Chapter 4 - Lumbar

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

Spinal cord terminates at which level

Answer 3

L1-L2

Question 4

Muscle of the lumbar spine

Answer 4

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

Question 5

Erector spine group

Answer 5

spinals, longissimus, iliocostalis (“SILO”)

Question 6

iliopsoas origin

Answer 6

T12-L5

Question 7

iliopsoas insertion

Answer 7

lesser trochanter of femur

Question 8

iliopsoas action

Answer 8

hip flexor, maintaining lumbosacral angle

Question 9

iliopsoas dysfunction

Answer 9

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

Question 10

Iliac crest level

Answer 10

L4-L5 IV disc

Question 11

Umbilicus level

Answer 11

L3-L4 IV disc

Question 12

Most common anomaly of the lumbar spine

Answer 12

Facet trophism

Question 13

Facet trophism

Answer 13

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

Question 14

Sacralization

Answer 14

1 or both TPs of L5 articulate w/ the sacrum

Question 15

Lumbarization

Answer 15

failure of S1 to fuse w/ sacrum

Question 16

Spina bifida

Answer 16

defect in the closure of the lamina

Question 17

Spina bifida occulta

Answer 17

no herniation - course patch of hair over defect

Question 18

Spina bifida meningocele

Answer 18

herniation of meninges

Question 19

Spina bifida meningomyelocele

Answer 19

meninges & nerve root herniation -> neuro deficits

Question 20

Major motion of Lumbar spine?

Answer 20

Flexion/extension

Question 21

L5 SB influences the sacrum by

Answer 21

engaging the oblique axis on the same side

Question 22

L5 Rotation influences the sacrum by

Answer 22

causing the sacrum to rotate opposite

Question 23

Lumbosacral angle (Ferguson’s angle) is formed by

Answer 23

intersecting horizontal line & the line of inclination of the sacrum

Question 24

Lumbosacral angle (Ferguson’s angle) is normally

Answer 24

25-35

Question 25

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

Answer 25

shear stress -> low back pain

Question 26

Acute low back pain causes

Answer 26

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

Question 27

Lumbosacral SD - HPI

Answer 27

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

Question 28

Herniated Nucleus Pulposus

Answer 28

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

Question 29

Most common location for Herniated Nucleus Pulposus

Answer 29

L4-L5, L5-S1 IV discs

Question 30

Herniated Nucleus Pulposus - HPI

Answer 30

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

Question 31

Herniated Nucleus Pulposus - PE

Answer 31

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

Question 32

Herniated Nucleus Pulposus - Tx

Answer 32

Indirect, gentle direct, (HVLA is contraindicated)

Question 33

Psoas Syndrome

Answer 33

prolonged shortened psoas or psoas spasm, organic causes as well

Question 34

Organic causes of Psoas Syndrome

Answer 34

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

Question 35

Psoas Syndrome - HPI

Answer 35

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

Question 36

Psoas Syndrome - PE

Answer 36

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

Question 37

Lumbar findings with Psoas Syndrome

Answer 37

non-neutral L1 or L2 dysfunction

Question 38

Tender point findings w/ Psoas Syndrome

Answer 38

tender point medial to ASIS

Question 39

Psoas Syndrome - Tx

Answer 39

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

Question 40

Spinal stenosis

Answer 40

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

Question 41

Spinal stenosis - HPI

Answer 41

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

Question 42

Spondylolisthesis

Answer 42

fractured pars interarticularis + anterior displacement

Question 43

Spondylolisthesis common locations

Answer 43

L4 or L5

Question 44

Spondylolisthesis - HPI

Answer 44

back/butt pain, worsened with extension

Question 45

Spondylolisthesis - PE

Answer 45

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

Question 46

Spondylolysis

Answer 46

fractured pars interarticularis w/o anterior displacement

Question 47

Spondylolysis - imaging

Answer 47

collar on the neck of the Scotty dog

Question 48

Spondylosis

Answer 48

degenerative changes w/in intervertebral disc & ankylosing

Question 49

Cauda Equina Syndrome

Answer 49

massive central disc herniation compressing nerve roots

Question 50

Cauda Equina Syndrome - HPI

Answer 50

saddle anesthesia, decreased DTR, decreased rectal sphincter tone

Question 51

Cauda Equina Syndrome - Tx

Answer 51

emergent surgical decompression

Question 52

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

Answer 52

L5