Lumbar Spine

Question 1

What percentage of the general population will experience low back pain (LBP) at some time in their lives?

Answer 1

80 percent.

Question 2

Neurofibromatosis

Answer 2

heredity disorder (autosomal dominant trait) that produces pigmented spots and pedunculate soft-tissue nodules clustered along nerve sheaths.

Question 3

Neurofibromatosis nodules develop:

Answer 3

during childhood, growing to more than .5 cm in size. throughout life they can reach 1.5 cm or more in size

Question 4

Café-Au-Lait patches

Answer 4

seen over the trunk, pelvis, and flexor creases of the elbows and knees

Question 5

Neurofibromatosis bone changes may result in:

Answer 5

skeletal deformities: scoliosis, vertebral body scalloping, fibrous dysplasia, tibial pseudoarthosis, sphenoid bone deformity, mental impairment, seizures, hearing loss, exophthalamos, decreased visual acuity and GI bleeding

Question 6

Gibbus deformity:

Answer 6

sharp kyphosis in the lower thoracics, affecting the normal lordosis of the lumbar spine

Question 7

Top of the iliac crest is followed towards the midline of the spine at what level?

Answer 7

L4-L5 interspinous space (usually, may vary by individual)

Question 8

A palpable or visible step off from one process to another may indicate what?

Answer 8

spondyloslsthesis

Question 9

a pars interarticularis defect indicates what?

Answer 9

spondylolysis (seen on oblique x-ray)

Question 10

Spondylolytic spondyloslisthesis:

Answer 10

a unilateral or bilateral defect in the pars interarticularis with anterior or posterior displacement of a vertebrae on the adjacent lower vertebrae.

Question 11

What scale is used to measure spondylolistehesis?

Answer 11

Meyerding’s Scale. Ranges from grade 1-grade 4. The grades represent 25 percent of the measurement of the sacrum to L5

Question 12

The articulations between 2 consecutive lumbar vertebrae form three joints:

Answer 12

1) the two vertebral bodies and the IVD
2 & 3) formed by the articulation of the superior articular process of one vertebra and the inferior articular process of the vertebra above

Question 13

The umbilicus lies at what disc level?

Answer 13

L3-L4

Question 14

Anterior portions of the vertebral bodies are covered by what?

Answer 14

ALL (anterior longitudinal ligament)

Question 15

Primary function of the zygapophyseal joint?

Answer 15

to protect the motion segment from anterior shear forces, excessive rotation, and flexion

Question 16

Anterior Longitudinal Ligament (ALL):

Answer 16

from sacrum along the anterior aspect of the entire spinal column, becoming thinner as it ascends.

Question 17

Posterior Longitudinal Ligament (PLL):

Answer 17

Found throughout the spinal column where it covers the posterior aspect and the IVD

Question 18

Ligamentum Flavum:

Answer 18

Connects 2 consecutive laminae

Question 19

Interspinous Ligament:

Answer 19

connects 2 consecutive spinal processes

Question 20

Supraspinous ligament

Answer 20

connects the tips of two adjacent spinous processes

Question 21

Iliolumbar ligament:

Answer 21

functions to restrain flexion, extension, axial rotation and side bending of L5-S1

Question 22

Pseudoligaments:

Answer 22

interetransverse, transforaminal, and mamillo-accessory, resemble the membranous part of the fascial system separating paravertebral compartments and do not have any mechanical function.

Question 23

Quadratus lumborum:

Answer 23

lumbar spine stabilizer

Question 24

Lumbar multifidus:

Answer 24

lumbar segmental stability. provides segmental stiffness and controls motion

Question 25

erector spinae:

Answer 25

composed of iliocostalis lumborum and throacic longissimus

Question 26

thoracolumbar fascia:

Answer 26

assists the transmission of extension forces during lifting activities, stabilizes the spine against anterior shear and flexion moments

Question 27

psoas muscles:

Answer 27

takes origin from anterior portion of T12-L5 vertebral bodies and discs. (main hip flexor) pain from psoas access increases when hip is actively flexed

Question 28

Sciatic Nerve

Answer 28

largest nerve in the body, gives off braces to the hamstrings and then divides into 2 terminal braces : tibial and peroneal divisions

Question 29

Sciatic nerve palpation:

Answer 29

midpoint between ischial tuberosity and the greater trochanter. Disc pathology or space-occupying lesion can cause the nerve to be tender.

Question 30

A disc is named after the vertebrae ____:

Answer 30

above.

