Podcast
Questions and Answers
Which of the following is considered a potential etiological factor for spondylolisthesis?
Which of the following is considered a potential etiological factor for spondylolisthesis?
According to the Meyerding classification, what percentage of vertebral slippage characterizes Grade 3 spondylolisthesis?
According to the Meyerding classification, what percentage of vertebral slippage characterizes Grade 3 spondylolisthesis?
The presence of neurological symptoms is most commonly associated with which grade of spondylolisthesis according to the information provided?
The presence of neurological symptoms is most commonly associated with which grade of spondylolisthesis according to the information provided?
Which of the following is a key characteristic of Schmorl's nodes, as described in the provided information?
Which of the following is a key characteristic of Schmorl's nodes, as described in the provided information?
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The terms 'Spondylosis', 'Degenerative Joint Disease (DJD)', 'Osteoarthritis (OA)', and 'Facet arthropathy' are presented in the context as:
The terms 'Spondylosis', 'Degenerative Joint Disease (DJD)', 'Osteoarthritis (OA)', and 'Facet arthropathy' are presented in the context as:
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What is the focus of pathology, as it relates to disease?
What is the focus of pathology, as it relates to disease?
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According to the Lumbar Clinical Practice Guideline, what is the basis for classifying low back pain?
According to the Lumbar Clinical Practice Guideline, what is the basis for classifying low back pain?
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Which of the following is categorized as a 'Serious/Systemic Pathology' in the context of lumbopelvic issues?
Which of the following is categorized as a 'Serious/Systemic Pathology' in the context of lumbopelvic issues?
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What is a key characteristic of Ankylosing Spondylitis?
What is a key characteristic of Ankylosing Spondylitis?
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Which symptom is most indicative of a compression fracture in the spine?
Which symptom is most indicative of a compression fracture in the spine?
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Which of these locations is LEAST likely to be affected by a compression fracture?
Which of these locations is LEAST likely to be affected by a compression fracture?
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What is the primary diagnostic tool for confirming a compression fracture of the spine?
What is the primary diagnostic tool for confirming a compression fracture of the spine?
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Metastatic tumors in the spine are classified as:
Metastatic tumors in the spine are classified as:
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Which intervention is considered a conservative treatment approach for facet arthritis?
Which intervention is considered a conservative treatment approach for facet arthritis?
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What is a characteristic symptom commonly associated with sacroiliac (SI) joint dysfunction?
What is a characteristic symptom commonly associated with sacroiliac (SI) joint dysfunction?
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Which population is LEAST likely to be predisposed to sacroiliac (SI) joint issues related to hypermobility?
Which population is LEAST likely to be predisposed to sacroiliac (SI) joint issues related to hypermobility?
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Which activity is MOST likely to exacerbate pain associated with sacroiliac (SI) joint dysfunction?
Which activity is MOST likely to exacerbate pain associated with sacroiliac (SI) joint dysfunction?
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Which of the following is NOT typically included in the conservative treatment approach for Sacroiliac (SI) joint dysfunction?
Which of the following is NOT typically included in the conservative treatment approach for Sacroiliac (SI) joint dysfunction?
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According to the provided information, what is the estimated prevalence range of pain related to disc herniation in the general population?
According to the provided information, what is the estimated prevalence range of pain related to disc herniation in the general population?
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In Degenerative Disc Disease (DDD), a decrease in proteoglycans primarily leads to which biomechanical change in the intervertebral disc?
In Degenerative Disc Disease (DDD), a decrease in proteoglycans primarily leads to which biomechanical change in the intervertebral disc?
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Which of the following is presented as having a strong link to Degenerative Disc Disease (DDD)?
Which of the following is presented as having a strong link to Degenerative Disc Disease (DDD)?
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What is true about disc herniation extrusion?
What is true about disc herniation extrusion?
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Which symptom is commonly associated with disc herniation?
Which symptom is commonly associated with disc herniation?
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What typically worsens the symptoms of a disc herniation?
What typically worsens the symptoms of a disc herniation?
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Which treatment for disc herniation is recommended for rapid neurological symptoms?
Which treatment for disc herniation is recommended for rapid neurological symptoms?
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What does sequestration in disc herniation involve?
What does sequestration in disc herniation involve?
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Which of the following is most commonly associated with spinal stenosis?
Which of the following is most commonly associated with spinal stenosis?
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At what age does radiculopathy most commonly occur in men?
At what age does radiculopathy most commonly occur in men?
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What is a common symptom of foraminal stenosis?
