Lumbar Spine Disc Herniations Flashcards
What is the most common direction of herniation?
posterolateral
Central disc herniation results in (unilateral/bilateral) s/s.
bilateral s/s
(true/false) Prognosis for a central disc herniation is good
false
What segments account for >90% of lumbar disc herniations?
L4/L5, L5/S1
What are the 4 stages of disc herniation in order?
- Disc bulge (degeneration)
- disc protrusion
- Disc extrusion
- Disc prolapse
Disc herniation stage:
Cracks in the annulus causing symmetrical flattening of the disc in all directions
disc bulge (1)
(true/false) Disc bulges cause radicular pain.
false (local)
(true/false) Disc protrusion causes local pain.
true
Disc herniation stage:
nucleus pulposus pushes into the outer layers of the annulus fibrosis but doesn’t break through the annulus fibrosis
disc protrusion (2)
Disc herniation stage:
fragments of the nucleus pulposus completely break through the annulus fibrosis
- can aggravate nerve roots causing myotomal weakness and inflammation
disc extrusion (3)
What stage of disc herniation is commonly the beginning of when medication is being prescribed?
Stage 3: disc extrusion
Disc herniation stage:
fragments of the nucleus pulposus and annulus fibrosis detach completely from the disc
disc prolapse
What population commonly presents with lumbar disc herniation(s)?
Age 30-55
When looking at patient history, those with lumbar disc herniation have LBP and/or LE symptoms with ___ and ____ combined.
sitting and lumbar flexion combined (ex: putting shoes on)
What provides relief for lumbar disc herniation?
standing, walking, prone-lying, EXT, sitting in a chair with hip elevated (offloading the LE)
A patient’s symptoms of lumbar disc herniation can be increased due to what?
increased abdominal pressure (sneezing, coughing, laughing)
prolonged WB postures (despite being in EXT)
Lumbar disc herniation causes painful/limited ____.
FLX
Those with lumbar disc herniation have centralization with ____ and peripheralization with _____ during repeated movement testing.
Extension, flexion
(true/false) Patients with lumbar disc herniations can demonstrate a lateral shift in sitting and/or standing.
True
(true/false) Lumbar disc herniations can show a (+) neurological compression test
true
Those with Lumbar disc herniations often show (hypo-reflexive/hyper-reflexive) DTRs and spring testing corresponding to the level of the herniation.
hyporeflexive
(true/false) It is possible to have sensory and/or motor loss in the dermatome/myotomal levels affected by a disc herniation
true
When performing a physical exam, observe the patient’s gait for _____. How do you test for this?
Foot drop
Test with heel/toe walking to test (L4-S1 motor functions)
A person with a lumbar disc herniation is (+/-) for the SLUMP test and have a (+) SLR of ___-___ degrees.
(+) slump
(+) SLR 30-70 degrees –> can potentially have a (+) crossed SLR test)
What test has a high specificity for diagnosis of centrally herniated discs?
(+) Crossed SLR test
What are the red flags for lumbar disc herniation?
- cancer cluster
- cauda equina symptoms
- (+) UMN signs/pathological reflexes
- complete foot drop and/or unable to extend the great toe
- multi-level myotomal weakness
What is the cancer cluster?
Age > 50
unexplained weight loss
PMH of cancer
failure to respond to conservative treatment
Increased ESR
What TBC do disc herniations fit into? How do you know which to choose?
- Specific exercise - Extension (s/s are distal to the knee and there are (+) signs of nerve root compression)
- Traction
- Mobilization/manipulation (if s/s are proximal to the knee)
Early morning ___ movements can increase risk of re-injury in a patient who has lumbar herniation.
flexion
What exercises can you have a patient perform in the morning to provide them some relief prior to getting out of bed?
LTRs
Prone lying
prone press-ups
How should one encourage maintenance of lumbar lordosis during the day?
sitting with a lumbar roll/towel roll
(true/false) Having long periods of sitting throughout the day is recommended for a patient with lumbar herniation.
false (standing rest breaks are recommended)
(true/false) MRI findings do not always correlate with clinical symptoms.
true
