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MSK PT > Lumbar Spine Anatomy > Flashcards

Lumbar Spine Anatomy Flashcards

1
Q

the top and bottom surfaces of the VB are smooth and have perforation holes for …

A

nutrition

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2
Q

what structure articulates with the disc and holds the end plate in place

A

ring apophysis

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3
Q

the posterior surface of the VB have large holes for…

A

nutrient arteries and basovertebral vein

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4
Q

what 2 trabecular systems are in the VB and what is the significance of each?

A

transverse - resists tension
vertical - resists compression

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5
Q

what is important about having trabeculae systems in the VB?

A

keep it light

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6
Q

what 4 structures make up the neural arch?

A
  • pedicle
  • lamina
  • SP
  • TP
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7
Q

what forces do the pedicles resist?

A

bending and tension

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8
Q

what is significant about the accessory or mamillary processes?

A

provide surface for m attachment (miltifidi)

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9
Q

describe the orientation of the superior facet

A

concave and faces medially and posteriorly

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10
Q

describe the orientation of the inferior facet

A

convex and face laterally and anteriorly

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11
Q

what structure sustains bending force from pedicle to lamina

A

pars interarticularis

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12
Q

what motion is favored by the orientation of the Lumbar facets?

A

sagittal plane motion - flex/ext

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13
Q

what shape is the VB of L5

A

wedge

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14
Q

describe the characteristics of the following structures for L5
- disc
- TP
- SP
- Z joint

A

disc = smaller surface
TP = larger
SP = smaller
Z - joint = orientation in coronal plane

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15
Q

what is the significance of the shape of the L5 VB

A

it can accommodate for the lumbosacral angle

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16
Q

how many articulations are at each vertebral segment of the lumbar spine

A

6 articulations
- superior and inferior IV joints (2)
- bilat superior and inferior Z joints (4)

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17
Q

what type of joint is the IV join

A

cartilagenous

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18
Q

what structure:
- accounts for 25% of total height of vertebral column
- allows mvmt
- absorbs shock and distributes load

A

IV disc

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19
Q

collagen fibers in the AF are oriented _____ off the vertical line and ______ opposite to each other

A

60
120 degrees

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20
Q

what forces does the AF resisit

A

compression, shear and torsion

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21
Q

what forces does the NP resist

A

compression and shear

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22
Q

what happens to the NP with axial loading

A

does not deform
reduces in height and expands radially toward AF, end plate and VB

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23
Q

what is the end plate made of

A

fibrocartilage and hyaline cartilage

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24
Q

what forces does the end plate resist

A

it is weak when exposed to compression forces

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25
Q

when you have a normal/intact disc, how much force does the z joint carry?
How much is it when the disc is diseased?

A

normal = 20-25%
diseased = up to 70% force thru the Z joint

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26
Q

how does the IV disc receive nutrients

A

by diffusion thru cartilagenous end plate

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27
Q

how does the disc receive its nerve supply

A

peripherally by branches of anterior rami and gray rami communicans

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28
Q

what are the pain sensitive structures surrounding the disc

A

ALL, PLL, nerve roots, VB, cartilage of z joint

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29
Q

what shape is ideal/normal for the Z joint

A

C or L (J) shape

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30
Q

how much motion occurs are the Z joint

A

5-8mm up and down

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31
Q

what is the function of the miltifidi

A

approximation of the z joint - stabilization

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32
Q

what is the significance of having J shaped z joints

A

resist anterior shear force on anteromedial aspect of z joint

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33
Q

what is the significance of C and J shaped joints

A

increases bony congruence = stability

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34
Q

what strucutre reinforces the z joint capsule anteriorly

A

ligamentum flavum

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35
Q

what position is the z joint capsule tight in?

A

all positions

36
Q

what 2 structures reinforce the z joint capsule

A

miltifidi and lig flavum

37
Q

what is the function of the fibroadipose meniscoid

A

protect z joint surface during motion

38
Q

what happens when the fibroadipose meniscoid malfunctions

A

becomes buckled/relaxed in flexion and lodged under the capsule –> blocking extension and causing acute locking

