Lumbar Spine Dysfxn

Question 1

The anterior disc and vertebral body take on ___ of the weight while paired facet joints posteriorly take on ___ of the weight.

Answer 1

2/3 (ant)

1/3 (post)

Question 2

Describe the early destruction phase of spinal degeneration:

Answer 2

synovitis of facet joints; circumferential or radial tears in annulus of disc

Question 3

Describe the intermediate stage of spinal degeneration:

Answer 3

instability stage
vertebral/peri-facet osteophytes and traction spurs
laxity of posterior joint capsule and annulus

Question 4

Laxity of posterior joint capsule and annulus can lead to:

Answer 4

spondylo-retrolisthesis

disc herniation

Question 5

Describe the final stage of spinal degeneration:

Answer 5

fibrosis of facets and capsule
loss of disc material and height
osteophytes
bony ankylosis of vertebral bodies
stenosis

Question 6

With one segment involvement below L1, central stenosis vs. lateral stenosis:

Answer 6

central: more likely B symptoms and may cover multiple nerve roots
lateral: more likely unilateral symptoms and may follow dermatomal pattern

Question 7

Describe the clinical presentation of spinal stenosis:

Answer 7

back pain with uni/bi radicular symptoms
loss of trunk mobility
symptoms aggravated with walking, standing upright
symptoms relieved with sitting, flexing forward or lying down

Question 8

Describe the clinical presentation of spinal instability:

Answer 8

back or neck pain with radicular symptoms
protective muscle spasms
“juttering” with motion
may have step deformity on palpation

Question 9

Describe spondylolysis:

Answer 9

fracture at pars interarticularis

scotty dog “colalr” on oblique x-ray

Question 10

Describe spondylolisthesis:

Answer 10

anterior translation of superior vertebral body relative to inferior
seen on lateral plain film and graded by %

Question 11

IV disc lesion phase 1

Answer 11

Bulge, prolapse – nucleus bulges but outer annular fibers remain intact and contain the nuclear material

Question 12

IV disc lesion phase 2

Answer 12

Extruded - nuclear material breaks through the annulus but is still connected

Question 13

IV disc lesion phase 3

Answer 13

Sequestered – nuclear material has broken away form the disc and is a free mass

Question 14

Describe the directions of disc herniation:

Answer 14

Posterolateral: most common in l-spine and s-spine
Central: B symptoms, can create cauda equina syndrome
Anteriorly: most common in c-spine

Question 15

Acute lumbar disc dysfxn presents clinically with:

Answer 15

muscle spasm

may see forward flexed, flattened l-spine, or lateral shift

Question 16

What are common spinal surgical procedures for decompression?

Answer 16

1. microdiscectomy (for HNP)

2. laminectomy (for HNP or stenosis)

Question 17

What are common spinal surgical procedures for instability?

Answer 17

1. posterior gutter fusion (graft strips along lamina, can use pedicle screw fixation)
2. interbody fusion (ant or post with cages)

Question 18

Facet joint dysfunction falls into these three categories:

Answer 18

Joint capsule sprain
Impingment
Subluxation

Question 19

Facet joint capsule sprain

Answer 19

sprain of facet joint capsule without subluxation associated with at least moderate trauma; sxs include inflamm, effusion, muscle guarding; may lead to hypomobility at segment over time

Question 20

Facet joint impingment

Answer 20

locking , blockage , or subluxation after a sudden unguarded motion often into combined motion (e.g. rotation and BB) with no real trauma
active motion shows segmental limitation and pain, rest usually relieves
no neural symptoms usually BUT could produce pain/paresthesiae in a radicular distribution from local inflammation but NOT reflex changes or myotomal weakness
may see positional or rotational faults

Question 21

Facet impingement or subluxation by respond well to early _____.

Answer 21

manipulation