Term
| The gradual result of aging and "wear and tear" on the spine and/or a genetic predisposition to narrowing of the spinal canal. |
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Definition
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Term
| What is the last level of the spinal cord before it becomes the cauda equina? |
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Definition
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Term
| With age, the disc space decreases in height and bulges posteriorly toward the spinal canal. |
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Definition
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Term
| Outgrowth of the bone is known as |
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Definition
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Term
| Joints of Luschka can degenerate and create what? |
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Definition
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Term
| The facet joints and ligaments also enlarge and bulge toward where? |
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Definition
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Term
| Where the ligaments of the spine can harden and thicken |
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Definition
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Term
| Bones and joints may also enlarge when __ develops in the small joints of the spine (facets), and bone spurs (osteophytes) may form compressing nerves and the spinal canal. |
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Definition
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Term
| The slipping of one vertebra onto another, also may occur and lead to compression. "shearing effect" |
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Definition
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Term
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Definition
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Term
| What is the most common problem of non-acute stenosis? |
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Definition
| A combination of degenerative problems |
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Term
| If a younger person had lumbar stenosis, what might cause this? |
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Definition
| Congenital or acute cause |
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Term
| The most common problem in the elderly population. More frequent found in men than women. |
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Definition
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Term
| Pressure on the spinal canal causes cauda equina symptoms. |
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Definition
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Term
| Name 4 S&S of cauda equina syndrome. |
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Definition
1. Increase tonicity in the lower roots (H/S, G/S) due to irritability not spasticity
2. Weakness in the affected musculature
3. Some numbnessa nd tingling in legs
4. Pain early in the process of syndrome and less pain over time |
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Term
| Decreased space results in decreased blood supply to nerves. This results in |
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Definition
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Term
| Lack of adequate blood flow may be the predominant reason for symptoms. Dural tissues and blood supply to the cauda equina is compromised. Pain is similar to a peripheral vascular diseases in some patients. |
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Definition
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Term
| How is location of pain different between neurogenic and vascular claudication? |
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Definition
N = thighs, calves, back, rarely butt
V = buttocks or calves |
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Term
| How is the quality of pain different between neurogenic and vascular claudication? |
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Definition
N = Burning, cramping
V = Cramping |
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Term
| How are aggravating factors different between neurogenic and vascular claudication? |
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Definition
N = erect posture, ambulation, extension of spine
V = any leg exercise |
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Term
| What are some relieving factors between neurogenic and vascular claudication? |
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Definition
N = Squatting, bending forward, sitting
V = Rest |
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Term
| How are leg pulses and BPs different between neurogenic and vascular claudication? |
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Definition
N = usually normal
V = BP decreased; pulses decreased or absent; bruits or murmurs may be present |
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Term
| How are skin/trophic changes different between neurogenic and vascular claudication? |
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Definition
N = Usually absent
V = Often present (pallor, cyanosis) |
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Term
| How are autonomic changes different between neurogenic and vascular claudication? |
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Definition
N = Bladder incontinence (rare)
V = Impotence may coexist with other symptoms of vascular claudication |
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Term
| This is typical in pts with a previous history of instability |
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Definition
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Term
| Another suffested cause of increasing stenosis. Instability causes chronic inflammatin of the lumbar support tissues. Support tissues thicken or swell and osseous structures also hypertrophy due to continued stress. Combination causes impingement. |
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Definition
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Term
| This is the most common stenosis. It is more common in men than women and usually affects ages 50-80. |
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Definition
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Term
| Name the 2 types of lumbar stenosis |
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Definition
1. Those involving osseous structures
2. Those involving non-osseous structures |
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Term
| Name 4 steps to the typical progression of lumbar stenosis dz. |
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Definition
1. Degenerative disc changes with narrowing of the disc space
