Lumbar Spine Flashcards
the last rib articulates with what rib?
t12
what XR view of the spine evaluates the pars interarticularis?
oblique
loss of disc space height on XR evaluates for what etiology?
DDD
stiffness after inactivity indicates what general type of lumbar spine pathology?
spondylosis
pain with spinal extension / rotation indicates what etiology of pain?
spondylosis
synovitis around the facet joint can compress what structure?
neuroforamina
narrowing of joint space and sclerosis is indicative of what type of spine pathology?
spondylosis
what are the grades of spondylolisthesis?
Grades 1-IV
what XR views should you get to evaluate for lumbar spondylolisthesis?
flex/extend views
how much segmental motion is considered significant displacement in spondylolisthesis?
3mm or greater
what nerve roots make up the sciatic nerve?
L4-S2
what nerve root provides motor innervation to the iliopsoas?
L3
what nerve root level provides motor innervation to the tibialis anterior?
L4
what nerve root provides sensory innervation to the dorsolateral thigh?
L5
medial branches of the spinal nerves innervate what two structures?
facet joint and multifidus muscles
what is the only true lateral flexor of the L-spine?
quadratus lumborum
what is the primary type of collagen in the nucleus pulposus?
type II collagen
what is the type of collagen that predominantly comprises the annulus fibrosus?
type I collagen
t/f the pain from a foraminal disc herniation can be worse with lumbar spine extension
true
what is the Kirkaldy-Willis Degenerative cascade of the lumbar spine?
the natural course of the interrelationship between disc and facet joint degeneration/instability/stenosis
generally, what are the two types of intervertebral disc herniations?
protrusion and extrusion
what is the difference between protrusion and extrusion?
protrusion - base is larger than amount of disc material
extrusion - base is smaller than amount of disc material
what is the most common zone for disc herniation?
subarticular zone, just off midline anterior to the facet joint
in a paramedian disc herniation, what nerve root is most likely to be affected?
the nerve root beneath the level of the herniation
what is the typical MOI of annular fissure?
flexion combined with rotation
what is the most common etiology of facet syndrome?
OA
in a foraminal disc herniation, what nerve root is most likely to be affected?
exiting nerve root at the level of the disc
t/f there is no consensus on the correct imaging for spondylolysis and oblique views have fallen out of favor
true
how does spondylolysis start?
stress reaction
other than bracing and physical therapy, what other modality has the potential to improve radiographic healing in spondylolysis?
bone stimulator
what is the primary issue that generates pain at the SIJ?
hypermobility of the joint
t/f there is no definitive diagnostic test for piriformis syndrome and it is actually very rare
true
instead of piriformis syndrome, what is the preferred term for this pain pattern?
deep gluteal syndrome
what is the rehab protocol with the most evidence for addressing lumbar spine pathologies with a directional preference?
mechanical diagnosis and therapy (MDT)
what type of intervention injection for facet mediated pain has the most evidence?
medial branch block
what is the difference between radiculitis and radiculopathy?
radiculitis - pain down a dermatome
radiculopathy - pain with weakness or abnormal reflex(es)
t/f facet joint pain can cause pain down a portion of the leg
true
a paramedian disc herniation occurring at the L4-L5 level is most likely to cause nerve root involvement at what level?
L5
what is the incidence of piriformis syndrome in a patient with buttocks pain with intermittent radicular symptoms?
6-8%
T1 weighted images emphasize what type of tissue?
fat / adipose
T2 weighted immages highlight what material?
water
what ligament of the spine is located at the inner margins of the lamina?
ligamentum flavum
what is the name for the degenerative end plate changes resulting from disc height loss and osseous changes?
Modic changes
which portion of the annulus is most prone to tearing?
posterolateral
what type of annulus tear is typically more likely to be symptomatic?
radial tear
t/f circumferential or transverse annular tears are often not associated with clinical symptoms
true
what are the three zones of nerve impingement?
- lateral recess (medial to the pedicle)
- foraminal
- extraforaminal
