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PCM II Exam 1 > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

There are 5 lumbar vertebral bodies, which are wider and deeper than any other vertebra. What 2 features do lumbar vertebra lack which are found in either cervical or thoracic vertebrae?

A

Transverse foramina (found in cervicals)

Costal facets (found in thoracics)

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2
Q

What anatomical feature of lumbar vertebrae is located immediately beneath each vertebra, containing spinal nerve roots, recurrent meningeal nerves, and radicular blood vessels?

A

Intervertebral neural foramina

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3
Q

Intervertebral neural foramina are narrowed with extension as pedicles glide toward one another. What pathological conditions might cause narrowing of these foramina?

A 
Arthritis
Spurs
Hypertrophy of posterior longitudinal ligamnet
Herniation of nucleus pulposus
Tissue congestion/edema
Inflammation
Perineural edema
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4
Q

How are intervertebral discs named?

A

Named for vertebra above (e.g. below L2 = 2nd lumbar disc)

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5
Q

Intervertebral discs funciton to dissipate heavy loads. They consist in part of a _____ ____which is the soft mucoid central core, which is surrounded by the ____ _____ made up of concentric lamellae of collagenous fibers

A

Nucleus pulposus

Annulus fibrosis

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6
Q

Intervertebral discs are thicker anteriorly and thinner posteriorly. Why is this clinically significant?

A

Discs are more likely to herniate posteriorly

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7
Q

Where do lumbar nerve roots exit in relation to their named vertebrae?

A

Lumbar nerve roots exit below named vertebra

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8
Q

What nerve plexus provides sensory and motor info to lower extremity?

A

Lumbosacral plexus

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9
Q

______ = posterior element of lumbar spine that connects other posterior elements to the vertebral body and protects from significant disc herniations of the same vertebra

A

Pedicles

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10
Q

______ = posterior element of lumbar spine that are lateral projections that lie in the same horizontal plane as the spinous processes

A

Transverse processes

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11
Q

The inferior facets of lumbar vertebrae face _____, while superior facets face _______

The facets join to form _______ joints with the vertebral units above and below

A

Laterally; medially

Zygopophyseal

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12
Q

What is the most common lumbar congenital abnormality, occurring in 30% of patients?

A

Zygapophyseal joint tropism — articular pillars on one side of vertebral unit are twisted so plane of joint does not match that of other side. Assessed with asymmetric muscle tensions and altered spinal motions

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13
Q

What characteristics distinguish spinous processes of lumbar vertebrae from thoracic?

A

They are thick, quadrangular, and “spade-like” at the ends

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14
Q

The height of the iliac crests corresponds to what lumbar anatomical landmark?

A

The L4 spinous process

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15
Q

The spinal canal contains the dural tube, spinal cord, and origins of spinal nerves down to approximately ______ or ______ where the spinal cord ends. Below that point is the ______ and ______ of the spinal cord

A

L1-L2; L2-L3; cauda equina; filum terminalis

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16
Q

The lumbar spine is very mobile and thus predisposed to aches and pain. What are the major motions at the lumbar spine?

A

Flexion/extension

Sidebending and rotation

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17
Q

T/F: In the lumbar spine, sidebending and rotation are coupled motions (one cannot occur without the other)

A

True

[can be type 1 or type 2 mechanics]

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18
Q

What are some observations you can make in terms of patient posture while examining the lumbar spine?

A 
Slumped over
Erect stance
Asymmetry
Lumbar lordosis
Gait changes
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19
Q

What are some etiologies for slumped over posture while examining the lumbar spine?

A 
Psychiatric considerations — depression
Muscle spasm (e.g., psoas)
Reactive effort (relief of pressure from condition impinging on lumbar nerves in intervertebral foramen)
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20
Q

What are some etiologies for erect stance posture while examining the lumbar spine?

A

Protecting herniated disc or effects of spinal stenosis. Especially consider with muscular weakness, reflex changes, or muscle atrophy

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21
Q

How would you evaluate asymmetries while examining the lumbar spine? What are some etiologies for asymmetry?

A

Evaluate iliac crest heights, greater trochanter heights, asymmetric sacral sulci, and paravertebral muscle humping

Etiologies: short leg syndrome, sacral base unleveling, muscle spasm, scoliosis

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22
Q

What are some gait changes you might note while examining the lumbar spine?

