Thoracolumbar Spine VII- Stenosis through Anomalies Flashcards
_______ is narrowing around and compression of neurological structures
Stenosis
Stenosis is MOST common dx for spinal sx in adults > _____ yrs. of age
60
The population for stenosis is typically > ______ yrs. of age
65
The population for stenosis could be younger due to ___________
spondylolisthesis
_____% of asymptomatic individuals had canal narrowing on imaging
30
With stenosis involving compression from the outside in, it is typically more ________ than bilateral and central
unilateral
With stenosis involving compression from the outside in, is due to what commonly?
Age-Related Disc and Joint Changes
Besides Age-Related Disc and Joint Changes, what are some other causes for stenosis?
Instability (older or younger)
Enfolding of ligamentum flavum (likely need sx)
With stenosis involving compression from the inside out, it involves a _____ around the nerve that is ________ due to persistent inflammation
sheath; fibrotic
With stenosis involving compression from the inside out, it has _______ blood supply to the nerve with activity, particuraly with ______, which causes the nerves to enlarge
increased; walking
With stenosis involving compression from the inside out, the ______ nerve won’t expand, there is compression from inside out
fibrotic
With stenosis involving compression from the inside out, it has the same result as _______ but different mechanism
narrowing
With stenosis, there is ______ compression and ______ congestion with
- spinal n.
- radicular aa. supply spinal nn.
ischemic; venous
With stenosis there is NO _______ veins in the PNS or CNS
lymphatic
Review this
Lateral Stenosis Symptoms
_________ LE > LBP!
with _________ paresthesias and ______ type P! due to ischemia
Unilateral or Bilateral?
Non-segmental or segmental?
gripping; lengthening
Unilateral
Segmental
Gripping
A patient with lateral stenosis will have increased P! with what actions?
LBP- standing/walking, possibly coughing, sneezing if acute
A patient with lateral stenosis will have decreased P! with what actions?
LBP- FB/sitting/AM
A patient with lateral stenosis may have decreased symptoms with walking on incline why?
an incline causes some forward bending which reliefs their symptoms
What might you notice during observation on a patient with lateral stenosis?
Slouched posture
Possible scoliosis
A patient with lateral stenosis will have increased LE and LBP with what ROM?
It may demonstrate what kind of motion? (limited or excess?)
EXT
ipsilateral SB
limited motion due to contact with spinal n.
A patient with lateral stenosis will have decreased LE and LBP with what ROM?
It may demonstrate what?
FLX
contralateral SB
limited motion DUE to not being able to open lateral foramen
With lateral stenosis ______ ROM is inconstent to produce symptoms
A. SB
B. ROT
C. EXT
B.
Will neuro tests be + or - with lateral stenosis? If yes, what condition?
+; radiculopathy
Stress tests with lateral stenosis could be + with…?
with PA pressure/torsion when SUSTAINED
Lateral stenosis is a ________ condition
A. hypermobility
B. hypomobility
B.
With possible hypomobility indication, you should follow up with ______ _______ testing?
accesory motion
With lateral stenosis there could be hypomobility in the _______ joints
lower ________
upper ________ and or LE
especially _____
adjacent
thoracic
lumbar
hip
With lateral stenosis there could be hypomobility in the _______ joints
in ______ flexion and _________ SB to open lateral foramen
adjacent
lumbar
contralateral
With stenosis,
there are usually impaired _____ muscles to help with stabilization
local
With special tests involving stenosis,
Stability tests- possible excessive _______
______ discrepancies
______ deficits with wide based gait
shearing
LE
BALANCE
Cook’s CPR for stenosis
_______ symptoms (bilateral or unilateral)
____ P! > LBP (hip or LE)
Standing/_____ P! (Walking or sitting)
P! relief with ______ (standing or sitting)
> ____ yrs. of age (65 or 48)
Bilateral
LE
Walking
sitting
48
The Ankle Brachial Index (ABI): tests for ______ arterial disease
It is a ratio of which two arteries?
peripheral
tibial and brachial
The bicycle test (neural vs vascular causes)
Cycle upright (slight extension) then bend to lean on handlebars for 3 min. each:
If stenosis, pain will decrease with ____ position. If it doesn’t, _____ is indicated
bent; PAD
Lateral spurs are involved with ______ stenosis: and can affect multiple _____ because they are positioned more vertical than cervical spine
central; spinal n.
2 hallmark signs of cauda equina syndrome
badder incontinence
saddle paresthesias
With stenosis PT Rx: there should be patient _______ and overall has a good ________
education; prognosis
A patient with stenosis, would perfer directional preference in ______
FLX
With stenosis:
________ traction may be helpful with radiculopathy, especially, if no centralization
Intermittent
Joint mobz with should be performed in which direction?
in the opposite direction to open up the ipsilateral symptomatic side
Manipulation is MOST effective for sub-group of stenosis with LBP:
Lower ________
Lumbar manip, MOST effective when combined with _______
Evidence of support for addition of ____ joint manipulation
thoracic
exercise
hip
With PT Rx:
If there is a gliding restriction, you want to use _______ mobilizations
neural
With PT Rx, you want to focus on _____ opening
foraminal
With MET involving stenosis you want:
Aerobic or Anerobic?
