Degenerative Disc Module Flashcards Preview

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Flashcards in Degenerative Disc Module Deck (90):
1

Contains collagen fibers and proteoglycans

Nucleus pulposus

2

Water attracting proteins

Proteoglycans

3

What is the role of the annulus?

To contain the nucleus

4

True or false: intervertebral discs are avascular

True

5

How does the disc receive nutrients?

Vertebral route (through endplates from vessels in vert body)

Annular route (small vessels in outer third of annulus)

6

What are the nerve endings in the outer third of nucleus called?

Sinuvertebral nerves

7

Three major functions of disc

Spacer
Distribute Load
Accommodate movement

8

Phases of degenerative cascade

Dysfunction
Instability
Stabilization

9

Describe dysfunction phase of degen cascade

Small tears develop in annulus - acute or chronic back pain resolves with rest

10

Describe instability phase of degen cascade

Multiple annular tears, internal disc disruption, loss of height results in hyper mobility of motion segment

11

Describe stabilization phase of degen cascade

Further disc deterioration, disc space narrowing, endplate disruption, and osteophyte formation

12

Can result in general laxity in annulus

Bulging disc

13

Nucleus begins to protrude through a year in annulus in one area

Herniated disc

14

The type of herniation in which a portion of disc that has protruded through the annulus remains attached to remain material

Extruded disc herniation

15

Protruding portion of disc detached from remainder of disc

Sequestration disc herniation

16

Herniation towards midline putting pressure on spinal cord or cauda equina

Central herniation

17

Can result in weakness and numbness in lower extremities, bowel/bladder dysfunction, difficulty walking

Central herniation

18

May experience localized numbness, weakness, and tingling

Far lateral herniation

19

Generally affects spinal nerve

Far lateral herniation

20

When a herniation affect both spinal cord and spinal nerve

Paracentral herniation

21

When disc herniates through endplate

Schmorl’s Node

22

Condition that develops when the ligaments and posterior elements hypertrophy, enlarge, and the vertebral foramen narrows

Spinal stenosis

23

Numbness and tingling

Paresthesia

24

Intermittent pain or paresthesia in the legs that is brought on by standing and relieved by sitting

Neurogenic claudification

25

Compression of multiple spinal nerves within cauda equina

Cauda equina syndrome

26

Symptoms of cauda equina syndrome

Caused by lumbar stenosis or central herniation causing bilateral leg pain and parathesia, bowel and bladder dysfunction, and saddle anesthesia (loss of sensation restricted to area of buttocks and perineum)

27

Type of spondylolisthesis caused by abnormality in formation of Spine

Type 1 - Congenital

28

This type of spondylolisthesis is caused by a defect in pars articularis

Type 2 - Isthmic

29

Type of spondylolisthesis caused by degenerative changes in disc and facet

Type 3 - Degenerative

30

Type of spondylolisthesis secondary to severe injury that fractures any part of the vertebrae other than the pars interarticularis

Type 4 - Traumatic

31

Type of spondylolisthesis secondary to a general disease such as a tumor

Type 5 - Pathologic

32

Spondylo means what in Greek

Vertebra

33

Listhesis means what in Greek

To slide on an incline

34

What is spondylolysis

When the pars fractures completely

35

0-25 % slipped

Grade 1

36

25-50% slipped

Grade 2

37

50-75% slipped

Grade 3

38

75-100% slipped

Grade 4

39

Spondyloloptis (vb falls off the anterior edge of the vertebral body below)

Grade 5

40

What are radicular symptoms

Numbness, tingling, weakness, and/or paresthesia

41

Radicular symptoms typically correspond to what?

A dermatome

42

What do myelopathic symptoms typically indicate?

Impingement of spinal cord

43

What are myelopathic symptoms?

