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Front Back
What part of the disc is avascular
Everything but the outer rings
Flexed posterior displaces nucleus posteriorally. 
T or F
True. 
How many levels of disc herniation are there?  Name them in order of severity.
Four
Disc Protrusion/Bulge
Disc prolapse
Disc extrusion
Disc Sequestration
When the nucleus separates from the disc and is free floating, what level of herniation is this?
Disc sequestration
If the outer annulus is intact, what level of herniation is this?
Disc prolapse
If the annulus is still intact what level of herniation is this?
Disc protrusion/bulge
If the nucleus is partially out of the disc, but is still maintained by the posterior longitudinal ligament, what level of herniation is this?
Disc extrusion
After age 55 what happens to the nucleus of the discs?
It dries out
If a person has a HNP, will the sx increase or decrease with trunk extension?
Decrease
If a person has a HNP, will sx increase or decrease with walking and laying flat?
Decrease
Joe Schmoe walks with a flexed posture with his trunk slightly shifted to one side.  What might be his problem?
HNP
What is the narrowing of the spinal canal and/or intervertebral foramen called?
Spinal stenosis
If a person has spinal stenosis does it hurt when they flex or extend the trunk?
Extension hurts
Name 5 causes of Spinal Stenosis
DDD
Bone spurring
buckling of ligamentum flavum
degenerative spondylolisthesis
Sally is complaining of pain in her back that radiated to her thigh. She has numbness and tingling in her leg. It hurts more when she walks, and sx decrease when she is sitting or when her spine is flexed.  What might her dx be?
Spinal stenosis
What is a defect in pars interarticularis called?
spondylolysis
What is the slippage of one vertebrae over another called?
spondylolysthesis
What is OA/DJD of the facet joints of the spine called?
spondylosis
Does a person with spondylosis feel better in flexion or extension?
flexion
What is the difference between spondylolysis and spondylolysthesis?
With spondylolysis there is no attachment; the two sides of the vertebrae are not connected. With spondylolysthesis the vertebrae are still connected on one side.
Name the grades and the percentages of spondylolysthesis.
Grade I: 25%
Grade II: 25-50%
Grade III: 50-75% (surgery)
Grade IV: 75-100 % (surgery)
What type of movement should a person with spondylolysthesis avoid?
Ballistic extension and rotation
Jane has complaints of pain around her waist area, which gets worse with she extends her back.  Upon palpation, her PT found her spinous process to be more anterior. Name her dx.
spondylolysthesis
Pain with active contraction of muscle and passive stretch of muscles is indicitive of what pathology?
Muscle strain
Pain with passive stretch is indicitive of what pathology?
Ligament sprain
What are some of the common sites of sprain/strain/damage to the lumbar spine?
iliac crest (d/t attachment of lumodorsal fascia, QL, erector spinae, iliolumbar ligament)
What are some of the common sites of sprain/strain/damage to the cervical spine?
w/ ext injury: facet joints, hyoid muscles, SCM, TMJ

w/ flex injury: TMJ, posterior cervical muscles, posterior ligaments, ligamentum nuchae, facet joint capsules
Name the 4 phases of treatment for muscle strains and ligament sprains
I: rest & restrictive activity; meds and modalities; instr on body mech. and posture
II: early motion within pain-free movement
III: Conditioning to prevent reinjury
IV: ADL & functional work activities
How would you describe the vertebrae of person with degenerative kyphosis?
wedge-shaped
Degenerative kyphosis is usually a result of what two conditions?
osteoporosis and possible compression fx
A person with kyphosis may have pain from their fractures, but what other condition may cause them pain?
Stretched erector spinae and posterior longitudinal ligament
What is the condition of the cervical spine of a kyphotic person?
Upper cervical spine may be hyperextended, while lower cervical spine has increased flexion.  pt needs to strengthen extensors.
What is another name for Scheurmanns disease?
kyphoscoliosis
What age group does Scheurmanns disease affect?
adolescents
What are signs & sx of Scheurmanns disease?
slouched shoulders, anterior pelvic tilt, increased lumbar lordosis, Schmorls nodes
When the nucleus herniates into the center of the vertebral body, what is this known as?
Schmorls nodes.
With Scheurmanns disease, what muscles need to be strengthened?  What muscles and ligaments need to be stretched?
Back extensors - strengthened
HS, Pect, Abs, Anterior longitudinal ligament stretched.
Describe functional scoliosis
Curvature straightens and no rib hump present (is fixable)
Describe structural scoliosis
Asymmetric shoulder and pelvis, head off center, if not fully compensated, primary and compensatory curves, gibbus in forward bend on convex side.  Not able to be fixed - has rib hump.
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