Chapter 4 Lumbar Spine Flashcards
Reason why lumbar spine is more susceptible to disc herniation?
Narrowing of posterior longitudinal ligament
Comparison of posterior longitudinal ligament at L1 and at L4-5?
Is 1/2 the width at L4-5 than at L1
Location of where spinal cord terminates?
L1-2
Location of where nerve roots exit in lumbar spine?
Below corresponding vertebrae, but above the IV disc
Origin of iliopsoas m?
T12-L5 vertebral bodies
Insertion of iliopsoas m?
Lesser trochanter
Erector spinae mm from lateral to medial?
Iliocostalis, Longissimus, Spinalis (I Love Spine)
Level of iliac crest?
L4-L5
T10 dermatome at umbilicus is anterior to which IV disc?
L3-L4
Most common anomaly in lumbar spine?
Facet trophism–predisposes to early degenerative changes
What is facet trophism?
Lumbar facet joints are aligned in coronal plane (instead of sagittal)
What is sacralization?
TPs of L5 are long and articulate with sacrum–predisposes to early degenerative changes
What is lumbarization?
Failure of fusion of S1 with other sacral segements
What is spina bifida?
Defect in closure of limina of vertebral segment
3 types of spina bifida?
Occulta, meningocele, meningomyelocele
Alignment of lumbar facets?
Backward and medial for superior facets
Major motion of lumbar spine?
Flexion and extension (small degree of SB, limited rotation)
Sidebending of L5 will cause what sacral motion?
Sacral oblique axis will be engaged on same side
Rotation of L5 will cause what sacral motion?
Sacrum will rotate toward opposite side
Ferguson’s angle?
Lumbosacral angle–formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)
98% of disc herniations occur where?
Between L4-5 or L5-S1
A herniation bt L4-5 will exert pressure on which nerve root?
L5 (the nerve root below)
Positive test seen in disc herniation?
Straight leg raising test
What is relatively CI in herniation?
HVLA
OMT for herniation?
Initially indirect techniques, then gentle direct
Positive test seen in psoas syndrome?
Thomas test
Tender point seen in psoas syndrome?
Medial to ASIS
Dysfunctions seen in psoas syndrome?
Nonneutral dysfunction of L1-2, positive pelvic shift test to contralateral side, sacral dysfunction on an oblique axis, and contralateral piriformis spasm
When do you stretch psoas m in psoas syndrome?
Chronic spasms
OMT for psoas syndrome?
Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction
Causes of spinal stenosis?
Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height
Radiology for spinal stenosis?
Osteophytes and decreased IV disc space, foraminal narrowing on oblique views
What is spondylolisthesis?
Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis
Where does spondylolisthesis occur?
L4 or L5
What are the neuro deficits in spondylolisthesis?
None
What is a positive vertebral step-off sign?
Palpating the spinous process there is an obvious forward displacement at the area of listhesis
S/S of spondylolisthesis?
Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait
Goal of tx for spondylolisthesis?
Reduce lumbar lordosis and somatic dysfunction
What is CI in spondylolisthesis?
HVLA
Grading for spondylolisthesis?
1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%
What is spondylolysis?
Defect of pars interarticularis WITHOUT anterior displacement of vertebral body
Radiology for spondylolysis?
Scotty dog on oblique view–fracture of pars interarticularis
What is spondylosis?
Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies
How do you dx spondylolisthesis vs. spondylolysis?
Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray
Cause of cauda equina syndrome?
Massive central disc herniation
S/S of cauda equina syndrome?
Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control
Result of delay in surgery for tx cauda equina?
Irreversible paralysis
