Spinal conditions Flashcards
What do degenerative conditions include?
- Stenosis
2. Spondylosis
What do instability conditions include?
- Spondylolysis
2. Spondylolisthesis
What do bone health conditions include?
- Osteoporosis
2. Pagets
What do developmental conditions include?
Scoliosis
What do traumatic conditions include?
- Acute disc
2. Whiplash
What is included in a spinal segment ?
2 vertebrae and corresponding disc
Each segment contributes to overall ______ and _______.
mobility; stability
The different angulation of disc layers is especially important in withstanding _______ forces.
rotary
Rotary forces include what other two types of forces?
- Compression
2. Shear
Anything that could decrease space in the intervertebral foramen could compress the _______
nerve.
spinal
What are 3 examples of conditions that might decrease the intervertebral space?
- Disc degeneration
- Spinal infection
- Osteophyte
What is the main function of the intervertebral disc?
To act as a mechanical spacer
What types of forces does the intervertebral disc provide resistance against?
- compression
- shear
- torque (rotary)
Loss of disc height can lead to nerve _______ and/or _______ changes to the joints.
compression; degenerative
The facet joint ______ to allow segmental movement.
glides
What two movements load up the facet joints?
- Extension
2. Hyperextension
Overloading the facet joint can lead to what 3 things?
- Bony hypertrophy
- Osteoarthritis (spondylosis)
- Osteophyte formation
The facet joints glide ____ when flexion, and glide _____ when extending.
up; down
If the facet joint is inflamed, ______ will be more painful.
extension
_______ increases the space in the IV foramen.
flexion
What is the main function of the IV foramen?
maintain space for the nerve root
Spondylosis is also known as spine _______.
arthritis
What are some signs and symptoms of spondylosis?
- morning stiffness
- improves with mobility
- pain at EOD
- aggravated by prolonged positioning in either standing or sitting
- X-Ray will present degenerative changes which may include osteophytes
What are the two types of stenosis?
- Central
2. Lateral
What are the clinical presentations of stenosis?
- LBP, maybe with bilateral or unilateral leg pain
- Aggravated by extension
- Eased by flexion and sitting down
- Usually older age group
- Associated with degenerative changes
- Can be progressive
Stress in the pars interarticularis may lead to what?
spondylolysis
Does spondylolysis lead to change in the anterior region?
NO
Does spondylolisthesis lead to change in the anterior region?
YES
A spondylolisthesis is a full fracture though what?
pars interarticularis
Where does a spondylolysis usually occur?
at L5
Spondylolysis has a “______” effect on facet joints of hyperextension
nutcracker
Spondylolysis is most common in what population?
adolescents, gymnasts, figure skaters, and football players
_______ can lead to spondylolisthesis
spondylolysis
___________ = anterior slippage of one vertebrae on the other.
spondylolisthesis
What is a grade 1 spondylolisthesis?
< 25% slippage
What is a grade 2 spondylolisthesis?
25-50% slippage
Why does spondylolisthesis usually occur at the level of L4 and L5?
Anatomical reasons
What are 2 common treatments for people with spondylolisthesis?
- Lengthen hamstring
2. Strengthen core
Whether a fracture through the pars is unilateral or bilateral depends on the ________ pattern.
loading
What is a grade 3 spondylolisthesis?
50-75% slippage
What is a grade 4 spondylolisthesis?
> 75% slippage
What are clinical presentations of spondylolisthesis?
- Step deformity palpable
- Aggravated by extension
- Eased by flexion
- Responds to posture and core stabilization and avoiding hyperextension
- Can be progressive but generally good clinical outcome
What are 2 main differences between spondylolysis and stenosis?
- Age (stenosis = older adults)
2. Spondylolysis may present on X-Ray
What 3 things are critical to bone health?
- Calcium
- Vitamin D
- Weight bearing exercises
1 in __ women and at least 1 in __ men over the age of 50 have osteoporosis
4;8
1 in ___ women and 1 in ___ men will break a bone due to osteoporosis
3;5
Why is osteoporosis often secondary to other conditions such as cancer, IBS, medication and gastric surgery?
Because absorption of nutrients is effected
What area is especially vulnerable to spontaneous fractures when the patient has OP?
T spine
Osteoporosis is known as a _______ disease.
silent
_________ is common in people who have chronic LBP.
osteoporosis
In ________ disease, bone is replaced faster than normal, but it is weaker.
pagets
______ disease has a familial tendency
pagets
What regions does pagets disease most frequently effect?
- skull
- pelvis
- spine
When is pagets disease usually noticed?
> 40, males > females
How is pagets disease usually diagnosed?
blood work and X-Rays
What are possible treatments for pagets disease?
- Oral or injectable bisphonates
2. calcitonin
What are the 3 main classifications of scoliosis?
- Congenital
- Idiopathic
- Neuromuscular
What type of scoliosis is most common?
Idiopathic
_______ scoliosis is secondary to other conditions such as cerebral palsy and spina bifida.
neuromuscular
_______ scoliosis is associated with vertebral deformities
congenital
When is scoliosis usually noted?
in growth spurt before puberty
Clinically, how does scoliosis present?
rib hump on forward bend and asymmetrical waist and shoulders
Is there a more severe progression of scoliosis in girls or boys?
girls
In ______, individual assessment is required to assess which tissues are affected.
WAD
A classification system for WAD is used by who?
3rd party payers such as ICBC
What is a grade 1 WAD?
Neck pain and stiffness, tenderness and no physical signs
What is a grade 2 WAD?
Neck complaint and MCK signs (decreased RO M and tenderness)
What is a grade 3 WAD?
Neck complaint and neurological signs (weakness, decreased sensation and decreased reflex)
What is a grade 4 WAD?
neck complaint and fracture or dislocation
What are clinical presentations of disc pathology?
- LBP, leg pain (maybe)
- Aggravated by cough or sneeze
- Worse with flexion activities
- Better wit extension activities
Disc pathology generally has functional healing (T/F)
TRUE
What are 5 characteristics of postural back pain?
- Prolonged poor postures
- Ligament creep and hysteresis
- Deep core muscle inhibition
- Postural muscle imbalance
- Esp. treatable and responsive to exercise and postural management
What are 3 indications for medical co-management?
- Any of the conditions requiring medication for bone health
- Where medical management of pain is required (WAD, acute disc)
- Where further investigations (X-Ray, MRI) is required
in what cases might further medical investigation be needed?
Spondylolisthesis, stenosis and scoliosis
