Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Functional Anatomy > Lumbar Spine Osteology and Disk > Flashcards

Lumbar Spine Osteology and Disk Flashcards

1
Q

Describe bony make up of lumbar vertebral bodies

A

Block of trabecular/ spongy bone covered by cortical bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Function of pedicles in lumbar spine

A

Transmit tension and bending forces from posterior elements to the vertebral body (e.g. ligaments)
Act as a lever for skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mammillary process of lumbar vertebra

A
  • On transverse process/ superior articular process

- Where multifidi attach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pars Interarticularis

A
  • Common site for stress fracture

- Between superior and inferior articular processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe Laminae of lumbar vertebrae

A

Thick –> Can encroach on spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Function of spinous processes in lumbar vertebrae

A

Attachment of ligaments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Orientation of facet surfaces in lumbar vertebrae favors:

A

Flexion and extension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Superior Facets in lumbar vertebrae

A
  • Concave

- Face medial/ posteromedial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inferior Facets in lumbar vertebrae

A
  • Convex

- Lateral/ anteriolateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

5th lumbar vertebra

A
  • Body is wedge shaped (greater height anteriorly)
  • Shape helps counter anterior sheer
  • L5-S1 is a site with increased stress to disc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lumbar Spondylosis

A

Degenerative changes

  • Facet joints: Osteophytes and joint hypertrophy –> Pressure on ligaments (pain) and stiffness
  • Vertebral bodies: Osteophytes
  • Intervertebral Disc: Thinning (dehydration), breakdown of annulus and excessive motion of pulposus

**Pain and stiffness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of lumbar spondylosis

A

General: Unload Structures

  • Extension loads the bones the most –> Pts will like flexion
  • Postural education: Neutral spine/ wherever pt is most comfortable is optimal. This may be some flexion
  • Joint mobilization to reduce pain and increase motion
  • Traction (manual or mechanical)
  • Core stabilization (TA) in functional positions with optimal posture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Non-PT management of lumbar spondylosis

A
  • Facet injection
    • Benefit = sxs decrease
    • Limit: Temporary; pt doesn’t change dysfunctional movement
  • Surgical stabilization –> unpredictable outcomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of lumbar stenosis

A

Central (central canal) or

Lateral (intervertebral foramen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Central canal dimensions (normal vs. stenosis)

A

Normal: 15 to 23 mm
Narrowing: 10-12 mm

–> can compress spinal cord or spinal nerve roots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Signs of lumbar spine stenosis

A
  • Postural adjustments to get comfortable
  • Walk with flexed posture
  • Pain with lumbar extension (or even neutral)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Symptoms of lumbar spine stenosis

A
  • Radicular ache/ cramp into lower limbs when in extension
  • AKA Neurogenic claudication (gets worse the longer pt is in extension)

Diagnosis:
Increase incline on treadmill. This will make pts with stenosis feel better, because they have to lean forward into flexion as incline increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Lumbar spinal stenosis management

A

Flexion progression:

  • Supine or seated
  • Teach patient positions of flexion to work in

Stretch hip flexors:

  • Tight hip flexors will –> ant pelvic til –> lumbar extension
  • Stretch on plinth - helps isolate hip flexors and keep pts from cheating by extending back

Strengthen core musculature: TA in neutral or flexed

Surgery: Laminectomy

19
Q

Spondylolysis

A
  • Usually younger population
  • Stress fracture in pars interarticularis
  • Typically aggravated with extension activities
20
Q

4 potential causes of spondylolysis

A
  1. Mechanical (Excessive extension)
  2. Congenital
  3. Traumatic (MVA)
  4. Pathologic (Osteoporosis, bone mets)
21
Q

Spondylolysis diagnostic test

A

Single leg hyperextension test

  • Used by other medical providers more than PT
  • Metrics are questionable

Test:

  • Stand on one leg
  • Extend the spine
  • Positive: Pt’s sxs are reproduced
22
Q

Management of spondylolysis

A
  • Avoid extension
  • Rest, initially

Brace
Core stability training
Flexibility of hip flexors
Modified movement/ training patterns (after period of rest) - avoid extension

