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Complementary and alternative medicine treatments, 146-150 as indication for spinal surgery, 153 low assessment and management, 329-331 cardiovascular conditioning, role of, 108-109 common causes of lumbar pain, 106 complementary and alternative medicine treatments for, 146-150 discogenic, 337-341 lumbar spine exam, 41-44 in lumbar spine injuries in athletes, 417 orthosis for, 144 probability of recovery, changes in, 106 treatment plan for, 106 trunk strength deficits and, 110 pediatric,...

Which patients are less than ideal candidates for surgical treatment for lumbar DDD

Surgical treatment is associated with poor outcomes in patients with unresolved secondary gain issues, worker's compensation claims, litigation, multiple emergency department visits, high levels of opioid usage, abnormal psychometrics, chronic pain illness, and exaggerated pain behaviors. Patients off work greater than 3 months tend to have worse results. To have any sense that surgery might benefit the patient, the surgeon must get to know the patient. Overreliance on MRI or discography data...

What is the most important component of an exercise program for the treatment of low back pain due to lumbar DDD

The most important component of a low back exercise program is to address fear-avoidance behavior of the patient by reassuring the patient that it is safe to exercise despite the chronic pain he or she may experience. The appropriate exercise program is a supervised active physical therapy program that uses progressive, non-pain contingent exercise (i.e. the patient is encouraged to exercise despite their pain) to increase strength and endurance. Successful outcomes may be achieved with a...

What is the anatomic basis for EDX as it relates to the assessment of spinal disorders

The purpose of the EDX is to assess the motor and sensory function related to the spinal nerves. Each spinal nerve contains both motor and sensory fibers and contributes to the formation of the peripheral nerve. The cell bodies for the motor axons are situated within the anterior horn of the spinal cord. The cell bodies for the sensory axons are located within the dorsal root ganglion near its junction with the ventral root. There it forms the mixed spinal nerve in the region of the...

Define ankylosing spondylitis

Ankylosing spondylitis (AS) is a seronegative inflammatory arthritis of the spine of unknown etiology. It presents in the early stages with an inflammatory arthritic pain that typically involves the sacroiliac joints initially and later the other spinal regions. The classic feature of AS is enthesopathy (inflammation at the attachments of ligaments, tendons, and joint capsules to bone). Initially, range of motion is normal or mildly limited. Disease progression leads to spinal ossification,...

Explain how EMG is used to assess patients with spinal disorders for the presence of a radiculopathy

Specific muscles are selected for EMG assessment. Six upper limb muscles, including paraspinal muscles, consistently identify more than 98 of cervical radiculopathies that are confirmable by electrodiagnosis. For upper-limb EMG evaluation, a suggested screen includes deltoid, triceps, pronator teres, abductor pollicis brevis, extensor digitorum communis, and cervical paraspinal muscles. Six lower limb muscles, including paraspinal muscles, consistently identify more than 98 of...

Are anterior approaches commonly performed today for the treatment of adult scoliosis

As a result of the potential morbidity from an anterior approach and the fact that recent data suggest the same correction and similar fusion rates are achievable through a posterior-only approach, the enthusiasm for anterior fusions or combined anterior posterior fusions for adult spinal deformity has declined over recent years. A mini-open anterior retroperitoneal approach is, however, still commonly performed to achieve anterior column structural interbody grafting at caudal segments of a...

How is a PET scan performed

A positron-emitting radionuclide is injected into the body. As the positrons are emitted and travel through tissue they collide with electrons, resulting in production of gamma rays. A PET scanner records and analyzes these data and creates an image. CT or MRI may be combined with PET to maximize diagnostic potential. FDG is currently the most commonly used radiotracer. It is transported and becomes trapped intracellular as a result of phosphorylation by hexokinase. FDG accumulates at sites of...

How does RA affect the cervical spine

Rheumatoid Arthritis Anaesthesia Spine

The cervical spine is composed of 32 synovial joints. The occiput-C1 and C1-C2 articulations rely on soft tissue integrity for stability. In the subaxial cervical spine, the facet joints are true synovial joints. Rheumatoid pannus produces enzymes that destroy cartilage, ligaments, tendons, and bone. This synovitis leads to spinal instability, subluxation, and spinal deformity. Secondarily, the discs in the subaxial spine degenerate, which may result in additional facet joint subluxation and or...

What CAM treatments work best for the treatment of back pain

Popularity or personal testimonials do not prove or disprove treatment efficacy. CAM therapies are most frequently administered in combination with traditional therapeutic interventions for back pain using nonstandardized protocols. The medical evidence to support specific CAM treatments for back pain may be unavailable, insufficient, or conflicting depending on the specific intervention that is evaluated. Nevertheless, standardized reviews and randomized controlled trials have been published...

How is the clinical syndrome of lumbar DDD characterized

Lumbar DDD refers to a continuum of nonradicular pain disorders of degenerative origin. Specifically excluded are symptoms related to disc impingement on neural elements, facet-mediated back pain, and spinal deformities secondary to lumbar DDD (e.g. spondylolisthesis, degenerative scoliosis). Presenting symptom is primarily low back pain, which may radiate to the sacroiliac and or buttock region. Common physical examination findings include tenderness with palpation over the lumbar region and...

