| Flap 1 |
Flap 2 |
| What is the old idea about all back pain? | It all comes from "slipped" discs or bulge/herniation |
| What is the old idea about sciatica? | It is pain in butt and/or down leg from irritation to sciatic nerve roots |
| Why is pain into the buttocks and/or down the leg acutally referred pain and not sciatica? | The only sensory distribution of the sciatic nerve roots is BELOW THE KNEE |
| Macnab conducted a study where a catheter was inserted under nerve roots during surgery. What were the sensations of the normal vs. inflammed nerve root? | Normal: numbness, loss of strength, and NO pain; Inflammed: pain similar to a sunburn |
| What causes inflammation of a nerve root? | Antibody/histamine reaction: Prolapse of nucleus pulposus to nerve root (body doesn't recognize nucleus as self for some reason) |
| What is the pattern of pain for chemical radiculitis? | Dermatomal |
| Why is most pain NOT dermatomal? | Because most pain is not due to radiculitis, but REFERRED PAIN |
| What are the steps of chemical radiculitis? | 1. LEAKING nucleus pulposus 2. Causes INFLAMMATION reaction in nerve 3. PRESSURE from DISC on the nerve 4. RADIATING pain |
| What is the mechanism of irritation by Alf Brieg? | Constant rubbing on disc bulge during physiologic motion |
| If there is an irritation of the L4 nerve which disc is irritated/inflammed? | L3 disc |
| A patient leans ______ (AWAY/TOWARD) a LATERAL bulge. | AWAY |
| A patient leans ______ (AWAY/TOWARD) a MEDIAL bulge. | TOWARD |
| Why is a "PINCHED NERVE" an unlikely occurence? | The IVF is MUCH larger than the nerve. (Normal 185 mm2, Degenerated 108 mm2) |
| What changes in IVF size are seen in physiologic motion? | Flexion: opens 24%; Extension: closes 20%); Lateral and rotation is even less significant |
| What is the cross sectional area of a nerve root? spinal nerve? spinal nerve root + DRG? | 1.2 mm2; 2.4 mm2, 5mm2 |
| What is most likely happening to an irritated nerve since it is not being pinched? | STRETCHING |
| Define RADICULAR: | Pertaining to the nerve root |
| Define REFERRED PAIN: | Pain experienced at a site or in a tissue DISTANT to the tissue causing the pain |
| Name a common treatment for referred pain. | TRIGGER POINT therapy (ice massage, ischemic compression, acupuncture) |
| In reference to the Dallas discogram descriptions, describe the annular disruption grades (0, 1, 2, 3)? | 0: None; 1: Annular fissure = dye not outside normal disc contour; 2: Protrusion = dye bulging outside normal disc contour; 3: Leaking = dye in spinal canal |
| In Sachs' study of annular discruption and patient symptoms, patients described injection of contract medium. What were the ratings used in the study? | 0 = Pressure; 1 = Dissimilar; 2 = Similar; 3 = Exact |
| Along with discography of the lower 3 lumbars, how did patients describe pain in response to infections in the study by Ohnmeiss, Vanharanta, and Elholm? | Pain drawings (Low back/buttocks, thigh, leg) |
| In the Ohnmeiss, etc study, the discograms were scored just like the Dallas discrograms grade 2&3. How were these patients' pain responses recorded? | Pressure only or painless; Pain dissimilar to clinical sxs; Pain similar to sxs; Exact reproduction of sxs |
| T/F The results in the Ohnmeiss, etc study showed NO significant difference in the distal extent of pain between grade 2 and grade 3. | TRUE (Grade 2 reported more aching) |
