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COMLEX - OMED > Chapter 4 - Lumbar > Flashcards

Chapter 4 - Lumbar Flashcards

1
Q

Why are disc herniations more common in the lower lumbar region?

A

posterior longitudinal ligament narrows -> weakness in the posteriolateral aspect of the IV disc

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2
Q

Where do thoracic & lumbar nerve roots exit the spinal column?

A

Below its corresponding vertebra (L4 exits b/w L4/L5)

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3
Q

Spinal cord terminates at which level

A

L1-L2

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4
Q

Muscle of the lumbar spine

A

Erector spine group (spinals, longissimus, iliocostalis), multifidus, rotatores, quadratus lumborum, iliopsoas (psoas major & iliacus)

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5
Q

Erector spine group

A

spinals, longissimus, iliocostalis (“SILO”)

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6
Q

iliopsoas origin

A

T12-L5

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7
Q

iliopsoas insertion

A

lesser trochanter of femur

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8
Q

iliopsoas action

A

hip flexor, maintaining lumbosacral angle

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9
Q

iliopsoas dysfunction

A

prolonged shortening of mm -> PSS, +Thomas test, SD in upper lumbars

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10
Q

Iliac crest level

A

L4-L5 IV disc

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11
Q

Umbilicus level

A

L3-L4 IV disc

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12
Q

Most common anomaly of the lumbar spine

A

Facet trophism

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13
Q

Facet trophism

A

asymmetry of the facet joint angles (should align w/ sagittal plane (Backward, Medial), but align w/ coronal plane)

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14
Q

Sacralization

A

1 or both TPs of L5 articulate w/ the sacrum

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15
Q

Lumbarization

A

failure of S1 to fuse w/ sacrum

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16
Q

Spina bifida

A

defect in the closure of the lamina

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17
Q

Spina bifida occulta

A

no herniation - course patch of hair over defect

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18
Q

Spina bifida meningocele

A

herniation of meninges

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19
Q

Spina bifida meningomyelocele

A

meninges & nerve root herniation -> neuro deficits

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20
Q

Major motion of Lumbar spine?

A

Flexion/extension

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21
Q

L5 SB influences the sacrum by

A

engaging the oblique axis on the same side

22
Q

L5 Rotation influences the sacrum by

A

causing the sacrum to rotate opposite

23
Q

Lumbosacral angle (Ferguson’s angle) is formed by

A

intersecting horizontal line & the line of inclination of the sacrum

24
Q

Lumbosacral angle (Ferguson’s angle) is normally

A

25-35

25
Q

Lumbosacral angle (Ferguson’s angle) when increased can cause

A

shear stress -> low back pain

26
Q

Acute low back pain causes

A

fracture, strain, disc herniation, infection (osteomyelitis, meningitis), referred pain

27
Q

Lumbosacral SD - HPI

A

muscle spasm, ache in low back, butt, or posterolateral thigh that increases in pain w/ activity, prolonged sitting or standing

28
Q

Herniated Nucleus Pulposus

A

narrow posterior longitudinal ligament allows herniation -> pressure on nerve root of vertebrae below

29
Q

Most common location for Herniated Nucleus Pulposus

A

L4-L5, L5-S1 IV discs

30
Q

Herniated Nucleus Pulposus - HPI

A

low back & leg numbness/tingling w/ sharp, burning, shooting pain down leg, worse w/ flexion

31
Q

Herniated Nucleus Pulposus - PE

A

weak reflexes w/ associated nerve root, +Straight leg raise

32
Q

Herniated Nucleus Pulposus - Tx

A

Indirect, gentle direct, (HVLA is contraindicated)

33
Q

Psoas Syndrome

A

prolonged shortened psoas or psoas spasm, organic causes as well

34
Q

Organic causes of Psoas Syndrome

A

appendicitis, sigmoid colon dysfunction, ureteral calculi, ureter dysfunction, metastatic carcinoma of the prostate, salpingitis

35
Q

Psoas Syndrome - HPI

A

back pain radiating to groin, ache or muscle spasm that worsens w/ walking or standing

36
Q

Psoas Syndrome - PE

A

+Thomas test, +PSS to contralateral side, contralateral piriformis spasm

37
Q

Lumbar findings with Psoas Syndrome

A

non-neutral L1 or L2 dysfunction

38
Q

Tender point findings w/ Psoas Syndrome

A

tender point medial to ASIS

39
Q

Psoas Syndrome - Tx

A

ice, CS, ME, HVLA, only stretch chronic psoas SD

40
Q

Spinal stenosis

A

degenerative changes including hypertrophy of facet joints, Ca2+ deposits in ligamentum flavum or posterior longitudinal ligament, loss of IV disc height

41
Q

Spinal stenosis - HPI

A

low back, butt shooting pain or paresthesias, worsened by extension

42
Q

Spondylolisthesis

A

fractured pars interarticularis + anterior displacement

43
Q

Spondylolisthesis common locations

A

L4 or L5

44
Q

Spondylolisthesis - HPI

A

back/butt pain, worsened with extension

45
Q

Spondylolisthesis - PE

A

tight hamstrings, short strides, +Vertebral Step-Off Sign (obvious forward displacement)

46
Q

Spondylolysis

A

fractured pars interarticularis w/o anterior displacement

47
Q

Spondylolysis - imaging

A

collar on the neck of the Scotty dog

48
Q

Spondylosis

A

degenerative changes w/in intervertebral disc & ankylosing

49
Q

Cauda Equina Syndrome

A

massive central disc herniation compressing nerve roots

50
Q

Cauda Equina Syndrome - HPI

A

saddle anesthesia, decreased DTR, decreased rectal sphincter tone

51
Q

Cauda Equina Syndrome - Tx

A

emergent surgical decompression

52
Q

L4/L5 IV disc herniation would compress which nerve root?

A

L5

COMLEX - OMED (20 decks)

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