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GM Biomechanics > Exam 2: Lumbar Spine > Flashcards

Exam 2: Lumbar Spine Flashcards

1
Q

What are the main responsibilities of the lumbar spine

A

Bears large loads, used for powerful muscle actions, trunk mobility, significant biomehcanical needs

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2
Q

What are the characteristics of lumbar facets

A

Thick large and strong

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3
Q

The inferior articular processes of lumbars are ____ and face _____

A

Convex; anterolaterally

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4
Q

The superior articular processes of the lumbars are ____ and face ____

A

Concave; posteromedially

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5
Q

Lumbar facets lie primarily in what plane

A

Sagittal, becoming more coronal at lumbosacral joint

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6
Q

What is a developmental abnormality where one facet faces sagitally and the other facet faces coronally and where is it mc

A

Facet tropism mc L5-S1 then L4-L5

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7
Q

Facet configuration in the lumbars limits ____ and allows for greater _____

A

Limits rotational flexibility and allows for greater mobility in flexion and extension

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8
Q

Which lumbar facets have sagittal orientation and limit axial rotation (theta Y)

A

L1-L4 facets

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9
Q

Which facets are in a coronal orientation and limit posterior/anterior shear (z translation)

A

L5-S1 facets

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10
Q

The lumbar facets normally carry ___ of axial load and up to ____ in extension

A

18%; 33%

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11
Q

What is the primary movement in l/s

A

Flexion/extension

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12
Q

What percentage of trunk flexion/extension takes place in l/s

A

75%; twice as much flexion as extension

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13
Q

What is limited due to sagittal facet orientation

A

Axial rotation

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14
Q

Lateral bending is controlled primarily by what

A

Eccentric activity of the QL

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15
Q

Normal muscular activity leads to spinous processes rotation toward what

A

Side of lateral extension, spinous to ipsilateral side can switch at L4/L5

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16
Q

The nucleus of lumbar IVD are localized somewhat _____ in the disc

A

Posteriorly

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17
Q

What is the disc height to body height ratio of the lumbar IVD

A

1:3

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18
Q

The ratio of 1:3 in the lumbars allow more movement than ____ but less than ____ and gives the disc greater resistance to ____

A

T/s; c/s; axial compressive forces

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19
Q

Lumbar spinal canal contains enlargement of spinal cord proximally called what

A

Conus medularis and the cauda equina with spinal nerves distally

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20
Q

CNS is tethered to the coccyx by what

A

Filum terminale

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21
Q

Where does the spinal cord end

A

L2

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22
Q

After the spinal cord ends the nerve roots continue down the spinal canal as what

A

Cauda equina

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23
Q

Nerve roots in lumbars exit the dura how

A

Slightly above the foraminal opening

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24
Q

What does the exit of the nerve roots at the dura cause

A

Causes their course to be more oblique and length to increase

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25
Q

When does the secondary lumbar lordotic curve begin to develop

A

Starts developing 9-12 months of age/beginning to sit up

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26
Q

When does the secondary lumbar lordotic curve become established

A

When learning to stand at about 18 months

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27
Q

Where is the apex of the lumbar lordotic curve

A

L3/L4 disc

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28
Q

Normal lumbar lordosis should be how many degrees

A

20-60 degrees

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29
Q

Changes in the sacral base angle can influence the depth of what

A

A-P curves in the spine

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30
Q

Sacral base angle increase with what

A

Anterior pelvic tilt

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31
Q

Anterior pelvic tilt increases the sacral base angle and causes lumbar lordosis, and weight bearing responsibilities how

A

Increases the lumbar lordosis which places more weight bearing responsibility on the facets

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32
Q

The sacral base angle decreases with what

A

With posterior pelvic tilt

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33
Q

Posterior pelvic tilt causes a decrease in the sacral base angle resulting in what impact on lumbar lordosis and weight bearing responsibilities

A

Results in decrease in the lumbar lordosis placing more weight bearing responsiblity on the disc and decreases the spines ability to absorb axial compressive forces

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34
Q

What is the major stabilizer of the L/s

A

The quadratus lumborum

35
Q

When is the QL most active

A

During heavy lifting but is active in flex/extend, and lateral bend

36
Q

Identify when the QL is more active between heavy lifts, isometric lateral bending holds, during standing isometric twists

A

Heavy lifts> isometric lateral bend holds > during standing isometric twists

37
Q

What ligaments restrict excessive flexion/extension

A

ALL/PLL

38
Q

What ligament is highly elastic and acts as a barrier to material that would otherwise enncroach on the cord during range of motion

A

Ligamentum flavum

39
Q

What ligament acts like a larger extensor retinaculum to constrain long tendons of thoracic and lumbar extensors

A

Lumbodorsal fascia

40
Q

What ligament acts like a collateral ligament and controls vertebral rotation to follow an arc through flexion range, also assist facet to remain in contact with rotation