2. Micro-instability leads to thickening of ligamentous tissues
3. Overload and subsequent overgrowth of the facets and contact creates osteophytes at edges of body of vertebra
4. Stenosis becomes progressive |
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Term
| What are some congenital causes of lumbar stenosis? |
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Definition
| Makes up a small subset of stenosis. Shallow lumbar canals due to thickened lamina, shortened pedicles, or excessive scoliotic or lordotic curves. Typically defined as canals between 10-12mm in diameter |
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Term
| What is the normal measurement of canals? |
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Definition
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Term
| Name 5 symptoms of lumbar stenosis. |
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Definition
1. Pain in back early in dz
2. Progression to pain into butt and becoming more peripheral
3. Cramping of HS and GS with activity (always feels tight)
4. Numbness, tingling, paresthesias, and weakness in LEs
5. Worse with activity and better immediately with rest or lumbar flexion |
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Term
| What is the directional preference for someone who has lumber stenosis? |
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Definition
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Term
| Name 5 additional symptoms of lumbar stenosis. |
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Definition
1. Pts walk with forward bent or stooped posture
2. Walking while leaning on assistive device usually helps
3. Better with biking or curling in a ball
4. Worse with any extension activities
5. Can progress to urinary or fecal incontinence (rare) |
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Term
| Lumbar stenosis can also be confused with __ which is normally noticed in people in thier 20s-30s |
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Definition
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Term
| Lumbar stenosis can be confused with __ __ caused by vessel-related dz which occurs in ppl in thier 20s-30s |
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Definition
| Intermittent claudication |
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Term
| __ of the canal can cause the same symptoms and can create a mass effect. Usually seen in 30s-40s. |
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Definition
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Term
| Name 3 differential dx for lumbar stenosis. |
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Definition
De-myelinating dz
Tumors
Intermittent claudication |
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Term
| Name 7 differential diagnoses for lumbar stenosis. |
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Definition
1. Conus medullaris and cauda equina neoplasms, and benign cystic lesions (weakness and will get worse)
2. Neural compression from metastatic dz to bone (cancer)
3. Centrally herniated discs (usually under 50 y/o)
4. Degenerative spondylolisthesis
5. Trauma/fractures
6. Epidural abscess (infection, fever)
7. Inflammatory arachnoiditis (fever) |
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Term
| Name 4 types of testing to identify lumbar stenosis |
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Definition
-X-rays (osseous changes, loss is disc height, spondylolisthesis)
-CT Scans (great to reveal bony changes and bony tumors)
-MRI (most definitive for all soft tissue and bony encroachments)
-Myelogram (less commonly used due to complications of the dye and b/c it is invasive) |
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Term
| Name 6 examination procedures done to see if pt has lumbar stenosis. |
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Definition
1. Check posture and curves
2. Examine for spondylolisthesis
3. SLR usually neg but H/S tightness
4. Neuro sensory testing usually negative in neutral positions
5. Exacerbates with ext or activity
6. Neural tension test can be positive |
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Term
| ame 3 treatments for lumbar stensosi |
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Definition
1. Surgical
- Roto-router (clean out canal and fuse it)
- Posterior Laminectomy (take out post wall and fuse it)
- Laminectomy with fusion
2. Conservative
- PT and Rest
3. Combination
- Conservative (surgical intervention)
- Most effective with significant stenosis |
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Term
| How can lumbar stenosis be treated with exercise? |
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Definition
1. Flexion exercises (lumbar tx in flexion)
2. Mobilization/manipulation general LE strengthening (neural mobs and weight-assisted walking program) |
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Term
| Persons needing this are older and have more complications. It is aggressive and recovery is slow. |
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Definition
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Term
| What are some PT interventions for lumbar stenosis? |
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Definition
-Need to treat cause of stenosis
-Instability needs stabilization
-Degenerative dz responds well to traction
-Flexion and H/S stretching are important
-Stretch so the scar tissue will not cause contracture |
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Term
| Results are variable. Its helpful with pts with combination of DDD and DJD in lumbar. |
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Definition
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Term
| How is traction performed in the lumbar? |
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Definition
-90/90 positioning (b/c u want flexion)
-Pelvic harness only (b/c stabilizing upper torso is not important)
-Intermittent only (want motion not a steady stretch)
-How long? On 60 Off 20
-How strong? all studies are diff |
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Term
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Definition
Spasticity
Increased tone
Hyper-reflexia |
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Term
| Which is more serious: lumbar or cervical stenosis? |
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Definition
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Term
| Cord is dense and thick here and extra space in foramen is minimal |
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Definition
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Term
| Compromise of space in the c-spine causes __ symptoms in trunk and LE as well as __ symptoms in the UE |
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Definition
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Term
