Thoracolumbar Spine VII- Stenosis through Anomalies

Question 1

_______ is narrowing around and compression of neurological structures

Answer 1

Stenosis

Question 2

Stenosis is MOST common dx for spinal sx in adults > _____ yrs. of age

Answer 2

60

Question 3

The population for stenosis is typically > ______ yrs. of age

Answer 3

65

Question 4

The population for stenosis could be younger due to ___________

Answer 4

spondylolisthesis

Question 5

_____% of asymptomatic individuals had canal narrowing on imaging

Answer 5

30

Question 6

With stenosis involving compression from the outside in, it is typically more ________ than bilateral and central

Answer 6

unilateral

Question 7

With stenosis involving compression from the outside in, is due to what commonly?

Answer 7

Age-Related Disc and Joint Changes

Question 8

Besides Age-Related Disc and Joint Changes, what are some other causes for stenosis?

Answer 8

Instability (older or younger)
Enfolding of ligamentum flavum (likely need sx)

Question 9

With stenosis involving compression from the inside out, it involves a _____ around the nerve that is ________ due to persistent inflammation

Answer 9

sheath; fibrotic

Question 10

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

Answer 10

increased; walking

Question 11

With stenosis involving compression from the inside out, the ______ nerve won’t expand, there is compression from inside out

Answer 11

fibrotic

Question 12

With stenosis involving compression from the inside out, it has the same result as _______ but different mechanism

Answer 12

narrowing

Question 13

With stenosis, there is ______ compression and ______ congestion with

• spinal n.
• radicular aa. supply spinal nn.

Answer 13

ischemic; venous

Question 14

With stenosis there is NO _______ veins in the PNS or CNS

Answer 14

lymphatic

Question 15

Review this

Question 16

Lateral Stenosis Symptoms

_________ LE > LBP!
with _________ paresthesias and ______ type P! due to ischemia

Unilateral or Bilateral?

Non-segmental or segmental?

gripping; lengthening

Answer 16

Unilateral

Segmental

Gripping

Question 17

A patient with lateral stenosis will have increased P! with what actions?

Answer 17

LBP- standing/walking, possibly coughing, sneezing if acute

Question 18

A patient with lateral stenosis will have decreased P! with what actions?

Answer 18

LBP- FB/sitting/AM

Question 19

A patient with lateral stenosis may have decreased symptoms with walking on incline why?

Answer 19

an incline causes some forward bending which reliefs their symptoms

Question 20

What might you notice during observation on a patient with lateral stenosis?

Answer 20

Slouched posture
Possible scoliosis

Question 21

A patient with lateral stenosis will have increased LE and LBP with what ROM?

It may demonstrate what kind of motion? (limited or excess?)

Answer 21

EXT
ipsilateral SB

limited motion due to contact with spinal n.

Question 22

A patient with lateral stenosis will have decreased LE and LBP with what ROM?

It may demonstrate what?

Answer 22

FLX
contralateral SB

limited motion DUE to not being able to open lateral foramen

Question 23

With lateral stenosis ______ ROM is inconstent to produce symptoms

A. SB
B. ROT
C. EXT

Answer 23

B.

Question 24

Will neuro tests be + or - with lateral stenosis? If yes, what condition?

Answer 24

+; radiculopathy

Question 25

Stress tests with lateral stenosis could be + with...?

Answer 25

with PA pressure/torsion when SUSTAINED

Question 26

Lateral stenosis is a ________ condition A. hypermobility B. hypomobility

Answer 26

B.

Question 27

With possible hypomobility indication, you should follow up with ______ _______ testing?

Answer 27

accesory motion

Question 28

With lateral stenosis there could be hypomobility in the _______ joints lower ________ upper ________ and or LE especially _____

Answer 28

adjacent thoracic lumbar hip

Question 29

With lateral stenosis there could be hypomobility in the _______ joints in ______ flexion and _________ SB to open lateral foramen

Answer 29

adjacent lumbar contralateral

Question 30

With stenosis, there are usually impaired _____ muscles to help with stabilization

Answer 30

local

Question 31

With special tests involving stenosis, Stability tests- possible excessive _______ ______ discrepancies ______ deficits with wide based gait

Answer 31

shearing LE BALANCE

Question 32

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)

Answer 32

Bilateral LE Walking sitting 48

Question 33

The Ankle Brachial Index (ABI): tests for ______ arterial disease It is a ratio of which two arteries?

Answer 33

peripheral tibial and brachial

Question 34

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

Answer 34

bent; PAD

Question 35

Lateral spurs are involved with ______ stenosis: and can affect multiple _____ because they are positioned more vertical than cervical spine

Answer 35

central; spinal n.

Question 36

2 hallmark signs of cauda equina syndrome

Answer 36

badder incontinence saddle paresthesias

Question 37

With stenosis PT Rx: there should be patient _______ and overall has a good ________

Answer 37

education; prognosis

Question 38

A patient with stenosis, would perfer directional preference in ______

Answer 38

FLX

Question 39

With stenosis: ________ traction may be helpful with radiculopathy, especially, if no centralization

Answer 39

Intermittent

Question 40

Joint mobz with should be performed in which direction?

