Term
| Most common site of disc rupture + root compression |
|
Definition
|
|
Term
| Disc rupture + root compression: Hx |
|
Definition
M, 40s
intermittent LBP
follows prolonged sitting then lifting |
|
|
Term
| Disc rupture + root compression: physical exam |
|
Definition
younger pt = limited SLR
(+) neuro signs
pain down leg is very defined; distal>prox; sitting>standing |
|
|
Term
| Disc rupture + root compression: Imaging |
|
Definition
|
|
Term
| Disc rupture + root compression: Rx |
|
Definition
centralize symptoms (McKenzie)
avoid postures that incr intradiscal pressure
mech traction in position of relief |
|
|
Term
| Disc rupture + root compression: Medical Rx |
|
Definition
NSAIDs, opioid analgesics, mm relaxants
sx for pts c progressive neuro deficit/cauda equina symptoms |
|
|
Term
| Disc rupture + root compression: pt outcomes - conservative Rx |
|
Definition
60% recover full motor fxn
58% recover sensory deficits |
|
|
Term
| Order of return of fxn (p chronic LBP) |
|
Definition
| strength >> reflexes >> sensation |
|
|
Term
| Disc rupture + root compression: self-resolution of disc herniation |
|
Definition
43% completely resolved
36% improved
21% unchanged
4/18 had surgery |
|
|
Term
| Disc Injury c Dural Irritation: S/Sx |
|
Definition
similar to pts c mechanical compression
less distinct dermatomal pattern
pain prox>distal |
|
|
Term
| Disc Injury c Dural Irritation: cause of pain |
|
Definition
| 'leaking' nucleus (small tear in outer annulus) |
|
|
Term
| Disc Injury c Dural Irritation: Neuro signs |
|
Definition
none
limited SLR/slump in acute |
|
|
Term
| Internal disc disruption: hx |
|
Definition
long hx of intermittent LBP
usually no neuro signs |
|
|
Term
| Internal disc disruption: physical exam |
|
Definition
repeated mvmt centralizes pain (unless outer annulus is torn)
lateral shift sometimes
(+) instability tests |
|
|
Term
| Internal disc disruption: imaging |
|
Definition
CT, XRay
no pain c Grade 1 tears (discography)
discs above/below level = negative |
|
|
Term
| Internal disc disruption: Rx - conservative |
|
Definition
centralizing postures/mvmtts
short-term bracing if (+) instability tests
Ø disc-loading postures
aggressive stabilization & strengthening
NSAIDs |
|
|
Term
| Internal disc disruption: Rx - surgical |
|
Definition
nuclear decompression
intradiscal electrothermoplasty (IDET)
fusion
artificial disc |
|
|
Term
|
Definition
use radiowaves to break down nucleus >> decr pressure on disc
no significant supporting research |
|
|
Term
|
Definition
heat annulus to cause breakdown & restructuring
ablate nn endings
outpt sx; pt usually back to full activity in 6 mos |
|
|
Term
| Fusion sx (3 types, cost) |
|
Definition
posterior
anterior interbody (cage)
360 fusion
costs $35K |
|
|
Term
|
Definition
| no better than fusion at this stage |
|
|
Term
| Acute Locked Back: presentation |
|
Definition
pt locked into stooped posture p lifting positioned in flex >> sudden, severe pain
no lumbar lordosis
ext is very painful |
|
|
Term
| Acute Locked Back: 2 theories |
|
Definition
meniscal entrapment
intradiscal nuclear displacement (McKenzie derangement) |
|
|
Term
| Acute Locked Back: meniscal entrapment |
|
Definition
| zygapophyseal meniscus is drawn out of jt during flex |
|
|
Term
| Acute Locked Back: meniscal entrapment - types of meniscoid structures in lumbar facet jts (3) |
|
Definition
connective tissue rim
adipose tissue pad
fibro-adipose meniscoid (largest) |
|
|
Term
| Acute Locked Back: intradiscal nuclear displacement |
|
Definition
| prolonged flex >> post migration of nucleus thru small fissure in annulus >> lodges between annular layers |
|
|
Term
| Types of Lumbar Instability (5) |
|
Definition
degenerative
spondylolisthetic
retrolisthetic
post-sx
hypermobile |
|
|
Term
|
Definition
| report sudden 'giving way' during trivial activity |
|
|
Term
| Lumbar Instability: physical exam |
|
Definition
aberrant motion on flex/ext testing
(+) Gower's sign
incr PPIVM
incr PAM
symptom relief c use of corset
general hypermobility
poor contraction of TrA & multifidus
(+) instability tests |
|
|
Term
| Lumbar Instability: imaging - flex/ext views |
|
Definition
incr fwd/bkwd translation in flex/ext by ≥5% or more
incr post opening in flex (>15-25º) |
|
|
Term
| Lumbar Instability: imaging - compression/traction views |
|
Definition
at unstable segment, UPPER vertebra moves...
