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DIT OMM > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

Most common site of disc herniation

A

L5-S1 or L4-L5

Posterior longitudinal ligament most narrow

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2
Q

Level of spinal cord termination

A

L1-L2

Becomes cauda equina

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3
Q

LPs

A

Body of L4 is at the level of the iliac crest

aim for L3-L4 or L4-L5 for LPs

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4
Q

Iliolumbar ligament

A

Connects TP of L4 and L5 with iliac crest

refers pain to groin area

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5
Q

Supraspinal ligament

A

between L5-S1 always tender

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6
Q

Major motion of L Spine

A

Flexion and extension - due to orientation of superior facets (BM)

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7
Q

Erector spinae group

A

“I love spaghetti” lateral to medial

Iliocostalis
Longissimus
Spinalis

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8
Q

Iliospoas

A

primary flexor of hip

Originates T12 - L5 vertebral bodies
Inserts lesser trochanter of femur

Maintains lumbosacral angle (Ferguson’s angle) - normally 25-35 degrees

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9
Q

L5 on S1

example L5 N SrRl

A

L5 pins down sacrum
Sidebending of L5 causes sacral oblique axis to engage on same side
Rotation of L5 will cause sacrum to rotate toward the opposite side

Example: L5 N SrRl

L5 SB right will set sacral axis to that side = right oblique axis

Will cause it to rotate toward opposite side. L5 rotated left will cause sacrum to rotate right

result of L5 N SrRl will be a right on right forward sacral torsion

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10
Q

Facet (zygopophyseal) trophism

A

asymmetry of facet joint angles - more closely aligned to coronal plane (backwards)

predisposes to early degenerative changes

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11
Q

Sacralization

A

One or both TPs of L5 articulate w/ the sacrum

-> early disc degeneration

Bat-wing on XR

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12
Q

Lumbarization

A

failure of fusion of S1 to other sacral segments

less common

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13
Q

Spina bifida occulta

A

no herniation through defect
patch of hair over site
rarely assoc w/ neuro deficits

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14
Q

Spina bifida meningocele

A

herniation of the meninges through the defect

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15
Q

Spina bifida meningomyelocele

A

herniation of the meninges and nerve roots through the defect

assoc with neurological deficits

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16
Q

Positive straight leg raise

A

radicular pain above 30-35 degrees

17
Q

Herniated nucleus pulposus

A

most between L4-L5 or L5-S1

Herniated disc in lumbar region exerts pressure on nerve root of the vertebrae below (herniate L4-L5 affects L5 nerve root)

Numbness/tingling w/ sharp, burning or shooting pain down leg, worse with flexion of L-spine

S/S: weakness and decreased reflexes assoc w/ nerve root, sensory deficit over dermatome
Positive straight leg test

MRI gold standard

Tx conservatively

OMT - indirect initially followed by gentle direct

HVLA relatively contraindicated

18
Q

Psoas Syndrome (flexion contracture of iliopsoas)

A

prolonged positions that shorten psoas, r/o other causes

LBP radiating to groin
aching pain, muscle spasm

S/S: increased pain w/ standing or walking, positive Thomas test, tender point medial to ASIS

nonneutral dysfunction of L1 or L2
Hypertonic psoas
Backward sacral torsion
Contralateral pelvis shift
Contralateral piriformis spasm

Treat L1/L2 first
Ice not heat at first
Counterstrain anterior iliopsoas tender point first then ME or HVLA to high lumbar dysfunction
Only stretch chronic psoas spasms

19
Q

Spondylolisthesis

A

Anterior displacement, usually due to fractures of pars interarticularis of the vertebrae

LBP, buttock, or posterior thigh pain - ache

Increased pain w/ extension
tight hamstrings b/l
Stiffed legged, short stride, waddling type gait
Positive vertebral step off sign

Tx: conservative, HVLA contraindicated
wt loss, avoid high heels, avoid flexion based exercises

Grade 1: 0-25 percent
Grade 2: 25-50 percent
Grade 3: 50-75 percent
Grade 4: over 75 percent slippage

20
Q

Spondylolysis

A

oblique view XR shows fracture of pars interarticularis w/o anterior displacement

“collar” on neck of scotty dog

95% at L5

21
Q

Spondylosis

A

degenerative changes w/in intervertebral disc and ankylosing of adjacent vertebral bodies

22
Q

Cauda Equina syndrome

A

pressure on nerve roots of cauda equina
-massive central disc herniation, mets

Sharp low back pain

Saddle anesthesia, decreased DTRs, decreased rectal sphincter tone, loss of bowel and bladder control

Surgical emergency, risk of irreversible paralysis

DIT OMM (18 decks)

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