Lumbar Spine part 1

Question 1

What is the strongest predictor of further incidence of LBP?

Answer 1

Hx of LBP

Question 2

What is the percent of LBP that have compression fracture and neoplasm?

Answer 2

4% and 1%

Question 3

Prevalence of prolapsed IVD

Answer 3

1-3%

Question 4

Lumbar flexion:

Answer 4

40-50

Question 5

Lumbar extension:

Answer 5

15-20

Question 6

Lumbar axial rotation

Answer 6

5-7

Question 7

Lumbar lateral flexion

Answer 7

20

Question 8

Kinematics of T/L flexion shown through an 85° arc:

Answer 8

35° of thoracic flexion and 50°of lumbar flexion

Question 9

Kinematics of T/L extension shown through an arc of 35°-40°:

Answer 9

20°-25° of thoracic extension and 15° of lumbar extension

Question 10

T/L axial rotation shown through an ~40° arc

Answer 10

sum of about 35° of thoracic rotation and 5° of lumbar rotation

Question 11

Kinematics of T/L lateral flexion shown through ~45° arc

Answer 11

sum of 25° of thoracic lateral flexion and 20° of lumbar lateral flexion

Question 12

Schmorl’s node

Answer 12

local area of bone collapses under end plate to create a pit or crater that gradually forms

Question 13

When does Schmori’s node occur?

Answer 13

This type of injury associated with spinal compression when spine is in neutral ROM (i.e., not flexed, bent or twisted)

Question 14

What leads to spondylolisthesis?

Answer 14

Repeated, cyclic full spine flexion and extension leads to fatigue within arch (repeated stress reversals), thereby leading to a pars fracture

Question 15

Mobility or stability for spondylolisthesis?

Answer 15

stability

Question 16

Orientation of each collagen fiber of annulus fibrosus (AF?

Answer 16

65 degrees from vertical

every other layer running in same direction

Question 17

IVD has three major components

Answer 17

nucleus pulposus, annulus fibrosis, and end plates

Question 18

How are collage fibers of each lamina oriented?

Answer 18

obliquely oriented and obliquity runs in opposite direction in each concentric lamella

Question 19

Four general conclusions about annulus injury and resulting bulging or herniation

Answer 19

Appears disc must be bent to full ROM in order to herniate
Disc herniation associated with repeated loading in range of thousands of times (implicating role of fatigue as injury mechanism)
Data link herniation with sedentary occupations and sitting posture
Herniations tend to occur in younger spines, those with higher water content and more hydraulic behavior

Question 20

Disc Bulge

Answer 20

Expansion of disc material beyond its normal border (e.g., a normal disc during compression, or a degenerated disc with decreased disc height) – the AF is bulging

Question 21

Protrusion

Answer 21

Discrete localized bulge in the AF, the disc material is displaced (i.e., the NP has protruded through the inner layers of AF) – a true herniation

Question 22

Extrusion

Answer 22

NP has protruded through all layers of AF, but remains attached to disc of origin

Question 23

Sequestration

Answer 23

A free disc fragment is located in epidural space can migrate superiorly, inferiorly, medially, or laterally

Question 24

Damage to annulus of disc (herniation) appears to be associated with:

Answer 24

fully flexing spine for repeated or prolonged period of time

Question 25

Rotatores and Intertransversarii

Answer 25

Typically function of small rotator muscles of spine, which attach to adjacent vertebrae, are delineated as creating axial twisting torque

Question 26

What often gives function of lateral flexion?

Answer 26

Intertransversari

Question 27

Rotatores and intertransversarii muscles have 4-7 times more what than multifidus?

Answer 27

muscle spindle

Question 28

Extensors: Longissimus, Iliocostalis, and Multifidus Groups

Answer 28

Major extensors of thoracolumbar spine are the longissimus, iliocostalis, and multifidus groups

Question 29

How many slow twitch fibers does the thoracic section contain?

Answer 29

about 75%

Question 30

What is flexion of the torso accomplished through?

Answer 30

hip flexion

Question 31

Rectus Abdominis

Answer 31

major trunk flexor and most active during sit-ups and curl-ups

Question 32

Three layers of abdominal wall

Answer 32

external oblique, internal oblique, and transverse abdominis

Question 33

Flexion relieving position or movement:

Answer 33

facet joint involvement low back strain lateral stenosis

Question 34

Extension relieving position or movement:

Answer 34

disk involvement | nerve root irritation (herniation)

Question 35

Rest relieving position or movement:

Answer 35

neurogenic claudation

Question 36

Reports of restricted motion of lumbar spine associated with LB or buttock pain exacerbated by pattern of movement that indicates possible opening or closing joint restriction (i.e., decreased extension, right sidebending, and right rotation)

Answer 36

Zygapophyseal joint pain syndromes

Question 37

Reports of centralization or peripheralization of symptoms during repetitive movements or prolonged periods in certain positions

Answer 37

Possible discogenic pain

Question 38

Reports of lower extremity pain/paresthesias, which is greater than LBP. May report experiencing episodes of lower extremity weakness

Answer 38

Possible sciatica or lumbar radiculopathy

Question 39

Pain in lower extremities exacerbated by extension and quickly relieved by flexion of spine

Answer 39

Possible spinal stenosis

Question 40

Patient reports of recurrent locking, catching, or giving way of low back during active motion

Answer 40

Possible lumbar instability

Question 41

Reports of LBP exacerbated by stretch of either ligament or muscles. Might also report pain with contraction of muscular tissues

Answer 41

Muscle/ligamentous sprain/strain

Question 42

Lumbar red flags:

Answer 42

Severe trauma Fever or recent bacterial infection Saddle anesthesia Severe or progressive neurological complaints Recent onset bladder dysfunction associated with onset LBP Unexplained weight loss History of cancer IV drug abuse, HIV or immunosupression Pain worse with recumbency or worse at night Constant progressive, non-mechanical pain (no relief with bed rest) Age of onset 55 years

Question 43

A Sensitive test helps rule

Answer 43

out disease (when the result is negative) Sensitivity rule out or "Snout"

Question 44

Sensitivity=

Answer 44

true positives/(true positive + false negative)

Question 45

Specificity=

Answer 45

true negatives/(true negative + false positives)

Question 46

Lumbar yellow flags:

Answer 46

factors that increase risk of developing, or perpetuating chronic pain and long-term disability including work loss associated with LBP

Question 47

Patellar reflex

Answer 47

L3/L4

Question 48

Medial Hamstring

Answer 48

L5/S1

Question 49

Lateral Hamstring

Answer 49

S1/S2

Question 50

Posterior tibial

Answer 50

L4/L5

Question 51

Achilles reflex

Answer 51

S1/S2

Question 52

Lumbar Coupled Motion | Patterns in Neutral

Answer 52

Ipsilateral SP rotation except L5 (can be either way)

Question 53

Lumbar Coupled Motion | Patterns in Flexion

Answer 53

Contralateral SP rotation

Question 54

L1

Answer 54

Hip flexion

Question 55

L2

Answer 55

Hip flexion, hip abduction

Question 56

L3

Answer 56

Knee extension

Question 57

L4

Answer 57

Ankle dorsiflexion

Question 58

L5

Answer 58

Foot/toes dorsiflexion

Question 59

S1

Answer 59

Plantar flexion foot/toes, ankle eversion, hip extension

Question 60

S2

Answer 60

Knee flexion

Question 61

S3

Answer 61

Foot intrinsics