Thoracolumbar Spine V- Persistent IDD

Question 1

Persistent IDD is aka as….?

Answer 1

Degenerative Disc Disease (DDD)

Age-related disc changes although NOT always due to age

Question 2

With chronic or persistent IDD, disc changes are due to numerous ________ and allow herniations (_______ _______) to GRADUALLY develop over time

Answer 2

variables; nuclear migration

Question 3

Persistent IDD is most common in what region?

Answer 3

Lumbar

Question 4

With persistent IDD, only ___-____% are symptomatic

Answer 4

1-3

Question 5

Persistent IDD is the source of pain in < ___% of LBP

Answer 5

5

Question 6

Persistent IDD is most common in ___-____ yr. olds

Answer 6

30-50

Question 7

95% of persistent IDD cases occurs at which vertebral levels?

Answer 7

L4-S1

Question 8

Persistent IDD ____ Acute IDD

A. >
B. <

Answer 8

A.

Question 9

Is persistent IDD or acute IDD more prevalent?

Answer 9

Persistent IDD

Question 10

Etiology of persistent IDD:

Acute ____

Mixed findings with ____

______ strength

_______ lifestyle

Answer 10

IDD
age
Lower
Sedentary

Question 11

With persistent IDD, why could lower strength be the cause?

Answer 11

Bc the local muscles become weak and then the global muscles have to take over and become overworked from “picking up the slack”

Question 12

With persistent IDD, why could a sedentary lifestyle be the cause?

Answer 12

“You don’t use it, you lose it” They are not moving enough and too little stress on the spine, is just as bad as doing nothing

Question 13

What are two additional etiologies of persistent IDD?

Answer 13

Heavier occupational lifting

Smoking

Question 14

With the etiology of persistent IDD, genetics typically are associated with:

_____ IDD and with ____-______ _______changes in the cervical region

Answer 14

Lumbar; age-related disc

Question 15

With the etiology of persistent IDD involving genetics, ___-____% of inheritance can be modified by diet and lifestyle

Answer 15

65-85

Question 16

With persistent IDD, it is NOT caused by….

_______ loading/______ activities

________ driving

Answer 16

routine/ physical

prolonged

Question 17

The pathogenesis of persistent IDD is ________ and has what kind of inflammation?

Answer 17

gradual; persistent

Question 18

With persistent inflammation, there is an in-growth of _______ fibers from _____IDD healing and can lead to what kind of pain?

Answer 18

nociceptive
ACUTE
nociplastic

Question 19

With persistent inflammation, it brings excessive and destructive proteins ( _______ ) and what likely enters the disc?

Answer 19

amyloidosis; low-grade infection

Question 20

Persistent IDD pathogenesis (gradual):

____ GAGs and MORE ______ and dehydrated nucleus (more or less/ synovial or fibrotic)

MORE _____ disc that kills disc cells and limits ______ (base or acidic/inflammation or proliferation)

_______ disorganization (annular or endplate)

_______ and loss of cartilage at ____ _____ (thickening or thinning/ nucleus pulposus or end plates)

________ inflammation and fatty deposits in vertebra ( ______ )- (decreased or increased/ fibrotic or modic)

NOW _______ herniations and nuclear migration GRADUALLY develop (per Miller)
(acute or persistent)

Answer 20

Less; fibrotic

acidic; proliferation

annular

Thinning; end plates

Increased; modic

persistent

Question 21

Protrusion is also called a _____

Answer 21

bulge

Question 22

With a protrusion (bulge), the nucleus ______ but remains contained in the ____

Answer 22

migrates; anulus

Question 23

What is the MOST common herniation?

Answer 23

Protrusion (bulge)

Question 24

With _______ the nucleus migrates through the outer annulus

A. protrusion
B. extrusion
C. free sequestration

Answer 24

B.

Question 25

_____ ______ is when the nucleus migrates and breaks away from the annulus

Answer 25

Free Sequestration

Question 26

With persistent IDD, what likely develops where the nucleus migrates into the vertebral body?