post c traction
ant c compression |
|
|
Term
|
Definition
prevent further damage, manip neighboring hypomobilities
improve proprioception
improve strength & endurance of dynamic restraints
improve control |
|
|
Term
| CPR for lumbar stabilization (4) |
|
Definition
<40 yo
SLR >91º
(+) prone instability test
aberrant motion c fwd bend |
|
|
Term
| Lumbar Spondyloysis: description |
|
Definition
pars defect s slippage (usually stress fx)
associ c sports c high incidence of loading in ext
can progress to Type II spondylolisthesis |
|
|
Term
|
Definition
deep dull ache; usually not past buttock
aggravated by ext activities
relieved by sitting (flex) |
|
|
Term
| Lumbar Spondyloysis: physical exam |
|
Definition
regular compressive symptoms c motion testing
localized mm spasm |
|
|
Term
| Lumbar Spondyloysis: imaging |
|
Definition
|
|
Term
|
Definition
acute - 3mos bracing
avoid ext loading
specific stabilization >> abd strengthening & stabilization
Sx (ORIF) if Øheal/symptoms persist |
|
|
Term
| Lumbar Spondylolisthesis: prevalence |
|
Definition
| occurs in 5-8% of population |
|
|
Term
| Lumbar Spondylolisthesis: type I |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type Ia - articular dysplasia |
|
Definition
| dysplastic articular processes oriented HORIZONTALLY |
|
|
Term
| Lumbar Spondylolisthesis: type Ia - gender affected |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type Ia - segment affected |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type Ia - degree of slippage >> cauda equina compression |
|
Definition
| cauda equina compression c slip >35% |
|
|
Term
| Lumbar Spondylolisthesis: type Ia - common co-condition |
|
Definition
| often combined c spina bifida |
|
|
Term
| Lumbar Spondylolisthesis: type Ib - articular dysplasia |
|
Definition
| SAGITTAL orientation of articular processes |
|
|
Term
| Lumbar Spondylolisthesis: type Ib - amt of slip decreased by... |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type Ic |
|
Definition
rare
often lumbar kyphosis deformity |
|
|
Term
| Lumbar Spondylolisthesis: type II |
|
Definition
| Isthmic - fx in pars interarticularis |
|
|
Term
| Lumbar Spondylolisthesis: type IIa (name & descr) |
|
Definition
lytic
separation of pars p fx
15% hereditary component |
|
|
Term
| Lumbar Spondylolisthesis: type IIb (name & descr) |
|
Definition
non-lytic
repeated fx >> healing >> elongation of pars
NO cord compression |
|
|
Term
| Lumbar Spondylolisthesis: type III - |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type III - cause |
|
Definition
| long-standing intersegmental instability |
|
|
Term
| Lumbar Spondylolisthesis: type III - pathogenesis |
|
Definition
| disc degeneration >> incr facet strain >> remodeling >> slip |
|
|
Term
| Lumbar Spondylolisthesis: type III - degree of slip |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type III - common segment |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type III - gender |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type III - age |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: type III - co-conditions |
|
Definition
claudication in calf
stenosis |
|
|
Term
| Lumbar Spondylolisthesis: type IV (name & descr) |
|
Definition
post-traumatic
acute fx in bony restraints other than pars (2º to trauma) |
|
|
Term
| Lumbar Spondylolisthesis: type V |
|
Definition
pathologic
infections, tumors, rare diseases |
|
|
Term
| Lumbar Spondylolisthesis: type VI |
|
Definition
post-sx
(post-laminectomy) |
|
|
Term
| Lumbar Spondylolisthesis: Hx |
|
Definition
insidious onset
symptoms incr c ext activity, relieved c sitting |
|
|
Term
| Lumbar Spondylolisthesis: Type I Hx |
|
Definition
| cord compression >> unilat pain |
|
|
Term
| Lumbar Spondylolisthesis: Type II Hx |
|
Definition
pain localized to lumbar spine/buttock
Large slip may cause L5 vert to tension L5 root |
|
|
Term
| Lumbar Spondylolisthesis: Type III Hx |
|
Definition
| leg pain incr c standing/walking (2º to spinal stenosis) |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - gait |
|
Definition
toe walking if hamstring spasm is severe (usually Type I)
may not stand c knees ext
decr hamstring flexibility |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - integument observation |
|
Definition
| skin crease above iliac crest |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - lordosis (types I&II) |
