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MSK II - Exam 1 > Spine- Thoracolumbar V- Persistent IDDs > Flashcards

Spine- Thoracolumbar V- Persistent IDDs Flashcards

1
Q

What is persistent IDD also known as?

A
  • degenerative disc disease (DDD)
  • Age-related Disc Changes (although not always due to age)
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2
Q

how can disc changes allow herniations?

A

Gradually develops over time due to numerous variables

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3
Q

Where is persistent IDD most common?

A

Lumbar region

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4
Q

What percentage of IDDs are symptomatic?

A

1-3%

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5
Q

Persistent IDD is the cause of 5% of what condition?

A

LBP

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6
Q

What age group is persistent IDD most prevalent in?

A

30-50 year olds

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7
Q

What segment is 95% of persistent IDD located in?

A

L4-S1

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8
Q

What is the etiology of persistent IDD?

A
  • acute IDD
  • Mixed findings with age
  • Lower strength
  • Sedentary lifestyle
  • Heavier Occupational Lifting
  • Smoking
  • Genetics
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9
Q

Why can lower strength lead to persistent IDD?

A

Less stabilization, acute restraints take on more of the load progressively

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10
Q

What can a sedentary lifestyle lead to persistent IDD?

A

Structures break down with disuse; wont keep its integrity

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11
Q

Acute IDD is the only back condition that is _______?

A

Genetic

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12
Q

What is lumbar IDD associated with?

A

Age-related disc changes in cervical region

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13
Q

What percentage of persistent IDD is inheritance?

A

65-85% but can be modified by diet and lifestyle

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14
Q

What is persistent IDD NOT from?

A
  • Routine loading/physical activities
  • prolonged driving
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15
Q

What is beneficial for persistent IDD?

A

Routine loading

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16
Q

What is the pathogenesis of persistent IDD?

A

Gradual
- persistent inflammation
- Less GAGs so more fibrotic and dehydrated nucleus
- More acidic disc that kills disc cells and limits proliferation
- Annular disorganization
- Thinning and loss of cartilage at end plates
- Increased inflammation and fatty deposits in vertebra

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17
Q

Why does persistent inflammation lead to persistent IDD?

A
  • in growth of nociceptive fibers from acute iDD > healing can lead to nociplastic pain
  • Brings excessive and destructive proteins and a low grade infection enters disc
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18
Q

What happens per the miller classifications once changes occur to the disc?

A

Persistent herniations and nuclear migration gradually develop

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19
Q

What are the categories of herniation per Miller?

A
  • Protrusion (bulge)
  • Extrusion
  • Free Sequestration
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20
Q

What is a protrusion? (bulge)

A
  • nucleus migrates but remains contained in annulus
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21
Q

What is the most common herniation?

A

Protrusion (bulge)

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22
Q

What is an extrusion?

A
  • Nucleus migrates thru the outer annulus
23
Q

What is free sequestration?

A
  • Nucleus migrates and breaks away from annulus
24
Q

What will develop where the nucleus migrates into the vertebral body?

A

Schmorl’s Nodes

25
Q

Why can the disc with persistent IDD be not bright white on an x-ray?

A

persistent inflammation; not the same as an acute

26
Q

Why can the initial changes of disc height and integrity as well as narrowing lead to instability/hypermobility?

A
  • Joint space narrowing, greater load on facets
  • stenosis may develop due to the neural foramen narrowing
27
Q

What planes will joint hypermobility present in with persistent IDD?

A

sagittal and frontal plane motions, NOT in the transverse plane

28
Q

What happens with later changes due to narrowing with persistent IDD?

A
  • greater age related joint changes
  • can less prior instability due to associated stiffening of joint
29
Q

What is multiple levels of IDD?

A

Spondylosis

30
Q

What allows the tissues to adapt without symptoms for some time?

A

SLOW change

31
Q

What percentage of changes have a lack of symptoms with imaging?

A

2/3

32
Q

What benefit is mechanical diagnosis and therapy (McKenzie)?

A

Short term benefit

33
Q

What is mechanical diagnosis and therapy better for?

A

Placebo for pain but NOT function

34
Q

What is mechanical diagnosis and therapy NOT superior to?

A
  • Education
  • Manual therapy and motion exercises
  • Stabilization exercises
35
Q

What do we need to consider even if imaging shows disc changes?

A

The primary driver of symptoms from the development of other conditions
- Instability?
- Stenosis?
- Age-related Joint Changes?
- Combinations?

36
Q

What is a negative outcome predictor for acute and persistent IDD?

A

Peripheralizaiton

37
Q

What does peripheralization have a significant association with?

A
  • mental distress/depression
  • pain behaviors
  • somatisation
  • fear of work
  • non-organic signs
38
Q

When is there worse outcomes regarding symptoms with acute AND persistent IDD?

A

symptoms present more than six months prior to any treatment, including surgery

39
Q

What medications have conflicting and unclear benefits with acute and persistent IDD?

A

NSAIDS, muscle relaxants, acetaminophen

40
Q

What can be prescribed for a large inflammatory response?

A

Steroid dose pack

41
Q

What benefit do epidural injections have with persistent and acute IDD?

A

Short term but not long term relief or functional changes

42
Q

What can benefit the potential infection source for IDD?

A

Antibiotic treatment

43
Q

Waiting an average of 4 and a half months on surgery did what?

A
  • did NOT minimize benefits of surgery
44
Q

What can be better with surgery vs PT?

A

Earlier and improved benefit, particularly with severe acute IDD

45
Q

What should we know about PT vs surgery?

A

Slower but the same overall outcomes without surgery after two years

46
Q

What kind of surgery can help IDD?

A
  • Spinal decompression
  • laminectomy, partial discectomy
47
Q

What can indicate a spinal decompression surgery?

A
  • persistent and/or worsening radiculopathy
  • symptoms unresponsive to non-surgical treatments
48
Q

What surgery can be done with hypermobility/instability?

A
  • Lumbar fusion
  • Total disc replacement (TDR) with persistent IDD
49
Q

Whats the difference between a lumbar fusion and PT?

A
  • no difference in long-term outcomes with pain, health status, satisfaction, or disability
50
Q

What is a Lumbar fusion not additive to?

A
  • Laminectomy or discectomy
51
Q

What can a lumbar fusion lead to?

A

Adjacent joint hypermobility/instability

52
Q

What does a TDR with persistent IDD do with the segments?

A

Leads to a better load distribution across segments

53
Q

When is a TDR a safe an effective treatment?

A

MORE than 5 years postoperatively

54
Q

What is the difference between a TDR and PT?

A
  • no differences at 2 years follow up compared to PT alone without radiculopathy for in return to work, life satisfaction, fear avoidance behavior, drug use, back performance

MSK II - Exam 1 (7 decks)

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