[11.09] Spine Degeneration V2.pdf

two vertebral bodies and one intervertebral disc

What constitutes the functional unit of the spine?

three joints

How many joints are in one functional unit of the spine?

facet joints

What is the other name for zygapophyseal or apophyseal joints?

synovial joints

What type of joints are the facet joints?

synovial fluid

What do the synoviocytes in the facet capsule produce?

knee

Which joint is the facet joint very similar to?

symphysis joint

What type of joint is the intervertebral disc?

pubic symphysis

The intervertebral disc joint is similar to which other joint in the body?

facet joints

Forward and backward motion of the spine is allowed by which joints?

intervertebral discs

Compression between vertebral bodies is allowed by what?

vertebral bodies and intervertebral disc

What are the anterior elements of the spine?

weight bearing

Why are the anterior elements more massive than the posterior elements?

80 percent

What percentage of the load is carried by the anterior elements?

20 percent

What percentage of the load is carried by the facet joints?

increase from cephalad to caudal

How does the size of intervertebral discs change as you move down the spine?

more weight is carried lower in the spine

Why do discs get bigger from cephalad to caudal?

spinous processes and facet joints

What are the posterior elements of the spine?

biomechanical weight bearing

What changes in the spine as it degenerates?

load bearing, mobility and locomotion, and protection of structures

What are the three main functions of the spine?

Kirkaldy Willis Degeneration

What is the name of the cascade of events starting with dysfunction of the functional unit?

dysfunction, instability, and stability

What are the three overlapping phases of spine degeneration?

joint erosion and capsule laxity

What changes occur in the facet joints during the instability phase?

instability

What do joint erosion and capsule laxity lead to?

bones connecting vertebral bodies

What leads to the stability phase after instability?

fusion or ankylosing

What is the process called when bones connect vertebral bodies during the stability phase?

initial dysfunction

In which phase do early degenerative changes occur in the disc?

abnormal motion and pain

Segmental instability caused by progressive disc degeneration leads to what?

osteophyte formation and fibrosis

What two things occur to reduce motion during the stability phase?

decreased disc pressure and height

What is an early sign of disc degeneration related to pressure?

fibrosis of the NP and AF

What happens to the nucleus pulposus and annulus fibrosus during disc degeneration?

spondylosis changes

Facet joint arthropathy and ligament degeneration are part of what changes?

claudication and myelopathy

What are two results of spinal canal narrowing?

radiculopathy

What is the result of foraminal narrowing?

disc desiccation and fibrosis

What are the primary structural changes in a degenerating disc?

nucleus pulposus and annulus fibrosus

What are the two parts of the intervertebral disc?

Type II collagen

What type of collagen is found in the nucleus pulposus?

Type I collagen

What type of collagen is found in the annulus fibrosus?

hydrostatic structure

What type of structure does Type II collagen make the nucleus pulposus?

decreased water content

What causes the nucleus to become more fibrotic as it ages?

disc desiccation

What term refers to the drying out of the disc seen on MRI?

joints

When a disc degenerates, where is the weight bearing load transferred?

arthritis or arthropathy of joints

What does the transfer of weight bearing to the facet joints cause?

dark rim

How does the annulus fibrosus appear on a T2 MRI?

80 percent

What is the water content of the nucleus pulposus at birth?

genetics

What is the highest risk factor for spine degeneration?

aging and environmental factors

Besides genetics, what two other factors affect degeneration?

spondylosis

What is the general term for spine degeneration?

it is not necessarily a disease

Does having spondylosis automatically mean you have a disease?

asymptomatic

What is the most common presentation for patients with spondylosis?

neck or back pain and neurologic deficits

Besides being asymptomatic, what are two other presentations?

30 percent

What percentage of patients aged 20-30 show disc desiccation?

50 percent

What percentage of patients in their 40s show disc degeneration?

90 percent

What percentage of 80 year olds have disc degeneration?

occupation, lifestyle, and comorbidities

Name three factors that compound the genetic risk of degeneration.

hypertension and diabetes

Which two comorbidities are mentioned as compounding factors?

smoking

Which lifestyle habit is specifically listed as a compounding factor?

axial pain

What is another name for dull, midline chronic low back pain?

discogenic or facetogenic

Axial pain can be either of which two types?

radicular symptoms

What symptoms follow a dermatomal pattern?

numbness or weakness of a myotome

Radicular symptoms are associated with what two neurological findings?

myelopathy

What is the term for signs of spinal cord compression?

neurogenic claudication

What is the term for spinal nerve compression in lumbar stenosis?

thick ligamentum flavum

What structure can thicken and compress pleural elements, causing symptoms?

progressive neurological deficits

Name one red flag in history taking.

bowel and bladder dysfunction

What red flag is associated with cauda equina syndrome?

unexplained weight loss or night pain

What two red flags suggest possible malignancy?

urgent referral or intervention

What do red flags warrant?

canal stenosis

What is the cause of pain in neurogenic claudication?

standing

What activity worsens low back pain in neurogenic claudication?

sitting

What activity relieves low back pain in neurogenic claudication?

plumb line

What tool is used during inspection to check the head and back alignment?

Forward Bending Test

What test is used to assess for scoliosis?

sagittal profile

Kyphosis is checked by inspecting which profile?

facet joints and muscles

What two areas are palpated for tenderness during a spine exam?

Spurling Test

Which test involves lateral head bending and compression to check for disc herniation?

pain radiating down the upper limb

What is a positive result for Spurling test?

compression side

On which side is pain felt in a positive Spurling test?

Lhermitte Test

Which test involves flexing the neck forward to stretch the cervical spinal cord?

electric-type pins and needles sensation

What is a positive result for Lhermitte test?

L2 to L4

What nerve roots constitute the femoral nerve?

anterior thigh

Where does the femoral nerve provide innervation?

Femoral Nerve Stretch Test

Which test involves passively extending the hip and flexing the knee in a prone patient?

pain in the anterior thigh

What is a positive result for the Femoral Nerve Stretch Test?

L5 to S1

What nerve roots constitute the lumbosacral or sciatic nerve?

Straight Leg Raise Test

Which test involves lifting a supine patient's leg by the heel with the knee straight?

30 to 70 degrees

At what angle of elevation is a Straight Leg Raise test considered positive?

buttocks radiating down the leg

Where is the pain located in a positive SLR test?

malingering

If a patient feels pain at less than 30 degrees during SLR, what might they be doing?

hamstring strain

Pain beyond 70 degrees during an SLR suggests what?

Contralateral Straight Leg Raise Test

What is it called when lifting the right leg causes pain in the left radicular path?

Lasegue Test

What test involves flexing the hip with a flexed knee, then slowly extending the knee?

dorsiflexion

In the Lasegue test, what can be done to the foot to further assess nerve sensitivity?

Sitting Straight Leg Raise Test

Which SLR variation is performed from a seated position?

Waddell signs

What set of 4 tests aims to detect if a patient is malingering?

spinal cord compression

Myelopathic signs are considered when there is what?

gait instability, coordination changes, and trunk numbness

Name three general signs of myelopathy.

tandem gait or Romberg test

What two tests check for gait instability?

cervical spine

Hand signs of myelopathy are seen especially in which part of the spine?

Grip Release Test

Which test requires a patient to open and close their hands quickly for 10 seconds?

20 cycles

What is the normal number of cycles in 10 seconds for the Grip Release Test?