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Spinal Tx 600 > Lumbar > Flashcards

Lumbar Flashcards

1
Q

How many facet joints in lumbar spinal segments?

A

Five pairs

Apophyseal or zyoapophyseal (facet)

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2
Q

What direction do lubar facets face?

A

Superior: medial and posterior
Inferior: lateral and anterior

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3
Q

Which movements are limited by facet joints

A

Side flexion
Flexion
Extension

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4
Q

Relationship between lumbar TVPs and SPs

A

Same level

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5
Q

Lumbar joints: Capsular pattern

A

Side flexion = rotation, then extension

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6
Q

Degrees of AROM: lumbar flexion

A

40-60º

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7
Q

Degrees of AROM: lumbar extension

A

20-35º

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8
Q

Degrees of AROM: lumbar lateral flexion

A

15-20º

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9
Q

Degrees of AROM: Rotation

A

2-18º

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10
Q

Lumbar: IL side flexion increases pain; no radicular symptoms

A

Problem probably intra-articular (since muscles and ligaments relaxed)

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11
Q

Lumbar: IL side flexion increases pain and radicular symptoms

A

Likely disc protrusion lateral to nerve root

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12
Q

Lumbar: CL side flexion increases pain and radicular symptoms

A

Likely disc protrusion medial to nerve root

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13
Q

Lumbar: coupled movements

A

side flexion + rotation

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14
Q

Ligament unique to lumbar spine

A

Iliolumbar ligament
TVP of L5 to posterior ilium
Stabilizes L5, prevents anterior displacement

Commonly injured with flexion + twisting

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15
Q

Anterior longitudinal ligament

A

Occiput –> sacrum
Strongest ligament in body
Prevents hyperextension

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16
Q

Posterior longitudinal ligament

A

Occiput to sacrum
Anterior aspect of neural canal
Attaches to IVD but not vertebral bodies
Limits forward bending

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17
Q

Ligamentum flavum

A

Ant-inf border of superior lamina –> posterior border of inferior lamina
C2 –> S1
Most elastic tissue in the body
Prevents meninsci and synovial lining from being caught in articular joint surfaces

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18
Q

Intertransverse Ligaments

A

Limit lateral flexion and rotation

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19
Q

Interspinous ligaments

A

Go up and backwards, not up and forwards

–> allow for flexion but within control

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20
Q

Supraspinous ligaments

A

Connect aspices of spines C7-L4

Most superficial, most likely to sprain

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21
Q

Nuchal Ligament

A

Supraspinous ligament from C7–> occiput

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22
Q

Lumbar: Each nerve root is named for …

A

The vertebra above it.

Thoracic: same; Cervical: named for below

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23
Q

Two components of Intervertebral Discs

A

Nucleus pulposes

Annulus pulposes

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24
Q

Function of IVD

A
  1. shock absorption
  2. hold vertebrae together while allowing movement
  3. separate vertebrae into functional segments
  4. separate vertebrae to allow passage of nerve roots through intervertebral foramina
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25
Q

Lumbarization

A

Unfused S1 –> additional lumbar segment

Lower stability, increased mobility

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26
Q

Sacralization

A

Fused L5 –> additional sacral segment

Lower mobility, increased stability

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27
Q

Spondylosis

A

Degeneration of IVD

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28
Q

Spondylolysis

A

Defect in pars interarticularis

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29
Q

Spondylolisthesis

A

Forward displacement of one vertebral segment over another

30
Q

Retrolisthesis

A

Backwards displacement of one vertebra on another

31
Q

Motion segment

A

Facet joints + IVDs

32
Q

Four stages of disc herniation:

A
  1. protrusion
  2. prolapse
  3. extrusion
  4. sequestration
33
Q

Protrusion

A

Nucleus bulges without rupture of annulus fibrosus

34
Q

Prolapse

A

“Only outermost fibres of annulus contain nucleus” (I think it’s a big protrusion)

35
Q

Extrusion

A

Annulus is perforated and discal material moves into epidural space

36
Q

Sequestration

A

Formation of discal fragments from annulus and nucleus outside the disc proper

37
Q

Most common herniation locations

A

L4-5 (affects 5th lumbar nerve root)
then L5-S1 (affects first sacral root)
then L3-4