What is a common symptom of foraminal stenosis?
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What term is used to describe the adherence of connective tissue in nerve entrapment?
What term is used to describe the adherence of connective tissue in nerve entrapment?
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What type of neurological deficits are associated with radiculopathy?
What type of neurological deficits are associated with radiculopathy?
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Which condition involves narrow spaces due to thickening of ligamentum flavum?
Which condition involves narrow spaces due to thickening of ligamentum flavum?
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What is the primary characteristic of neurogenic claudication in central stenosis?
What is the primary characteristic of neurogenic claudication in central stenosis?
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In which age group is radiculopathy most prevalent in women?
In which age group is radiculopathy most prevalent in women?
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What is a more appropriate term for 'nerve entrapment'?
What is a more appropriate term for 'nerve entrapment'?
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Which of the following conditions is associated with 'Double Crush' syndrome?
Which of the following conditions is associated with 'Double Crush' syndrome?
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Which symptom is NOT typically associated with nerve mechanosensitivity?
Which symptom is NOT typically associated with nerve mechanosensitivity?
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Which of the following is NOT one of the three things that nerves require for proper function?
Which of the following is NOT one of the three things that nerves require for proper function?
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Which treatment is commonly used for contractile pathology in the lumbar spine?
Which treatment is commonly used for contractile pathology in the lumbar spine?
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What symptom is typically related to contractile pathology in the lumbar spine?
What symptom is typically related to contractile pathology in the lumbar spine?
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Which is a potential cause for muscle spasm in contractile pathology?
Which is a potential cause for muscle spasm in contractile pathology?
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Which of the following exercises is suggested for improving nerve function?
Which of the following exercises is suggested for improving nerve function?
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Study Notes
Lumbopelvic Pathology
- Presentation by Adam Squires, PT, DPT, Cert SMT, Cert DN, Board Certified Specialist in Orthopedic Physical Therapy
- Focuses on understanding impairment-based classifications of low back pain and common lumbopelvic pathologies.
Definitions
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Pathology: Structural and functional deviations from normal, constituting disease, or characterizing it
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The study of the essential nature of diseases and significant structural and functional changes produced by them
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Pathology doesn't always equate to pain or limitation
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Important to understand the difference
Lumbopelvic Clinical Practice Guideline
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Published 2012, updated 2021
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Focuses on impairment-based classifications for low back pain (not pathology)
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Types included:
- Low back pain with mobility deficits (acute, subacute, chronic)
- Low back pain with movement coordination impairments (acute, subacute, chronic)
- Low back pain with radiating pain (acute, subacute, chronic)
Overview of Pathology
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Serious/Systemic:
- Spondyloarthropathies (e.g., Ankylosing Spondylitis)
- Cauda Equina
- Abdominal Aortic Aneurysm (AAA)
- Cancer
- Fracture
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Bone Pathologies:
- Spondylolysis
- Spondylolisthesis
- Schmorl's Nodes
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Joint Pathology:
- Spondylosis
- Degenerative Joint Disease (DJD)/Osteoarthritis (OA)
- Facet arthropathy
Ankylosing Spondylitis
- Inflammatory condition of the spine, eventually leading to spinal fusion
- Primarily affects men, starting in early adulthood (80% under 40)
- Incidence: 0.2-0.5%
- Symptoms:
- SI joint and lumbar pain
- Pain worsened by inactivity, improved with movement
- Uveitis (iris and ciliary body inflammation)
- Pain in hip and shoulder
Cauda Equina Syndrome
- Compression of the cauda equina (cauda nerve roots), often due to trauma, disc protrusion , hemorrhage, tumors, etc.
