Anatomy - Verterbal Column - Lower Back

Question 1

Spondylogenic referred pain

Answer 1

• origin: structures other than nerve roots
• cause: infflammatin, mechanical cpmpression, mechanical strain
• Clinical feature: Deep dull aching pain
• usually not past knee
• no neurological sign

Question 2

Radicular referred pain

Answer 2

• origin: nerve roots, DRG
• cause: tension, mechanical compression, ischemia, chemical irritation
• referral along dermatome
• neurological sign

Question 3

Lateral recess stenosis

Answer 3

= narrowing at IVF

- will relieve their symptoms by flexion of lumbar spine

Question 4

Lumbar vertebral canal

Answer 4

Boundaries:

• anterior: vertebral bodies and discs
• Lateral: pedicles and intervertebral foramina
• Posterior: lamina and ligamenta flava

Contents: spinal cord and nerve roots, CSF in subarachnoid space, epidural space

Question 5

Spondylolisthesis

Answer 5

• at L5/S1
• secondary to spindylosis
• bilateral fracture and vertebral body slips forward

Question 6

Lumbar Disc herniations

Answer 6

• 95% of lumbar disc herniation occur at L4/5 and L5/S1, most are posterolateral
• posterolateral: may impige on dura and nerve roots that are moving laterally towards IVF
• posterior: may impige on centrally-located sacral nerve roots (cauda equina syndrome)
• ventral nerve root compression: weakness/flaccid paralysis
• dorsal nerve root compression: sensory deficit/anethesis

Question 7

Test for myotomes and dermatomes
L2
L3
L4
L5
S1

Answer 7

L2: hip flexion
L3: Knee extension/ knee jerk
L4: foot inversion/ knee jerk
L5: great toe extension
S1: Ankle plantarflexion: foot eversin

Question 8

Straight leg raise

Answer 8

• reproduce pain in leg
• stretches the sciatic nerve and its associated rami and roots

Test for malingering: leg is lowered slightly to point of no pain then ankle is dorsiflexed -> restretches sciatic nerve and its associates rami and roots

Question 9

Position to reduce load on lumbar disc

Answer 9

• Supine
• avoidance of low back flexion
• hips flexed
• knees flexed

Question 10

Central stenosis of vertebral canal

Answer 10

• narrowing of vertebral canal
• compresses dural sac and its contents
• causes: congenital, arthropathy, disc bulge/herniation, ligamentum flavum thickening/buckling or combination
• lumbar stenosis may cause neurogenic claudication: pain and weakness in leg, stoop to continue walking