Questions
1-2 long questions per professional exam
Difficulty
Medium-Hard
Importance
High yield for BPT clinical exams
Overview
Spondylosis refers to age-related degenerative changes of the spine, while Intervertebral Disc Prolapse (IVDP) involves the displacement of disc material. These topics are fundamental to orthopaedic physical therapy, focusing on understanding nerve root compression and biomechanical failure.
Cervical Spondylosis
Cervical spondylosis involves chronic degeneration of the cervical spine, leading to narrowing of the spinal canal or foramina. It typically presents with neck pain, radiculopathy, or myelopathy depending on the extent of neural compression.
- Common at C5-C6 and C6-C7 levels
- Associated with osteophyte formation
- Spurling's test is used for diagnosis
- Myelopathic symptoms include gait disturbances and hyperreflexia
Lumbar Spondylosis
Lumbar spondylosis encompasses degenerative changes including facet joint hypertrophy and disc desiccation. It is the leading cause of chronic low back pain and functional disability in elderly populations.
- Commonly affects L4-L5 and L5-S1 levels
- Symptoms often aggravated by extension
- Associated with lumbar spinal stenosis
- Neurogenic claudication is a key differentiator
Intervertebral Disc Prolapse (IVDP)
IVDP occurs when the nucleus pulposus herniates through a tear in the annulus fibrosus, causing chemical or mechanical nerve root irritation. Classification includes protrusion, extrusion, and sequestration.
- Positive Straight Leg Raise (SLR) test
- Sciatica indicates L4-S1 nerve root involvement
- Can lead to Cauda Equina Syndrome (emergency)
- Dermatomal sensory deficits are common
Physiotherapy Management
PT management emphasizes pain relief, restoration of spinal mobility, and strengthening of the stabilizing musculature. A graded approach is essential to prevent acute exacerbation of symptoms.
- McKenzie's extension exercises for disc issues
- Core stabilization and abdominal strengthening
- Traction therapy for nerve root decompression
- Postural education and ergonomic modifications
Exam Tip
Always mention the specific neurological level involved (dermatome/myotome) when describing the clinical features of IVDP to secure high marks.
Common Mistakes
- Confusing the sensory distribution of nerve roots in cervical vs lumbar radiculopathy.
- Neglecting the red flags for Cauda Equina syndrome when discussing IVDP.
- Failing to differentiate between mechanical back pain and neurological claudication.
More Revision Notes
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