Lumbar part 1 Flashcards
The medical community knows how to approach the problem of LBP (true/false)
false
Most people with low back pain will get better no matter what you do (true/false)
false
List the risk factors related to LBP
smoking
spending more than 1hr/day in a car
spending more than 1hr/day in activity with vibratory forces
full term pregnancy with vaginal delivery
weak increase with repetitive heavy lifting
What are work requirements that are predictors?
unexpected lifting lifting with rotation static work positions vibration handling materials while seated
Job satisfaction sense of value supervisor relationship and review time away from job these are _ factors
psychosocial
if away from job for 6 months, _ chance of return to work
50%
if away from job for 1 year, _ chance of return to work
25%
Psychological distress attitudes and beliefs social environment illness behavior _ model
biopsychosocial
It is important to start PT as early as possible (true/false)
true
Treat LBP patients with passive treatment in mind vs active treatment (true/false)
false
ACTIVE
Starting PT within _ days decreased the likelihood of having surgery or epidural steroid injections versus those seen after 90 days
30
The tissues involved need to AVOID controlled stress (true/false)
false
NEED controlled stress
The lumbar spine and associated soft tissues are the “hub” of weight-bearing and force attenuation (True/false)
true
What are the functions of the spine?
supports the body
facilitates movement
protects the spinal cord
shock absorber
The first sacral segment of the sacrum is loose and behaves like another lumbar vertebra, what is this development of the spine called?
a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease
lumbarization
L5 fused to S1, this type of development in the spine can be called
a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease
sacralization
_ is a stress response that is developmental and happens later in life
tropisims
A Schmorl node is described as a
intravertebral disc herniation
by itself, a Schmorl node is highly correlated to pain (true/false)
false
A schmorl node can be causing pain if its in combination with VB compromised (true/false)
true
if a patient has Schmorl node in correlation with _ or _ it could be mildly correlated to pain
osteoporosis
degeneration
This type of development in the spine is when vertebrae become wedged more than 5 degrees and it increases kyphosis
a. lumbarization
b. sacralization
c. Schmorl Nodules
d. Scheurmanns disease
Scheurmanns disease
Scheurmanns disease is associated with what other development of the spine?
schmorl node
Only the vertebrae is vascular in the fetus and infant (true/false)
false
Which structures in the fetus and infant are vascular?
vertebrae and disc
Blood vessels evolve from the growing disc during childhood (true/false)
false
Blood vessels disappear from the growing disc during childhood, but the vertebrae remains highly vascular (true/false)
true
The vertebrae remains highly vascular after childhood (true/false)
true
The adult disc is
a. vascular
b. avascular
c. nociceptive
d. all of the above
avascular
The disc cells depend on diffusion from _ _ at the margins of the disc to supply nutrients essential for _ activity and viability and to remove _ wastes
blood vessels
cellular
metabolic
List 4 reasons nutrient supply can fail
Changes in blood supply
sclerosis of the subchondral bone
endplate calcification
lifestyle choices
What small nutrients are supplied to the discs entirely by diffusion?
oxygen
glucose
Loss of nutrient supply can lead to
cell death
loss of matrix production
increase in matrix degradation
disc degeneration
What exercise produces some of the largest amount of fluid transfer in the IVD and decreases swelling/pressure?
a. flexion
b. extension
c. side bending
d. rotation
extension
Disc degeneration is highly correlated to pain (true/false)
false
only in combo with other factors
What can be associated with DD and LBP?
aortic atherosclerosis and stenosis
When a child begins ambulating, the lumbar endplate changes from _ to _
convex to concave
What of the vertebral body contains the red marrow?
bony honeycomb
The purpose of this structure is to increase the stiffness of the vertical load-bearing trabeculae
a. vertical trabeculae
b. vertebral endplates
c. horizontal trabeculae
d. facet joints
horizontal trabeculae
(vertical/horizontal) load-bearing trabeculae support the vertebral endplates
vertical
This can be defined as central compression with bowing of endplates and central expansion of discs
a. vertical load bearing
b. horizontal load bearing
c. Scheurmanns disease
d. vertebral osteoporosis
vertebral osteoporosis
The lumbar vertebrae becomes _ and _ in old age with (increased/decreased) endplate concavity
shorter
wider
increased
What can change arthrokinematically in the low back?
a. the vertebral bodies become more convex
b. vertebral bodies wedge
c. vertebral end plates compression leads to increased concavity
d. vertebral end plates compression leads to increased convexity
vertebral end plates compression leads to increased concavity
Vertebral body fractures are twice as common as hip fractures (True/false)
true
Compression fractures of the vertebral body are poorly correlated to pain (True/false)
false
With aging, what changes happen at the lumbar disc?
