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Modic Changes - Leaderboard
Modic Changes - Details
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1) Reactive parainflammatory change in the vertebral body bone marrow, immediately adjacent to the vertebral endplate 2) Type 1, 2, 3 - type one is most associated with | What are modic changes? |
1) Central lesion (posterior) (transiting nerve root) 2) Subarticular/lateral recess (post/lat) (transiting/exiting nerve +-DRG) 3) Foraminal (lat/post) (exiting nerve + DRG ) 4) Extraformainal/far lateral = exiting + DRG | What are the different likely geographical locations of a disc lesion - and what structures might they affect? What directions must the disc protrusion move to mechanically affect a exiting/transiting nerve. |
Mechanosensitivity of the nerve trunk - which is caused by the chemical sensitisation of the nervi nervorum. Importantly - reduction in ROM of SLR/Slump is a guarding response of the local muscles - the nerves just become very sensitised to movement and load. | What is PSLR + slump testing? What does reduce ROM mean in these tests? |
Limb pain (does/doesn't have to?) + one of: 1) Muscle weakness (myotomal deficit) 2) Impaired tendon reflex) 3) Altered sensation (light tough, or pin-prick) 4) Neurodynamic tests that reproduce/provoke the limb pain (< 60º SLR) | How do you diagnose nerve root involvement (radic+radiculopathy)? |
Depends on how quickly, but send for neurosurgeon review. But the majority of disc herniations do not (kjaer et al (2016) 4-8yr F/U) | If the conduction problems were deteriorating, what would you do? Do Disc herniations deteriorate over time? |