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SST Spine Training > Section 8 - Degenerative Diseases > Flashcards

Section 8 - Degenerative Diseases Flashcards

1
Q

What is a Degenerative Disease

A

Refers to the loss of normal tissue structure and function as a result of the aging process.

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2
Q

OsteoArthritis

A

Degenerative changes cause symptoms in the joints, usually pain. This means that there is an inflammation of the bones and cartilage of a joint due to a degenerative process.

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3
Q

Motion Segment

A

The functional unit of this mechanism. It is hiw tge soine works to create movement.

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4
Q

What is the three-joint complex of each motion segment

A

Comprised of two facet and the intervertebral disc.

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5
Q

What are the two important functions of the intervertebral disc (IVD) ?

A
  1. The IVD acts as a shock absorber, taking up much of the compressive (axial) weight of the trunk and upper extremities and distributing it between the vertebral bodies.
  2. The IVD acts as a pivot point in the motion segment. It functions as a contained, deformable ball bearing to allow for motion in all degrees of freedom.
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6
Q

Identify structures in the following diagram:

A
  1. Annulus Fibrosus
  2. Nucleus Pulposus
  3. Lamellae
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7
Q

The nucleus pulposus is the central gelatinous substance that accounts for about ______ of the IVD.

A

40% of the IVD

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8
Q

Which has more water and proteoglycan content - the nucleus or the annulus of the IVD?

A

The Nucleus Pulposus has a much greater water and proteoglycan content than does the annulus. At birth it is approximately 90% and gradually decreases to approximately 70% by the age of 50.

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9
Q

In which region of the spine is each of these vertebral bodies found?

A

Top = C3

Bottom = L5

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10
Q

Which carries the smallest portion of the compressive load – the cortical shell or the spongy trabecular bone?

A

The spongy trabecular cancellous bone

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11
Q

The endplate is composed of how many layers?

A

2 layers

  1. The inner bony layer
  2. The outer cartilaginous, which represents the transition between the disc and the vertebra.
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12
Q

The cartilaginous layer is highly porous and nutrition diffuses across this surface from the __________ layer.

A

The cartilaginous layer is highly porous and nutrition diffuses across this surface from the bony layer.

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13
Q

The facet joints are important in stabilizing the spine. Their __________ and __________ affect the mobility of each spinal region.

A

The facet joints are important in stabilizing the spine. Their anatomic position** and **orientation affect the mobility of each spinal region.

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14
Q

The facet joints in the lumbar region are oriented in the __________ plane and limit the __________ in rotation.

A

The facet joints in the lumbar region are oriented in the sagittal plane and limit the range of motion in rotation

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15
Q

Ligaments have many functions including:

•

•

•

•

A

Ligaments attach bone to bone

  • They provide stability to the spine, yet allow for normal spinal motion.
  • Ligaments protect the spine and neurological structures from the effects of excessive motion.
  • Ligaments do not resist compressive loads and tend to buckle when subjected to them
  • Individual spinal ligaments readily resist tensile forces and prevent the motion segment from exceeding its physiologic range of motion.
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16
Q

List the seven ligaments that attach the motion segment together.

1.

2.

3.

4.

5.

6.

7.

A
  1. Anterior Longitudinal Ligament - ALL
  2. Posterior Longitudinal Ligament - PLL
  3. Ligamentum Flavum
  4. Facet Capsular Ligament
  5. Intertransverse Ligament
  6. Interspinous Ligament
  7. Supraspinous Ligament
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17
Q

Label the following diagram:

A

A. Intertransverse Ligament

B. Ligamentum Flavum

C. Supraspinous Ligament

D. Interspinous Ligament

E. Facet Capsular Ligament

F. Anterior Longitudinal

G. Posterior Longitudinal Ligament

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18
Q

Label the following diagram:

A

A. Longus Rotatores Lumborum Muscle

B. Lateral Intertransversarius Muscle

C. Interspinalis Lumborum Muscle

D. Brevis Rotatores Lumborum Muscle

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19
Q

Fill in the blanks.

Muscles are the _______________that produce _______________through _______________and _______________across a _______________or _______________. Muscles also provide significant _______________and _______________to the spinal column. They resist _______________placed on the body through _______________.

A

Muscles are the active structures** that produce **spinal movements** through **bending movements and torque across a joint or motion segment. Muscles also provide significant dynamic stability** and **stiffness** to the spinal column. They resist **external loads** placed on the body through **isometric forces.

20
Q

The most significant alterations of the disc are:

•

•

•

•

A
  • Decreased water and proteoglycan content of the nucleus pulposus.
  • Decreased water and proteoglycan content of the annulus, though not to the extent of the nucleus.
  • Distortion of the collagen fibers of the annulus fibrosus.
  • Tears may in the lamellae, due in part to distortion of the collagen fibers, which could result in a loss of annular strength.
21
Q

What are the two most negative effects of sclerosis on the motion segment?

1.

2.

A
  1. Sclerosis decreases the amount of nutrients diffusing across the cartilaginous end plate into the intervertebral disc, resulting in degeneration of the disc.
  2. Sclerosis stiffens the end plate and makes it less able to absorb load transferred from the disc.
22
Q

What is another name for traction spurs?

A

Peripheral Osteophytes

23
Q

Major trauma or repetitive minor trauma may lead to ____________________.

