Midterm Questions v1

Question 1

What are 3 causes of caudal equina compression?

Answer 1

Large disc herniation
Severe central stenosis
Tumor - cancerous

Question 2

Where is the ALL, what does it prevent and where does it extend to?

Answer 2

It covers the anterior bodies and discs, helps prevent anterior disc herniation and it extends all the way to the sacrum

Question 3

How is central stenosis associated with neurogenic claudication?

Answer 3

Patient will walk a couple blocks and legs will start hurting really bad and feeling heavy.

When the patient sits down, the pain “magically” goes away and the patient is able to walk a little further.

Question 4

What kind of referral is it when there is a presentation of impaired bowel and/or bladder function?

Answer 4

Medical Emergency! ER!

Question 5

What are the differences between DISH and AS?

Answer 5

DISH: older age, asymptomatic w/ normal SI joints

AS: 2nd decade of life (in 20s), spinal pain and stiffness with an abnormal SI joint

Question 6

Know about lateral listless and what type of motion radiography should you order.

Answer 6

Lateral bending study - weight bearing to assess stability. We want to make sure it’s not sliding or rotating.

Question 7

Know about symptomatic central stenosis.

Answer 7

“Shopping cart sign” = person likes to be in flexion

Older people will like to be in flexion and push the shopping cart around

Question 8

Know about which orthopedic tests are good for diagnosing a disc herniation.

Answer 8

Slump > SLR

SLR = better for patient comfort in an acute condition, 15-30* radicular pain = HNP

Question 9

Which muscles does the Sciatic N leave the pelvis?

Answer 9

Piriformis m and gemellus m

Question 10

What’s the difference between lumbarization and sacralization?

Answer 10

Lumbarization = is a lumbar transitional segment of the S1 sacral segment

Sacralization = is a sacral transitional segment of L5 vertebra into the sacrum

Question 11

Know mnemonic about the drag racer.

Answer 11

HI PROs Never Idle

History
Inspection
Palpation
ROM
Orthopedic Tests
Neurological Tests
Imaging

Question 12

What are the 3 parts of the IVD?

Answer 12

Vertebral end plates
Annulus Fibrosis (AF)
Nucleus Pulposis (NP)

Question 13

What are the 9 typical causes of LBP?

Answer 13

(VPFDSSSS)
Vertebrogenic Pain Syndrome
Piriformis Syndrome
Facet Syndrome
Discogenic Pain Syndrome
Spondylolysis/ Spondylolisthesis
Stenosis
Scoliosis
SI Syndrome

Question 14

Know the components of a good history. (Pneumonic MDS WRITE Medical Medication Poorly)

Answer 14

MDS WRITE Medical Medication Poorly

Mechanism of Injury
Date of Injury
Subjectives and Severity
Work ability and history
Radicular pain (radiation)
Imaging History
Treatment History
Empty and hold bladder
Medical history
Medication history
Progress

Question 15

What are the components of the inner and outer annulus fibrosis?

Answer 15

2 cell types: Chondrocytes - made up of proteoglycans; Fibroblasts - made up of Type 1 collagen (lamella)

The inner AF wraps around the end plate

Sharper’s Fibers are related to the outer part

Question 16

What is a Chance Fracture (NOT a Lap Belt Fracture!)?

Answer 16

Unexpected and extreme forward flexion around a fulcrum that snaps the pedicles right in half.
(Example: A driver hits a telephone pole, and the backseat driver is only wearing a lap seat belt. When their body flexes forward, the lap seat belt acts as a fulcrum point and snaps the pedicles right in half.

Question 17

What does a Motion Segment consist of?

Answer 17

A Three-Joint-Complex (adjacent vertebra and IVD of those vertebrae)

Question 18

What forms the facet joint?

Answer 18

Pedicle and lamina of the SAME vertebra

Question 19

What are the maximum doses of acetaminophen (Tylenol), Naproxen Sodium (Aleve), Ibuprofen (Advil) and Gapapentin/ Neurontin?

Answer 19

Acetaminophen (Tylenol) = 4,000 mg/d
Naproxen Sodium (Aleve) = 1,100 mg/d
Ibuprofen (Advil) = 3,200 mg/d
Gapapentin/ Neurontin = 3,600 mg MAX

Question 20

Where do the nerve roots bud off the thecal sac?

Answer 20

L1-L3 bud off of the same level discs
L4-L5 bud off of the disc level above
S1 Traversing nerve root buds off of the L5 segment (making it more vulnerable to herniation, since it is exposed as it passes the L5 disc)

Question 21

Describe the Ligamentum Flavum.

Answer 21

It forms the “root” of the spinal canal, is a “yellow ligament” because it is 80% elastin. (It connects B/L lamella together)

Question 22

What are the parts of the vertebral arch?

Answer 22

Anterior part of the spinous process (part of the posterior arch)

Question 23

Describe the PLL

Answer 23

It gives reinforcement to the back of the disc, central fibers are more narrow than the ALL. The fibers spread laterally over posterior disc for strength = allows for HNP in lateral recess. (Looks like a T bar, on a cross, at the back of each disc)

Question 24

What are symptoms of Saddle Paresthesia?

Answer 24

Progressive or severe neurological deficit - foot drop, can’t heel or toe walk; severe unrelenting pain that is not relieved by removing gravity (lying down in bed, reclining).

Question 25

What is the subchondral bone innervated by, and can it be a pain generator?

Answer 25

The basivertebral nerve innervates the subchondral bone, and since it is right above the vertebral end plate, it CAN be a pain generator.

Question 26

What’s is the new theory of pain?

Answer 26

Pain -> Sinuvertebral nerves of the disc -> grey rams communicates -> sympathetic chain and ganglion of L2

Question 27

What is the type of disc herniation that compresses the traversing nerve root? And why?

Answer 27

Paracentral disc herniation because it occurs at a weak spot (lateral aspect where PLL starts to thin out at the paracentral area) in the PLL (protects the back of disc).

Question 28

What is a typical disc herniation?

Answer 28

Paracentral that compresses the nerve roots and traversing nerve roots (the ones below).
Example: L3 typical disc herniation, compresses the traversing nerve root of L4

Question 29

What causes central stenosis in association with neurogenic claudication?

Answer 29

Hypertrophy of ligamentum flavum.

Question 30

What innervates the anterior part of the thecal sac?

Answer 30

Traversing nerve

Question 31

What innervates the back of the disc?

Answer 31

Sinuvertebral nerve

Question 32

What innervates the facets?

Answer 32

Medial branch of the posterior primary rami (same level AND 1/2 of the one above)

Question 33

Will the lateral disc herniation compress the exiting nerve root?

Answer 33

Yes

Question 34

Will the far lateral disc herniation compress the traversing nerve root?

Answer 34

No

Question 35

What are yellow flag warnings?

Answer 35

Blood thinners