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IMPACT Manual Therapy > Anatomy and Classification of Lower Back Pain > Flashcards

Anatomy and Classification of Lower Back Pain Flashcards

1
Q

Lumbar Vertebral Body:

  1. Designed to support ___________ loads
  2. Internal Structure: _______ shell with cancellous cavity
  3. Trabeculae: strong, but ______ ________ load bearing structure
  4. ________ _________: spaces between trabeculae for blood supply and venouse drainage
A
  1. Longitudinal
  2. Cortical
  3. Light Weight
  4. Verteral Spongiosa
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2
Q

Lumbar Vertebrae Pedicles:

  1. Cylindrical with thick walls, ________ center
  2. Enables them to ______ motion in ___ ___________
A
  1. Hollow
  2. Resist, All Directions
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3
Q

Lumbar Vertebrae Posterior Elements (4)

A
  1. Artiular Processes (inferior and superior)
  2. Spinous, Transverse, Accessory, and Mamillary Processes
  3. Lamina
  4. Pars Interarticularis
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4
Q

Definition: Processes that form lumbar synovial joint that locks and prevent forward sliding and twisting of vertebral bodies

A

Term: Inferior and Superior Articular Processes

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5
Q

Definition: Processes for lumbar muscular attachment, processes also acts a levers

A

Term: Spinous, Transverse, Accessory, and Mamillary Processes

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6
Q

Definition: Transmits forces from spinous process or inferior articular process

A

Term: Lamina

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7
Q

Definition: Between superior and inferior articular processes, significant junction between vertical lamina and horizontal pedicle

A

Term: Pars Interarticularis

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8
Q

Q: What two muscles attache to vertebral bodies?

A
  1. Crura of the diaphragm
  2. Psoas
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9
Q

Q: Where does the multifidi muscle attach?

A

Mamillary Process

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10
Q

Q: Define the three borders of the vertebral canal.

A
  1. Anterior = Vertebral Body
  2. Lateral = Pedicle
  3. Posterior = Lamina
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11
Q

Q: List the advantage and disadvantage of the trabecular structure of vertebral bodies

A
  1. Advantage: light weight and stability to longitudinal forces
  2. Disadvantage: provide limited stability to horizontal and rotational forces
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12
Q

Q: What structure of the lumbar vertebrae resist horizontal and rotational forces?

A

The posterior elements (articular processes, processes, lamina, pars interarticularis)

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13
Q

Q: What structure forms the neural arch?

A

Pedicles

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14
Q

Q: What structures form the intervertebral foramina?

A

The vertebral notches above and below the pedicles of each vertebrae

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15
Q

Q: List the two types of stress fractures that occur in lumbar pedicles

A
  1. Fatigue
  2. Stress: due to repetitive large activity of the spine, contralateral spondyloolysis, prior lumbar sx. Stress can be shear/twisting followed by hyperextension/flexion. Extremely rare cause of LBP
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16
Q

Zyapophyseal Joints

  1. Typical __________ joint
  2. Most cases ___ or ___ shaped to resist both ______ _______ and ________ motions
  3. Capsule has loose superior and inferior poles for ____
A
  1. Synovial
  2. C, J, Forward, Sliding, Rotary
  3. Fat
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17
Q

Facet Orientation

  1. Orientation is defined by the average plane of the joint relative to the __________ plane
  2. The ability to restrict forward displacement depends on the orientation of the ___________ articular facet backward.
  3. The ability to restrict rotary motion depends on the ________ orientation of the __________ facet.
A
  1. Sagittal
  2. Superior
  3. Medial, Superior
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18
Q

Facet Orientation During Lumbar Degradation

  1. Spodylolithesis is associated with _________ orientation
  2. Osteoarthritis is associated with _________ orientation
  3. Frontal plane orientation will resist ________ displacement but will be less capable of limiting __________
  4. Sagittal plane orientation will resist ________ movements but will be less capable of limiting _________ displacement.
A
  1. Sagittal
  2. Sagittal
  3. Forward, Rotation
  4. Rotational, Forward
19
Q

Q: What 3 joints are formed by the intervertebral joint?

A

1 interbody joint and 2 zygopophyseal joints

20
Q

Q: What are the 2 functions of the lumbar disc?

A
  1. Allow movement between vertebral bodies
  2. Transmit load from one vertebral body another
21
Q

Q: How would the intervertebral joint function without the lumbar disc?

A
  1. 2 flat vertebrae could bear weight but would only allow gliding motion
  2. If only the joint only had the curved surfaces of the vertebrae it would allow for rocking/rolling but would result in decreased stability to load (due to decreased surface area and tendency to roll)
22
Q

Lumbar Disc Structure

  1. Nucleus Pulposis: ______% water/fluid, _______% protoeglycans, _______% collagen
  2. Anulus Fibrosis: ______% water/fluid, _______% protoeglycans, _______% elastic, aligned in _________ ____
  3. Vertebral Endplate: ________ to vertebral endplate (weak attachment) and _________ to nucleus (strong attachment)
A
  1. 70-90, 65, 15-20
  2. 60-70, 50-60, 10, Concentric Rings
  3. Hyaline, Fibrocartilage
23
Q

Q: What are the 3 components of the lumbar disc structure?

