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SPINE/MARCIE > LUMBAR SPINE > Flashcards

LUMBAR SPINE Flashcards

1
Q

localized L3 px is where

A

knee

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2
Q

Describe localized T9 px

A

btwn the medial iliac crests

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3
Q

localized L4 px

A

abdominal or testicular area

or band around the ankle

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4
Q

localized L5 px

A

general upper lumbar

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5
Q

L5/S1 localized px

A

coccyx or medial buttocks

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6
Q

deep, vague ache to buttock…think what kind of px

A

discogenic

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7
Q

Anterior thigh pain, pain signals enter above L2, referred pain to anterior groin/ thigh)

A

lower lumbar disc

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8
Q

px at PSIS is usually from

A

lumbar region issues

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9
Q

neurogenic px for L1 goes where

A

above the iliac crest or at groin

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10
Q

neurogenic px for L2

A

across the iliac crest anterior proximal thigh

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11
Q

neurogenic px L3

A

below the iliac crest/ above the greater trochanter anterior-medial aspect of distal thigh/ anterior-medial lower leg

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12
Q

neurogenic px L4

A

across the greater trochanter anterior-lateral thigh/ anterior-medial distal leg/ hallux

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13
Q

neurogenic px L5

A

across the ischial tuberosity Lateral thigh/ lateral distal leg/ dorsum of foot/ middle 3 toes

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14
Q

neurogenic px S1

A

medial to the ischial tuberosity posterior thigh/ posterior lower leg/ lateral foot and toe 5

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15
Q

neurogenic px S2

A

saddle area or medial heel

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16
Q

diverticulitis viserogenic px is where

A

left lower quadrant, low pack pain/ pelvic pain; can refer to hip/ thigh with abscess formative

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17
Q

Affects ages of 40-60+years
Pain is usually bilateral
Occurs in calf (foot, thigh, hip, or buttocks)
NO burning or dysethesia
Pain consistent in all spinal positions
Pain is brought on by physical exertion, relieved promptly by rest (1-5 min)
Pain is increased by walking uphill
Decreased or absent pulses in LE
Color and skin changes in feet; cold, numb, dry, or scaly skin; and poor nail and hair growth

A

intermittent claudication (vascular claudication of LS plexus)

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18
Q

A disorder of the elderly

Pain is usually bilateral and occurs in back, buttocks, thighs, calves, and feet

Burning and numbness present in LE
Pain is decreased in spinal flexion and increased in spinal extension and with walking

Pain is decreased by recumbency (walking uphill)

Pain is relieved with prolonged rest (may persist hours after resting)

Normal pulses

A

spinal stenosis

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19
Q

3 parts to a lumbar vert

A

body
pedicle
post elements

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20
Q

the function of the body of the vertebrate

A

WB - compression

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21
Q

3 main parts of the post elements

A

lamina
pars
mamillary process

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22
Q

what is the lamina

A

bony protective covering over neural contents

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23
Q

significance of mammillary process

A

where multifidi attach

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24
Q

nucleus of the IVD resists what force

A

comprssion

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25
Q

nucleus is type __ collagen

A

2

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26
Q

anulus fibrosis is type ___ collagen

A

1

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27
Q

anulus resists what type of force

A

tensile forces

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28
Q

function of IVD

A

transmit force btwn bodies

aid in proprioception

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29
Q

with distraction, what fibers of AF are effected

A

ALL with distraction

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30
Q

with shearing forces, what fibers of AF are effected

A

only those in the line of force

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31
Q

optimal stimulus for regeneration of AF is

A

rotation

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32
Q

optimal stimulus for regeneration of NP is

A

compression/decompression

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33
Q

where the end plates don’t cover the AF, but rather the AF fibers insert in to the bone of the body of the vertebrae is called

A

sharpey fibers

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34
Q

the principal WB of lumbar spine is the ___joints

A

interbody

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35
Q

function of facet joints (or zygoapophaseal joints)

