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level: Level 1

Questions and Answers List

level questions: Level 1

Question	Answer
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?
Radicular pain refers to pain without any sign of conduction compromise typically in a dermatomal pattern. Radicular P) = dull ache, sharp, shooting, lancinating in nature. It can involve chemical sensitisation, or compression sensitising the sensory root/ganglion to mechanical loads. The nerve root must be inflamed to cause radicular P) 2º to insult/injury. Radicupathy can have radicular p) (but doesn't have to) but shows signs of conduction compromise. This is typically from impaired intraneuralaxo-plasmic flow; paraesthesis, motor and reflex impairment.	What is the difference between radicular versus radiculopathy?
1) Protrusion is focal, asymmetric, beyond endplate, outer annulus intact 2) Extrusion - the nucleus pulposus goes beyond its confines of the annulus and it enters the epidural space 3) Sequestration - disc material separated from the parent disc	Difference between protrusion, extrusion, sequestration?
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.
Sciatic P) is irritation/sensitisation of one or more L4-S2 nerve roots Inflammation and sensitisation of the nerve fibres, which are the nervi nervorum (nerve supply of the nerve trunk). Conduction issue versus chemical sensitisation (of nervi nervorum). Chemical sensitisation causes the increased mechano-sensitivity of which PSLR + Slump are symptom	What is sciatic P), and what is the cause of sciatic pain?
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?
Somatic referred pain is when structures most often proximally at the spine, refer symptoms distally. Ie cardiac arrest causing pain down the shoulder and left arm (visceral somatic referral). It is most often diagnosed by AROM, palpation (which reproduces symptoms)	What is somatic referred pain? How would it be diagnosed?