38
Q

Common presentation of disc herniation

A
    • few days after excessive activity or mild injury
    • aggravated by coughing, sneezing, reaching or stooping
    • lumbar muscle spasm –> decreased lordosis
    • lateral truck shift in standing
    • restricted active flexion and extension
39
Q

Most common herniation direction

A

Posterolateral

PLL prevents it from going directly posterior

40
Q

Herniation: Pain and position

A

Worse with sitting, lifting, twisting, bending, sustained posture

Morphs to severe pain radiating down one limb

Often better with extension

41
Q

Herniation: pain in anterolateral leg

A

L4

42
Q

Herniation: pain radiating to posterior foot

A

L5

43
Q

Cauda equina syndrome

A

Lesion affecting cauda equina

Loss of bladder and bowel function, saddle anaesthesis

44
Q

Schmorl’s Nodules

A

Herniations of nucleus pulposus into vertebral body

Results from direct vertical pressure

45
Q

Paresthesia

A

Pins and needles, burning

46
Q

Herniation vs Facet Lock

A

Herniation:
– immediate pain, posterior thigh, leg, foot, glutes,

Facet Lock

    • pain doesn’t go distal to knee
    • back may get locked into position
47
Q

Mechanical LBP

A

aka lumbago
Unilateral pain with no referral below knee
Possible strain, sprain, facet joint or SI joint problem

48
Q

Back/buttock pain.
Worse in flexion. Better with extension.
Stiff in am

A

Mechanical LBP

Likely disc involvement (minor herniation, spondylosis, sprain, strain)

49
Q

Back/buttock pain
Worse with extension/rotation
Better with flexion

A

Mechanical LBP

Likely facet joint involvement, strain

50
Q

Leg pain below knee
Myotomes affected, dermatome pain
Worse with flexion, better with extension

A

Nonmechanical LBP

Nerve root irritation – most likely herniation

51
Q

Leg pain below knee, maybe bilateral
Myotomes affected, dermatome pain
Pain with walking, better with rest

A

Neurogenic
intermittent claudication
Stenosis

52
Q

What refers pain to the low back?

A

Pancreatic tumours

53
Q

Looks mechanical, but DDx of disc involvement

A

Pain on standing, flexion
Improvement when walking
No muscle tenderness

54
Q

Normal lordotic curve

A

50º

55
Q

What happens to lumbar SPs during flexion

A

(Anterior roll, posterior glide)

Move further apart and posteriorly

56
Q

What happens to lumbar SPs during extension

A

(Posterior roll, anterior glide)

Move closer together and anteriorly

57
Q

Three grades of DDD

A
  1. dysfunctional
  2. unstable
  3. stabilization
58
Q

Dysfunctional DDD

A

Phase 1
Tearing around outer surface of annulus
Disc begins to shrink

59
Q

Unstable DDD

A

Phase 2
Joint loses strength
Continued tearing on horizontal axis of didsc
Cartilage degeneration

60
Q

Stabilization (DDD)

A

Phase 3
Surface of vertebral bodies above and below of IVD showing damage. Disc thin and fibrotic.
Formation of arthritic osteophytes (spurs)

61
Q

Constant ache

A

Inflammatory process, venous hypertension

62
Q

Pain on movement

A

Noxious mechanical stimulus (stretch, pressure, crush)

63
Q

Pain accumulates with activity

A

Repeated mechanical stress
Inflammation
DDD

64
Q

Pain increases with sustained posture

A

Muscle fatigue

Gradual tissue creep

65
Q

Latent nerve root pain

A

Movement has produced an acute and temporary neuropraxia

66
Q

IVD’s make up how much of the length of the vertebral column

A

20-25%

67
Q

Lumbar resting position

A

Between flexion and extension

68
Q

Lumbar close packed position

A

Full extension

69
Q

If lumbar lesion is medial to nerve root:

A

Patient may list to same side as lesion

Demonstrate pain during SLR of unaffected leg

70
Q

Most important signs of disc herniation

A

History
Decreased ROM
Neuro dynamic tests

Spinal Tx 600 (9 decks)

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