Thoracolumbar Spine V- Persistent IDD Flashcards
Persistent IDD is aka as….?
Degenerative Disc Disease (DDD)
Age-related disc changes although NOT always due to age
With chronic or persistent IDD, disc changes are due to numerous ________ and allow herniations (_______ _______) to GRADUALLY develop over time
variables; nuclear migration
Persistent IDD is most common in what region?
Lumbar
With persistent IDD, only ___-____% are symptomatic
1-3
Persistent IDD is the source of pain in < ___% of LBP
5
Persistent IDD is most common in ___-____ yr. olds
30-50
95% of persistent IDD cases occurs at which vertebral levels?
L4-S1
Persistent IDD ____ Acute IDD
A. >
B. <
A.
Is persistent IDD or acute IDD more prevalent?
Persistent IDD
Etiology of persistent IDD:
Acute ____
Mixed findings with ____
______ strength
_______ lifestyle
IDD
age
Lower
Sedentary
With persistent IDD, why could lower strength be the cause?
Bc the local muscles become weak and then the global muscles have to take over and become overworked from “picking up the slack”
With persistent IDD, why could a sedentary lifestyle be the cause?
“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
What are two additional etiologies of persistent IDD?
Heavier occupational lifting
Smoking
With the etiology of persistent IDD, genetics typically are associated with:
_____ IDD and with ____-______ _______changes in the cervical region
Lumbar; age-related disc
With the etiology of persistent IDD involving genetics, ___-____% of inheritance can be modified by diet and lifestyle
65-85
With persistent IDD, it is NOT caused by….
_______ loading/______ activities
________ driving
routine/ physical
prolonged
The pathogenesis of persistent IDD is ________ and has what kind of inflammation?
gradual; persistent
With persistent inflammation, there is an in-growth of _______ fibers from _____IDD healing and can lead to what kind of pain?
nociceptive
ACUTE
nociplastic
With persistent inflammation, it brings excessive and destructive proteins ( _______ ) and what likely enters the disc?
amyloidosis; low-grade infection
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)
Less; fibrotic
acidic; proliferation
annular
Thinning; end plates
Increased; modic
persistent
Protrusion is also called a _____
bulge
With a protrusion (bulge), the nucleus ______ but remains contained in the ____
migrates; anulus
What is the MOST common herniation?
Protrusion (bulge)
With _______ the nucleus migrates through the outer annulus
A. protrusion
B. extrusion
C. free sequestration
B.
_____ ______ is when the nucleus migrates and breaks away from the annulus
Free Sequestration
With persistent IDD, what likely develops where the nucleus migrates into the vertebral body?
Schmorl’s Nodes
With persistent IDD, there can be ________ and cause initial changes related to loss of disc height and integrity
narrowing
With persistent IDD, _______ may develop and lead to ??
instability, hypermobility
With joint hypermobility relating to persistent IDD, it is noted during _____ and _____ planes but not _____ plane
sgaittal; frontal; transverse
With persistent IDD and joint narrowing….
it contributes to initial _______
has a _____ load bearing on facets
A.instability; greater
B. hypomobility; greater
instability; greater
If the neural foramen starts to narrow, what can develop?
stenosis
With persistent IDD, there are greater ______
It can lessen prior instability due to associated ______ of a joint
ARJC
stiffening
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
Slow; 2/3
With persistent IDD, symptoms may present as..?
acute
With persistent IDD, PT Rx:
Mechanical Diagnosis and Therapy
_____-_____ benefit
Better for P! and NOT _______
NOT Superior to:
Education
______ therapy and motion _____
_______ exercises
Short-term
function
Manual; exercises
Stabilization
With persistent IDD, PT Rx:
You need to consider ________ driver of symptoms from the development of other conditions even if imaging shows _____ _______
primary; disc changes
With acute and persistent internal disc derangement, there is a negative outcome predictor with ________
peripheralization
Peripheralization is the opposite of _______
centralization
With acute and persistent IDD, peripheralization has a significant association with:
Mental ______/depression
____ behaviors
_______ - coversion of anxiety into bodily symptoms
fear of ______
___-______ signs
distress
pain
Somastication
work
non-organic
With acute and persistent IDD, if symptoms present > six months prior to any treatment this could lead to what kind of outcome?
worse
With acute and persistent IDD MD Rx:
There are conflicting and unclear benefits with these medications: ______, ________ ______, AND _________
NSAIDS, muscle relaxants, acetaminophen
With acute and persistent IDD MD Rx: patients may be prescribed a ______ dose pack for a large inflammatory response
steroid
With acute and persistent IDD MD Rx:
A _______ injection is short-term but NOT long-term relief or functional changes
epidural
With acute and persistent IDD MD Rx:
_______ treatment benefits the potential infection source
Antibiotic
With acute and persistent IDD MD Rx involving surgery:
Waiting an avg. of _____ months of sx does NOT minimize the benefits of sx
4 1/2
With acute and persistent IDD MD Rx involving surgery:
Some studies demonstrated _____ and improved benefit with sx vs. PT; particularly with severe _____ IDD
earlier; acute
With acute and persistent IDD MD Rx involving surgery:
It is a _____ process and has the same overall outcomes without sx after 2 years
slower
With acute and persistent IDD MD Rx:
What is an example of a spinal decompression surgery?
laminectomy or partial discetomy
With acute and persistent IDD MD Rx:
What are some indications for surgery?
persistent and or worsening radiculopathy
when symptoms are unresponsive to non-surgical treatments
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
Lumbar
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
segments
5
2