a. more diffusion
b. loss of proteoglycans and water
c. less water and diffusion
d. loss of vascularization
loss of proteoglycans and water
The loss of stature in elderly is due to
a. loss in disc space
b. loss in disc height
c. loss in vertebral body shape
d. loss in vertebral body height
loss in vertebral body height
A tear in the annulus is also called
disc fissuring
A majority of lower lumbar discs from elderly show thinning degeneration (true/false)
false
Selective bone loss + change in VB shape + change in IVD shape =
decreased lordosis
What are the 3 parts of the intervertebral disc?
annulus fibrosus
cartilage endplates
nucleus pulposus
The _ _ and the _ encase the nucleus pulposus
annulus fibrosus
cartilage endplate
The purpose of the annulus fibrosus is to
a. absorb impact
b. diffuse water
c. resist tensile forces
d. absorb nutrients
resist tensile forces
The outer annulus is
a. ligamentous
b. cartilaginous
ligamentous
The inner annulus is
a. ligamentous
b. cartilaginous
cartilaginous
The ligamentous outer annulus units the vertebral rims and
a. absorbs impact
b. resists tensile forces
c. has a load-bearing role
d. diffuses water
resists tensile forces
The outer annulus has a (low/high) proteoglycan content
low
The inner annulus has a (low/high) proteoglycan content
high
The cartilaginous inner annulus purpose is to:
a. absorbs impact
b. resists tensile forces
c. has a load-bearing role
d. diffuses water
has a load-bearing role
Which part of the intervertebral disc is innervated by nociceptive nerve fibers?
a. inner annulus
b. outer annulus
c. cartilage endplate
d. nucleus pulposus
outer annulus
This structure of the intervertebral disc is hyaline cartilage, partly penetrated by small vascular buds from vertebra and is a pathway for diffusion of nutrients to disc
a. inner annulus
b. outer annulus
c. cartilage endplate
d. nucleus pulposus
cartialge endplate
Which part of the IVD gives a pathway for diffusion of nutrients to the disc?
cartilage endplate
In erect posture, 85% of axial loads pass through the
a. vertebral column
b. IVD discs
c. vertebral bodies and IVD
d. ligaments
vertebral bodies and IVD
The avascular adult disc is nourished by _ from vascular buds at the vertebral body disc interface
a. absorption
b. diffusion
c. secretion
d. none of the above
diffusion
The disc receives nourishment from
diffuson in IVD and
small vessels in outermost annulus
How does the disc resist axial load?
intradiscal pressure
capacity of its PG to absorb and hold water
Which component of the IVD assists the nucleus in load-bearing?
a. cartilage endplate
b. inner annulus
c. outer annulus
d. none of the above
inner annulus
How does the disc change throughout the day?
fluid changes and squeezes out throughout the day
This concept is defined as prolonged axial loading reduces stature by squeezing water out of the discs
a. disc pressure
b. swelling pressure
c. flexion creep
d. extension creep
flexion creep
Increased loading on the nucleus and inner annulus fibers, more likely to damage, disc loaded more
a. morning
b. evening
c. consistent throughout the day
d. this happens with any LBP
morning
Increased loading on the nucleus and outer annulus fibers, more likely to damage and facet joints are loaded more
a. morning
b. evening
c. same throughout the day
d. this happens with any LBP injury
evening
Intradiscal disc pressure is related to breathing rhythms (true/false)
true
With (inspiration/expiration) pressure increases in the IVD
inspiration
With (inspiration/expiration) pressure decreases in the IVD
expiration
What kind of tears can occur in the annulus?
annulus tears
rim lesions
high intensity zones
A patient has local pain, especially after loading, pain lasts a day or two and goes away. It comes back but pain lasts a little longer, but eventually goes away. This leads to
progressive radial tears with scar formation
tears get larger and reach outer rims
The annulus weakens over time with progressive tears (true/false)
true
Radial fissuring often affects the _ annulus and is painful when it reaches the _ of the annulus
posterior
outer third
Genetics, heavy lifting, and frequent loaded positions can lead to
a. avascular disc changes
b. less diffusion in the IVD
c. osteoporosis
d. disc degeneration
disc degeneration
This change in the disc is a progressive deformation (strain) of a structure, or of tissues under prolonged loading (stress)
a. disc degeneration
b. creep
c. hysteresis
d. disc fissuring
creep
Functional changes in the disc lead to increased _ and _
creep
hysteresis
This change in the disc is the recovery from distortion, the lag of recovery from deformation after a load has been removed
a. disc degeneration
b. creep
c. hysteresis
d. disc fissuring
hysteresis
What are the functional changes in the disc?
increased disc stiffness
decreased ranges of movement
increased creep and hysteresis
What can cause diurnal loss of stature due to loss of water from the disc from axial loading in erect posture
a. disc stiffness
b. disc degeneration
c. decreased ROM
d. hysteresis
hysteresis
Discs are NOT designed to bulge out (true/false)
false
Buckling of the inner annulus, disc bulges inward
metaplastic proliferation
Metaplastic proliferation can lead to
compression of the nerve root
Studies show that disc bulges (do/do not) absorb over time
do
What did the study on sequestration show with regards to radicular pain?