Answer 40

in the opposite direction to open up the ipsilateral symptomatic side

Question 41

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

Answer 41

thoracic exercise hip

Question 42

With PT Rx: If there is a gliding restriction, you want to use _______ mobilizations

Answer 42

neural

Question 43

With PT Rx, you want to focus on _____ opening

Answer 43

foraminal

Question 44

With MET involving stenosis you want: Aerobic or Anerobic? _______ walking _______ as effective as un-weighted walking This will improve _______

Answer 44

Aerobic Unweighted Cycling Circulation

Question 45

With stenosis, you want to perform balancing training in what position?

Answer 45

sitting

Question 46

With stenosis and MD Rx: Sx indications - Presence of constant or ______ symptoms - Failure to obtain relief with __-___ months of non-surgical treatments

Answer 46

worsening 3; 6

Question 47

With Sx and stenosis: it is inconclusive and best with spinal decrompession of __________ and or partial __________ with or w/o fusion

Answer 47

laminectomy disecotomy

Question 48

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

Answer 48

P!/disability spondylolisthesis

Question 49

_____________ is a bony defect or fracture pars interarticularis unilaterally or bilaterally A. Spondylolisthesis B. Spondylosis

Answer 49

B. spondylosis

Question 50

With spondylosis, the etiology involves excessive and repetitive _______, particuraly when combined with ________

Answer 50

extension; rotation

Question 51

With spondylosis, it is ________ and could be _________ and caused my direct ________ A. non-congenital; symptomatic, contact B. congenital; asymptomatic; trauma

Answer 51

B.

Question 52

With spondylosis, it is highest in ______ ________ A. older adults B. adolescent athletes C. older athletes

Answer 52

B.

Question 53

With spondylosis, it is more prevelant in biological _______

Answer 53

males

Question 54

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 _________

Answer 54

athletics D Genetics lordosis

Question 55

With spondylosis, it is MOST common at the _____, ______ level Secondarily at ____,______

Answer 55

L5; S1 L4; 5

Question 56

The S&S with spondylosis: Like a worse case of _______ S&S Possible _______ S&S Conditions leading to low _____ ______

Answer 56

instability fracture vitamin D

Question 57

With _______ is anterior vertebral segment slippage A. Spondylosis B. Spondylolisthesis

Answer 57

B.

Question 58

With Spondylolisthesis, what is the MOST common type? A. Isthmic or adolescent with spondylosis B. Degenerative

Answer 58

A.

Question 59

With Spondylolisthesis, which age group has the MOST rapid slipping and which action is repetitive and traumatic? A. adolescent; extension B. older; extension

Answer 59

A.

Question 60

With degenerative spondylolisthesis, it is due to what? Does it involve a fracture?

Answer 60

Age-related disc changes; NO

Question 61

With Spondylolisthesis and degrees of disc slippage: Grade I= ___-__% Grade II= ___-____% Grade III=_____-____% Grade IV= ___-____%

Answer 61

0; 25 26; 50 51; 75 76; 100

Question 62

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

Answer 62

instability stenosis slippage

Question 63

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

Answer 63

10; local

Question 64

With Spondylolysis and Spondylolisthesis PT Rx and prognosis: there is greater healing with ______ lesion (71%) than _______ (18%)

Answer 64

unilateral; bilateral

Question 65

With Spondylolysis and Spondylolisthesis PT Rx: ____% of children and young adults improved after 1 year with up to ____% slippage

Answer 65

85; 25

Question 66

With Spondylolysis and Spondylolisthesis PT Rx: ____% of adolescents returned to sports within ____ months

Answer 66

92; 6

Question 67

With Spondylolisthesis and MD Rx: Sx indications- confirmed ______ without conservative benefits Sx outcomes- 83% ______ to _____ outcome with modified Scott technique vs others (fusion)

Answer 67

imaging; excellent; good

Question 68

Repetitive extension/hyperextension with McKenzie directional preference is often used (70%) when a _____ _____ is indicated

Answer 68

disc change

Question 69

Sitting with forward head posture reduces _______ and how much MVC %?

Answer 69

circulation; 30

Question 70

_____ _______ and regular change of ______ is helpful for circulation

Answer 70

proper posture; positions

Question 71

With sitting FHP the thorax becomes ______ and ________ This leads to compression in what area?

Answer 71

flexed; depressed diaphragm

Question 72

With sitting FHP, the diaphragm becomes overworked and is associated with persistent _______

Answer 72

LBP

Question 73

With sitting FHP, _______ extensors and accesory ______ muscles overwork to compensate

Answer 73

thoracic; respiratory

Question 74

With sitting FHP, there is a decrease in the ____-_____ reflex of muscles and leads to _____ muscle inhibition

Answer 74

anti-gravity local

Question 75

With sitting FHP, there is a smaller ______ ______ in those with persistent neck P!

Answer 75

Transversus Abdominis

Question 76

With sitting FHP,the load ______ on the _____ region for every anterior inch of FHP

Answer 76

doubles; lumbar

Question 77

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

Answer 77

Posture tall; supportive Diaphragmatic MT; MET local

Question 78

With anomalies what are the two types of fusions?

Answer 78

Congenital and Autolytic

Question 79

With congenital anomalies you have ______ization and _______ization

Answer 79

Lumbar; Sacral

Question 80

With lumbarization has ____ vertebra and sacralization has ____ lumbar vertebra

Answer 80

6; 4

Question 81

With autolytic anomalies, it is due to.....

Answer 81

age-related joint disease

Question 82

With autolytic anomalies, it involves _____ bridges and _____ joints

Answer 82

spurring; fuses