Shared Flashcard Set

Details

Lumbar Spine Pathologies
lumbar spine pathologies powerpoint
84
Anatomy
Graduate
04/23/2012

Additional Anatomy Flashcards

 


 

Cards

Term
define lumbar spinal stenosis
Definition
narrowing of spinal canal caused by degeneration of bony and soft tissues
Term
what are the 2 ways of classifying lumbar spinal stenosis
Definition
by type and by location
Term
what are the 2 types of lumbar spinal stenosis
Definition
acquired, congenital
Term
what are the 3 locations of lumbar spinal stenosis
Definition
central, lateral, foraminal
Term
what are 4 things that cause lumbar spinal stenosis
Definition
degenerative disc disease, disc protrusion, facet hypertrophy, ligamentum flavum thickening
Term
if you have DDD causing lumbar spinal stenosis, will flexion or extension feel better
Definition
flexion feels better
Term
what is disc protrusion
Definition
disc takes up space
Term
what causes facet hypertrophy
Definition
ossification from wear and tear. Body responds to use and repeated aggravation with bone suprs and calcium deposits
Term
who is likely to have a thickened ligamentum flavum
Definition
someone who has a high flexion job or uses bad body mechanics
Term
what does the ligamentum flavum do
Definition
helps body pull back up after flexion
Term
what happens if you use your ligamentum flavum a lot
Definition
it will thicken and take up space in the spinal canal
Term
what is the general age of patients with lumbar spinal stenosis (old or young) and why
Definition
old; nucleus pulposus is gooier when you're younger
Term
what is the common presentation of patients with lumbar spinal stenosis
Definition
severe lower extremity pain; relief with sitting/flexion
Term
what is neurogenic intermittent claudication
Definition
pain that comes and goes
Term
when is pain worse with lumbar spinal stenosis
Definition
with standing, walking, and lumbar extension activities.
Term
could you feel leg pain/numbness/tingling with neurogenic intermittent claudication
Definition
yes
Term
is the central canal area increased or decreased with flexion
Definition
Increased by 11%
Term
is the central canal area increased or decreased with extension
Definition
decreased by 11%
Term
is the foramen increased or decreased by flexion
Definition
increased by 12%
Term
is the foramen increased or decreased by extension
Definition
decreased by 15%
Term
what are clinical observations of a patient with lumbar spinal stenosis
Definition
poor posture, wide base gait, neuromuscular deficits, dull ache
Term
what poor posture characteristics are observed in patients with lumbar spinal stenosis
Definition
forward head, delordosed spine, posterior pelvic tilt
Term
what neuromuscular deficits might be exhibited by a patient with lumbar spinal stenosis and why
Definition
if they have pressure on a nerve, they could have weakness or sensory changes
Term
could a patient with lumbar spinal stenosis feel relief when walking with a grocery cart
Definition
yes
Term
what is the result of delordosed, forward head, posterior pelvic tilt posture with lumbar spinal stenosis
Definition
causes balance issues posteriorly; fall back on their heels; reason for wide based gait
Term
what are differential diagnoses for lumbar spinal stenosis
Definition
hip OA, trochanteric bursitis, vascular disease, herniated disc, osteoporotic compression fracture
Term
what are symptoms of vascular disease
Definition
leg pain that is worse with walking. Not affected by posture
Term
If someone has vascular disease, will they get relief by walkign with the grocery cart
Definition
no
Term
why does it hurt your legs to grocery shop with no relief from grocery cart if you have vascular diseae
Definition
when you walk and have to stop and stand, you've increased demand for blood in your legs but it's harder for blood to get through
Term
what is the general clinical picture of a patient with lumbar spinal stenosis
Definition
neurogenic intermittent claudication; poor posture; muscular weakness; impared balance/gait
Term
what is the common age range for intervertebral disc lesions
Definition
25-40
Term
what are the 4 typs of intervertebral disc lesions
Definition
herniated nucleus (protrusion), prolapsed nucleus, extruded disc, sequestration of nuclear material
Term
what is a herniated nucleus
Definition
protrusion: tear in the inner layers of the posterior annulus fibrosus allowing nucleus pulposus to bulge into the annulus a bit while not pushing all the way through
Term
what does a herniated nucleus apply pressure to, and what is the result
Definition
posterior longitudinal ligament or outer annular fibers, resulting in pain
Term
what is a prolapsed nucleus
Definition
outer annulus and ligamentous fibers are the only thing that restrain the nucleus from entering into the neural canal
Term
what is an extruded disc
Definition
disc material pushes out all the way through the annular fibers and through the posterior longitudinal ligament, perforating them
Term
what is sequestration of nuclear material
Definition
nuclear material in little pieces in the neural canal
Term
of the 4 types of iv disc lesions, what is the progression from least entry of pulposus into the canal to most entry of pulposus into the canal
Definition
herniated nucleus, prolapsed nucleus, extruded disc, sequestration of nuclear material
Term
in which 2 types of iv disc lesions is there no entry of nucleus itself (without something around it) into the canal
Definition
herniated nucleus, prolapsed nucleus
Term
in which 2 types of iv disc lesions is the annulus perforated
Definition
extrusion, sequestration
Term
what are each of the 4 types of iv disc lesions often referred to as
Definition
hernation
Term
what is the most common type of iv disc lesion
Definition
prolapsed nucleus
Term
at what spinal levels are most disc prolapses
Definition
98% of disc prolapses are at L4-5 and L5-S1
Term
are men or women more likely to have iv disc lesions and by how much
Definition
men:women, 3:2
Term
what are risk factors for iv disc lesions
Definition
high physical demand with low strength, repeated lifting of heavy objects, lifting with lateral bend and twisting, poor sitting posture, smoking, coughing, spend more than half of work day in car