Question 31

A disc pathology affects the nerve root ____:

Answer 31

below. i.e.: an L4 disc pathology affects the L5 nerve root.

Question 32

Disc pathologies: Protrusion:

Answer 32

little pieces of the nucleus pulposus protrude into the annular fibers and weaken them.

Question 33

Disc pathologies: Prolapse (Bulge):

Answer 33

nucleus pops out of the annular fibers. fibers not torn, just stretched.

Question 34

Disc pathologies: extrusion (herniation):

Answer 34

fibers torn, nucleus bursts into PLL, PLL is torn, patient describes shredding noise

Question 35

disc pathologies: sequestration:

Answer 35

multiple pieces of the nucleus are in the spinal canal.

Question 36

L4 muscle testing and reflex:

Answer 36

Muscle test: foot dorsiflexion and inversion: tibias anterior (deep peroneal nerve) L4 reflex= patellar reflex

Question 37

L4 dermatome:

Answer 37

medial leg, behind the medial malleolus and along the medial side of the foot and great toe

Question 38

L5 muscle testing and reflex:

Answer 38

foot dorsiflexion
big toe dorsiflexion: extensor helices longus (deep peroneal nerve), toes 2, 3, 4 dorsiflexion: extensor digitorum longs and brevis (deep peroneal nerve), hip and pelvis abduction: gluteus medium and minimum (superior gluteal nerve)

L5 Reflex= there is no reflex for this nerve root level.

Question 39

L5 dermatome:

Answer 39

lateral aspect of the leg, anterior to the lateral malleolus, dorsum of the foot and the middle three toes (2,3,4)

Question 40

S1 muscle testing:

Answer 40

foot plantar flexion: gastrocnemius and soleus (tibial nerve), foot plantar flexion and eversion: peroneus longus and braves (superficial peroneal nerve), hip extension: gluteus maximus (inferior gluteal nerve)

Question 41

S1 reflex:

Answer 41

achilles reflex

Question 42

S1 sensation:

Answer 42

posterior aspect of the leg, lateral aspect of the foot, and lateral aspect of the little toe

Question 43

Nerve supply to the lumbar spine:

Answer 43

outer half of the IVD innervated by sinuvertebral nerve and the gray rami communicants. posterior lateral aspect innervated by both sinuvertebral and gray rami. Lateral aspect receives only sympathetic innervation.

Question 44

zygapophyseal joints are innervated by what:

Answer 44

medial branches of dorsal rami

Question 45

Motion at lumbar spine joints:

Answer 45

sagittal (flexion/extension), coronal (side bending), and transverse (rotation).. 6 degrees of freedom are available at the lumbar spine.

Question 46

most flexion and extension occurs:

Answer 46

in the lower segmental levels

Question 47

most side bending occurs:

Answer 47

mid-lumbar area

Question 48

rotation occurs:

Answer 48

rotation occurs with side bending as a coupled motion. it’s minimal, and occurs most at the lumbosacral junction

Question 49

Flexion:

Answer 49

produces a combination of an anterior roll and an anterior glide of the vertebral body, and a straightening of the lordosis. (at l4-l5, reversal of the lordosis may occur but at the l5-s1 level the joint will straighten, not reverse unless there is a pathology)

Question 50

Extension:

Answer 50

involves a posterior roll and glide of the vertebra, a posterior inferior motion of the zyg. joints but not a change in the degree of lordosis.

Question 51

axial rotation:

Answer 51

about 13 degrees to both sides. about 5 degrees occurs at the L5-S1 segment

Question 52

physical examination of the lumbar spine:

Answer 52

must include thorough assessment of neuromuscular, vascular and orthopedic systems of the hip, lower extremities, low back and pelvic region

Question 53

Active ROM:

Answer 53

involves fully functional contractile and inert tissues and optimal neurological function. QUALITY of motion and symptoms provokes is more important than the quantity of motion.

Question 54

Acute Phase intervention goals:

Answer 54

decrease pain, inflammation and muscle spasm, promote healing of tissues, increase pain-free ROM, regain soft tissue extensibility, regain neuromuscular control, allow progression to the functional stage

Question 55

Functional phase intervention goals:

Answer 55

correction of imbalances of strength and flexibility, incorporate neuromuscular re-education, strengthening of entire kinetic chain, postural correction and retraining, initiate and execute functional activities without pain and while dynamically stabilizing the spine in an automatic manner.