A

“Listing” of trunk to one side
Antalgic or limping
Foot drop, hiking up hip, rotation of lower extremity
Shuffling or fenestrated gait

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23
Q

Etiologies of gait change: “listing” of trunk to one side

A

Disc herniation, muscle weakness — especially glut medius

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24
Q

Etiology of gait changes: foot drop, hiking up hip, rotating of lower extremity

A

Neuromuscular etiologies

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25
Q

Etiology of shuffling or fenestrated gait

A

Parkinson’s disease

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26
Q

What are some etiologies for tenderness to the spinous processes of lumbar vertebrae?

A

Fracture, dislocation, underlying infection, arthritis

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27
Q

What are some etiologies of “step-offs” palpated on lumbar spinous processes?

A

Spondylolisthesis (forward slippage of vertebra which may compress spinal cord)

28
Q

What are all aspects of your palpation exam of lumbar spine?

A

Spinous processes for tenderness and/or step-off

SI joint tenderness

Paravertebral muscles for tenderness and/or spasm

Sciatic n. tenderness

29
Q

Etiologies of SI joint tenderness

A

Sacroiliitis

Ankylosing spondylitis

30
Q

Etiologies of paravertebral muscle tenderness and/or spasm in lumbar region

A 
Degenerative/inflammatory MSK abnormalities
Overuse injury
Poor posture
Anxiety
Somatic dysfunction
31
Q

Herniated intervertebral discs, which occur most commonly at ____-____ or _____-_____ may produce tenderness of spinous processes, intervertebral joints, muscles, and/or nerves.

Low back pain may also be referred from the pelvis or abdomen.

A

L5-S1; L4-L5

32
Q

Palpation for sciatic nerve tenderness is done in the ____ position with the hip _____

A

Lateral recumbent; flexed

33
Q

The sciatic n. is the largest nerve in the body consisting of _____ nerve roots. It lies midway between the _____ and _______ (=sciatic notch)

A

L4-S3; greater trochanter; ischial tuberosity

34
Q

Etiologies of sciatic n. tenderness

A

Herniated disc or mass lesion impinging on contributing nerve roots

35
Q

It is important to inspect and evaluate overlying skin in lumbar region, as dermatologic conditions/rashes may occur with various conditions including infection, reactive processes, and spondyloarthropathies. What are some examples of skin changes you could see?

A

Birth marks, port-wine stains, lipomas

Patches of hair (spina bifida)

Cafe-au-lait spots, skin tags, or fibrous tumors (neurofibromatosis)

36
Q

Normal ROM for lumbar flexion

A

40-90

37
Q

Muscles involved in lumbar extension

A

Deep intrinsic back muscles

38
Q

Normal ROM of lumbar spine extension

A

20-45

39
Q

Muscles involved in lumbar rotation

A

Abdominal mm.

Intrinsic mm. of back

40
Q

Normal ROM for lumbar rotation

A

3-18

41
Q

Muscles involved in lumbar sidebending

A

Abdominal mm.

Intrinsic back mm.

42
Q

Normal ROM for lumbar sidebending

A

15-30

43
Q

Describe test, what is positive, what this indicates:

Straight Leg Raise (Lasegue) Test

A

Patient supine, passively flex pt’s ipsilateral hip with knee extended. Add dorsiflexion to increase dural tension in low lumbar and high sacral levels

+ test = presence or worsening of radicular pain radiating into ipsilateral leg, especially between 30-60 degrees and worse with dorsiflexion

Indicates: lumbosacral radiculopathy (usually from herniated disc) and/or sciatic neuropathy

44
Q

SLR is considered positive for lumbosacral radiculopathy between 30-60 degrees. What would a positive test mean at greater than 70 degrees vs. pain at around 15 degrees?

A

Positive signs at >70 is more likely mechanical LBP d/t muscle strain or joint disease

Pain laterally at >15 degrees could indicate IT band contracture

45
Q

Greater than 95% of disc herniations occur at what region of the spine? Why?

A

L5-S1 — spine angles sharply posterior

46
Q

What 2 signs/symptoms make diagnosis of sciatic 5x more likely?

A

Ipsilateral calf wasting

Weak dorsiflexion

47
Q

The diagnostic accuracy of the SLR test is limited by its low specificity (but high sensitivity) for dx of radiculopathy due to disc herniation. What additional test can be done to increase specificity?