A

locking to prevent anterior translation

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36
Q

optimal stimulus to regenerate facet joints

A

compress/decompress

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37
Q

PLL and LF resists lumbar

A

flexion

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38
Q

ALL resists

A

lumbar ext

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39
Q

what also resists lumbar ext

A

bony spinous processess

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40
Q

what limits rotation

A

liggs and facet joints

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41
Q

area on body where there is no movement of neural tissue as other tissues move

A

tension point

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42
Q

during a side bend, the ___ side of the joint closes and the ___ side opens

A

ipsi closes

contra opens

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43
Q

facets of L1-L4 are vertically oriented, so this facilitates __ and __

A

flexion and ext

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44
Q

what motion is limited for L1-L4

A

rotation and side bending

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45
Q

facets of L5 and S1 resist what motions

A

flexion and ext

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46
Q

in neutral spine, what motions are coupled

A

SB and Rot are opposite

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47
Q

in extended spine, what motions are coupled

A

SB and Rot are opp

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48
Q

in flexed spine what motions are coupled

A

SB and rot are SAME

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49
Q

quadrant movement is

A

combined (not natural)

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50
Q

so in ext combined/quadrand movement is

A

SB and rot are same

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51
Q

IDD means

A

internal disc disruption

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52
Q

tearing of AF through the end plate can lead to extrusion. before this occurs, the pt often has

A

schmorls nodes at that location

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53
Q

primary MOI of a lumbar disc injury would be what motions

A

repetitive lifting or bending with rotation in a neutral spine

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54
Q

avulsion fxs are due to

A

lack of anchoring of AF fibers

55
Q

if disc materials migrate out of of the annular fibers it is considered

A

EDD

56
Q

type of disc disorder where the fissures occur inside out (IDD)

A

transverse radial

57
Q

which will have pos tension signs, IDD or EDD

A

EDD

58
Q

where is radicular px for L1

A

groin and above iliac crest

59
Q

where is radicular px for L2

A

ant proximal thigh and at iliac crest

60
Q

where is radicular px for L3

A

below iliac crest and medial distal thigh

61
Q

where is radicular px for L4

A

hallux and GT

62
Q

where is radicular px for L5

A

dorsum of foot and middle toes and IT

63
Q

where is radicular px for S1

A

lateral foot and 5th toe and medial to IT

64
Q

radicular px for S2/S3

A

saddle and medial ankle

65
Q

hallux radicular area is which lumbar vert again

A

L4 hallux

66
Q

order of severity of HNP

A

TLE (protrusion, prolapse, extrusion)

67
Q

2 types of prolapse

A

central - PLL just irritated

PPL (primary, post lat) - goes outside of PLL

68
Q

extrusion is so severe bc

A

it ruptures PLL

69
Q

“sick disc” unstable

A

extrusion

70
Q

if pt c/o sensory sx first think

A

primary dorsal root with secondary disc

71
Q

if pt c/o motor sx first think

A

primary disc 2ndary ventral root

72
Q

type of stenosis where there is loss of disc ht

the spinal canal encroaches around the nerve

A

lateral

73
Q

pt will present with px where for DDD/DJD

A

B LBP

74
Q

age fro DDD/DJD

A

55-60 ish

75
Q

what relieves px for DDD/DJD

A

unloading the joint (laying down)

76
Q

typically, do DJD/DDD pts have hx of episodes

A

yes

77
Q

is neurodynamic testing feasible for DDD/DJD

A

no

78
Q

what form of assessment is a must for DDD/DJD

A

central PA (pushing on spinous processes with heel of hand to assess mvmt)

79
Q

IDD/EDD typical age

A

20-40

80
Q

IDD Presents with px where

A

local unilateral

81
Q

what relieves px for IDD EDD

A

unloading the joint (like DDD/DJD)

82
Q

are neurodynamic tests pos or neg for IDD EDD

A

neurodynamic tests are pos for EDD only

83
Q

what motion increases px with IDD EDD

A

flexion

84
Q

reporting pulling like a tight string is an ex of

A

adverse neurodynamic (extraneural)

85
Q

primary way to injure an IVD is

A

repetitive mvmt

rotation while not in neutral

86
Q

avulsion fxs occur dt

A

inadequate anchoring of the AF

87
Q

avulsion usually occurs with what population

A

younger pts

88
Q

circumferential tear of AF at the endplate is

A

schmorls node

89
Q

px where is common with avulsion fx

A

leg px

90
Q

when annulus migrates through the AF

A

EDD

91
Q

type of IDD fissure that is circumferential

A

concentric delamination

92
Q

nerve root lesions that are lateral, the pt shifts to which side

A

opp

93
Q

nerve root lesions that are medial, pt shifts to which side

A

same

94
Q

two types of adverse neurodynamics

A

extraneural and intraneural

95
Q

sitting in prolonged lordosis bothers what pathologies

A

DDD/DJD/ IDD/EDD

96
Q

describe location of px with a protrusion

A

bilateral paravertebral px, may go into buttock but breaks up at leg (not complete dermatomal pattern)