Describe the course of the vertebral artery in the cervical spine

The vertebral artery arises from the subclavian artery. It enters the transverse foramen at C6 in 95 of people and courses upward through the foramina above. At C1, the vertebral artery exits from the foramen, courses medially on the superior groove of the posterior ring of the atlas, and enters the foramen magnum to unite with the opposite vertebral artery to form the basilar artery. Figure 25-2. Vertebral artery. (From Winter R, Lonstein J, Denis F, et al. Posterior upper cervical procedures...

What are the different types of osteoporosis

Osteoporosis has been classified into two major types primary and secondary. Primary osteoporosis is further subdivided into type 1 or postmenopausal osteoporosis and type 2 or senile osteoporosis Type 1 osteoporosis is due to estrogen deficiency and typically occurs in women 5 to 10 years after menopause. It predominantly affects trabecular bone and is associated with vertebral fractures, intertrochanteric hip fractures, and distal radius fractures Figure 65-1. Specimen radiographs of 2-mm...

What is the degenerative cascade

The term degenerative cascade was introduced by Dr. Kirkaldy-Willis to explain the typical progression of lumbar spine degeneration. This process is conceptualized in terms of a three-joint complex composed of the intervertebral disc and two zygoapophyseal joints that comprise a functional spinal unit, the smallest anatomic unit of the spinal column that demonstrates its basic functional characteristics. The progression of degenerative changes involving the three-joint complex is conceptualized...

R

Radiation therapy, for metastatic spinal disease, 445 Radicular artery of Adamkiewicz, 22 Radiculopathy cervical computed tomography, 93 described, 36 disc replacement, 320 electrodiagnosis, 132 magnetic resonance imaging (MRI), 86, 93 natural history of, 104 nonsurgical treatment plan for, 105 provocative maneuvers for evaluation, 36 electrodiagnosis, 129, 130-131, 130t, 132-133 lumbar electrodiagnosis, 132 nonsurgical treatment plan for, 106 thoracic electrodiagnosis, 132-133 treatment plan...

Provide a brief description of the types of mindbody therapy that have been used to treat patients with LBP

Cognitive-behavioral programs are a component of many established pain treatment centers. These programs focus on educating patients and teaching coping skills in a highly structured group setting under the guidance of a clinical psychologist. They frequently incorporate hypnosis, meditation, and biofeedback techniques 2. The Alexander technique is a method of modifying chronic patterns of back and neck muscle tension through an instructor's verbal direction and awareness exercises. Patients...

What are the options for reconstruction of the anterior and middle spinal columns after resection of a metastatic

Options for reconstruction of the anterior and middle spinal columns include bone graft (autograft or allograft), methylmethacrylate, titanium mesh cages, and carbon fiber or polyether ether ketone (PEEK) cages. Expandable cages have been popularized for use in this setting. All of these intracolumnar implants are used in combination with anterior spinal instrumentation (plate systems, rod systems) and or posterior segmental spinal fixation. 29. What is the role of kyphoplasty and...

Cervical Spine Injuries In Athletesi

Watkins, IV, MD, and Robert G. Watkins, III, MD O 1. What sports are associated with the highest risk for head and neck injuries The organized sports with the highest risk for head and neck injuries are football, gymnastics, wrestling, and ice hockey. Football is the sport associated with the highest risk of such injuries. Head and neck injuries also occur in a variety of nonorganized sports activities including diving, skiing, surfing, and trampoline use. 2. What types of cervical...

What is Pagets disease

Mitch Paget

Paget's disease is named after Sir James Paget, who described its clinical and pathologic aspects in 1876. Paget's disease is the second most common metabolic bone disease. It has been found in up to 5 of northern European adults older than 55 years. However, most affected individuals are asymptomatic. The cause is unknown, but viral infection and genetic factors are believed to be responsible. The disease causes focal enlargement and deformity of the skeleton. The pathologic lesion is abnormal...

What is lifting capacity

Lifting capacity assesses the spinal functional unit (extensor unit lumbar paraspinals, gluteals, and hamstrings) and its interaction with the body's other functional units in performance of activities of daily living. Patients with chronic low back pain have a 30 to 50 reduction in lifting capacity. Normal lifting capacity from floor to waist (lumbar lift) is approximately 50 of IBW for men and 35 of IBW for women. Normal lifting capacity from waist to shoulder (cervical lift) is 40 of IBW for...

Lumbar Spine Injuries In Athletesi

Watkins, V MD, and Robert G. Watkins, III, MD O 1. What is the differential diagnosis for an athlete who presents with symptoms of low back pain with or without radiculopathy Muscle strain ligament sprain Lumbar disc injury (annular tear, discogenic pain syndrome, disc herniation) Ring apophyseal injury (adolescents) Stress fracture (e.g. spondylolysis, sacral stress fracture) Minor lumbar fracture (e.g. transverse process fracture) Serious underlying spinal condition (discitis...