Exam 2: Lumbars Flashcards by Marissa Kline

Lumbar spine is largely responsible for

Trunk mobility

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Inferior articular processes are ____ and face ____

Convex; anterolaterally

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Orientation of inferior articular processes

AIL

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Superior articular processes are ___ and face ____

Concave; posteromedially

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Lumbar facets lie primarily in

Sagittal plane

Coronal at lumbosacral jxn

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Sagittal facet configuration limits _____

Rotational flexibility

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Sagittal facet configuration allows for greater mobility in

Flexion and extension

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L1-L4 facets have ___ orientation and limit ____

Sagittal; axial rotation (thetaY)

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L5-S1 facets have ___ orientation and limit _____

Coronal; P/A shear (z translation)

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Lumbar facets normally carry ____% of axial load and up to ___% in extension

18% normally; 33% in extension

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Primary movement in lumbar spine

Flexion/extension

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___% of trunk Flex/ext occurs in lumbar spine

75%

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Lumbar spine exhibits ___ times as much flexion as extension

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Lateral bending is coupled w/

Axial rotation

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Spinous rotates to ___ side

Ipsilateral side

EXCEPT it may switch at L4/5

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Nucleus pulposus in lumbar IVD are oriented

Posteriorly

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Disc height to body height ratio =

1:3

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The ratio gives disc greater

Resistance to axial compressive forces

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Lumbar spinal canal contains/protects _____ proximally and the ____ distally

Lumbar enlargement (conus medullaris) proximally; cauda equina w/ spinal nerves distally

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CNS is tethered to coccyx by

Filum terminale

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Is the dural sac and its contents freely mobile?

No, Hoffman ligs stabilize them

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Lumbar lordotic curve is a ____ curve

Secondary

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Lumbar curve starts to develop

9-12 months of age (beginning to sit up)

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Apex of lumbar curve

L3-4 disc

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Normal lumbar lordosis should be ____ degrees

20-60 degrees

Sacral base angle increases with ant pelvic tils which results in

Inc in lumbar lordosis, and mor weight-bearing responsibility on facets

Sacral base angle dec w/ a posterior pelvic tilt which results in

Dec in lumbar lordosis, and more weight on disc Dec in spines ability to absorb axial compression forces

Major stabilizer of L spine

Quadratus lumborum

QL is most active during

Heavy lifts (74%) Isometric lateral bending (54%) Standing isometric twists (42%)

ALL/PLL in lumbar spine restrict

Flexion/extension

This ligament provides stability by preventing excess motion btw vertebrae

Ligamentum flavum

Lumbodorsal fascia acts like a large

Extensor retinaculum: constrains long tendons of T/L extensors

Interspinous ligament controls what movement

Rotation Also guards against posterior shear

Supraspinous ligament provides resistance against

Excessive forward flexion

Facet capsule restricts

Joint flexion and distraction of facet surfaces

Trauma causes ligament damage which causes _____

Joint laxity

Joint ____ follows joint laxity

Degeneration

Percent of adults that will experience low back pain sometime in their lives

80%

Back pain ranks second to ___ as most frequent location for pain

Headaches

Poor and constrained posture can lead to

LBP and muscle fatigue Inc, asymmetric disc pressure Stress/irritation of facet/ligaments

Most pressure on disc is in what position

Forward flexed (less than 80 degrees btw trunk and legs)

Extension increases

Tensile force at ant annulus Loading/compression of posterior facets

Flexion increases

Posterior annulus tensile forces Inc in AP shear on posterior facets

Static sitting/standing is concerning because of

Fatigue mechanisms

Human body requires movement to

Nourish structures (nucleus pulposus and IVD)

Dangers of sustained static posture

Creates stress at posterior annulus and PLL Stress at posterior facet damages hyaline cartilage

Recommendations to reduce static compressive forces

Alternate sitting and standing Change 20-30 minutes w/ 2 mins of movement in between

Spondylolisthesis is a defect of the

Pars interarticularis

Pars fractures are from

Posterior shear force to inf articular process Repeatedly alternating flex/ext

Spondylolisthesis definition

Anterior displacement of vertebra

Spondys are usually at what level

L5 (67%)

Overall incidence of spondys

5-7% Higher in males

Type I Spondy

Congenital | Abnormal neural arch

Type II Isthmic Spondy

Defect of pars interarticularis (stress fracture)

Isthmic spondy are MC in _____ patients and typically occurs at ____

Younger; L5

Type III degenerative spondy

Segmental instability secondary to advanced DDD

Degenerative spondy MC in ____ patients and typically occur at ___

Older; L4

Type IV Traumatic spondy

Fracture of neural arch, NOT pars interarticularis

Type V pathologic spondy

Osseous deformity secondary to pathology

Spondylolysthesis Grade I

0-25% slippage

Spondy grade II

26-50% slippage

Grade III

51-75%

Grade IV

76-100% slippage

Grade V

Spondyloptisis (VB falls of VB below it)

Burst fractures

Comminuted VB fractures, disruption of A and P walls

Burst fractures cause severe neurological problems from

Retropulsion of bone into spinal canal

Burst fractures result from high-energy axial load

Traffic collisions Falls w/ great height/speed Seizures

Fracture type w/ compression of Ant and middle column, posterior column intact

Burst

Type of fracture w/ anterior column intact, middle and posterior columns w/ distraction

Chance