NMS 2 Exam 3 Flashcards
Type 1 Spondylolisthesis
-Dysplastic
-Congenital defect in neural arch or sacrum
Type 2 Spondylolisthesis
-Isthmic
-Lytic: Stress fracture in pars
-Acute: Fracture in Pars
Type 3 Spondylolisthesis
-Degenerative
-Degenerative arthrosis of regional lumbar anatomy
Type 4 Spondylolisthesis
-Traumatic
-Fracture of neural arch other than pars
Type 5 Spondylolisthesis
-Pathologic
-Occurs as a result of bone pathology
Lumbar Myelopathy
-Compression of the spinal cord causing neurologic dysfunction (gait disturbance, pathologic reflexes, muscle weakness, and/or numbness)
Causes of Lumbar Myelopathy
Degenerative changes, central disc herniations, autoimmune disorders, hernias, cysts, hematomas and spinal tumors
Symptoms of Lumbar Myelopathy
-Leg/Lower back pain
-Tingling, numbness or weakness
-Increased reflexes in the extremities
-Difficulty walking
-Loss of urinary or bowel control
-Issues with balance and coordination
Lumbar Radiculopathy
-IVF compresses the nerve root as it exits the vertebrae
-Can cause compressive or inflammatory lesions
-Compressive: Space occupying lesion
-Inflammatory: Reaction leading to sensitivity
Examples of Lumbar Radiculopathy
Disc herniations, degenerative changes and expansile lesions
Risk factors of Lumbar radiculopathy
Degenerative, repetitive lifting/twisting, chronic overloading, prior trauma, poor posture, muscle imbalance, congenital defects, family history, lack of exercise, poor core strength
Lumbar Spinal Stenosis
Narrowing of the lumbar vertebral spinal canal with possible subsequent neural compression (neurogenic claudication)
Neurogenic claudication
Cramping/weakness in legs
Stenosis: Clinical Presentation
-Elderly undergoing extensive degenerative changes
-Discomfort is generally local as dull/achy pain
-Pain worse with extension and extercise
-Pain better with rest and flexion
-Most common at L5/S1
Central Canal Disc Lesion
-Compressed the spinal cord in the cervical and thoracic regions, compresses the cauda equina in the lumbar region
-Myelopathy and cauda equina syndrome
-Central, paracentral, lateral
IVF disc lesion
Compresses the nerve root as it exits the vertebrae
-Radiculopathy
-Medial/Lateral
Types of Disc Lesions
-Contained (intact annular fibers): Protrusion, Subannular extrusion
-Non-Contained (disruption of annular fibers): Transannular, Sequestered
Progression of Disc Lesions
-90% of patients have resolution of symptoms within 3 months of onset
-Nearly complete recovery, although flareups can occur
-75% of herniations resolve spontaneously within 6 months due to resporption of herniated material
At what point should we be looking at surgery for a disc lesion if conservative care isn’t working
Approximately 8-12 weeks
Lumbar Facet Syndrome
LBP d/t inflammation or degeneration of the facet joint or joint capsule often aggravated by hyperlordosis or extension movements
-Peak incidence in 40-50 years old
Lumbar Facet Syndrome: Presentation
-Dull, achy LBP w/ some sharp, acute episodes
-Insidious (degenerative)/Sudden (trauma)
-Pain worse with prolonged standings/lumbar ext
-Pain better lying supine, sitting or lumbar flexion
Causes of stenosis
-Primary causes: Anything that alters size/shape of the canal, usually during the developmental years
-Secondary causes: Degenerative changes or any condition that invades or compromises the space
Grade 1 Sprain/Strain
-Mild swelling/point tenderness over ligament
-No bruising
>10% fiber damage
-Mild stretch, no instability
(-) stretch tests, mild pain at extreme ROM
-Recovery: 2-14 days
Grade 2: Sprain/Strain
-Mild to moderate swelling
-Large spectrum injury that can include partial tearing
-11-90% fiber damage
-Mild to moderate instability may be demonstrated
-Recovery: 14 days to 2 months