Lumbar Spine part 1 Flashcards
What is the strongest predictor of further incidence of LBP?
Hx of LBP
What is the percent of LBP that have compression fracture and neoplasm?
4% and 1%
Prevalence of prolapsed IVD
1-3%
Lumbar flexion:
40-50
Lumbar extension:
15-20
Lumbar axial rotation
5-7
Lumbar lateral flexion
20
Kinematics of T/L flexion shown through an 85° arc:
35° of thoracic flexion and 50°of lumbar flexion
Kinematics of T/L extension shown through an arc of 35°-40°:
20°-25° of thoracic extension and 15° of lumbar extension
T/L axial rotation shown through an ~40° arc
sum of about 35° of thoracic rotation and 5° of lumbar rotation
Kinematics of T/L lateral flexion shown through ~45° arc
sum of 25° of thoracic lateral flexion and 20° of lumbar lateral flexion
Schmorl’s node
local area of bone collapses under end plate to create a pit or crater that gradually forms
When does Schmori’s node occur?
This type of injury associated with spinal compression when spine is in neutral ROM (i.e., not flexed, bent or twisted)
What leads to spondylolisthesis?
Repeated, cyclic full spine flexion and extension leads to fatigue within arch (repeated stress reversals), thereby leading to a pars fracture
Mobility or stability for spondylolisthesis?
stability
Orientation of each collagen fiber of annulus fibrosus (AF?
65 degrees from vertical
every other layer running in same direction
IVD has three major components
nucleus pulposus, annulus fibrosis, and end plates
How are collage fibers of each lamina oriented?
obliquely oriented and obliquity runs in opposite direction in each concentric lamella
Four general conclusions about annulus injury and resulting bulging or herniation
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
Disc Bulge
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
Protrusion
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
Extrusion
NP has protruded through all layers of AF, but remains attached to disc of origin
Sequestration
A free disc fragment is located in epidural space can migrate superiorly, inferiorly, medially, or laterally
Damage to annulus of disc (herniation) appears to be associated with:
fully flexing spine for repeated or prolonged period of time
Rotatores and Intertransversarii
Typically function of small rotator muscles of spine, which attach to adjacent vertebrae, are delineated as creating axial twisting torque
What often gives function of lateral flexion?
Intertransversari
Rotatores and intertransversarii muscles have 4-7 times more what than multifidus?
muscle spindle
Extensors: Longissimus, Iliocostalis, and Multifidus Groups
Major extensors of thoracolumbar spine are the longissimus, iliocostalis, and multifidus groups
How many slow twitch fibers does the thoracic section contain?
about 75%
What is flexion of the torso accomplished through?
hip flexion
Rectus Abdominis
major trunk flexor and most active during sit-ups and curl-ups
Three layers of abdominal wall
external oblique, internal oblique, and transverse abdominis
Flexion relieving position or movement:
facet joint involvement
low back strain
lateral stenosis
Extension relieving position or movement:
disk involvement
nerve root irritation (herniation)
Rest relieving position or movement:
neurogenic claudation
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)
Zygapophyseal joint pain syndromes
Reports of centralization or peripheralization of symptoms during repetitive movements or prolonged periods in certain positions
Possible discogenic pain
Reports of lower extremity pain/paresthesias, which is greater than LBP. May report experiencing episodes of lower extremity weakness
Possible sciatica or lumbar radiculopathy
Pain in lower extremities exacerbated by extension and quickly relieved by flexion of spine
Possible spinal stenosis
Patient reports of recurrent locking, catching, or giving way of low back during active motion
Possible lumbar instability
Reports of LBP exacerbated by stretch of either ligament or muscles. Might also report pain with contraction of muscular tissues
Muscle/ligamentous sprain/strain
Lumbar red flags:
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
A Sensitive test helps rule
out disease (when the result is negative) Sensitivity rule out or “Snout”
Sensitivity=
true positives/(true positive + false negative)
Specificity=
true negatives/(true negative + false positives)
Lumbar yellow flags:
factors that increase risk of developing, or perpetuating chronic pain and long-term disability including work loss associated with LBP
Patellar reflex
L3/L4
Medial Hamstring
L5/S1
Lateral Hamstring
S1/S2
Posterior tibial
L4/L5
Achilles reflex
S1/S2
Lumbar Coupled Motion
Patterns in Neutral
Ipsilateral SP rotation except L5 (can be either way)
Lumbar Coupled Motion
Patterns in Flexion
Contralateral SP rotation
L1
Hip flexion
L2
Hip flexion, hip abduction
L3
Knee extension
L4
Ankle dorsiflexion
L5
Foot/toes dorsiflexion
S1
Plantar flexion foot/toes, ankle eversion, hip extension
S2
Knee flexion
S3
Foot intrinsics