Term
why is smoking a risk factor for iv disc lesion
Definition
negative impact on circulation affects the disc
Term
what are aggs for iv disc lesions
Definition
forward trunk flexion, cough/sneeze, laughing, small jumps, lift heavy weight, valsalva
Term
what are eases for iv disc lesinos
Definition
extension (standing or prone), lie down with feet up
Term
if you have a posterolateral or central iv disc lesion, what does it affect
Definition
cauda equina
Term
when will you have bilateral symptoms with iv disc lesion
Definition
when the protrusion is central
Term
if you have an iv disc lesion and you extend, what happens
Definition
we squeeze the material back in
Term
if you have an iv disc lesion and you flex, what happens
Definition
the disc protrudes and causes symptoms
Term
if you have a large lesion, will it hurt in extension or flexion
Definition
both
Term
if you have a central/medial herniation in the axilla/armpit of the nerve root (below where it comes off the spinal cord), and the patient flexes cervical/thoracic/lumbar, what will happen, and how will symptoms change
Definition
this puts tension on the cord/nerves, pulling them up towards the head and away from the protrusion. Makes the patient feel better because it pulls the neural structures off th herniation
Term
if you have a central/medial herniation in the axilla/armpit of the root (below where it comes off), and the patient straightens her leg out and pulls the foot, what happens
Definition
this puts tension on the cord/nerves, pulling them down towards the feet and into the protrusion. This causes pain because it pulls the neural structures into the herniation
Term
if you have a central/medial herniation in the axilla/armpit of the root (below where it comes off), and the patient lifts her head at the end of the slump test (after it was initially flexed), will she feel better or worse and why
Definition
worse because she is now bringing tension back caudally on the cord/nerves, pulling them down twards the feet and into the protrusion
Term
if a patient has a more lateral herniation and we flex their head, does it get better or worse and why
Definition
worse. The herniation is now above the protrusion, so when the patient flexes and pulls the neural structures toward the head, they hit the protrusion, causing pain
Term
if a patient has a more lateral herniation and we lift her head and the end of the slump test (from flexion to normal), does it get better or worse and why
Definition
gets better because it slackens neural structures, allowing them to move below the protrusion and they feel better
Term
if you have a reduction in symptoms when you lift your head at the end of the slump test, is the herniation more lateral or more medial
Definition
more latearl
Term
if you have an increase in pain when you left your head at the end of the slump test (lift it out of flexion), is the lesion more medial or more lateral
Definition
more medial
Term
can the affected side hurt in SLR when the opposite leg is raised and why
Definition
if you have a left herniation and you raise your R leg, raising the R leg will pull the L structures medially and into a medial herniation
Term
what is another term for mechanical low back pain
Definition
lumbago
Term
what 3 things cause mechanical low back pain/lumbago
Definition
muscle strain, facet joint, sacroiliac joints
Term
what are characteristics of mechanical low back pain
Definition
morning stiffness, pain to low back/butt/thigh but not below knees, pain is cyclic
Term
what are aggs for mechanical low back pain
Definition
turnk motion (flex/ext/SB/rot); stiff or painful when motion is initiated
Term
what are eases for mechanical low back pain
Definition
change positions. Lying down - usually better in fetal position
Term
if you push on it/stretch them/move them and it causes back pain, what is probably the problem
Definition
mechanical low back pain
Term
why is morning stiffness common in mechanical low back pain
Definition
inflammation
Term
how to determine treatment for mechanical low back pain
Definition
depends on cause: hypomobile, muscle strain, or SIJ
Term
how to treat if mechanical LBP is caused by hypomobility
Definition
joint mobilization, stretching, posture, strengthening, core stabilization
Term
how to treat if mechanical LBP is caused by muscle strain
Definition
reduce inflammation; restore mobility; posture; strengthen core; PPIVMs- move them while flexing/extending
Term
how to treat if mechanical LBP is caused by SIJ
Definition
address asymmetry and muscle imbalance if present. Joint mobilization/stretching. Posture. Strengthen core
Term
what is spondylolisis
Definition
fracture of vertebrae at pars interarticularis
Term
what is spondylolisthesis
Definition
slippage of verebrae
Term
what is anterolisthesis
Definition
slipping of veterbal body anteriorly
Term
what are the 2 cuases of spondylolisthesis
Definition
degenerative, truamatic
Term
what is the most common cause of spondylolisthesis
Definition
degenerative
Term
what is the most common region of degenerative spondylolisthesis
Definition
L4-5
Term
what are symptoms of spondylolisthesis
Definition
LBP, muscle tightness (tight hamstrings), pain in thighs and butt, stiffness, tenderness in the area of the slipped disc, may cause paraesthesia and/or motor weakness
Term
how to assess for spondylolisthesi
Definition
stork standing test
Term
describe the stork standing test
Definition
patient stands on one leg and extends spine. Then patient stands on opposite leg and extends spine.
Term
what is a positive stork test
Definition
pain in the back when standing on the ipsilateral leg (that has the fracture). If I've fractured the pars interarticularis on just one side, it wont separate but will be painful when I load that side and extend. Positive = reproduction of symptoms on one side but not the other
Term
how to treat spondylolisthesis
Definition
avoid hyper extension, strengthen, core stabilization
Term
what is the difference between spondylolysis and spondylolisthesis
Definition
both are fractures of pars interarticularis. In spondylolisthesis, the vertebra has shifted forward due to instability from the pars defect
Supporting users have an ad free experience!