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Savarese > Chapter 4 Lumbar Spine > Flashcards

Chapter 4 Lumbar Spine Flashcards

1
Q

Reason why lumbar spine is more susceptible to disc herniation?

A

Narrowing of posterior longitudinal ligament

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2
Q

Comparison of posterior longitudinal ligament at L1 and at L4-5?

A

Is 1/2 the width at L4-5 than at L1

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3
Q

Location of where spinal cord terminates?

A

L1-2

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4
Q

Location of where nerve roots exit in lumbar spine?

A

Below corresponding vertebrae, but above the IV disc

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5
Q

Origin of iliopsoas m?

A

T12-L5 vertebral bodies

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6
Q

Insertion of iliopsoas m?

A

Lesser trochanter

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7
Q

Erector spinae mm from lateral to medial?

A

Iliocostalis, Longissimus, Spinalis (I Love Spine)

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8
Q

Level of iliac crest?

A

L4-L5

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9
Q

T10 dermatome at umbilicus is anterior to which IV disc?

A

L3-L4

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10
Q

Most common anomaly in lumbar spine?

A

Facet trophism–predisposes to early degenerative changes

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11
Q

What is facet trophism?

A

Lumbar facet joints are aligned in coronal plane (instead of sagittal)

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12
Q

What is sacralization?

A

TPs of L5 are long and articulate with sacrum–predisposes to early degenerative changes

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13
Q

What is lumbarization?

A

Failure of fusion of S1 with other sacral segements

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14
Q

What is spina bifida?

A

Defect in closure of limina of vertebral segment

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15
Q

3 types of spina bifida?

A

Occulta, meningocele, meningomyelocele

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16
Q

Alignment of lumbar facets?

A

Backward and medial for superior facets

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17
Q

Major motion of lumbar spine?

A

Flexion and extension (small degree of SB, limited rotation)

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18
Q

Sidebending of L5 will cause what sacral motion?

A

Sacral oblique axis will be engaged on same side

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19
Q

Rotation of L5 will cause what sacral motion?

A

Sacrum will rotate toward opposite side

20
Q

Ferguson’s angle?

A

Lumbosacral angle–formed by intersection of a horizontal line and the line of inclination of the sacrum (25-35 degrees)

21
Q

98% of disc herniations occur where?

A

Between L4-5 or L5-S1

22
Q

A herniation bt L4-5 will exert pressure on which nerve root?

A

L5 (the nerve root below)

23
Q

Positive test seen in disc herniation?

A

Straight leg raising test

24
Q

What is relatively CI in herniation?

A

HVLA

25
Q

OMT for herniation?

A

Initially indirect techniques, then gentle direct

26
Q

Positive test seen in psoas syndrome?

A

Thomas test

27
Q

Tender point seen in psoas syndrome?

A

Medial to ASIS

28
Q

Dysfunctions seen in psoas syndrome?

A

Nonneutral dysfunction of L1-2, positive pelvic shift test to contralateral side, sacral dysfunction on an oblique axis, and contralateral piriformis spasm

29
Q

When do you stretch psoas m in psoas syndrome?

A

Chronic spasms

30
Q

OMT for psoas syndrome?

A

Counterstrain to anterior iliopsoas tenderpoint followed by ME/HVLA to high lumbar dysfunction

31
Q

Causes of spinal stenosis?

A

Hypertrophy of facet joints, Ca deposits within ligamentum flavum and posterior longitudinal l, loss of IV disc height

32
Q

Radiology for spinal stenosis?

A

Osteophytes and decreased IV disc space, foraminal narrowing on oblique views

33
Q

What is spondylolisthesis?

A

Anterior displacement of one vertebrae in relation to one below due to fractures in the pars interarticularis

34
Q

Where does spondylolisthesis occur?

A

L4 or L5

35
Q

What are the neuro deficits in spondylolisthesis?

A

None

36
Q

What is a positive vertebral step-off sign?

A

Palpating the spinous process there is an obvious forward displacement at the area of listhesis

37
Q

S/S of spondylolisthesis?

A

Pain with extension-based activities, tight hams b/l, stiff-legged, short stride, waddling gait

38
Q

Goal of tx for spondylolisthesis?

A

Reduce lumbar lordosis and somatic dysfunction

39
Q

What is CI in spondylolisthesis?

A

HVLA

40
Q

Grading for spondylolisthesis?

A

1 = 0-25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%

41
Q

What is spondylolysis?

A

Defect of pars interarticularis WITHOUT anterior displacement of vertebral body

42
Q

Radiology for spondylolysis?

A

Scotty dog on oblique view–fracture of pars interarticularis

43
Q

What is spondylosis?

A

Radiological term for degenerative changes within IV disc and ankylosing of adjacent vertebral bodies

44
Q

How do you dx spondylolisthesis vs. spondylolysis?

A

Spondylolisthesis = lateral x-ray; sponylolysis = oblique x-ray

45
Q

Cause of cauda equina syndrome?

A

Massive central disc herniation

46
Q

S/S of cauda equina syndrome?

A

Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel/bladder control

47
Q

Result of delay in surgery for tx cauda equina?

A

Irreversible paralysis

Savarese (31 decks)

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