39
Q

where does the z joint get its nerve supply

A

medial branch of the dorsal root of the same segment and the segment below

40
Q

how many and what articulations occur at the lumbosacral junction

A

3 articulations - IV joint and bilat facet joints

41
Q

what is the normal LS angle

A

40 deg

42
Q

describe the incline of S1 at the LS angle

A

inclines inferiorly and anteriorly forming and angle to horizontal line

43
Q

what determines the lumbar curve

A

LS angle

44
Q

what structures stabilize LS junction anteriorly and posteriorly

A

ALL and iliolumbar ligaments

45
Q

where does the L5 VB tend to slide

A

anteriorly and inferiorly

46
Q

what counterbalances the translation of L5 on S1

A

vertebral arch junction b/w superior and inferior facets

47
Q

if the pars interarticularis breaks =

A

spondylolysis

48
Q

if L5 is displaced anteriorly =

A

spondylolisthesis

49
Q

what radiographic view can you see spondylolysis

A

oblique view = broken neck of scottie dog

50
Q

the ALL has the greatest tensile strength in what region

A

lumbar region

51
Q

what forces does the ALL resist

A

extension or excessive lordosis

52
Q

what structure is diamond shaped and deviates laterally at disc level to support AF

A

PLL

53
Q

why is it significant that the PLL is weak in the lumbar region

A

high incidence of HNP in this region

54
Q

what forces does the PLL resist

A

flexion and traction

55
Q

the ligamentum flavum extends _____ to cover the ______

A

laterally to cover the z joints

56
Q

the ligamentum flavum contains a high % of ________
what does this allow it to do?

A
  • elastin
  • able to recoil and not buckle
57
Q

where is the ligamentum flavum strongest and weakest

A

stringest - L region
weakest - cervical

58
Q

what direction dies the lig flavum resist

A

flexion
slack in ext

59
Q

what are the posterior ligaments of the vertebral column

A

interspinous, supraspinous and intertransverse

60
Q

what direction does the interspinous and supraspinous ligaments resist

A

hyperflexion

61
Q

palpable tenderness of the interspinous ligament may indicate…

A

hypermobility or instability

62
Q

the supraspinous ligament does not have direct attachment to ______

A

thoracolumbar fascia at L4 - L5

63
Q

what motion does the intertransverse ligament resist?
what is its contribution to stability

A

contralateral flexion
- no contribution to stability - it is just there

64
Q

what are the 5 bands of the iliolumbar ligament

A

anterior, superior, inferior, vertical and posterior

65
Q

what motion does the posterior band of the iliolumbar ligament resist

A

flexion

66
Q

what is the function of the posterior band of the iliolumbar ligament

A

stabilize L5 from anterior displacement and resist lateral flexion at L5

67
Q

where do the superficial layers of the Thoracolumbar fascia come from

A

latissimus dorsi

68
Q

4 functions of thoracolumbar fascia

A
  • m attachment
  • resist segmental flexion
  • assist in transmission of extension during lifting
    ** pull of TrA –> increase in tension of fascia –> limit intersegmental flexion and anterior translation
69
Q

what is the most effect lateral flexors of the trunk

A

erector spinae

70
Q

bilateral contraction of erector spinae will create what 3 things

A
  • extend trunk
  • tilt pelvis anterior
  • increase L lordosis
71
Q

unilateral contraction of erector spinae will create what 2 motions

A
  • lateral flexion and rotation of trunk to SS
72
Q

what 3 m groups make up the deep layers of the back m

A

transversospinal m group = semispinalis, miltifidi, rotatores

73
Q

what is the “rotator cuff” of the z joint and why is it called that

A

multifidi - produces compression force during contraction to stabilize joint

74
Q

pts with segmental instability show what 2 characterisitics of the multifidi

A

fatty replacement and atrohpy

75
Q

as a group, the transversosponal muscles do what?

A

fine control of spinal motions

76
Q

what does the evidence say about multifidi m recovery after decrease of LBP

A

m recovery is not automatic

77
Q

what is one of the biggest findings in pts with LBP

A

m atrophy of multifidi –> inability to contract

78
Q

bilateral contraction of the EO m will create…
Unilateral contraction …

A

bilat - trunk flex, post tilt of pelvis
unilat - I/L trunk lateral flex and C/L rotation

79
Q

bilat contraction of IO m will create…
unilateral contraction …

A

bilat - trunk flexion and post tilt pelvis
unilat - I/L tunk lateral flex, I/L rotation

80
Q

bilat contraction of TrA…

A

compression of abdominal cavity and increase tension of thoracolumbar fascia
- primary stabilizer

81
Q

LBP pts failed to recruit _____ and ____ with fast speed arm mvmts

A

TrA and IO

82
Q

what is the predominant hip flexor

A

iliacus

83
Q

contraction of the psoas will create…

A

lateral lumbar flexion and vertical stabilization

84
Q

the iliopsoas creates ________ by tilting the pelvis ______

A

lumbar lordosis
anteriorly

85
Q

what characteristics does the iliopsoas present with in a pt with LBP

A

short (spasm) and atrophied

86
Q

bilat QL contraction …
Unilat QL contraction …

A

bilat = extend lumbar
unilat = lateral flex L spine or elevate pelvis

MSK PT (7 decks)

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