ALL patients recovered within 3-6 weeks
Correlated resorption of sequestered IVD herniation at
a. 5 months
b. 3-6 months
c. 7 months
d. 4-9 months
4-9 months
Most herniated discs heal spontaneously (true/false)
true
Which disc lesion has the highest probability of spontaneous disc regression?
a. disc extrusion
b. disc sequestration
c. disc protrusion
d. disc bulging
disc sequestration
Discs are swollen more in the
a. morning
b. evening
c. middle of the day
d. none of the above
morning
The time of day that an MRI is done does not affect the results of the MRI (true/false)
false
Where is the most common disc lesion located?
a. L4/L5 or L5/S1
b. L1/L2
c. L5/S1 or L2/L3
d. L2/L3
L4/L5 or L5/S1
What happens with an endplate fracture?
a. nerve damage
b. blood goes into the disc and can lead to irritation of the DRG
c. less space at the joints and causes stenosis
d. disc bulge losing water
blood goes into the disc and can lead to irritation of the DRG
The annulus is affected, rim lesion, audible pop, immediate pain, local pain and no distal pain. These characteristics fit
a. soft lesion
b. hard lesion
c. annulus lesion
d. entire disc lesion
hard lesion
This type of disc lesion shows a favorable response to treatment and spinal manipulation can be done
a. soft lesion
b. hard lesion
c. somatic pain
d. entire disc lesion
hard lesion
A progressive small annulus tear, the nucleus is involved, pain increases, distal symptoms, morning pain is worse. These characteristics fit
a. entire disc lesion
b. hard lesion
c. annulus lesion
d. soft lesion
soft lesion
This type of disc lesion is slow to respond to treatment, and should not have spinal manipulation
a. soft lesion
b. hard lesion
c. somatic pain
d. entire disc lesion
soft lesion
Which direction do patients favor the most with a disc lesion?
a. posterior-medial
b. posterior-lateral
c. flexion
d. extension
posterior lateral
With a posterior-lateral direction preference, leaning (towards/away) eases pain
away
With a posterior-lateral direction preference, leaning (towards/away) increases pain
toward
How should you treat a patient that prefers a posterior-lateral direction?
a. stretch the ligaments
b. strengthen the core
c. opening techniques
d. work into pain
opening techniques
With a posterior-medial direction preference, leaning (towards/away) increases pain
away
With a posterior-medial direction preference, leaning (towards/away) decreases pain
towards
A patient shifts away one day then shifts towards another day, which direction do they prefer?
a. posterior-lateral
b. posterior-medial
c. alternating disc lesion
d. direct posterior
alternating disc lesion
This patient is often “stuck” in flexion with severe guarding. Which is their direction preference?
a. posterior-lateral
b. posterior-medial
c. alternating disc lesion
d. direct posterior
direct posterior
Aggs of disc lesion
valsalva AM and PM flexed position sustain positions vibration
Eases of disc lesion
movement
supine
avoiding sustained positions
lumbosacral support
Somatic pain as hip bursitis
L4 disc
Somatic pain at the coccyx is referred from
L5 disc
Somatic pain at the T/L junction
L5 spinous process and to either side
How does the disc receive blood supply as an adult when it becomes avascular?
through diffusion from blood vessels in the disc margins
loss in stature is due to loss in the disc height (true/false)
false
vertebral body height
The first structure to fail in a disc lesion
a. annulus fibrosis
b. nucleus purposes
c. cartilage endplate
d. outer annulus
cartilage end plate
A compression fracture is related to pain (true/false)
true
Treat posterior disc lesion with (mobilization/traction)
traction
In the acute phase treat a disc lesion with _ mobilization (at/below) the level
PA
at
How do you treat chronic disc lesion?
levels are stiff
spinal stabilization
Alternating disc lesion treat with (mobilization/traction)
mobilization
Which part of the meninges is stressed mechanically with neurodynamic tests?
a. dura mater
b. arachnoid
c. pia mater
d. all of the above
dura mater
