Lumbar spine anatomy

Question 1

4 stages of herniation

Answer 1

Protrusion
Prolapse
Extrusion
Sequestration

Question 2

how many % of water in the disc initially and later in life

Answer 2

85%-90% to 65%

Question 3

what the another name of herniation of the nucleus puloposus

Answer 3

Schmorl nodules

Question 4

what a sequestrated disc can cause?

Answer 4

myelopahty (pressure on spinal cord itself)

cauda equina syndrome (saddle anesthesia, bowelbladder dysfunction) or pressure on nerve root (most common)

Question 5

what nerve likely to be affected by L4-L5 disc pathology?

Answer 5

L5 (L4 will exit out, but L5 will be passing behind the disc. Bulging disk may likely push against L5.

Question 6

4 categories of back pain

Answer 6

Back pain dominant 1 (back/buttocks): disc involvement (herniation or spondylosis) or sprain/strain, aggravated by flexion, stiff in the morning. Relieved by extension. No Myo or dermatome.

Back pain dominant 2 (back/buttocks): facet involvement (strain), aggravated by extension/rotation, relieved by flexion, no myo or dermatome.

Leg Pain dominant 3 (below knee): nerve root involvement, aggravated by flexion, relieved by extension. myotome dermatome affected.

Leg pain dominant 4 (below knee): neurogenic intermittent claudication (pressure on the cauda equina), aggravated by walking/extension, releived by rest (sitting) or postural change. myotome, dermatome affected.

Question 7

what are differences between spondylosis, spondylolysis, spondylolisthesis and retrolisthesis

Answer 7

Spondylosis: degeneration of the disc
Spondylolysis: a defect of par interarticularis or the arch of the vertebrae
Spondylolisthesis: a forward displacement of one vertebrae over another
Retrolisthesis: backward displacement of one vertebra on another

Question 8

what is deconditioning syndrome?

Answer 8

Deconditioning syndrome is caused by a prolonged decrease in physical activity due to chronic low back or neck pain. It is associated with a gradual reduction and change in muscular strength, mobility of joints, and even cardiovascular fitness.

Question 9

what is lumbago

Answer 9

AKA mechanical low back pain. unilateral pin with no referral below the knee caused by injury to muscles (strain) or ligament (sprain), the facet joint, or some cases the sacroiliac joint.

Question 10

what iliolumbar ligament helps L5 with

Answer 10

anterior displacement of L5

Question 11

what is functional segmental unit in lumbar spine

Answer 11

two vertebral with one intervertebral disc (3 joint complex)

Question 12

outer fibrocartilage of annulus fibrosus is called

Answer 12

sharpey fibers

Question 13

what intervertebral disc contains

Answer 13

mucopolysaccharids as incompressible fluid, but over age, replaced with collagen

Question 14

cauda equina syndrome is called

Answer 14

saddle anesthesia, bowel bladder dysfunction

Question 15

pain in anterolateral aspect of the leg

Answer 15

L4

Question 16

Pain in posterior aspect of the foot

Answer 16

L5

Question 17

Pain referred to buttock and posteiror leg

Answer 17

Lumbar and sacroiliac

Question 18

groin and anterior thigh, may be referred to the knee (medial)

Answer 18

Hip

Question 19

how do you rule out hip pain from other?

Answer 19

capsular pattan and a negative sign of the buttock

Question 20

Classic disc pathology pain

Answer 20

sitting, lifting, twisting and bending, most common cause of radiating pain below the knee

Question 21

pelvic crossed syndrome what are weak and what are short

Answer 21

weak long: abdominal, glute max, glute med
Tension: hamstring (trying to pull pelvis back)

Strong short: hip flexors (iliopsoas) and back extensors, QL, TFL
Result in Ant. Pelvic tilt, lumbar lordosis

Question 22

Greatest movement in Lumbar spine

Answer 22

L4 and L5, L5 and S1

Question 23

lumbago

Answer 23

mechanical low back pain

Question 24

instability jog

Answer 24

a sudden movement shift or rippling of the muscles during active movement, indicating an unstable segment

Question 25

Disc degeneration 3 stages

Answer 25

dysfunctional, unstable : both intersegmental motion increases in flexion, rotation and side flexion,
and stable

Question 26

normal measurement increase in forward flexion in L spine

Answer 26

T12 to S1 is 7-8 cm

Question 27

if a side flexion toward the painful side increases the symptoms…

Answer 27

leision is probably intra articular, because the muscles and ligaments on that side are relaxed

Question 28

when side flexing away from the pain increases the pain

Answer 28

muscular strain, articular, or disc produce medial to the nerve

Question 29

When L4 disc herniates which nerve affected

Answer 29

L5

Question 30

Slump test

Answer 30

1. Slump the back with head straight.
   Pressure down (thoracic and lumbar)
2. Head to chin
   Pressure down (thoracic and Lumbar and Cervical)
3. hold leg to dorsiflex, then ask to extend the leg
   If patient is unable to extend because pain then release the pressure. If it relieves the pain, patient actively extends the head

Question 31

Straight leg raising test is also called

Answer 31

Lasegue’s test

Question 32

Straight leg test with neck flexion is called

Answer 32

Hydnman’s sign, Brudzinski sign, Linder sign and Soto Hall test

Question 33

Straight leg test with ankle dorsiflexion is called

Answer 33

Bragard’s test

Question 34

Straight leg test with big toe extension

Answer 34

Sicard’s test, (Turyn’s test)

Question 35

Straight leg test which degree and what nerves are completely stretched?

Answer 35

70 degree, L5, S1, S2

Question 36

Straight leg, pain in the back, pain in back and posterior aspect, and pain down to the leg

Answer 36

pain in the back: central protrusion
Pain in the low back and posterior aspect of leg: protrusion in the intermediate area
pain in the posterior leg below the knee: lateral protrusion

Question 37

Bilateral straight leg raising interpretation

Answer 37

70 degree pain SI

after 70 lumbar

Question 38

Straight leg, pain on the other side is called and what it means

Answer 38

Well leg raising test of Fajersztajn, prostrated leg raising test, sciatic phenomenon, Lhermitt’s test or the crossover sign

Means large protrusion on medial to the nerve root on the other side of the leg

Question 39

Lateral cutaneous nerve of thigh

Answer 39

L2-L3, Sensory loss lateral thigh often intermittent

Question 40

Posteiror cutaneous nerve of thigh

Answer 40

S1-S2 Posterior thigh, maybe trauma, pelvic mass, Hip tracture

Question 41

Obturator nerve

Answer 41

L2-L4, Medial thigh, Often none or medial thigh, thigh adduction may be affected

Question 42

Femoral nerve

Answer 42

L2-L4 Anteromedial thigh and leg sensory loss and knee extension and hip flexion motor loss,
Retroperitoneal or pelvic mass, Femoral artery aneurysm, Diabetic mononeuritis

Question 43

Saphenous branch of femoral nerve

Answer 43

Anteromedial knee and medial leg sensory loss, no motor loss, entrapment above medial femoral condyle

Question 44

Sciatic nerve

Answer 44

L4-L5, S1 Anterior and posterior leg, sole and dorsum of foot sensory loss, Motor loss Foot dorsiflexion, foot inversion, plantar flexion, knee flexion, Diminished ankle jerk

Question 45

Common peroneal nerve

Answer 45

Anterior leg, dorsum of foot sensory loss if any. Motor loss foot dorsiflexion and inversion and eversion, entrapment at neck of fibula,