| In this area the discs sit in a bowl and the lateral sides are higher |
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Definition
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Term
| What are some tissues that compromise in cervical stenosis? |
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Definition
-Very common to have involvement of PLL and lig flavuum
-Facets and uncovertebral joint overgrowth
-Osteophytes of the posterior body of the vertebra
(Disc may cause PLL to protrude) |
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Term
| Just as common in females a males. Instability is an extremely strong aggravating factor. |
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Definition
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Term
| Name 5 reasons for cervical stenosis. |
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Definition
1. Congenital (end ROM and compression of disc)
2. Degeneration
3. Spinal instability (b/c ligs take all the load)
4. Disc herniation (almost always goes post/central which makes PLL protrude)
5. Constriction of the blood supply to the SC |
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Term
| The bony spinal canal normally has more than enough room for the SC. Typically the canal is __ mm around. |
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Definition
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Term
| Spinal stenosis occurs when the canal narrows to __ mm or less. |
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Definition
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Term
| When the canal narrows to __ mm, severe symptoms of myelopathy occur. |
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Definition
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Term
| Pathology of the SC which manifests of LMN of UE and UMN of LE. |
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Definition
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Term
| How does cervical stenosis progress? |
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Definition
-Most common in spines with instability
-Dz is very slow in progression over time and is usually precipitated by injury
-Symptoms are a mix of lower and upper motor neuropathies
-Can be easily confused with MS except for the typical age of the pt |
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Term
| What are the typical symptoms of cervical stenosis? |
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Definition
| UMN myelopathy refers to dysfunction of the long tracts of the SC |
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Term
| UMN myelopathy may manifest as: (6) |
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Definition
Weakness
Spasticity (below injury level)
Sensory Loss
Position sense loss
Incontinence (or continence change)
Impotence |
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Term
| Where is a common site of instability in the c-spine? |
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Definition
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Term
| LMN Symptoms: All of the following occur in the UE at or near the level of involvement of the stenosis: |
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Definition
Numbness
Tingling
Weakness
Parasthesias
Pain |
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Term
| What are some tests and measures that can be done to dx cervical stenosis? |
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Definition
-Neurological testing for UE and LE for both UMN and LMN lesions
-Neck pain and reproduction of pain and symptoms with motion and resistance
-PIVM of the cervical looking for hyper-mobility or OA end feel with testing
-Compression would be worse and distraction better.
-Increase S&S at end range
-Pain with any Cervical motion |
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Term
| What are the typical treatments for cervical stenosis? |
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Definition
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Term
| What are the 3 types of surgeries done for cervical stenosis? |
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Definition
1. Cervical laminectomy with fusion (releases pressure around cord and is common for myelopathy)
2. Anterior body fusion
3. Corpectomy and strut graft |
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Term
| What are some conservative care approaches for cervical stenosis. |
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Definition
PT
Bracing and Splinting
-Both are used to stabilize the cervical to reduce the effects of the instability of ligamentous and bony tissues
-Not sure that strengthening the musculature is effective after the pt has myelopathy |
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Term
| Is traction good for cervical stenosis? |
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Definition
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Term
| Why would you do modalities for cervical stenosis? |
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Definition
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Term
| Intermitten cervical traction is the only thing that is not contraindicated for this. |
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Definition
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Term
| < 60 degrees rotation to involved side. Cervical traction. Spurling's test. VLTTA |
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Definition
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Term
| In ___ stenosis, if __ problems are manifest with UMN complications, a surgical referral would be the best solution but you could try intermittent traction. |
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Definition
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Term
| In __ stenosis, if only LMN symptoms, conservative care is the best early treatment. |
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Definition
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Term
| In __ stenosis, if symptoms are present and progressive, conservative care would be the best solution for tx and referral should be delayed until after a significant attempt at conservative management. |
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Definition
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Term
| Lumbar stenosis at __ mm or less |
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Definition
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Term
| Cervical stenosis at __ mm or less |
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Definition
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Term
| Treatment for lumbar is primarily __ and cervical is primarily __ |
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Definition
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