A

Contralateral (crossed) SLR test

48
Q

Describe test, what is positive, what this indicates:

Contralateral (crossed) SLR test

A

Patient supine, passively flex patient’s contralateral hip with knee extended

+ test = presence or worsening of radicular pain radiating into the contralateral leg, especially between 30-60 degrees

Indicates: lumbosacral radiculopathy (usually from herniated disc) and/or sciatic neruopathy

49
Q

Describe test, what is positive, what this indicates:

Hoover’s sign

A

Patient supine. Hold hand under heel of the unaffected leg. Ask pt to try and flex affected (weak) leg against slight resistance while maintaining extension at knee (straight leg). If an honest effort is made, the physician should feel unaffected leg’s heel pushing down as they attempt to raise the affected leg by flexing at the hip

+ test = no downward force of unaffected leg as they are “attempting” to lift affected leg

Indicates: functional weakness (“conversion disorder”) or malingering of the pt

50
Q

Describe test, what is positive, what this indicates:

Thomas test

A

Pt supine with buttocks toward end of table. Flex both hips and knees to chest (flattens lumbar lordosis and stabilizes pelvis). Have pt extend affected leg toward table and relax to allow full extension

+ test = lower extremity on involved side will be unable to fully extend at hip

Indicates: iliopsoas tension, shortening, or contracture

51
Q

T/F: iliopsoas hypertonicity is a common finding in acute and chronic LBP

A

True

52
Q

Describe test, what is positive, what this indicates:

Gaenslen test

A

Patient supine. Flex one hip and knee to chest while simultaneously extending opposite hip (off side of table)

alternative: lateral recumbent; patient flexes lower hip and holds, physician then extends top hip. Maneuver stresses both SI joints

+ test = posterior pelvic pain

Indicates: SI joint dysfunction or pathology

53
Q

Describe test, what is positive, what this indicates:

Valsalva test

A

Pt holds breath and bears down which increases intrathecal pressure

+ test = sciatic symptoms (sharp or burning pain radiating down the posterior or lateral aspect of the leg, usually to the foot or ankle)

Indicates: sciatica (sciatic n. compression or irritation), often associated with numbness or tingling

54
Q

T/F: pain radiating to just above the knee is more likely to represent true radiculopathy than distal leg pain

A

False; pain radiating below the knee is more likely to represent true radiculopathy than proximal leg pain

55
Q

Describe test, what is positive, what this indicates:

Stork test

A

Patient standing. Have patient flex hip and knee of one leg. Stabilize patient’s iliac crests, if needed, and have them lean back extending the lower back

+ test: pain in lower back as it stresses the posterior elements of the spine on the ipsilateral side

Indicates: possible pars defect/stress fracture; if bilateral, increased risk of spondylolisthesis

56
Q

Condition of spinal nerve root compression usually by massive disc protrusion, fracture/trauma, or tumor that results in bowel/bladder dysfunction

A

Cauda equina syndrome

57
Q

There is no single test for cauda equina syndrome, but what are some clinical features that require investivation?

A

LBP (usually first symptom, present in 83-95% of pts at time of dx; can precede neurologic symptoms by weeks in cases not secondary to immediate trauma)

Bowel/bladder dysfunction (overflow incontinence)

Sensory loss of perineum (“saddle anesthesia”) and decreased anal sphincter tone

Bilateral sciatica and leg weakness

58
Q

T/F: cauda equina syndrome requires emergent management and surgical decompression within 48 hours, or permanent neurologic damage can remain

A

True

59
Q

Congenital malformation (usually failure of lamina fusion in vertebra) leading to neural tube defects (incomplete closure) in lumbar spine

A

Spina bifida

60
Q

What type of spina bifida results in a small split in vertebra, with NO spinal cord protrusion, is asymptomatic and usually an incidental finding on radiograph?

A

Spina bifida occulta

[may also see patch of hair, birthmark, or dimple]

61
Q

At what spinal segment is spina bifida occulta most common?

A

L5-S1

62
Q

What type of spina bifida involves meninges forced out between vertebra and requires surgical repair, usually without any neurological damage

A

Meningocele

63
Q

What is the most common type of spina bifida?

A

Myelomeningocele — unfused portion of spinal cord protrudes through opening. Very severe (permanent) neurologic complications

64
Q

What is a normal Ferguson’s angle?

A

30-40

65
Q

What condition, typically seen on x-ray, appears as a defect or fracture in pars interarticularis of the vertebral arch?

A

Spondylolysis

66
Q

What condition, typically seen on lumbar x-ray, appears as an anterior displacement of vertebral body?

A

Spondylolisthesis

67
Q

Age-related wear and tear of the spine

A

Osteoarthritis (spondylosis)

PCM II Exam 1 (5 decks)

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