Chapter 4 - Lumbar Flashcards
Why are disc herniations more common in the lower lumbar region?
posterior longitudinal ligament narrows -> weakness in the posteriolateral aspect of the IV disc
Where do thoracic & lumbar nerve roots exit the spinal column?
Below its corresponding vertebra (L4 exits b/w L4/L5)
Spinal cord terminates at which level
L1-L2
Muscle of the lumbar spine
Erector spine group (spinals, longissimus, iliocostalis), multifidus, rotatores, quadratus lumborum, iliopsoas (psoas major & iliacus)
Erector spine group
spinals, longissimus, iliocostalis (“SILO”)
iliopsoas origin
T12-L5
iliopsoas insertion
lesser trochanter of femur
iliopsoas action
hip flexor, maintaining lumbosacral angle
iliopsoas dysfunction
prolonged shortening of mm -> PSS, +Thomas test, SD in upper lumbars
Iliac crest level
L4-L5 IV disc
Umbilicus level
L3-L4 IV disc
Most common anomaly of the lumbar spine
Facet trophism
Facet trophism
asymmetry of the facet joint angles (should align w/ sagittal plane (Backward, Medial), but align w/ coronal plane)
Sacralization
1 or both TPs of L5 articulate w/ the sacrum
Lumbarization
failure of S1 to fuse w/ sacrum
Spina bifida
defect in the closure of the lamina
Spina bifida occulta
no herniation - course patch of hair over defect
Spina bifida meningocele
herniation of meninges
Spina bifida meningomyelocele
meninges & nerve root herniation -> neuro deficits
Major motion of Lumbar spine?
Flexion/extension
L5 SB influences the sacrum by
engaging the oblique axis on the same side
L5 Rotation influences the sacrum by
causing the sacrum to rotate opposite
Lumbosacral angle (Ferguson’s angle) is formed by
intersecting horizontal line & the line of inclination of the sacrum
Lumbosacral angle (Ferguson’s angle) is normally
25-35
Lumbosacral angle (Ferguson’s angle) when increased can cause
shear stress -> low back pain
Acute low back pain causes
fracture, strain, disc herniation, infection (osteomyelitis, meningitis), referred pain
Lumbosacral SD - HPI
muscle spasm, ache in low back, butt, or posterolateral thigh that increases in pain w/ activity, prolonged sitting or standing
Herniated Nucleus Pulposus
narrow posterior longitudinal ligament allows herniation -> pressure on nerve root of vertebrae below
Most common location for Herniated Nucleus Pulposus
L4-L5, L5-S1 IV discs
Herniated Nucleus Pulposus - HPI
low back & leg numbness/tingling w/ sharp, burning, shooting pain down leg, worse w/ flexion
Herniated Nucleus Pulposus - PE
weak reflexes w/ associated nerve root, +Straight leg raise
Herniated Nucleus Pulposus - Tx
Indirect, gentle direct, (HVLA is contraindicated)
Psoas Syndrome
prolonged shortened psoas or psoas spasm, organic causes as well
Organic causes of Psoas Syndrome
appendicitis, sigmoid colon dysfunction, ureteral calculi, ureter dysfunction, metastatic carcinoma of the prostate, salpingitis
Psoas Syndrome - HPI
back pain radiating to groin, ache or muscle spasm that worsens w/ walking or standing
Psoas Syndrome - PE
+Thomas test, +PSS to contralateral side, contralateral piriformis spasm
Lumbar findings with Psoas Syndrome
non-neutral L1 or L2 dysfunction
Tender point findings w/ Psoas Syndrome
tender point medial to ASIS
Psoas Syndrome - Tx
ice, CS, ME, HVLA, only stretch chronic psoas SD
Spinal stenosis
degenerative changes including hypertrophy of facet joints, Ca2+ deposits in ligamentum flavum or posterior longitudinal ligament, loss of IV disc height
Spinal stenosis - HPI
low back, butt shooting pain or paresthesias, worsened by extension
Spondylolisthesis
fractured pars interarticularis + anterior displacement
Spondylolisthesis common locations
L4 or L5
Spondylolisthesis - HPI
back/butt pain, worsened with extension
Spondylolisthesis - PE
tight hamstrings, short strides, +Vertebral Step-Off Sign (obvious forward displacement)
Spondylolysis
fractured pars interarticularis w/o anterior displacement
Spondylolysis - imaging
collar on the neck of the Scotty dog
Spondylosis
degenerative changes w/in intervertebral disc & ankylosing
Cauda Equina Syndrome
massive central disc herniation compressing nerve roots
Cauda Equina Syndrome - HPI
saddle anesthesia, decreased DTR, decreased rectal sphincter tone
Cauda Equina Syndrome - Tx
emergent surgical decompression
L4/L5 IV disc herniation would compress which nerve root?
L5