Lumbar Spine

Question 1

Describe inner and outer layers of intervertebral disc(IVD)

Answer 1

outer layer of fibrocartilage

inner layer of well hydrated proteoglycan gel

Question 2

How much of total height of lumbar spine is attributed to healthy IVD?

Answer 2

~25%
-greater height allows for impove mobility and adequate passage for exiting spinal nerve roots

Question 3

Describe a bulging disc per “Lumbar disc herniation nomenclature: version 2.0”

Answer 3

bulging disc, NOT considered a type of herniated disc, is the presence of disc tissue extending beyond the edges of the ring apophyses throughout the circumference of the disc

Question 4

Describe a herniated disc protrusion per “Lumbar disc herniation nomenclature: version 2.0”

Answer 4

“the greatest distance between edges of disc material presenting outside the disc space is less than the distance between the edges of the be base of that disc material extending outside the disc space”

AKA the base of displaced disc material is wider than its dome and does not extend above or below disc level

Question 5

Describe disc extrusion per “Lumbar disc herniation nomenclature: version 2.0”

Answer 5

“any one distance between the edges of the disc material beyond the disc space is greater than the distance between the edges of the base of the disc material beyond the disc space”

AKA “disc extrusion” occurs when the base of the protruded disc material is narrower than its “dome” and may migrate superiorly or inferiorly, indicating a more severe disc herniation with a larger tear in the annulus fibrosus

Question 6

What is difference between disc protrusion and extrusion?

Answer 6

Base size: in a protrusion, herniated disc material is WIDER than the displaced part, whereas in extrusion, the base is NARROWER than the displaced part

Containment: protrusion usually a contained herniation within the disc space, while extrusion often not contained and extends beyond the disc level

Severity: disc extrusion is generally more severe form of disc herniation compared to protrusion

Question 7

Red flags for spinal fracture

Answer 7

-prolonged corticosteroid use
-significant trauma
-age > 70
-female

1 flag = +LR 1.8
2 flags= +LR 15.5
3 flags= +LR 218.3
4 flags= ??

however the absence of these flags does not have a strong NEGATIVE LR

Question 8

What are motor control exercises?

Answer 8

aim to target deep trunk muscles to actively stabilize and improve cLBP symptoms
BECAUSE
-individuals w/ cLBP demonstrate altered spinal loading

NOTE: they are better than minimal intervention but NO BETTER than general exercise

Question 9

What is graded activity?

Answer 9

uses principles of operant conditioning to reinforce patient activity levels

Question 10

What is graded exposure?

Answer 10

gradual exposure to feared activities

Question 11

CPR for spinal manipulation

Answer 11

1. no symptoms distal to knee
2. pain duration < 16 days
3. FABQ score < 19 on work subscale
4. at least 1 hypomobile segment in lumbar spine
5. 1 of both hips w/ > 35* of IR

4 of 5 criteria = +LR of 24.38