A

nonspecific synovitis.

(inflamation of synovial membrane)

24
Q

The articular processes begin to override each other as the joint capsules become stretched. This results in…

A

This results in a malalignment of the joints and abnormal biomechanical function of the motion segment.

25
Q

How do spinal ligaments show the effects of aging?

A

Spinal ligaments show the effects of aging through

  • Partial ruptures
  • Necrosis
  • Calcification of fibers
26
Q

List 7 changes to the motion segment that may occur due to degenerative disc disease.

1.

2.

3.

4.

5.

6.

7.

A
  1. The disc loses water, causing it to shrink in volume.
  2. The disc space begins to narrow. Concurrently, the facet joints begin to override and wear away at the hyaline cartilage surfaces.
  3. Compressive loads are transferred away from the nucleus/central end plate interface to the peripheral annulus/vertebral end plate margins.
  4. Sclerosis of the central end plate further reduces disc nutrition.
  5. The motion segment becomes hypermobile due to the narrowed intervertebral space and overriding of the facets
  6. Osteophytes develop in an attempt to stabilize excessive motion.
  7. Osteophytes may encroach on neurological structures.
27
Q

Though degenerative disc disease may be found in every spinal level, what are the most frequently affected levels by region?

A

Cervical 5-6

Lumbar 4-5

Lumbar 5-S1

28
Q

What does “stenosis” mean?

A

Derived from the Greek stenos: narrow, and osis: pathological condition.

Literally means “the narrowing of a tube.”

29
Q

What is the most common form of spinal stenosis?

A

Acquired degenerative type

The most frequently involved regions for degenerative spinal stenosis are in the lower cervical and lower lumbar areas.

30
Q

Label the diagram:

A.

B.

C.

D.

A

A. Central Stenosis

B. Thickened Ligamentum Flavum

C. Lateral Recess Stenosis

D. Foraminal Stenosis

31
Q

Describe the clinical presentation for degenerative lumbar spinal stenosis.

A

Symptoms appear gradually and back pain is almost always present. There may also be associated buttock and leg pain, usually bilaterally.

32
Q

What is neurogenic claudication and how can it be relieved?

A

Neurogenic Claudication is a symptom of lumbar spinal stenosis. Neurogenic claudication is brought on by and intensified by walking and standing upright.

Symptoms are often relieved when the patient flexes forward and opens more of the spinal canal, thereby relieving the pressure. Sitting and lying down in the fetal position also relieve claudication symptoms.

33
Q

What is the difference between neurogenic claudication and vascular claudication?

A

Vascular claudication is caused by narrowing of the major arteries supplying blood to the legs. Unlike Neurogenic claudication, symptoms for vascular claudication are relieved by standing and worsened by laying down.

Neurogenic - Causes back pain first, followed by pain descending down the legs.

Vascular - Pain originates in the lower leg and extends up the leg toward the lower back.

34
Q

What kind of radiographic studies are most commonly used when evaluating lumbar spinal stenosis?

A

Plain X-ray films (A-P and Lateral)

Myelography combined with CT scan

MRI

35
Q

What are some of the conservative treatments for mild degenerative lumbar stenosis?

A

Stretching exercises that increase their flexion motion.

-Biking, water walking, and swimming are excellent activities for these individuals.

Epidural steroid injections may reduce swelling in neurologic and vascular tissues, thereby improving circulation.

36
Q

What is the most common cause of spinal stenosis in the cervical region?

A

Degeneration of the three-joint complex is most common cause.

37
Q

What is radiculopathy?

A

Progressive deterioration of a nerve root

38
Q

What is myelopathy?

A

Progressive deterioration of the spinal cord

39
Q

Describe the clinical presentation of a patient with degenerative cervical stenosis.

A
  • May be in 40s or 50s
  • History of neck trauma preceding, by months or years
  • Onset of Stenosis symptoms
  • Radiculopathy of the C5,6,7 nerve root on one side only. Causing diminished sensation, muscle weakness and arm pain.
  • Myelopathy may lead to altered gait, diminished fine motor coordination, sensory changes, muscle weakness, and in late cases, bowel or bladder dysfunction.
40
Q

Conservative care for degenerative cervical stenosis is generally limited to what kind of patients?

A

Conservative care generally limited to individuals who suffer from radicular symptoms only.

41
Q

Surgical treatment for degenerative cervical stenosis is generally given to what kind of patients?

A

Patients with frank myelopathy from degenerative stenosis

Individuals with significant deformity and/or instability may be surgical candidates.

42
Q

Describe surgical approaches and techniques used for decompression in the cervical region.

A

Anterior, Posterior or combined approaches.

43
Q

What is a “laminectomy”?

A

Laminectomy involves partial or complete removal of the posterior elements, allowing increased space for the neural structures.

44
Q

What is a “laminoplasty”?

A

Laminoplasty is the surgical reconstruction of the posterior elements that allows for increased canal space but maintains the posterior arch.

45
Q

The cervical facets are oriented in the _________ plane and thus ____ ____ ______ flexion, lateral bending, or rotation very well; they do resist __________ somewhat.

A

The cervical facets are oriented in the coronal plane and thus do not resist flexion, lateral bending, or rotation very well; they do resist flexion somewhat.

**This is why the cervical spine has such a substantial range of motion.***

SST Spine Training (14 decks)

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