Lumbar, Thoracic, Cervical Spine (Exam 3) Flashcards
Second leading cause of all MD visits in U.S.
Lumbar Spine Problems
Lordotic Curve
Concave Posteriorly
Outer wall composed of concentric rings of fibrocartilage.
Annulus
Gelatinous center.
Nucleus Pulposus
Contains nucleus. Provides stability. Enhances movement b/w vertebral bodies. Shock absorption.
Annulus
Transmit forces. Equalizes stress. Promotes movement.
Nucleus Pulposus
Movement of spine from flexion to extension the nucleus moves _______.
Anteriorly
Movement of spine from extension to flexion the nucleus moves ______.
Posteriorly
Injury from sudden violent force or repeated stress.
Ligament Sprains
Limited ability to heal and repair itself due to not having an intense vascular response to injury.
Vertebral Disk Injuries
More common posteriorly. Due to weaker and narrower posterior longitudinal ligament (PLL).
Protrusions/Herniations
Nucleus bulges against intact annulus.
Disk Protrusion
Nucleus extend through annulus but nuclear material remains confined by PLL.
Extruded Disk
Nucleus is free within the canal.
Sequestrated Disk
More common in young to middle-aged adults.
Herniated Nucleus Pulposus (HNP)
Not as common in older individuals due to changes with aging such as decreased water content and increased collagen.
HNP
Symptoms are experienced further down the arm/leg.
Peripheralization
Radiating pain originating from the spine and referred distally is made to move away from the periphery and toward the mid-line of the spine.
Centralization
With a _____ shift, extension may increase pain, unless it is reduced prior to performing extension.
Lateral
Reduce pain. Protect affected area from unwanted stress and forces while encouraging and promoting movement. Increase muscle strength, endurance, and flexibility. Counsel patient concerning correct body mechanics.
General Objectives of HNP
Nucleases is reduced to a more anterior position and away from impingement.
Prone Extension Progression
Prone Extension Progression Steps
Prone on pillow. Prone. Prone with pillow under chest. Prone on elbows. Prone press-ups. Press-ups with overpressure.
Proper body mechanics. Sitting with lumbar roll. Avoid flexion positions.
Maintain neutral lordotic posture.
Goal is to relieve pain and inflammation. Doesn’t fix the problem.
Epidural steroid injection.
Remove the nonviable portion of the disk, thus decompressing the nerve root that is affected. Examples: Laminectomy, discectomy, fusion.
Surgical Intervention
Men twice as common as women. Late middle age and older.
Spinal Stenosis
Due to degenerative arthritic changes that encroach on canal, producing nerve root impingement.
Spinal Stenosis
Common with extension. Especially walking. Radicular ache into thighs and calves. Paresthesias into LE. Feels better with walking in flexion with cart, walker.
Spinal Stenosis Symptoms
Treatment of Spinal Stenosis
Avoid extension. Patient education on body mechanics and posture. General conditioning. Flexion exercises (William’s Flexion). Posterior pelvic tilt, knee to chest, and partial sit-ups.
Osteophytes formation at the superior and inferior margins of vertebral bodies.
Spondylosis
Bony defect in the pars interarticularis of the posterior spine.
SpondyLOLsis
Collar on “Scotty Dog”
SpondyLOLsis
Forward slippage of one superior vertebra over inferior vertebra (usually L4-L5, L5-SI) due to instability caused by defect in pars interarticularis.
SpondyLOListhesis
Grade I of Slippage
0-25%
Grade II of Slippage
25-50%
Grade III Slippage
50-75%
Grade IV Slippage
75-100%
Force producing fracture such as compression, flexion-rotation.
Lumbar Spine Fractures
Elderly persons many thoracic and high lumbar fractures due to _____.
Osteoporosis
Osteoporosis causes anterior wedging and creates kyphotic curve.
Thoracic Kyphosis
Any lateral curvature of the spine.
Scoliosis
Usually idiopathic.
75-85%
Can also result from neuromuscular causes, degenerative disease, osteoporosis, trauma, and post surgical factors.
Scoliosis Causes
Irreversible lateral curve with fixed rotation of vertebrae. Curve is not reversed by moving or changing position.
Structural Scoliosis
Reversible curve. Lateral curve dissipates with positional changes.
Nonstructural Scoliosis
Common among athletes and with MVA’s.
Muscle Strains
Muscles commonly involved in muscle sprains/strains.
SCM, traps, scalene, erectors, rhomboids, and levator scapulae.
Mechanisms of Injury Muscle Sprains/Strains
Hyperflexion, rotation, lateral flexion (of head and C-spine).
Chronic degenerative disk from wear and tear on WB structure of the C-Spine.
Cervical Spondylosis
Most common in 40’s, 50’s. Men > Women. C5-C6, C6-C7 most common segments.
Cervical Spondylosis
Compression of vascular or neurologic tissues as they exit the superior triangle opening of thorax. Compressed subclavian artery/vein, brachial plexus.
Thoracic Outlet Syndrome (TOS)
Cervical rib, shortened or hypertrophied anterior scalene, maluninon of clavicle, sublimed 1st thoracic rib.
Causes of Compression TOS
Chronic inflammatory auto-immune disease. Most common in Males.
Ankylosing Spondylitis
Average at age 23 (20-40). Early symptoms are pain and stiffness. Eventually spinal joints fuse together.
Ankylosing Spondylitis
Outer 2/3 of annulus innervated by _______.
Sinuvertebral Nerve
Reduce inflammation, restore function, and protect affected area.
Treatment goals for muscle strains.
Initial care for muscle strains.
Modalities, NSAIDS, protection.
After acute healing for muscle strains.
Submax isometrics, stretching.
Sub acute muscle strains.
Extensor exercises, abdominal stabilization exercises.
Bed Exercises Post-Op
Ankle pumps, quad sets, glut sets, proper breathing. Avoid valsalva maneuver.
Progression Post-Op
Extension (active), avoid flexion, pelvic tilts, ROM.
Before general conditioning program.
Increased motion, controlled pain, improved endurance, strength.
Stretching of PLL, muscle fatigue, postural syndromes, and neurological syndromes.
Pain of thoracic kyphosis is caused by.
Posterior pevlic tilt, knee to chest, partial sit-ups.
Flexion Exercises (William’s Flexion) Treatment for Spinal Stenosis
