Spinal Disorders

Question 1

What is spondylosis?

Answer 1

Degenerative changes of the spine OA.

AKA DJD or DDD

Question 2

How is the weight of the body distributed through the spine?

Answer 2

2/3 weight through the vertebral body and anterior disc

1/3 weight through the facet joints posteriorly

Question 3

What age does the disc begin to loose water?

Answer 3

20-40

Question 4

At what age does the disc increase the rate of water loss and disc space narrowing?

Answer 4

40-60

Question 5

At what age does the nucleus of the disc become fibrotic rather than gelatinous?

Answer 5

60+

Question 6

When do you start getting arthritic changes in the facet joints?

Answer 6

40-60 years

Question 7

When do you start getting subluxation of the facet joints (2ndary to IVF narrowing and decreased disc height)?

Answer 7

60+

Question 8

What are the three phases of degenerative changes in the spine?

Answer 8

early destruction phase
intermediate instability phase
final stabilization phase

Question 9

What happens in the early destruction phase of degeneration?

Answer 9

Synovitis of facet joints

Circumferential or radial tears in the annulus of the disc

Question 10

What happens in the intermediate instability stage of spinal degeneration?

Answer 10

vertebral and peri-facet osteophytes and traction spurs

laxity of posterior capsule and annulus can lead to spondo/retrolisthesis or disc herniation

Question 11

What happens in the final stabilization phase of spinal degeneration?

Answer 11

Fibrosis of the facets and capsule
loss of disc material and height
osteophytes
Bony ankylosis of verterbal bodies
Stenosis

Question 12

How will someone present with stenosis?

Answer 12

Back pain w/ uni/blateral radicular symptoms
Loss of trunk mobility
Symptoms aggravated with walking, standing upright
Symptoms relieved with sitting, forward flexion or lying down

Question 13

What is spinal instability and who is it typically seen in?

Answer 13

Loss of integrity of segmental soft tissue structures
Usually seen as degeration in older pts and in younger pts due to trauma, rupture or over stretching of ligaments or due to spondyolisthesis

Question 14

What is the clinical presentations of instability?

Answer 14

Back or neck pain w/ radicular symptoms
protective muscle spasm
juttering with motion
“step deformity”

Question 15

What is a Spondylolysis?

Answer 15

Fracture of pars interarticularis

shows up as a scotty dog collar on oblique x-ray

Question 16

What is a Spondylolisthesis? Where is it most common?

Answer 16

Anterior subluxation of vertebral body. Most common at L4-L5

Question 17

What are the three types of HNP?

Answer 17

bulge/prolapse-buldge but outer annular fibers remain intact
extruded-nuclear material breaks through annulus but is still connected
sequestered-nuclear material is free mass

Question 18

What is the most common direction of herniation in the lumbar spine?

Answer 18

Posterolaterally due to thin posterior longitudional ligament

Question 19

What are the demographics you see most often herniated NP’s?

Answer 19

Ages 31-50
somewhat more common in men
repetitive lifting, forward bending, driving, twistin

Question 20

Are you more or less likely to have symptoms below the knee with lumbar disc dysfunction?

Answer 20

More likely to have symptoms below the knee

Question 21

How will the lumbar spine usually present with a lumbar disc dysfunction?

Answer 21

forward flexed or flattened lumbar spine or lateral shift

Question 22

What is the order of positional tolerance with a lumbar disc dysfunction?

Answer 22

Lying>walking>standing>sitting most to least comfortable position