Radicular LB syndroms

Question 1

what are the radicular LB syndroms

Answer 1

• disk herniation
• Central spinal stenosis
• Lateral spinal stenosis
• cauda equina syndrome

Question 2

Anual and lifetime prevelence of lumbar disk herniation

Answer 2

annual- 1-5%
lifetime- 13-40%

mc in 30-50yolds (2x more in males)

Question 3

what % of cases will spontateously resolve

Answer 3

70% in 4-6w

if untreated 10% will have continued deficits

Question 4

2 prerequistes for lumbar disk herniation

Answer 4

1. radial fissure in annulus fibrosis

2. Altered biochemical properties of Nucleus pulpous

Question 5

Mc level of lumbar disk herniation

Answer 5

L5/s1- 50%

this causes S1 symptoms (if postlateral)

Question 6

% of herniations that are: posterolat, lat and central

Answer 6

posterolat- 80%
lat- 10%
central- 10%

Question 7

4 stages of disk herniation

Answer 7

1. intradiscal nuclear hern- nucleus pulposus bulges within annulus fib
2. Protrusion- displaced NP causes buldge of annulus
3. Extrusion- NP migrates thru annulus and reaches spinal canal
4. Sequestration- NP escapes as a free fragment

Question 8

changes that occur after middle age in: NP, Annulus, Vert body

Answer 8

NP- becomes solid, dry, granular
Annulus fibrosis- accumulates cracks etc
Vert body- height decreases

Question 9

Gradual vs sudden prolapse : which disks are more succeptible in each

Answer 9

gradual- young disks

sudden- old disks, caused by single high compressive load on flexed disk

Question 10

pain mech of lumbar disc herniation

Answer 10

1. chemical- degradation of NP causes seepage into outer 1/3 of annulus
2. Mechanical- facet irritation, endplate fracture due to compressive force

Question 11

what will fail first disk or endplate

Answer 11

in adults disks will herniate first (outer layers of annulus are the 1st region to fail)

Question 12

what direction will the angelic list happen in lateral and medial herniations

Answer 12

lat- list away

med- list towards

Question 13

what is the tripod sign

Answer 13

when doc extends knee the peson will lie back to relieve the flexion

Question 14

What is neurogenic claudication

Answer 14

• the clinical presentation and symptoms caused by stenosis

- symptoms alieviated by slouching

Question 15

what is the shopping cart sihgn

Answer 15

where patients are bent over to reduce symptoms of spinal stenosis

Question 16

prevelence of spinal stenosis

Answer 16

47% of adult patients

Question 17

What does spinal stenosis cause in regard to blood flow

Answer 17

-compresses venous plexus in back of SC which causes reduced venous flow, congestion

Question 18

differential diagnoses of spinal stenosis

Answer 18

1. Peripheral arterial disease
2. Hip osteparthritis
3. hip-spine syndrome
4. greater trochanter pain syndrome
5. lumbar disk herniation
6. neuropathy
7. cervical spinal stenosis

Question 19

Non operative management of nerogenic caudication

Answer 19

1. epidural injections
2. opiods
3. boot camp program

Question 20

4 aspects of the boot camp program

Answer 20

1. coaching on behaviour change
2. targeted manual therapy
3. specific exercises/ home training
4. Body repositioning (posture technique)