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spinal cord conditions Flashcards

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1
Q

degenerative category

A

refers to the spine structures like disc and facet joints; includes sponlysis and stenosis

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2
Q

spondylosis

A

degeneration of the spinal discs; arthritis in the spine

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3
Q

types of degenerative conditions

A

spondylosis and stenosis

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4
Q

instability conditions

A

spondylolysis and spondylolisthesis

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5
Q

bone health conditions

A

osteoporosis and pagets

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6
Q

developmental spinal condition

A

scoliosis

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7
Q

traumatic spinal condition

A

whiplash

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8
Q

motion segment meaning

A

refers to 2 adjacent vertebrae and interposing disc (includes intervertebral foramen and spinal nerve)

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9
Q

what would a reduced space between vertebrae on an X-ray mean?

A

a reduced disc height

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10
Q

what would a loss of disc height cause?

A

nerve compression and/or degeneration to the joints, leading to spondylosis

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11
Q

why is a disc referred to as a mechanical spacer?

A

because it increases the space for nerve roots in the intervertebral foramen

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12
Q

function of discs

A

resistance to compression, shear, and torque (rotation) forces

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13
Q

function of facet joints

A

allows for gliding movements

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14
Q

how does extension or hyperextension affect the facet joints?

A

it loads it up; overload can lead to bony hypertrophy, OA, and osteophyte formation (bone spur)

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15
Q

what is the bones response to overloading?

A

to create more bone, i.e. osteophytes

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16
Q

facet joint during flexion

A

glides up and increases the space of the intervertebral foramen; this position is more comfortable for those with spondylosis

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17
Q

facet joint during extension

A

glides down and decrease the space of the intervertebral foramen

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18
Q

function of the intervertebral foramen

A

maintains space for the nerve root

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19
Q

what can decrease the space of the intervertebral foramen?

A

extesnion or hyperextension, any space occupying lesions such as osteophytes, a loss of disc height, or disc protrusion

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20
Q

signs of spondylosis

A

am stiffness, improvement with some mobility, pain at the end at the end of the day, and aggravated by prolonged sitting or standing

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21
Q

why does am and pm stiffness occur with OA?

A

because there is a lack of mobility during these times, when movement occurs the pain decreases

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22
Q

how is the motion segment affected with spondylosis?

A

thinner disc, decreased intervertebral space, and arthritic facet joint

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23
Q

stenosis meaning

A

narrowing

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24
Q

spinal stenosis

A

2 types of this and is narrowing of the spinal canal or IVF and is often secondary to advanced spondylosis