Gait disturbances, bowel and bladder dysfunction, and or/generalized weakness

44

Pain that is felt in the back itself

Axial back pain

45

Theory as to why axial back pain occurs

Chemicals formed in the disc during degenerative process has irritated the sinuvertebral nerves

46

Uses radiation to create a picture of the tissues of the body

Radiography

47

Uses a computer to compile multiple views of the body

CT scan

48

Uses magnets and radio waves to create an image based on water content of the tissues

MRI (magnetic resonance imaging)

49

When radiopaque die is injected into multiple discs and the patient is prompted to notify the surgeon if they are experiencing concordant pain

Discography

50

Can be used to assess disc height, volume of intervertebral foramen, osteophytes and changes to endplate

Radiograph

51

Allows surgeon to assess patency (openness) of the vertebral and intervertebral foramina as well as condition of facet joints

CT Scan

52

Allows surgeon to examine the health and water content of discs

MRI

53

First step in treating DDD

Conservative therapy

54

Success rate for treating severe lumbar radiculopathy with conservative therapy

50%

55

% of back pain patient who never need surgery

90%

56

Removal of bone or soft tissue putting pressure on neural elements

Decompression

57

Physically removing the pieces of tissue that are exerting pressure onto a neural element

Direct decompression

58

Increasing the amount of room for the neural structures by increasing or restoring the height of the disc space

Indirect decompression

59

A procedure that increases the diameter of the intervertebral foramen

Foraminotomy

60

A procedure in which sections of the lamina and the facet are removed

Foraminotomy

61

Indications for foraminotomy

Radiculopathy caused by pressure on spinal nerve by disc herniation or osteophytes

62

Advantages of foraminotomy

Decompress neural elements without fusion, relief of cervical radiculopathy in 90% of patients

63

Disadvantages of foraminotomy

Not effective for myelopathy or pathology toward midline
May lead to spinal instability

64

Removal of part of the lamina to relieve compression on a neural element or to gain access to other anatomical structures

Laminotomy

65

Often done in conjunction with a foraminotomy, microdiscectomy, or posterior lumbar interbody fusion

Laminotomy

66

Indications for laminotomy

Herniated disc, compressed nerve root

67

Advantages of laminotomy

allows access to neural elements and disc from a posterior approach

68

Disadvantages of laminotomy

Not often a stand alone procedure

69

A procedure that involves the removal of the herniated portion of a disc, performed through a small incision, usually with the assistance of a microscope to enhance visualization

Microdiscectomy

70

Indications for microdiscectomy

Lumbar disc herniation with radicular symptoms or cauda equina syndrome

71

Advantages of microdiscectomy

Minimally invasive, small incision, no fusion

72

Disadvantages of microdiscectomy

Simply removes herniation, does not repair the disc or restore lost height of the disc

73

A procedure in which the lamina is removed

Laminectomy

74

Commonly performed to decompress the spinal cord

Laminectomy

75

Indications for laminectomy

Spinal stenosis

76

Advantages of laminectomy

Increases volume of vertebral foramen

77

Disadvantages of laminectomy

May destabilize the spine if performed over multiple levels, requiring instrumentation

78

Contraindications for laminectomy

Contraindicated if kyphotic deformity is present

79

A procedure that involves reshaping the lamina to increase the volume of the vertebral foramen and decompress the spinal cord without removing the protective function of the lamina

Laminoplasty

80

Indications for laminoplasty

Cervical and upper thoracic spinal stenosis

81

Advantages of laminoplasty

Increases the volume of the vertebral foramen over multiple levels without removing the protective function of the lamina or significantly destabilizing the spinal segment

82

Disadvantages of laminoplasty

Technically more demanding than a laminectomy and limited to cervical and upper thoracic spine

83

Contraindications for laminoplasty

Contraindicated if spine is in kyphosis

84

Removal of the disc

Discectomy

85

Inducing the body to grow a bridge of bone from one vertebra to another

Fusion

86

Five basic steps of discectomy and fusion

Removal of disc
Placement of spacer in disc space
Graft Augmentation
Stabilization
Fusion

87

This device attempts to achieve the goals of a fusion (decompression, relief of symptoms) while maintaining motion at the spinal segment

Disc replacement

88

Comprised of spinal instrumentation that may allow for controlled flexion, extension, lateral bending, and axial rotation while resisting unwanted shear motion of the spinal segment

Dynamic stabilization

89

Limit extension in patients suffering from spinal stenosis

Interspinous spacer

90

Replaces a diseased, painful facet

Facet replacement