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OCS Exam > Spine > Flashcards

Spine Flashcards

1
Q

How many degrees of fredom are available in the spine?

A

6

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2
Q

Describe Fryette’s laws of spinal biomechanics?

A

C-spine: side bend and rot occur to the same side; Lumbar and thoracic in neutral SB and Rot occur to the opposite side; Lumbar and thoracic in flex SB and rot same side; in reality spinal movement is highly variable in the thoracolumbar

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3
Q

Normal ranges for C0-C1

A

10-15 flex/ext, 8 degrees lateral flexion

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4
Q

Normal ranges: C1-2

A

10 flex/ext, 45 rot

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5
Q

Normal ranges: C3-7

A

64 flexion, 24 ext, 40 lateral flexion, 40 rot

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6
Q

Normal ranges: T1-S1

A

80 flex, 25 ext, 45 rot, 35 lat flexion

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7
Q

Angle of the facets for cerv, thoracic, lumbar:

A

Cerv: 45; thoracic: 60; lumbar vertical

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8
Q

Loads on the back when seated, standing forward bend, and seated forward bend?

A

145%, 150%, 180%

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9
Q

What level does the conus medullaris end?

A

L1-L2

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10
Q

How are facets innervated?

A

from one segment below and above

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11
Q

What happens during the straight leg raise test?

A

Neural movement: 0-30degrees slack is taken up, 35-70 the nerve root moves, 70-90 all structures are stretched

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12
Q

How effective are lumbosacral corsets for relief of spinal disk pressure?

A

Approximately 20-30% reduction in max disk load

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13
Q

What is the problem with supine situps in relation to the back:

A

high disk pressure therefore should be limited ~210% pressure

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14
Q

Chronic low back pain recruitment of erector spinae vs normal subjects shows what:

A

earlier and longer recruitment

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15
Q

What effect can a >3cm leg length discrepancy have on the lumbar spine?

A

Asymmetry in lateral bending during gait leading to accelerated degeneration

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16
Q

What is the role of bed rest in acute back pain

A

It should be limited, rest from activity but not from function except severe neurlogic involvement

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17
Q

Function of the intervertebral disk:

A

provides space and position; permits, guides, and restrains motion in all directions

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18
Q

What position facilitates disk nutrition?

A

sidelying or supine with knees bent

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19
Q

What is the source of diskogenic pain?

A

Healing response with vascularization and nerve growth causes pain

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20
Q

Describe stiffness in the low back

A

may occur after an acute injury with lack of movement resulting in collagen cross binging or fibrous adhesions

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21
Q

Describe mechanical block in the low back:

A

at L4/5 after stooping to pick up an object the joint may become locked in SB’ing; potentially related to a torn or seperated meniscoid or free fragment of articular cartilage

22
Q

Describe painful capsule entrapment:

A

This is what is thought to happen in the C-spine after an awkward movement with one sided pain

23
Q

Difference between protrusion and herniation?

A

Annular fibers are intact vs being disrupted

24
Q

How quickly does disk disease resolve:

A

90-95% resolve in 3-4 months

25
Q

Is intensive or mild exercise better after disk surgery?

A

Intensive 4-6 wks post surgery

26
Q

Manual therapy and disk herniation, is it warranted?

A

yes, it can help increase movement and get the muscles to relax

27
Q

What is spinal instability:

A

Osseoligamentous and neuromuscular components of the spine are unable to hold the spine against aberrant motions and slippage, leading to stress on soft tissues

28
Q

What is the order of soft tissue disruption with forward flexion injury?

A

supraspinous lig, interspinous lig, facet capsule, and disk

29
Q

What is spondylolisthesis?

A

anterior slippage of one vertebral body on an adj

30
Q

What is sacral angle?

A

The angle of displacement of the scarum from the verticle, the scarum becomes more verticle with progressive listhsis

31
Q

What is spondylolysis?

A

Defect in the vertebra, typically L5 that presents with fractures, especially in the par interarticularis

32
Q

Does spondylolysis always progress to sponylolisthesis?

A

No

33
Q

Should neurological comprimise be anticipated with spondylolisthesis?

A

Yes, it can occur with dysplastic and isthmic

34
Q

What is functional scoliosis:

A

appearant scoliosis caused by a leg length discrepency or muscle spasm

35
Q

When should be bracing be consider for scoliosis?

A

>20 degrees if progressing, >30 immediately

36
Q

Red flags for metastatic cancer in the back?

A

History of cancer, night pain or pain at rest, unexplained weight loss, >50 years old or <17 years old, Failure to improve over the predicted time interval

37
Q

Red flags for infection within the disk?

A

Immunosuppressed, prolonged fever >100.4, Hx of intravenous drug abuse, Hx of recent UTI, celluitis or pneumonia

38
Q

Red flags for undiagnosed vertebral fx?

A

Prolonged use of corticosteroids, mild trauma age >50, age >70, known Hx of osteoperosis, recent major trauma at any age (fall greater than 5 ft or MVA)

39
Q

Red flags for dangerous AAA

A

A pulsating mass in the abdomen, a hx of atherosclerotic vascular disease, a throbbing pulsing back pain at rest or with recumbency, > 60 y/o

40
Q

Lumbar Manipulation CPR?

A

No symptoms distal to the knee, Current episode 35 degrees (4/5 24.38 LR)

41
Q

Is a single red flag in the absence of serious disease worrisome?

A

No, red flags in isloation have little concern

42
Q

What is lateral vs central stenosis?

A

Lateral: narrowing occurs within the lumbar intervertebral foramina and/or the nerve root canal, causing, encroachment; Central: narrowing that occurs within the spinal canal

43
Q

What is primary vs secondary stenosis?

A

Primary: congenital malformation or defect in postnatal development; Secondary: narrowing resulting from aquired conditions such as degenerative changes

44
Q

What are the most common structural changes associated with lumbar stenosis?

A

Facet joint arthrosis and hypertrophy, bulging, and thickening of the ligamentum flavum, loss of disk are the most common changes contributing to lumbar spinal stenosis

45
Q

How will a lumbar stenosis patient typically present?

A

> 50 y/o long Hx of low back pain, pain and/or numbness in one or both legs; limited ROM especially ext and will often reproduce the symptoms; symptoms improve with flexion

46
Q

Why does spinal stenosis worsen with standing?

A

Ext narrows the spinal canal as does axial compression

47
Q

What is neurogenic cladication?

A

poorly localized pain, paresthesias, and cramping of one or both LE of a neurologic origin; symptoms are worsened with walking and relieved by sitting

48
Q

Are there other conditions that might be confused with lumbar stenosis?

A

OA of the ihip, vascular claudication, unstable spondylolisthesis, and lumbar intervertebral disk herniation

49
Q

Biggest differentiating factor for other condition from lumbar stenosis:

A

posture dependent pain with standing/ext vs no pain with sitting; bicycle test vs TM test

50
Q

Most common surgery for lumbar stenosis?

A

decompression laminectomy; fusion is usually only performed in the presenece of spondylisthesis

51
Q

Can an unweighted TM help patients with lumbar spinal stenosis?

A

Possible because it unloads the axial compression and may decrease the neurogenic claudication symptoms

52
Q

Common presentation of cervical stenosis patient:

A

Hyporeflexia, motor weakness, sensory disturbances, Cspine ROM limited, ext may aggravate Sx, may reduced symptoms with traction; + spurlings

OCS Exam (29 decks)

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