Scenario 11- 64 year old housewife, spondylosis of Tx, multiple level

Question 1

Spondylosis presentation?

Answer 1

Clinical presentation - Low back pain during and following sport, which eases with rest, back pain when extending spine (arching backwards), associated with sporting adolescents (eg cricket fast bowlers)
Diagnostic features - X-ray - showing narrowing of intervertebral disc space and bony oseteophytes (due to OA, secondary from spondylosis) - MRI and CT scans show nerve root impingement due to the narrowing of the neural foramen

Question 2

Spondylosis Pathology?

Answer 2

Pathophysiology - Spondylosis is osteoarthritis of the spine. It is a degenerative joint disease in which the protective cartilage that cushions the vertebrae wears down also affecting the facet joints, intervertebral discs causing osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability.

Osteophytes are laid down in an attempt to improve the congruence of the articular cartilage surfaces.

Wear and tear of osteoarthritis can sometimes put pressure on the nerves extending from the spinal column.

Question 3

Problem list

Answer 3

Intermittent dull ache 3/10, worsens with activity, extension (7/10) worse than flexion (2/10)
Intermittent sharp pain, immediate onset with extension and right rotation eases with return to normal
S – VAS 2-7/10, pain killers? Sleep disturbance? ADL?
I – aggs with activity, extension and right rotation. Eases immediate with neutral 24 hour pattern?
N – degenrative

Question 4

Objectives

Answer 4

Reduce intermittent dull ache in 2/52

Extension 4/10 in 2/52

Question 5

Assessment

Answer 5

PROM extension, flexion and rotation of thoracic spine

PAIVM’s - Mobilisations

Question 6

Treatment

Answer 6

MWM’s

PPIVMS: extension.

Left side PAIVMS to increase right rotation and open up foramina

Question 7

MDT

Answer 7

Drugs – pain killers, muscle relaxants, NSAID’s
Surgery - rarely used as spondylosis can usually be managed quite well with medication and physiotherapy. However surgery is performed if the spine is unstable, bowel or bladder dysfunction, spinal stenosis, experiencing other neurological dysfunction – severe limb weakness with p&N and numbness