Ms - Degenerative Diseases Of The Spine

Front 1

What decades of life is lower back pain attributable to degenerative disc disease most common in?

Back 1

4th and 5th

Front 2

What percent of individuals with back and neck pain caused by disc degeneration will see a significant clinical improvement within 6 weeks of the onset of symptoms?

Back 2

90%

Front 3

The likelihood of clinical improvement beyond 6 weeks is what? Beyond 12 weeks?

Back 3

Beyond 6 weeks - 20%

Beyond 12 weeks - 10%

Front 4

When is postural loading of the IV disc greater: standing or sitting?

Back 4

Sitting

Front 5

When is postural loading of the IV disc the lowest?

Back 5

Prone-laying

Front 6

What actions have been associated with disc degeneration?

Back 6

Repetitive axial loading, prolonged sitting, and bending and twisting motions

Front 7

What two intrisic factors have been identified which are related to the development of disc degeneration?

Back 7

Smoking and atherosclerosis

Front 8

What is chondroitin sulfate?

Back 8

Glycosaminoglycan which is very hydrophilic and is located on aggregan in the nuculus pulposus of IV discs. As humans age, the amount of chondroitin sulfate decreases and the amount of keratin sulfate increases. This causes water to be lost and causes IV disc degeneration.

Front 9

Which type of cell and collagen is predominantly found in the nucleus pulposus? What about in the annulus fibrous?

Back 9

Nucleus pulposus - chondrocytes and type II collagen

Annulus fibrous - fibroblasts and type I collagen

Front 10

Where are degenerative changes most commonly seen?

Back 10

L4-L5, and L5-S1

Front 11

What is spondylolisthesis?

Back 11

Vertebral bodies fail to align in the lateral view.

Front 12

What is the cause of radiculopathy?

Back 12

Direct compression of a spinal nerve root. Symptoms should follow dermatome.

Front 13

What is myelopathy?

Back 13

Pathology of the spinal cord. Generally develops in individuals with a congenitally narrow spinal canal who develop progressive degenerative changes. Since the canal is narrow, there is little room to accommodate degenerative osteophytes without developing spinal cord compression. Symptoms include loss of dexterity/coordination and impaired balance/gait. These changes are progressive.

Front 14

When should an MRI be performed for disc degeneration?

Back 14

Only to confirm a clinical diagnosis.

Front 15

What is cauda equina syndrome?

Back 15

Severe compression of the cauda equina. Symptoms include severe leg pain, saddle anesthesia, and altered bladder function. It is a surgical emergency.

Front 16

What are the red flags in back pain cases?

Back 16

Progressive, unrelenting pain
Worse at night or at rest
Fevers, chills, sweats
Anorexia, weight loss, fatigue
Progressive weakness
Acute dexterity or balance changes
Bladder dysfunction

Front 17

What are non-surgical treatments for arthritis of the spine?

Back 17

NSAIDs, acetominophen, newer COX II inhibitors (Refoxib and Celecoxib). Prednisone taper can be good but has significant side effects. No narcotics or bed rest. Muscle relaxants, when used, should be discontinued after 3-5 days.

Front 18

In the case of spinal infection, when should surgery be performed?

Back 18

After 6 weeks of antibiotics (cefazolin) are ineffective. Also to reconstruct areas of bone which were destroyed by the infection.

Front 19

What cases indicate prompt surgical intervention?

Back 19

Development of progressive neurologic defects, myelopathy, cancer (if chemo or radiation are ineffective), infection (if antibiotics are ineffective), significant deformity, cauda equina syndrome or dense neurologic defects