97
Q

describe location of px with prolapse

A

prolapse- px in leg and lumbar and in complete dermatome pattern

98
Q

describe px with extrusion

A

leg and lumbar in full/complete dermatome pattern.

may take over entire limb and be poly sectional

99
Q

with a PPL disc issue, the px is usually where

A

px is not in lumbar, but rather it is all leg

100
Q

protrusion or prolapse has fast onset

A

prolapse

101
Q

will neurodynamic testing (SLR or slump) be pos for disc with nerve root involvement

A

yes

102
Q

what type of disc issues would yield pos neuro exam findings

A

prob not protrusion or central

but PPL and extrusion would

103
Q

shoulder lesion is

A

lateral shift to opp

104
Q

axillary lesion is

A

medial shift to same

105
Q

S2 is level of

A

PSIS

106
Q

unilateral leg px with patchy dermatome pattern

extension hurts and standing hurts but flexion feels better

A

lateral stenosis

107
Q

differentiate btwn px location of lateral and central stenosis

A

lateral - patchy dermatomal pattern

central -many segments and bilateral px (back and leg)

108
Q

there is often a loss of ___ with stenosis

A

reflexes

109
Q

stenosis has pos or neg neuro tests

A

pos

110
Q

with facet issue, are neuro tests pos or neg

A

neg

111
Q

facet px is

A

local px (can refer, but not radiating)

112
Q

what causes px for facet joint

A

standing

decreases with sitting

113
Q

what test is always pos for facet

A

quadrant

114
Q 
sharp px with sudden movment
reports of weak or giving way feeling
px increases during the day
no neuro sx
unilateral px
ab muscle activation decreases sx
A

instability

115
Q

protrusion vs prolapse

A

protrusion - Displacement of nuclear material beyond inner annulus causing bulge in outer annulus without escape of nuclear material (outer annulus is intact).

prolapse - Displacement of nuclear material beyond inner annulus WITH ESCAPE of nuclear material

116
Q

injury or deficit to pars is which spondy

A

spondylolysis

117
Q

Anterior slippage and inability to resist shear forces relative to the vertebra below.

A

spondylolithsthesis (top vert slips forward)

118
Q

segmental levels of tension points

A

C6, T6, L4

119
Q

when a pt shifts to a side, you name the shift by

A

direction of the shoulders

120
Q

differences btwn stenosis and vascular claudication

A

stenosis- px decreases uphill
claudication -px increases uphill (px comes on with physical exertion)

stenosis- burning
claudication - no burning

stenosis - normal pulses
claudication -decreased pulses

121
Q

px with 3d movement is indicative of issues at the_____

A

facet

122
Q

antlike, dry, woody, dragging, electricity, crawling

A

intraneural adverse neurodynamics

123
Q

whiplash or some form of invasive trauma predisposes a pt to

A

neurodynamic adverse sx

124
Q

observing a pt and seeing knee flexed indicates

A

they are trying to take neural tension off sx

125
Q

double crush syndrome

A

added effect on the neural sx (increased down the chain)

126
Q

what is axoplasmic flow

A

flow of nutrients in the nervous sx (if altered it can cause double crush syndrome)

127
Q

with stenosis, does flexion or ext feel better

A

stenosis - flexion feels better

ext or standing is pxful

128
Q

what do you have to rule out with stenosis

A

vascular claudication

129
Q

which has sx of burning px, vascular claudication or stenosis

A

stenosis

130
Q

facet pts are usually around what age

A

60-70

131
Q

facet px refers to where

A

buttock or post thigh

132
Q

with facet, which hurts worse, standing or sitting

A

standing

133
Q

which conditions are episodic

A

DDD/DJD EDD/IDD Disc

instability can be

134
Q

what are the lumbar spine disorders

A 
flexion
ext
rot
rot with flex
rot with ext

SPINE/MARCIE (3 decks)

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