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25
2 types of spinal stenosis
central (affects the spinal canal) and lateral/foramina (affects the size of the IVF)
26
what is spinal stenosis usually secondary to?
advanced spondylosis
27
what does the spinal canal hold?
the spinal cord
28
signs of spinal stenosis
usually seen in older population and those with kyphosis/flexed spine, a posterior pelvic tilt, better with sitting (due to flexion), low back pain, and unilateral leg pain
29
why is their pain with standing in those with spinal stenosis?
because the facet joints compress the IVF in the extended position, thus compressing the spinal root and causing pain
30
why do those with spinal stenosis often experience unilateral leg pain?
only one foramen is being compressed
31
treatment of those with spinal stenosis
must be pain free mobility! and exercises would include those for endurance, cardiovascular, and core; find comfortable positions for them
32
endurance exercise for those with spinal stenosis
stationary bike (keeps flexed position which is important for spinal stenosis)
33
stenosis vs spondylosis population
stenosis is usually elderly (late 70s) and spondylosis is older adults
34
what segments of the vertebrae are most often affected by spondylosis and stenosis?
lumbar, specifically it is very often L4/L5
35
spondylolysis
is a defect causing elongation of the vertebrae usually caused by extension overload commonly diagnosed in the teenage years which can often progress to a stress fracture or an instability of vertebrae
36
where does the stress fracture in spondylolysis occur at?
the pars interarticularis
37
common population for spondylolysis
teenagers, specifically those engaging in a lot of spine and leg extension, often seen in sports like dancers, figure skaters, gymnasts, and football players
38
why does spondylolysis often affect younger populations?
because it teenage years, the bones are growing quicker than the muscles, causing great flexibility before growth sprout but when growth sprout occurs the spine often compensates to maintain the flexibility
39
what vertebrae segment does spondylolysis often affect?
L5
40
signs of spondylolysis
back pain made worse with sports, no pain during flexion but lots of pain with extension (often at L5)
41
treatment for spondylolysis
lots of core work and deloading the spine during extension (try to extend more from the leg); often resolves without problems (but can progress to spondylolisthesis)
42
spondylolisthesis
is a progression of spondylolysis when there is a stress fracture, leading to a vertebrae slipping out of place anteriorly and pressing on the vertebrae below
43
grade 1 spondylolisthesis
is when 25% or less of the vertebrae is anterior on the other one
44
grade 2 spondylolisthesis
up to 25-50% of the vertebrae pressing on the one below
45
grade 3 spondylolisthesis
is 50-75% of the vertebrae pressing on the one below, surgical candidate
46
grade 4 spondylolisthesis
is >75% of the vertebrae pressing on the one below, surgical candidate
47
signs of spondylolisthesis
gymnasts and dancers, step deformity is palpable in lumbar spine, aggravated by extension, and eased by flexion
48
diagnostic test for spondylolisthesis
side flexion on an X-ray but reluctance to do this in younger ages due to radiation exposure to gonads or palpating step deformity
49
treatment of spondylolisthesis
core exercises, avoid extension and hyperextension, stretching of shortened muscles like hamstrings, and activity modification
50
what factors are vital to bone health?
calcium, vitamin D, and weight bearing exercises
51
concern of loss of height
red flag for osteoporosis and sometimes for spinal stenosis
52
secondary causes of osteoporosis
cancer, IBS, medication such as glucocorticoids, gastric surgeries, smoking, and alcohol
53
when should you as a PT consider osteoporosis?
fragility fractures and loss of height
54
FRAX meaning
fracture risk assessment tool for those over 50
55
2 types of medication for osteoporosis
bone builders or preventing resorption
56
PT role in osteoporosis
fall prevention through balance exercises, strengthening, and weight bearing exercises
57
pagets disease
is a disorder that affects the bone remodelling process, leading to enlarged, weak, and misshapen bones
58
complications of pagets disease
genu varum, spinal nerve compression, hearing loss, or bone pain
59
what bones does paget's primarily affect?
skull, shoulder, spine, and upper femur
60
common population for paget's disease
males over 40
61
cause of pagets disease
is unknown but may be genetic
62
diagnosis of pagets disease
blood work (increased alkaline phosphate) and X-rays
63
treatment of pagets
is combined with an MD who prescribe oral or injectable bisphosphonates or calcitonin but we as PTs offer exercises and joint protection
64
3 main classifications of scoliosis
congenital, idiopathic, and neuromuscular
65
congenital scoliosis
is associated with vertebral deformities
66
neuromuscular scoliosis
is secondary to other conditions like cerebral palsy, spina bifida, or physical injury
67
most common form of scoliosis
idiopathic
68
when is scoliosis often diagnosed?
growth spurt before puberty
69
scoliosis between the genders
both genders are equally affected but the progression is more severe in females
70
ways to clinically diagnose scoliosis
rib hump on forward bend, asymmetrical waist, and shoulders
71
structural scoliosis
no change in sitting position
72
functional scoliosis
is secondary to leg length asymmetry so shoulders are even when sitting
73
treatment of scoliosis
exercises, bracing, surgery (> 40 degrees or those with neuromuscular threats), MT, stretching, proprioceptive treatment, and neuromuscular treatment
74
WAD
is whiplash associated disorder and is broad term describing the mechanism of injury but no descriptive of the tissues involved or the effect on activities and participation
75
3rd party payer for WAD
ICBC
76
who classified WAD?
quebec task force classification
77
grade 1 WAD
neck pain and stiffness, tenderness, and no physical signs; PTs often don't see these patients
78
grade II WAD
neck pain complaints and msk signs (decreased ROM and tenderness); PTs do see these patients
79
grade III WAD
includes neck pain and neurological signs (weakness, decreased sensation, and decreased reflexes); seen by MDs
80
grade IV WAD
includes neck pain complaints and fractures or dislocations; seen by MDs
81
WAD treatment
early implementation of active and appropriate exercise that progresses according to the stage of healing; ice, heat, MT, and education is not really good but can be beneficial weeks 2-12
82
when should we refer to a MD?
any conditions requiring medications for bone health like osteoporosis and pagets, where medical management of pain is required, new or worsening signs and symptoms, and where further investigations are required
511
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