Chapter 4 Lumbar Spine

Question 1

Reason why lumbar spine is more susceptible to disc herniation?

Answer 1

Narrowing of posterior longitudinal ligament

Question 2

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

Answer 2

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

Question 3

Location of where spinal cord terminates?

Answer 3

L1-2

Question 4

Location of where nerve roots exit in lumbar spine?

Answer 4

Below corresponding vertebrae, but above the IV disc

Question 5

Origin of iliopsoas m?

Answer 5

T12-L5 vertebral bodies

Question 6

Insertion of iliopsoas m?

Answer 6

Lesser trochanter

Question 7

Erector spinae mm from lateral to medial?

Answer 7

Iliocostalis, Longissimus, Spinalis (I Love Spine)

Question 8

Level of iliac crest?

Answer 8

L4-L5

Question 9

T10 dermatome at umbilicus is anterior to which IV disc?

Answer 9

L3-L4

Question 10

Most common anomaly in lumbar spine?

Answer 10

Facet trophism–predisposes to early degenerative changes

Question 11

What is facet trophism?

Answer 11

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

Question 12

What is sacralization?

Answer 12

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

Question 13

What is lumbarization?

Answer 13

Failure of fusion of S1 with other sacral segements

Question 14

What is spina bifida?

Answer 14

Defect in closure of limina of vertebral segment

Question 15

3 types of spina bifida?

Answer 15

Occulta, meningocele, meningomyelocele

Question 16

Alignment of lumbar facets?

Answer 16

Backward and medial for superior facets

Question 17

Major motion of lumbar spine?

Answer 17

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

Question 18

Sidebending of L5 will cause what sacral motion?

Answer 18

Sacral oblique axis will be engaged on same side

Question 19

Rotation of L5 will cause what sacral motion?

Answer 19

Sacrum will rotate toward opposite side

Question 20

Ferguson’s angle?

Answer 20

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

Question 21

98% of disc herniations occur where?

Answer 21

Between L4-5 or L5-S1

Question 22

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

Answer 22

L5 (the nerve root below)

Question 23

Positive test seen in disc herniation?

Answer 23

Straight leg raising test

Question 24

What is relatively CI in herniation?

Answer 24

HVLA

Question 25

OMT for herniation?

Answer 25

Initially indirect techniques, then gentle direct

Question 26

Positive test seen in psoas syndrome?

Answer 26

Thomas test

Question 27

Tender point seen in psoas syndrome?

Answer 27

Medial to ASIS

Question 28

Dysfunctions seen in psoas syndrome?

Answer 28

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

Question 29

When do you stretch psoas m in psoas syndrome?

Answer 29

Chronic spasms

Question 30

OMT for psoas syndrome?

Answer 30

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

Question 31

Causes of spinal stenosis?

Answer 31

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

Question 32

Radiology for spinal stenosis?

Answer 32

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

Question 33

What is spondylolisthesis?

Answer 33

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

Question 34

Where does spondylolisthesis occur?

Answer 34

L4 or L5

Question 35

What are the neuro deficits in spondylolisthesis?

Answer 35

None

Question 36

What is a positive vertebral step-off sign?

Answer 36

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

Question 37

S/S of spondylolisthesis?

Answer 37

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

Question 38

Goal of tx for spondylolisthesis?

Answer 38

Reduce lumbar lordosis and somatic dysfunction

Question 39

What is CI in spondylolisthesis?

Answer 39

HVLA

Question 40

Grading for spondylolisthesis?

Answer 40

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

Question 41

What is spondylolysis?

Answer 41

Defect of pars interarticularis WITHOUT anterior displacement of vertebral body

Question 42

Radiology for spondylolysis?

Answer 42

Scotty dog on oblique view--fracture of pars interarticularis

Question 43

What is spondylosis?

Answer 43

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

Question 44

How do you dx spondylolisthesis vs. spondylolysis?

Answer 44

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

Question 45

Cause of cauda equina syndrome?

Answer 45

Massive central disc herniation

Question 46

S/S of cauda equina syndrome?

Answer 46

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

Question 47

Result of delay in surgery for tx cauda equina?

Answer 47

Irreversible paralysis