|
Definition
| incr lordosis in isthmic, congenital |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - lordosis (type III) |
|
Definition
| flattened lordosis in degenerative |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - buttocks |
|
Definition
| prominent buttocks if slip is large |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - inner unit |
|
Definition
| unable to contract TrA (use rectus abd instead) |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - special tests |
|
Definition
(+) instability tests
(+) Stork test |
|
|
Term
| Lumbar Spondylolisthesis: physical exam - palpation |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: imaging |
|
Definition
oblique XRay
quantify degree of slip |
|
|
Term
| Lumbar Spondylolisthesis: Rx |
|
Definition
(determine if pain is coming from listhesis)
stabilization ex
Sx (fusion) for pts c intractable pain/neuro compromise |
|
|
Term
| Lumbar Spondylolisthesis: ___% slippage = insignificant |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: ___% slippage = questionable |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: ___% slippage = incr risk |
|
Definition
|
|
Term
| Lumbar Spondylolisthesis: ___% slippage = cord symptoms/compression |
|
Definition
|
|
Term
| Causes of Central Stenosis (4) |
|
Definition
facet jt hypertrophy
thickened ligt flavum
bulging of IV disc
spondylolisthesis |
|
|
Term
| Causes of Lateral Stenosis (4) |
|
Definition
decr disc height
facet jt hypertrophy
posterolat bulge of IV disc
spondylolisthesis |
|
|
Term
| Spinal Stenosis: Hx - age |
|
Definition
|
|
Term
| Spinal Stenosis: Hx - hx of LBP |
|
Definition
| long-standing hx of LBP (stenosis = RE-stabilization) |
|
|
Term
| Spinal Stenosis: Hx - position of limitation |
|
Definition
limitations in walking/standing
no pain c sitting |
|
|
Term
| Spinal Stenosis: Hx - pain |
|
Definition
leg pain in 90% of pts (unilat or bilat)
neurogenic claudication |
|
|
Term
| Spinal Stenosis: physical exam - neuro signs |
|
Definition
|
|
Term
| Spinal Stenosis: physical exam - ROM |
|
Definition
| decr, esp ext (usually capsular pattern) |
|
|
Term
| Spinal Stenosis: physical exam - diff dx |
|
Definition
PVD
hip/knee OA
spondylolisthesis |
|
|
Term
| Spinal Stenosis: physical exam - differentiating tests |
|
Definition
two-stage treadmill test ( (+) in 77% stenosis pts) (HIGH SPECIFICITY)
bicycle test |
|
|
Term
|
Definition
|
|
Term
|
Definition
Williams ex (flex)
pelvic tx
unloading (treadmill, pool)
abdominal strengthening
bracing |
|
|
Term
| Spinal Stenosis: Rx research (3) |
|
Definition
manual PT + unloading > flex ex + US
unweighted treadmill = stationary cycling
sx helpful? (some suggestions, but not strong) |
|
|
Term
|
Definition
NSAIDs (COX-II inhibitors)
epidural injections
decompressive sx ± fusion, X-stop |
|
|
Term
|
Definition
spacer btwn sp.pr
used in pts c pain relief in sitting
Ø spondylolisthesis
60% success @ 12mos |
|
|
Term
|
Definition
| difficult to clinically dx 2º to variation in pain relief |
|
|
Term
| Facet Jt Pain: pathology - innervation |
|
Definition
|
|
Term
| Facet Jt Pain: pathology - concurrent condition |
|
Definition
| disc degeneration in 80% of pts |
|
|
Term
| Facet Jt Pain: clinical presentation |
|
Definition
| UNPREDICTABLE pain pattern; usually low back (L5) and buttock |
|
|
Term
| Facet Jt Pain: Laslett criteria for pain relief c intra-articular injection (95%) |
|
Definition
age >50yo
pain best c sitting
pain in paraspinals
(+) ext-rot test
no centralization c repeated mvmt |
|
|
Term
|
Definition
none supported by research
based on PATIENT RESPONSE |
|
|
Term
|
Definition
NSAIDs
jt blocks
radiofrequency denervation |
|
|
Term
|
Definition
| higher score = higher disability |
|
|
Term
|
Definition
| bedridden OR pt exaggeration |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| consider D/C (unless working c athlete) |
|
|
Term
|
Definition
floor effect c subacute LBP
scale not appropriate for athletic population |
|
|
Term
| Roland-Morris questionnaire: disadvantage |
|
Definition
| ceiling effect in chronic pts |
|
|
Term
| Roland-Morris questionnaire: advantage |
|
Definition
| best scale for subacute population |
|
|
Term
| Pt Specific Fxnl Scale: high score = |
|
Definition
| high score = better function |
|
|