_______ walking
_______ as effective as un-weighted walking
This will improve _______
Aerobic
Unweighted
Cycling
Circulation
With stenosis, you want to perform balancing training in what position?
sitting
With stenosis and MD Rx:
Sx indications
- Presence of constant or ______ symptoms
- Failure to obtain relief with __-___ months of non-surgical treatments
worsening
3; 6
With Sx and stenosis:
it is inconclusive and best with spinal decrompession of __________ and or partial __________ with or w/o fusion
laminectomy
disecotomy
With Sx involving stenosis:
there is benefit with ____ but walking distance NOT better
Stenosis with _________ substantially greater pain relief and improvement in function vs. PT at 4 yrs
P!/disability
spondylolisthesis
_____________ is a bony defect or fracture pars interarticularis unilaterally or bilaterally
A. Spondylolisthesis
B. Spondylosis
B. spondylosis
With spondylosis, the etiology involves excessive and repetitive _______, particuraly when combined with ________
extension; rotation
With spondylosis, it is ________ and could be _________ and caused my direct ________
A. non-congenital; symptomatic, contact
B. congenital; asymptomatic; trauma
B.
With spondylosis, it is highest in ______ ________
A. older adults
B. adolescent athletes
C. older athletes
B.
With spondylosis, it is more prevelant in biological _______
males
With spondylosis, the risk factors include:
Most common- _______
Low vitamin ______ (in 75% of cases, more later with bone stress injuries in the LE)
________/bone morphology
Excessive _________
athletics
D
Genetics
lordosis
With spondylosis, it is MOST common at the _____, ______ level
Secondarily at ____,______
L5; S1
L4; 5
The S&S with spondylosis:
Like a worse case of _______ S&S
Possible _______ S&S
Conditions leading to low _____ ______
instability
fracture
vitamin D
With _______ is anterior vertebral segment slippage
A. Spondylosis
B. Spondylolisthesis
B.
With Spondylolisthesis, what is the MOST common type?
A. Isthmic or adolescent with spondylosis
B. Degenerative
A.
With Spondylolisthesis, which age group has the MOST rapid slipping and which action is repetitive and traumatic?
A. adolescent; extension
B. older; extension
A.
With degenerative spondylolisthesis, it is due to what?
Does it involve a fracture?
Age-related disc changes; NO
With Spondylolisthesis and degrees of disc slippage:
Grade I= ___-__%
Grade II= ___-____%
Grade III=_____-____%
Grade IV= ___-____%
0; 25
26; 50
51; 75
76; 100
With Spondylolisthesis S&S:
It is like a worse case of ______
Possible lateral or central _____
S&S with slippage
NO correlation with ______ and degree of symptoms
instability
stenosis
slippage
With Spondylolysis and Spondylolisthesis PT Rx and MET:
Better outcomes with ____ weeks of ______ muscle training vs traditional ther ex alone out to 1 1/2 years
10; local
With Spondylolysis and Spondylolisthesis PT Rx and prognosis:
there is greater healing with ______ lesion (71%) than _______ (18%)
unilateral; bilateral
With Spondylolysis and Spondylolisthesis PT Rx:
____% of children and young adults improved after 1 year with up to ____% slippage
85; 25
With Spondylolysis and Spondylolisthesis PT Rx:
____% of adolescents returned to sports within ____ months
92; 6
With Spondylolisthesis and MD Rx:
Sx indications- confirmed ______ without conservative benefits
Sx outcomes- 83% ______ to _____ outcome with modified Scott technique vs others (fusion)
imaging; excellent; good
Repetitive extension/hyperextension with McKenzie directional preference is often used (70%) when a _____ _____ is indicated
disc change
Sitting with forward head posture reduces _______ and how much MVC %?
circulation; 30
_____ _______ and regular change of ______ is helpful for circulation
proper posture; positions
With sitting FHP the thorax becomes ______ and ________
This leads to compression in what area?
flexed; depressed
diaphragm
With sitting FHP, the diaphragm becomes overworked and is associated with persistent _______
LBP
With sitting FHP, _______ extensors and accesory ______ muscles overwork to compensate
thoracic; respiratory
With sitting FHP, there is a decrease in the ____-_____ reflex of muscles and leads to _____ muscle inhibition
anti-gravity
local
With sitting FHP, there is a smaller ______ ______ in those with persistent neck P!
Transversus Abdominis
With sitting FHP,the load ______ on the _____ region for every anterior inch of FHP
doubles; lumbar
With sitting FHP and PT Rx should focus on:
_______/ergonomics
Education- sit ____ and have a ______ chair
__________ breathing to help minimize accesory respiratory mm.
____/______ in the thoracolumbar regions to improve mobility
MET to improve _____ muscle functions in the thoracolumbar regions
Posture
tall; supportive
Diaphragmatic
MT; MET
local
With anomalies what are the two types of fusions?
Congenital and Autolytic
With congenital anomalies you have ______ization and _______ization
Lumbar; Sacral
With lumbarization has ____ vertebra and sacralization has ____ lumbar vertebra
6; 4
With autolytic anomalies, it is due to…..
age-related joint disease
With autolytic anomalies, it involves _____ bridges and _____ joints
spurring; fuses