A

Interspinous

41
Q

What ligament guards against posterior shear

A

Interspinous

42
Q

What ligament provides resistance against excessive forward flexion

A

Supraspinous

43
Q

What well developed ligament restricts joint flexion, restricts distraction of facet surfaces during axial rotation

A

Facet capusle

44
Q

What is the cascade of ligament damage

A

Trauma causes damage leading to laxity leading to joint degeneration

45
Q

Which is more resistant to compressive forces: IVD or posterior facets

A

IVD = 80% resist of axial force, posterior facets = 10% of axial forces

46
Q

What loading causes a symmetric stress distribution on the IVD

A

Eccentric loading

47
Q

How much increase is there in resistance to axial forces in flexion and extenion in posterior facets

A

Increase 5x in flexion, incrreases 3x in extension

48
Q

There is significant increase in disc pressure with what type of sitting

A

Straightened or flexed sitting

49
Q

What motion increases tensile force at the anterior annulus and increases loading and compression of the posterior facets with a 3x increase in posterior facet compression forces

A

Extension

50
Q

What motion increase posterior annulus tensile forces and decreases the spines ability to absorb axial compression and 5x increase in A-P shear on the posterior facets

A

Flexion

51
Q

What motion decreases disc inhibition and metabolism, reduces disc height and increases annulus stress, increases mechanical load to posterior joints

A

Static loading

52
Q

What causes a spondylolisthesis

A

Defect of the pars interarticularis

53
Q

Spondylolisthesis fracture may come from repeatedly alternating flexion and extension movements especially what

A

Hyper extension

54
Q

Who and where is spondylolisthesis likely to occur

A

Usually at L5 in males

55
Q

What spondy is developmental abnormality of neural arch resulting in deformity and anterior vertebral dispalcement

A

Congenital

56
Q

What spondy class is a defect in pars interarticularis (stress fx) mc in younger paitents at L5

A

Isthmic

57
Q

What type of spondy has segmentally instability secondary to advanced DDD and posterior DJD, mc in older patients (women over 60 esp) and typically occurs at L4

A

Degenerative

58
Q

What type of spondy class is an acute fix involving neural arch but NOT pars interarticularis

A

Traumatic

59
Q

What spondy type is an osseous deformity secondary to local or systematic pathology (pagets mets, osteoporosis)

A

Pathologic

60
Q

What grades of spondy can we adjust

A

Grades 1/2

61
Q

What is the grading system of spondy’s called

A

Meyerding grading system

62
Q

How much movement means instability in a spondy

A

> 3.5 mm of movement in flexion/extension

63
Q

What fracture is a comminuted vertebral body fracture with disruption of the anterior and posterior walls of the VB

A

Burst fracture

64
Q

What does a burst fracture cause

A

Sever neuro problems from retropulsion of bone into spinal canal

65
Q

What causes a burst fracture

A

Results from high energy axial load like trafffic collision, high falls, seizures somtimes

66
Q

What type of complex is the pelvic joint

A

3 joint complex

67
Q

What type of joint is the SI

A

Mobile synovial joints

68
Q

What do pelvic joints do

A

Support trunk, guide movement, help absorb the compressive forces with locomotion/weight bearing

69
Q

Surface contours of the pelvis develop into what

A

Interlocking elevations and depressions

70
Q

What type of effect does the pelvis produce on the sacrum

A

Keystone effect distributing axial compressive forces

71
Q

At birth what are the joints of the SI like

A

Undeveloped, smooth, flat

72
Q

After ____ the SI joint begins to take their adult characteristics

A

Ambulation

73
Q

In the teen years what happens to the SI

A

The joint surfaces begin to roughen and develop characteristic grooves/ridges

74
Q

In later year what pateints will have interarticular adhesions across the SI joints and have lost SI joint motion

A

Mostly males

75
Q

When is the SI joints most activw

A

Locomotion in flex/extend along with hip joint

76
Q

As the left innominate moves posteriorly/inferiorly the left sacral base moves how

A

Anteriorly/inferiorly (nutation)

77
Q

As the right innominate moves anteriorly/superiorly, the sacral base moves how

A

Posteriorly and superiorly (counternutation)

78
Q

The proposed axes of motion in the SI articulation allow what type of movement

A

Gyroscopic figure 8 movement

79
Q

Is the SI joint crossed by muscle

A

No

80
Q

What contributes to the strength of the joint capusle at SI and ligaments

A

The different muscles near the SI providing stability not mobility

81
Q

What is the function of muscle at the SI

A

Not to generate motion but function as brace for the area and create stability for effective load transfer

82
Q

What happens to theta x when saccrum apex goes posterior

A

Nutation = flexion malposition

83
Q

What happens to theta x when saccrum base goes posterior

A

Counternutation = extension malposition

GM Biomechanics (5 decks)

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