- Low incidence, 0.005-0.03% of low back pain
- Symptoms:
- Urinary retention/incontinence
- "Saddle anesthesia" (sensory changes in buttocks, inner thighs, perineum)
- Loss of anal sphincter tone, leading to fecal incontinence
- Medical emergency; requires quick decompression to prevent permanent damage
Abdominal Aortic Aneurysm (AAA)
- Dilation of the abdominal aorta beyond 3 cm (1.2 inches)
- 4-8% of older men, 0.5-1.5% of older women
- Symptoms:
- Abdominal pain, backache
- Risk factors:
- Age, smoking, family history
- Diagnosis:
- Palpation
- Imaging (ultrasound, CT, MRI)
Compression Fracture
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Most common in vertebrae T8, T12, L1, and L5
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Causes:
- Trauma (significant in young people, minor in older people)
- Osteoporosis, postmenopausal women
- Long-term corticosteroid use
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Symptoms:
- Pain at fracture site
- Limited movement
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Diagnosis:
- X-ray
Tumors
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Primary: Rare, originates in spine
- Osteosarcoma, Multiple myeloma
-
Secondary: Common, metastasizes from other areas
- Breast, Lung, Thyroid, Kidney, Prostate
Spondylolysis
- Fracture of pars interarticularis without vertebral displacement
- Often associated with repeated/excessive end-range extension (e.g., gymnasts, dancers)
- Symptoms: localized low back pain
Spondylolisthesis
- Pars fracture with anterior displacement of vertebral body
- Common in L5/S1 lumbar region
- Etiology:
- Congenital
- Arthritis
- Trauma
- Stress fracture
- Diagnosis:
- X-ray
Meyerding Scale for Spondylolisthesis
- Grading system for spondylolisthesis based on percentage of vertebral displacement
- Grade 1: 0-25%
- Grade 2: 25-50%
- Grade 3: 50-75%
- Grade 4: 75-100%
- Spondyloptosis: >100%
Schmorl's Nodes
- Disc herniation through vertebral endplate into vertebral body
- Usually asymptomatic
Degenerative Disc Disease (DDD)
- Prevalence increases with age; 88-96% asymptomatic individuals have disc degeneration between the ages of 60 and 80.
- Related pain increases every decade after age 20.
- Decrease in proteoglycans, leading to reduced water imbibition, decreased vertical height, increased facet joint loading and ligamentous laxity. Bulging of disc into canal and foramina, lig. flavum also thickens. Loss of nutrients. Strong genetic link.
Disc Herniation
- Most common location is posterolateral.
- Degeneration and breakdown of inner rings, no outer ring deformation
- Bulging beyond normal annular margin, outer rings remain intact
- Types:
- Extrusion: Nucleus material escapes but remains in one piece; portion of broken annulus may also extrude.
- Sequestration: Nucleus material separated from disc, annular material may also break free
Nerve Pathology
- Overview: CPG – Low back pain with radiating pain; Radiculopathy; Stenosis; Nerve Entrapment; Nerve Mechanosensitivity; "Double Crush" Syndrome.
Radiculopathy
- Prevalence: 3-5%, age-related risk factors, typically affecting men in their 40s and women in their 50s-60s
- Etiology: degenerative spondyloarthropathies, disc herniation, spondylolisthesis
- Symptoms:
- True neurological deficits (dermatomes, myotomes, reflexes)
- Lower motor neuron deficits
- Pain in the area associated with the nerve root
- +/- Limited range of motion (ROM)
- Nerve mechanosensitivity.
Spinal Stenosis
- Narrowing of the spinal canal
- Types:
- Central stenosis: narrowing of the spinal cord space.
- Foraminal stenosis: narrowing of the neural foramina.
- Symptoms:
- Bilateral leg symptoms in central stenosis
- Unilateral symptoms in foraminal stenosis
- Neurogenic claudication/pain with walking
- Upper and lower motor neuron deficits.
Nerve Entrapment
- Theory: Minor injuries to nerves or connective tissues can cause adherence, shortening, and loss of elasticity. Leading to pain and paresthesia along the affected nerve
- Prevalence varies based on body area, with carpal tunnel high among others.
- Symptoms:
- Pain and paresthesia along affected nerve.
- +/- motor deficits
- Absence of myotomes
"Double Crush" Syndrome
- Compression or irritation in two or more distinct area, such as sciatic nerve and L4 nerve root or piriformus
Nerve Treatment
- Nerves rely on space, movement, and blood flow.
- Treatment options include
- Direction-specific exercises
- Surgery
- Injections
- Manual therapy
Contractile Pathology
- CPG- Low back pain with mobility deficits
- Can be overlooked as pain generator in lumbar spine
- Causes:
- Muscle strain (acute/chronic overuse)
- Muscle spasm (protective mechanism)
- Contractile, joint, disc, or nerve injury/pain.
- Symptoms:
- Sore, stiff
- Aching, sharp pain
- Localized to the lumbar musculature, decreased ROM.
- Treatment:
- Time
- Conservative treatment
- Trigger point injections
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Description
This quiz focuses on the key concepts related to spondylolisthesis and its classifications, including the Meyerding classification and associated pathologies like Ankylosing Spondylitis. Participants will explore potential etiological factors, clinical guidelines, and indicators of serious spinal conditions. Improve your understanding of spine health and pathology.