A
  1. Nucleus Pulposis
  2. Anulus Fibrosis
  3. Vertebral Endplate
24
Q

Definition: Thick anterior/laterally, thin/tight posteriorly, alternating orientation 65-70 deg

A

Term: Lamellae

25
Q

Q: List the 3 biomechanical requirements of the lumbar disc.

A
  1. Sustain a longitudinal load
  2. Accommodate to movement of the vertebrae
  3. Able to sustain stresses withouth injury
26
Q

Ligament:

  • Sacrum to C2 (then Ant Atlanto-Occipital Membrane)
  • 4 bands (deepest spans 1 segment)
  • NOT attached to disc
  • Resists anterior separation of vertebrae (extension)
  • Resists anterior bowing of spine
A

Anterior Longitudinal Ligament

27
Q

Ligament:

  • Resists separation of posterior vertebral bodies
  • Serrated, thin over body, expands over disc
  • Deepest fibers span 2 discs
  • Attaches to annulus
  • Long fibers span 3, 4 and 5 segments
A

Posterior Longitudinal Ligament

28
Q

Ligament:

  • Lamina to lamina
  • Paired ligament
  • Anterior Z-joint capsule
  • 80% elastin, 20% collagen
  • Prevents buckling into the spinal cord
  • Resist excess separation of lamina
A

Ligamentum Flavum

29
Q

Ligament:

  • 3 bands running postero-cranially between SP’s
  • Paired with fat
  • Resist separation of SP’s
  • Limit forward bending
A

Interspinous Ligament

30
Q

Ligament:

  • Midline SP to SP
  • Most studies show that it extends to L3,4, and sometimes (5%) L5
  • Usually lacking L5-S1
  • 3 layers- deep layer tendonous and reinforced by multifidus
A

Supraspinous Ligament

31
Q

Q: List the 5 parts of the Iliolumbar Ligament

A
  1. Anterior: well developed, ant TP L5, vertebral body to ant ilium
  2. Superior: ant/post fascia thickenings to surround QL
  3. Posterior: tip/post border TP L5 to ilium behind origin of QL
  4. Inferior: - lower border L5 TP, vertebral body to cross ant S-I ligament
  5. Vertical: ant/inf border L5 TP and descends vertically to iliopectineal line of pelvis
32
Q

Ligament:

  • TP to TP, more membranous
  • Divides anterior muscles of lumbar spine from posterior muscles
  • Laterally divided into 2 layers (ant and middle layers of T-L)
A

False Ligament: Intertransverse Ligament

33
Q

Q: List the 3 Functional Muscle Groups of the Lumbar Spine

A
  1. Anterior-lateral (Psoas)
  2. Transverse Process Lateral and Anterior (Intertransversarii Laterales & QL)
  3. Behind the Posterior Elements (Lumbar Back Muscles)
34
Q

Multifidus

  1. _________ and most medial fibers
  2. ______________ attachments from spinous processes
  3. __________ innervation
  4. _________ stabilizer
  5. Stabilize against _________ and ________ moments
  6. Create ___________ forcse on the lumbar segment
  7. Also has attachments to the _____ ________
A
  1. Largest
  2. Multi-segmental
  3. Segmental
  4. Local
  5. Flexion, Extension
  6. Compressive
  7. Joint Capsule
35
Q

Q: What is the T/L fascia combined with?

A

Transverse Abdominus

36
Q

Lumbar Nerve:

  • Off spinal cord
  • Spinal Nerve which lies in intervertebral foramen
A

Nerve Roots (Dorsal and Ventral)

37
Q

Q: Where does the spinal cord end?

A

L1-2

38
Q

Lumbar Nerve:

  • Extension of dura mater and arachnoid mater
  • As far as Intervertebral foramen
A

Dural Sleeve

39
Q

Lumbar Nerve: Within dural sleeve, just above intervertebral foramen

A

Dorsal Root Ganglion

40
Q

Lumbar Nerves: Cross Sectional Area

  1. _________ from L1-2 to L4-5
  2. _______ has the smallest forament
  3. _____ is the largest spinal nerve, occupies ______% of the foramen and is more susceptible to ___________ ___________
A
  1. Increases
  2. L5-S1
  3. L-5, 25-30, Foraminal Stenosis
41
Q

Lumbar Nerves: Dorsal Rami

  1. ____ branches from L1-4
  2. ____ branches at L5
  3. _________ branch: iliocostalis lumborum, some cutaneous
  4. _________ branch: longissimus muscle
  5. _________ branch: multifidus, interspinous ligament/muscle, Z-joints above and below
A
  1. 3
  2. 2
  3. Lateral
  4. Intermediate
  5. Medial
42
Q

Q: The ventral rami enter the substance of what muscles?

A

Psoas

43
Q

Lumbar Nerves: Sinuvertebral Nerve

  1. Recurrent from _______ ramus
  2. Mixed Nerve: ________ (Ventral Ramus) and _________ (Grey Rami Communicantes)
  3. To _____ at its level and one above
A
  1. Ventral
  2. Somatic, Autonomic
  3. Disc

IMPACT Manual Therapy (1 decks)

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