| Flap 1 |
Flap 2 |
| Where do the first age-related changes occur in an IVD? | Nucleus |
| What do ageing IVDs produce less/smaller/a lower concentration of? | Proteyglycans |
| What is the most important thing that ageing IVDs lack? | WATER! |
| What happens to the ageing IVD that indicates chemical changes? | Brown pigmentation |
| T/F Collagen cross links in IVDs are MEANT to be broken. | TRUE, however in an ageing disc the cross-links become less and less reducible (brittle) |
| What accelerates the chemical changes in the IVD? | Oxidative stress; i.e. pollution, cigarettes, etc. |
| T/F A disc is a vascular structure. | True AND False. The disc becomes avascular after about 25 years. |
| How does the IVD recieve nutrition and rid itself of waste? | Imbibition: "Drinking" by disc through movemnet of the spine |
| What happenes if calcification occurs at the endplates? | Less water can move in compromising nutrition |
| What happens to the annulus as it ages? | It becomes less pronounced and more brittle (collagen increase) |
| T/F Disc degeneration comes with age. | FALSE! Degeneration can occur at ANY age |
| Name 4 things that happen to an ageing nucleus. | Becomes dry, fibrous, stiff, and volume decreases |
| What happends to the ageing annulus of an IVD? | It becomes weaker, anular defects may occur. |
| T/F An ageing disc loses some of it's height. | FALSE! Although the annulus takes on a more compressive load, it does NOT lose disc height |
| T/F Disc degeneration usually happens after 20 YOA. | TRUE However, disc degeneration can occur at any age. |
| T/F Disc degeneation is more common in men and in lower lumbar vertebrae. | TRUE (This suggests a strong MECHANICAL influence) |
| During what age period are the most NEW cases of degeneration diagnosis made? | Middle Age |
| T/F The gross structural difference between disc ageing and degeneration is that degeneration is most evident in the anulus and endplate. | TRUE |
| T/F And MRI is needed to detect reduced disc height and end plate defects. | FALSE An X-ray can show these abnormalities, but an MRI is needed for any other abnormality |
| T/F a Circumferential tear is a tear from the inside out. | FALSE This is a tear between bands. |
| T/F You should NEVER adjust a patient with disc degeneration. | FALSE! Adjustment can help replenish water so degeneration is not always a contraindication. (Activator is good if nerve compression is a possibility.) |
| T/F Inward buckling or the inner anulus, radial bulging of the outer anulus, reduced disc height, and endplate defects are all structural changes that may be associate with disc degeneration. | TRUE |
| T/F vertical bulding of endplates into bodies, radial tears, circumferential tears, and prolapse are all possible structure changes in disc degeneration. | TRUE |
| T/F Decompression is often a successful treatment for disc degeneration. | FALSE! There is only ONE study in the treatment of disc degeneration with decompression therapy. |
| What type of treatment has a good history and is relatively inexpensive to treat disc degeneration? | Flexion/Distraction |
| When would fusion be necessary? | As a LAST RESORT when there is nerve root compresion |
| Name three types of anular tears. | Concentric clefts, rim lesion, and radial fissure |
| T/F If a patient has a radial fissure, they must first have had a rim lesion and concentric cleft. | FALSE! Anular tears are independent of each other |
| Describe concentric clefts. | A delamination of the anulus between adjacent lamellae |
| Describe a rim lesion. | Circumferential avulasion of periphery. |
| What are two things that may be associated with rim lesions? | Sclerosis and osteophytosis of adjacent bone |
| T/F Rim lesions usually occur posteriorly. | FALSE! There are 2 times more likely to occur anteriorly and typicall on the antero-lateral margin |
| Describe a radial fissure. | A radial disruption of the lamellae sometime resulting in escape of nucleus material (PROLAPSE) |
| How can cell and chemical changes in the disc be prevented? | KEEP MOVING! |
| Degenerated disc = ??? | LOSS OF WATER! |
| What are two other structural changes that can take place in a disc? | Degeneration of the z-joints and osteophytes around body margins |
| T/F Degeneration of z-joints can inhibit swallowing in cervical injuries. | FALSE! Osteophytes! NOT Z-joints |
| What may cause reduced ROM in bending and rotation? | Loss of facet cartilage - as a result of degeneration |
| In the Kirkaldy-Willis Degeneration Stages describe the DYSFUNCTION stage. | Abnormal motion, sxs with injury, small degree of joint subluxation |
| What is the "medical" definition of a subluxation? | A partially dislocated joint |
| In the Kirkaldy-Willis Degeneration Stages, describe the UNSTABLE phase. | INCREASED motion, observable catch/sway/shift, spodylolithesis on motion |
| In the Kirkaldy-Willis Degeneration Stages, describe the STABILIZATION stage. | DECREASING pain, stiffness/reduced movement, degenerative scoliosis, loss of disc height, osteophytes, smaller IVFs |
| T/F "Prolapse" and "herniation" are interchangealbe terms. | TRUE |
| T/F A prolapse usually occurs in the lower lumbar and is at the end-stage of degeneration. | FALSE! Occurs in lumbars, but has NO correlation with other signs of degeneration |
| Name three types of prolapse. | Protrusion, Extrusion, and Sequestration |
| Describe PROTRUSION. | Anulus bulges, but is NOT ruptured |
| Describe EXTRUSION. | Anulus ruptured, but nucleus remains intact |
| Describe SEQUESTRATION. | COMPLETE prolapse, nuclear tissue is expelled and no longer attached to nucleus |
| Most DCs NEVER adjust herniated discs, but one does... what three things may happen that justify his reasoning to go ahead and adjust? | The pt could get better, have no change, or have to have surgery (which would have had to happen anyway with no treatment) |
| T/F NOTHING is completely elastic. | TRUE!!! |
| Define ELASTICITY. | Property of a material to return to its original form following the removal of the deforming load |
| Define VISCOELASTICITY. | Property of elastisity combined with viscosity |
| Define VISCOSITY. | "stickiness" of a substance |
| T/F PHYSIOLOGIC loads have a SLOW loading rate while TRAUMATIC loads have a FAST loading rate. | TRUE |
| T/F In Virgin's test of Compression and Herniation, compression was proved to herniate discs. | FALSE!!! NO proof! |
| T/F Farfan's studies showed that degenerated discs are weaker than healthy discs. | FALSE!!! Degenerated discs are actually STRONGER! |
| T/F When Brown, Hanson, and Yorra compressed functional spine units, there was no herniation of the nucleus pulposes (even in degenerated discs) and the vertebral end-plates were fractured. | TRUE |
| What is the most common site of herniation? | Posterolateral |
| T/F The annulus can be subject to tensile stress in flexion, extension, etc, but the whole disc is seldom under tension even in traction. | TRUE |
| According to Brown, Hanson, and Yorra where is the disc the strongest? | Posterior/Anterior |
| According to Brown, Hanson, and Yorra, where is the disc found to be weakest? | Nucleus and lateral aspects |
| How did Brown, Hanson, and Yorra test for tensile strength? | They sliced the disc into small sections and tested the tensile strength of each individual section |
| Galante studied non-axial strength. In what plane did he find the discs to be strongest? | 30 degrees to disc plane (3 times stronger than horizontal!!!) |
| Define STIFFNESS. | A measure of resistance offered to external loads by a structure as it deforms. |
| What is the STIFFNESS COEFFICIENT? | Max. Load Applied/ Displacement Produced |
| Where is the greatest STIFFNESS found? | 15 degrees to the disc plane |
| T/F The disc is more stiff in TENSION than in COMPRESSION. | FALSE!! More stiff in TENSION |
