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MSK Final > Thoracolumbar Spine V- Persistent IDD > Flashcards

Thoracolumbar Spine V- Persistent IDD Flashcards

1
Q

Persistent IDD is aka as….?

A

Degenerative Disc Disease (DDD)

Age-related disc changes although NOT always due to age

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2
Q

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

A

variables; nuclear migration

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3
Q

Persistent IDD is most common in what region?

A

Lumbar

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4
Q

With persistent IDD, only ___-____% are symptomatic

A

1-3

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5
Q

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

A

5

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6
Q

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

A

30-50

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7
Q

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

A

L4-S1

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8
Q

Persistent IDD ____ Acute IDD

A. >
B. <

A

A.

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9
Q

Is persistent IDD or acute IDD more prevalent?

A

Persistent IDD

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10
Q

Etiology of persistent IDD:

Acute ____

Mixed findings with ____

______ strength

_______ lifestyle

A

IDD
age
Lower
Sedentary

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11
Q

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

A

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

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12
Q

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

A

“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

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13
Q

What are two additional etiologies of persistent IDD?

A

Heavier occupational lifting

Smoking

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14
Q

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

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

A

Lumbar; age-related disc

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15
Q

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

A

65-85

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16
Q

With persistent IDD, it is NOT caused by….

_______ loading/______ activities

________ driving

A

routine/ physical

prolonged

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17
Q

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

A

gradual; persistent

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18
Q

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

A

nociceptive
ACUTE
nociplastic

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19
Q

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

A

amyloidosis; low-grade infection

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20
Q

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)

A

Less; fibrotic

acidic; proliferation

annular

Thinning; end plates

Increased; modic

persistent

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21
Q

Protrusion is also called a _____

A

bulge

22
Q

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

A

migrates; anulus

23
Q

What is the MOST common herniation?

A

Protrusion (bulge)

24
Q

With _______ the nucleus migrates through the outer annulus

A. protrusion
B. extrusion
C. free sequestration

A

B.

25
Q

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

A

Free Sequestration

26
Q

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

A

Schmorl’s Nodes

27
Q

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

A

narrowing

28
Q

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

A

instability, hypermobility

29
Q

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

A

sgaittal; frontal; transverse

30
Q

With persistent IDD and joint narrowing….

it contributes to initial _______
has a _____ load bearing on facets

A.instability; greater
B. hypomobility; greater

A

instability; greater

31
Q

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

A

stenosis

32
Q

With persistent IDD, there are greater ______

It can lessen prior instability due to associated ______ of a joint

A

ARJC

stiffening

33
Q

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

A

Slow; 2/3

34
Q

With persistent IDD, symptoms may present as..?

A

acute

35
Q

With persistent IDD, PT Rx:

Mechanical Diagnosis and Therapy

_____-_____ benefit

Better for P! and NOT _______

NOT Superior to:
Education
______ therapy and motion _____

_______ exercises

A

Short-term

function

Manual; exercises

Stabilization

36
Q

With persistent IDD, PT Rx:

You need to consider ________ driver of symptoms from the development of other conditions even if imaging shows _____ _______

A

primary; disc changes

37
Q

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

A

peripheralization

38
Q

Peripheralization is the opposite of _______

A

centralization

39
Q

With acute and persistent IDD, peripheralization has a significant association with:

Mental ______/depression

____ behaviors
_______ - coversion of anxiety into bodily symptoms

fear of ______

___-______ signs

A

distress

pain

Somastication

work

non-organic

40
Q

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

A

worse

41
Q

With acute and persistent IDD MD Rx:

There are conflicting and unclear benefits with these medications: ______, ________ ______, AND _________

A

NSAIDS, muscle relaxants, acetaminophen

42
Q

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

A

steroid

43
Q

With acute and persistent IDD MD Rx:

A _______ injection is short-term but NOT long-term relief or functional changes

A

epidural

44
Q

With acute and persistent IDD MD Rx:

_______ treatment benefits the potential infection source

A

Antibiotic

45
Q

With acute and persistent IDD MD Rx involving surgery:

Waiting an avg. of _____ months of sx does NOT minimize the benefits of sx

A

4 1/2

46
Q

With acute and persistent IDD MD Rx involving surgery:

Some studies demonstrated _____ and improved benefit with sx vs. PT; particularly with severe _____ IDD

A

earlier; acute

47
Q

With acute and persistent IDD MD Rx involving surgery:

It is a _____ process and has the same overall outcomes without sx after 2 years

A

slower

48
Q

With acute and persistent IDD MD Rx:

What is an example of a spinal decompression surgery?

A

laminectomy or partial discetomy

49
Q

With acute and persistent IDD MD Rx:

What are some indications for surgery?

A

persistent and or worsening radiculopathy

when symptoms are unresponsive to non-surgical treatments

50
Q

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

A

Lumbar

51
Q

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

A

segments

5

2

52
Q
A

MSK Final (30 decks)

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