23
Q

Bracing for spondylolysis

A
  1. Boston Brace
    - Customized, less mobile
  2. Warm n form
    - Temporary
    - Make in clinic
    - More mobile
24
Q

Spondylolisthesis

A

Forward slippage of one superior vertebra as a result of instability caused by BILATERAL defect in pars interarticularis
“scotty dog decapitated”

–> Stress on sacral nerve roots –> leg pain

25
Q

Spondylolisthesis signs and sxs

A
  • Pain with extreme motion, esp extension
  • Pain generally follows belt line
  • May be able to palpate step off along spinous process
26
Q

Spondylolisthesis diagnosis

A
  • L4-5, L5-S1 most common
  • Slippage determined by XRay
  • 4 Grades, according to percent of shift across vertebra
    I. 0-25%
    II. 25-50%
    III. 50-75%
    IV. 75-100%
    (III and IV are surgical candidates)
27
Q

Spondylolisthesis management

A
  • Symptom management (modalities)
  • Lumbar core stabilization
  • Fusion surgery to prevent further slippage (if grade III or IV)
28
Q

Lumbar compression fracture

A

Less common than thoracic compression fx

  • Lumbar: Traumatic etiology
  • Thoracic: Osteoporosis
29
Q

Management of Vertebral Fx

A
  • Vertebroplasty or Kyphoplasty
  • Flexibility
  • Strength (core and lower limbs)
  • Function (teach body mechanics)
30
Q

Vertebroplasty

A

Cement-like material is injected directly into fractured bone
- Stabilizes fx and provides immediate pain relief in many cases

31
Q

Kyphoplasty

A

Includes additional step past vertebroplasty

  • Prior to injecting cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebra
  • Balloon is removed before cement is places

Goal of extra step is to restore height to the bone –> reducing deformity of spine

32
Q

Intervertebral Disk

A
  • 20-33% of length of spinal column
  • 3 mm thick in cervical spine, 9 mm thick in lumbar spine

Relevance to interbody joints (intervertebral disk, adjacent vertebral bodies, and vertebral endplates)
- When disk dehydrates, facet joints take more pressure

33
Q

Disk Anatomy - NP

A

70-90% Water
Type I and II collagen (mostly II)
Loads like a balloon

34
Q

Disk Anatomy - Annulus fibrosis

A
  • Collagen arranged in concentric rings (laminae)
  • Adjacent rings have opposite orientation to each other –> Helps protect NP during rotation
  • Role: Tension, keeps NP in place
35
Q

Disk Anatomy - Vertebral end plate

A
  • Articular cartilage

- Attaches to AF and vertebral body

36
Q

Intradiscal pressure depends on

A
  • Position and properties of disk
  • Applied load
  • Under prolonged low level loading, disks exhibit creep (e.g. in sitting) –> Pts get stuck in flexion

Loads to failure will cause endplate fracture before disk rupture

Bending loads include sitting, yard work

37
Q

Lumbar disk injury

A
  • Inherent to anatomy (mobility vs. stability)
  • Common mechanism of injury: Flexion, rotation, and loading
  • Posterior-lateral injury to the disk
  • Injury to lamella allows nucleus to protrude
38
Q

Pain with disk injury is due to:

A
  1. Pressure on nerve root

2. Chemical irritation (inflammation –> chemical mediators)

39
Q

Five stages of disk injury

A
  1. Fissure
  2. Protrusion
  3. Prolapse
  4. Extrusion
  5. Sequestration
    (pts usually come in with either fissure or protrusion)
40
Q

Examination of disk injury

A
  1. Mckenzie method of examination (movements to assess)

2. Identify aggravating activities

41
Q

Treatment of disk injury: cut knuckle analogy

A
  1. Bend a lot: Won’t heal quickly - need to modify activities to decrease flexion to decrease recovery time
  2. Need some movement (later in healing) to avoid adhesions

Establish a directional preference for pt’s symptoms – stay out of that position

42
Q

Treatment of disk injury: Education

A

Key to success
Role of HEP
Posture modifications

43
Q

Treatment of disk injury: Extension program

A

Prone –> Prone on elbows –> Extension in lying (on hands) –> Extension with overpressure (PT holds hips down)

**This is if extension helps pt! Disk bulging laterally could feel worse in extension

Functional Anatomy (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions