Midterm Questions v1 Flashcards
What are 3 causes of caudal equina compression?
Large disc herniation
Severe central stenosis
Tumor - cancerous
Where is the ALL, what does it prevent and where does it extend to?
It covers the anterior bodies and discs, helps prevent anterior disc herniation and it extends all the way to the sacrum
How is central stenosis associated with neurogenic claudication?
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.
What kind of referral is it when there is a presentation of impaired bowel and/or bladder function?
Medical Emergency! ER!
What are the differences between DISH and AS?
DISH: older age, asymptomatic w/ normal SI joints
AS: 2nd decade of life (in 20s), spinal pain and stiffness with an abnormal SI joint
Know about lateral listless and what type of motion radiography should you order.
Lateral bending study - weight bearing to assess stability. We want to make sure it’s not sliding or rotating.
Know about symptomatic central stenosis.
“Shopping cart sign” = person likes to be in flexion
Older people will like to be in flexion and push the shopping cart around
Know about which orthopedic tests are good for diagnosing a disc herniation.
Slump > SLR
SLR = better for patient comfort in an acute condition, 15-30* radicular pain = HNP
Which muscles does the Sciatic N leave the pelvis?
Piriformis m and gemellus m
What’s the difference between lumbarization and sacralization?
Lumbarization = is a lumbar transitional segment of the S1 sacral segment
Sacralization = is a sacral transitional segment of L5 vertebra into the sacrum
Know mnemonic about the drag racer.
HI PROs Never Idle
History Inspection Palpation ROM Orthopedic Tests Neurological Tests Imaging
What are the 3 parts of the IVD?
Vertebral end plates Annulus Fibrosis (AF) Nucleus Pulposis (NP)
What are the 9 typical causes of LBP?
(VPFDSSSS) Vertebrogenic Pain Syndrome Piriformis Syndrome Facet Syndrome Discogenic Pain Syndrome Spondylolysis/ Spondylolisthesis Stenosis Scoliosis SI Syndrome
Know the components of a good history. (Pneumonic MDS WRITE Medical Medication Poorly)
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
What are the components of the inner and outer annulus fibrosis?
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
What is a Chance Fracture (NOT a Lap Belt Fracture!)?
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.
What does a Motion Segment consist of?
A Three-Joint-Complex (adjacent vertebra and IVD of those vertebrae)
What forms the facet joint?
Pedicle and lamina of the SAME vertebra
What are the maximum doses of acetaminophen (Tylenol), Naproxen Sodium (Aleve), Ibuprofen (Advil) and Gapapentin/ Neurontin?
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
Where do the nerve roots bud off the thecal sac?
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)
Describe the Ligamentum Flavum.
It forms the “root” of the spinal canal, is a “yellow ligament” because it is 80% elastin. (It connects B/L lamella together)
What are the parts of the vertebral arch?
Anterior part of the spinous process (part of the posterior arch)
Describe the PLL
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)
What are symptoms of Saddle Paresthesia?
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).
What is the subchondral bone innervated by, and can it be a pain generator?
The basivertebral nerve innervates the subchondral bone, and since it is right above the vertebral end plate, it CAN be a pain generator.
What’s is the new theory of pain?
Pain -> Sinuvertebral nerves of the disc -> grey rams communicates -> sympathetic chain and ganglion of L2
What is the type of disc herniation that compresses the traversing nerve root? And why?
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).
What is a typical disc herniation?
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
What causes central stenosis in association with neurogenic claudication?
Hypertrophy of ligamentum flavum.
What innervates the anterior part of the thecal sac?
Traversing nerve
What innervates the back of the disc?
Sinuvertebral nerve
What innervates the facets?
Medial branch of the posterior primary rami (same level AND 1/2 of the one above)
Will the lateral disc herniation compress the exiting nerve root?
Yes
Will the far lateral disc herniation compress the traversing nerve root?
No
What are yellow flag warnings?
Blood thinners
