Workshop 2

Question 1

Define Invertebral Disc degeneration

Answer 1

“chronic” degeneration of discs associated with ageing, chronic heavy occupational/sport-related loading leading to fluid volume loss (decrease soluble proteins) in nucleus pulposus +/- annulus fibrosis weakening

PAIN!

Athletes: fast bowlers, gymnasts, swimers, soccer players - have higher rates of disc degeneration

Question 2

What reduces disc height?

Answer 2

• laxity of longitudinal ligaments (ANT, POS, or LAT shifting of vertebral bodies) –> facet joint misalignment
• vertebral foramen narrowing (stenosis) –> spinal nerve inflammation / impingement
• spinal canal narrowing (stenosis)
  osteophyte formation –> OA

Question 3

Define disc herniation

Answer 3

rupture of fibrous annulus of intervertebral disc, leading to herniation of nucleus pulposus

slightly >90% occur at L4-5 or L5-S1
may impine on L4, 5, or S1 nerve root

Question 4

Can intervertebral disc degeneration be conservatively managed?

Answer 4

Yes.
At least 6wks of rest, drug therapy, Ex therapy, epidural injection and lumbar traction

• lumbar disc herniation spontaneously absorbed.

Question 5

What is the process of reabsorbing a disc herniation?

Answer 5

macrophage regulation of inflammatory mediators, matrix metalloproteinases and specific cytokines

Question 6

Explain the operative management of disc degeneration.

Answer 6

1. spinal decompression surgery
   discectomy
   facetectomy
   foraminotomy
   laminectomy
   relieves pressure on SC or nerve roots
2. spinal fusion
3. artificial disc replacement, or intervertebral disc arthroplasty

Question 7

What are ganglion cysts?

Answer 7

benign soft tissue growths occurring around joints, tendons typically associated with repetitive microtrauma

connected to joints by stalks

can cause pain, tingling and muscle weakness (from nerve impingement)

Question 8

What is the difference between the degeneration theory and the secretion theory?

Answer 8

Degeneration: joint stress leads to degeneration of connective tissue near joint causing fluid (hyaluronic acid) accumulation and formation of fibrous cyst around fluid

Secretion: joint stress causes mucin production in soft tissue which coalesce into pools of mucin which then forms fibrous cystic wall around itself

Question 9

Surgical vs non-surgical approaches to rid ganglion cysts.

Answer 9

Arthroscopic surgery: excision to remove cyst wall, fluid and stalk. Complications: wound infection, neuroma, hypertrophic scar, neurapraxia, radial artery damage.

observation: relative rest, wrist brace/splint (decrease size), analgesic medication, remove fluid decompress cyst.
Complications: stalk not removed, recurrence rate high