Unit 2 - Non-surgical management of spine Flashcards
what is a schmorl node?
superior/inferior protrusion of disc nucleus
treatment: bracing, activity restriction
vibration and proprioception fiber types
large myelinated A alpha fibers, paresthesia
fast pain and temp fiber types
small myelinated A-delta, sharp, dermatomal pain
slow pain fiber type
unmyelinated C fibers, deep, aching sclerotomal pain
epidural steroid injections
efficacy debated, need 2 weeks to assess therapeutic benefit, used to relieve radicular pain, can be diagnostic
transforaminal injection
done under flouroscope, dura not punctured, medication placed at a specific level, insures that medication is reaching anterior epidural space
translaminar injection
usually obtain bilateral, but not always anterior flow, greatest risk of puncturing dura, not specific to one nerve root
caudal injection
little risk of puncturing dura, high volume of contrast shown to advanced to T-L junction, commonly accepted to reach L4
facet injection
usually at L4-L5-S1 levels, asses for pain reduction with provocation 30min after injection, each joint innervated by medial branches of primary dorsal rami from that level and level above.
Diagnosis of facet pain one of exclusion, confirmation of diagnosis requires successful injection
non-traumatic sacral fractures
population: military or distance runners, post menopausal, pregnant, post partum
symptoms: pain and tenderness over sacrum which may radiate, increased sxs with weightbearing and rotation
diagnosis: CT, bone scan, MRI
treatment: limit weightbearing, address imbalances, treat underlying osteoporosis
vertebral compression fractures
three types in osteoporosis: wedge, concave, crush, often in thoracic spine
management: education, meds, ice, bracing, rest, core strengthening, manage depression
vertebroplasty: injection of bone cement to reinforce vertebral body
kyphoplasty: infusion of bone cement into balloon within fx, can restore some vertebral height
surgical stabilization (fusion)
best diagnostic test for SIJ pain
fluoroscopic guided injection with local anesthetic, assess pain 30 min after injection
prolotherapy
inject sugar into joint space to attempt to ossify it (SIJ)
arthrodesis
joint fusion
indications for surgical referral
progressive neurological decline, failure of conservative treatment.
Emergent: myelopathic findings, bowel/bladder incontinence, spinal cord signal change on MRI.
