non-Operative Management of **Lumbar Canal Stenosis** - Indications

Answer 74

First line of treatmen

Question 75

Non-Operative Management of **Lumbar Canal Stenosis** - Modalities (Explained)

Answer 75

**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

Question 76

Surgical Management of **Lumbar Canal Stenosis**

Answer 76

Question 77

Surgical Management of **Lumbar Canal Stenosis** - Wide PTP Decompression

Answer 77

Question 78

Surgical Management of **Lumbar Canal Stenosis** - Wide PTP Decompression with instrumented fusion

Answer 78

Question 79

Def of **Spondylosis**

Answer 79

- 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)

Question 80

Def of **Spondylolishthesis**

Answer 80

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

Question 81

Grading of **Spondylolishthesis**

Answer 81

Question 82

Etiological Classification of **Spondylolishthesis**

Answer 82

Question 83

CP of **Spondoylolishthesis**

Answer 83

Question 84

Management of **Spondoylolishthesis**

Answer 84

- Non Operatice - Operative

Question 85

Management of **Spondoylolishthesis** - Non-Operative

Answer 85

Question 86

Non-Operative Management of **Spondoylolishthesis** - Examples

Answer 86

Oral medications, lifestyle modifications, therapy

Question 87

Non-Operative Management of **Spondoylolishthesis** - Techniques

Answer 87

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

Question 88

Non-Operative Management of **Spondoylolishthesis** - Indications

Answer 88

Most patients can be treated nonoperatively

Question 89

Operative Management of **Spondoylolishthesis**

Answer 89

- L5-S1 Decompression & Instrumented Fusion +- Reduction - L4-S1 Decompression & Instrumented Fusion +- Reduction - ALIF

Question 90

Operative Management of **Spondoylolishthesis** - L5-S1 Decompression & Instrumented Fusion +- Reduction

Answer 90

Question 91

Operative Management of **Spondoylolishthesis** - L5-S1 Decompression & Instrumented Fusion +- Reduction (Indications)

Answer 91

Question 92

Operative Management of **Spondoylolishthesis** - L5-S1 Decompression & Instrumented Fusion +- Reduction (Reduction)

Answer 92

Question 93

Operative Management of **Spondoylolishthesis** - L4-S1 Decompression & Instrumented Fusion +- Reduction

Answer 93

Question 94

Operative Management of **Spondoylolishthesis** - L4-S1 Decompression & Instrumented Fusion +- Reduction (Indications)

Answer 94

Question 95

Operative Management of **Spondoylolishthesis** - ALIF

Answer 95

Question 96

Operative Management of **Spondoylolishthesis** - ALIF (Indications)

Answer 96

Question 97

Operative Management of **Spondoylolishthesis** - ALIF (Outcomes)

Answer 97