Lumbar Spine Flashcards
Most common site of disc herniation
L5-S1 or L4-L5
Posterior longitudinal ligament most narrow
Level of spinal cord termination
L1-L2
Becomes cauda equina
LPs
Body of L4 is at the level of the iliac crest
aim for L3-L4 or L4-L5 for LPs
Iliolumbar ligament
Connects TP of L4 and L5 with iliac crest
refers pain to groin area
Supraspinal ligament
between L5-S1 always tender
Major motion of L Spine
Flexion and extension - due to orientation of superior facets (BM)
Erector spinae group
“I love spaghetti” lateral to medial
Iliocostalis
Longissimus
Spinalis
Iliospoas
primary flexor of hip
Originates T12 - L5 vertebral bodies
Inserts lesser trochanter of femur
Maintains lumbosacral angle (Ferguson’s angle) - normally 25-35 degrees
L5 on S1
example L5 N SrRl
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
Facet (zygopophyseal) trophism
asymmetry of facet joint angles - more closely aligned to coronal plane (backwards)
predisposes to early degenerative changes
Sacralization
One or both TPs of L5 articulate w/ the sacrum
-> early disc degeneration
Bat-wing on XR
Lumbarization
failure of fusion of S1 to other sacral segments
less common
Spina bifida occulta
no herniation through defect
patch of hair over site
rarely assoc w/ neuro deficits
Spina bifida meningocele
herniation of the meninges through the defect
Spina bifida meningomyelocele
herniation of the meninges and nerve roots through the defect
assoc with neurological deficits
Positive straight leg raise
radicular pain above 30-35 degrees
Herniated nucleus pulposus
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
Psoas Syndrome (flexion contracture of iliopsoas)
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
Spondylolisthesis
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
Spondylolysis
oblique view XR shows fracture of pars interarticularis w/o anterior displacement
“collar” on neck of scotty dog
95% at L5
Spondylosis
degenerative changes w/in intervertebral disc and ankylosing of adjacent vertebral bodies
Cauda Equina syndrome
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