Answer 26

Schmorl's Nodes

Question 27

With persistent IDD, there can be ________ and cause initial changes related to loss of disc height and integrity

Answer 27

narrowing

Question 28

With persistent IDD, _______ may develop and lead to ??

Answer 28

instability, hypermobility

Question 29

With joint hypermobility relating to persistent IDD, it is noted during _____ and _____ planes but not _____ plane

Answer 29

sgaittal; frontal; transverse

Question 30

With persistent IDD and joint narrowing.... it contributes to initial _______ has a _____ load bearing on facets A.instability; greater B. hypomobility; greater

Answer 30

instability; greater

Question 31

If the neural foramen starts to narrow, what can develop?

Answer 31

stenosis

Question 32

With persistent IDD, there are greater ______ It can lessen prior instability due to associated ______ of a joint

Answer 32

ARJC stiffening

Question 33

With persistent IDD S&S _____ change allows tissues to adapt w/o symptoms for some time indicated by lack of symptoms with image changes in ___/____ of individuals

Answer 33

Slow; 2/3

Question 34

With persistent IDD, symptoms may present as..?

Answer 34

acute

Question 35

With persistent IDD, PT Rx: Mechanical Diagnosis and Therapy _____-_____ benefit Better for P! and NOT _______ NOT Superior to: Education ______ therapy and motion _____ _______ exercises

Answer 35

Short-term function Manual; exercises Stabilization

Question 36

With persistent IDD, PT Rx: You need to consider ________ driver of symptoms from the development of other conditions even if imaging shows _____ _______

Answer 36

primary; disc changes

Question 37

With acute and persistent internal disc derangement, there is a negative outcome predictor with ________

Answer 37

peripheralization

Question 38

Peripheralization is the opposite of _______

Answer 38

centralization

Question 39

With acute and persistent IDD, peripheralization has a significant association with: Mental ______/depression ____ behaviors _______ - coversion of anxiety into bodily symptoms fear of ______ ___-______ signs

Answer 39

distress pain Somastication work non-organic

Question 40

With acute and persistent IDD, if symptoms present > six months prior to any treatment this could lead to what kind of outcome?

Answer 40

worse

Question 41

With acute and persistent IDD MD Rx: There are conflicting and unclear benefits with these medications: ______, ________ ______, AND _________

Answer 41

NSAIDS, muscle relaxants, acetaminophen

Question 42

With acute and persistent IDD MD Rx: patients may be prescribed a ______ dose pack for a large inflammatory response

Answer 42

steroid

Question 43

With acute and persistent IDD MD Rx: A _______ injection is short-term but NOT long-term relief or functional changes

Answer 43

epidural

Question 44

With acute and persistent IDD MD Rx: _______ treatment benefits the potential infection source

Answer 44

Antibiotic

Question 45

With acute and persistent IDD MD Rx involving surgery: Waiting an avg. of _____ months of sx does NOT minimize the benefits of sx

Answer 45

4 1/2

Question 46

With acute and persistent IDD MD Rx involving surgery: Some studies demonstrated _____ and improved benefit with sx vs. PT; particularly with severe _____ IDD

Answer 46

earlier; acute

Question 47

With acute and persistent IDD MD Rx involving surgery: It is a _____ process and has the same overall outcomes without sx after 2 years

Answer 47

slower

Question 48

With acute and persistent IDD MD Rx: What is an example of a spinal decompression surgery?

Answer 48

laminectomy or partial discetomy

Question 49

With acute and persistent IDD MD Rx: What are some indications for surgery?

Answer 49

persistent and or worsening radiculopathy when symptoms are unresponsive to non-surgical treatments

Question 50

With persistent IDD involving sx for hypermobility/instability present: ______ fusion has... NO difference vs. PT in long-term outcomes with pain, health status, satisfaction, or disability NOT additive to laminectomy or discectomy May lead to adjacent joint hypermobility/instability

Answer 50

Lumbar

Question 51

With persistent IDD involving sx and TDR: Better load distribution across _______ Safe and effective treatment MORE than ____ years post-op At ____ years follow up, no differences compared to PT alone without radiculopathy for in return to work, life satisfaction, fear avoidance behavior, drug use, back performance

Answer 51

segments 5 2