Questions Week 5

Graham Healy
Monday 19 Aug 2019

Questions (from notes on Intervertebral disc syndrome parts 1 and 2)

1. What are the most frequent sites of disc lesions? Can you give reasons why these sites are
most frequent for IVD lesions?
L4-5 and L5-S1
* the most weight bearing area of spine and sheering forces L5-S1
*usually posterior lateral
*flex-extension greatest L4-5,L5-S1 (16 & 17 degrees) (Bergmann p.235)
lateral flexion moderate(4-7 degrees)
C5-6 cervical Flexion –extension 17 degrees = greatest ROM of any segment.
2. What is the difference between a sequestration, protrusion and extrusion for an
intervertebral disc lesion?
*protrusion /nucleus polyposis does not break the annulus but may protrude into a nerve
root
*extrusion nucleus polyposis breathes through the annulus to nerve root (but remains
witching the disc)
*Sequestration is the breaking through of NP and lies outside the disc into the spinal canal
3. List the typical clinical signs and symptoms of a patient suffering from an IVD lesion.
*radiculopathy .nerve root/spinal cord/
*leg pain beyond the knee *previous episodes of LBP
*leg pain greater then back pain *pain following heavy lifting *pain sharp/shooting/electrical
*gait disturbance /Antalgic lean
*aggravated by bending, coughing, sneezing
*Numbness over one dermatome
*muscle weakness
4. Do radiographs provide diagnostic significance? Why?
MRI can see the disc degeneration /nerve impingent /degeneration of vertebrae (irritation
to nerve)
5. What diagnostic imaging is preferable for diagnosing an IVD lesion?
MRI
6. Generally, describe the chiropractic management of disc lesions.
*traction /intermittent
*mobilisation the open up IVF
*Ultrasound *Ice *STW (soft tissue work)/gentle stretching

7. List the clinical features of a thoracic disc herniation.

*rarely occurs
*vague back pain/referred unilaterally/bi laterally –chest-abs-legs
*Pain aggravated by c-flexion,coughing/straining
*pain relieved by recumbence
*sensory deficits /paraesthesia /paresis(muscle weakness due to nerve damage) often in
lower extremities
 *degerative changes on radio graphs + calcification of disc .

8. List the clinical features of a cervical disc herniation.

*occurs 20-55 years of age males>females
*Forwards head posture/repetitive arm/hand activities
*usually bulge postero-lateral causing unilateral ner root impigiment and shark neck pain
*most common C5-6 affecting C6 nerve root = forearm/thumb/1st digit
9. Do IVD lesions always involve the nerve root? Explain your answer.
*no the can extrude/protrude/prolapse anteriorly into the spinal cord
10. What are the complications of an IVD syndrome?
*Myelopathy –long trac signs in lower limb /bowel/bladder …refer
*persistent symptoms regardless of position or movement ….refer
*no responses to treatment ………..refer
11. What does SMART stand for? Are SMART changes usually detected in an IVD lesion?
*Sensory/motor/reflex/tension
Yes Radiculopathy /paraesthesia/muscle weakness/muscle weakness etc
12. Why do cervical disc herniation’s present with a diagnostic challenge? Explain your answer.
could be several things :
*neuropathy
*facet syndrome
*Myofascial pain ?trigger Points
*Infection/neoplasm/fracture
*cervical Myeopathy/CNS lesion
*rotatator Cuff/TOS
13. Thoracic disc herniations are less common compared with cervical and lumbar lesions. Why
is this the case?
Rib structure support of thoracic
14. Are neurological signs ALWAYS present with IVD lesions?
* in the early stages the degeneration may not present radicular pain may be referred as
degeneration progresses and a herniation or nerve irritation occurs ten radicular symptoms
will present .
15. What is a benign disc? Are there always clinical signs and symptoms associated with this
condition/entity?
*benign tumours are not cancerous/grow slowly/but can cause nerve pressure
clinical signs :
*pain at site /radiating pain/loss of bladder control /muscle weakness/loss of sensation

16. Why are cervical IVD lesions less common compared to lumbar IVD lesions?
the Lumbar IVD bears the weight of the body
17. True or false: patients with IVD lesions are generally over 70 years of age. Explain your
answer.
False –usually between 30-50 years of age (refer lecture notes) active lifting heavy objects
weightlifting etc
18. Describe the aetiology of an IVD lesion.
degeneration > mechanical factors >endplate damage >annulus overstrain >increased
 compressive loading>circumferential tears>radial tears > HERNIATION
>segmental instability>osteophytotic-fibrosis-sclerosis >segment stability

Non mechanical factors: Aging>dehydration>Segmental Instability

19. Generally, using signs and symptoms, how would you differentiate an IVD lesion and a facet
lesion?
facet = inflammatory =referred pain (deep 7 boring/ill defined/poorly localised
IVD= radiating pain =complex (sharp electric like/detmatonal pattern/weakness
atrophy/extends to lower limbs/feet
20. Which type of IVD lesion is more likely to give neurological signs, a bulge or a sequestration?
Pain scale
1) Protrusion
2) Extrusion
Sequestrated
Less Pain more neuro symptoms can be asymptomatic
Refer to the PDF on the ‘Code of Conduct’ from the Chiropractic Board of Australia and answer the
following questions. Refer to ‘working with patients’ section 4.
True or False
1. Subluxation based chiropractors do not need to use diagnostic and therapeutic tools when
treating a patient.
False
4.1 Use of diagnostic and therapeutic
modalities in chiropractic practice
Chiropractors use varying diagnostic and therapeutic
tools, tests and procedures in the assessment and
management of patients. Ensuring a high level of
competence and skill in using particular diagnostic or
therapeutic modalities is essential to good care.
Chiropractors should ensure that they are appropriately
trained, skilled and qualifed to practise any modalities

2. Chiropractors don’t need to understand the reliability and validity of tests….it’s what works
that’s more important.
false
Refer above
3. Subluxation based chiropractors don’t need to be bothered with a diagnosis and clinical
impression in patient care.
False refer above
4. It’s important that a chiropractor behaves professionally at all times on social media.
True
l) using social media, e-health and personally
controlled electronic health records appropriately,
an

5. Chiropractors should be aware of any relevant local, date or territory laws that may affect
the practice of different modalities.
True