Lumbar Spine Pathology

Question 1

11. Disc Herniation

Protrusion

Answer 1

NP bulges out through the tear to strain, but escape, te outer AF

• Disc bulges against the dura and posterior longitudinal ligament
• Dull, poorly localized low back and sacroiliac pain
• Pain worse in am, with sitting and bending
• Minimal to no leg pain, -SLR

Question 2

Disc Herniation

Answer 2

Extrusion/Prolapse
-NP material bulges out through the tear to strain, but not escape , the outer AF
-Disc bulges against the dura and posterior longitudinal ligament
-Dull, poorly localized low back and sacroiliac pain
-Pain worse in the am, with sitting and bending
-Minimal to no leg pain, SLR
(happy with Extension to relieve posterior Annulus pain—dull deep not specifically localized pain) WIll be very sore in the morning.

Question 3

Disc Herniation Sequestration

Answer 3

NP material breaks contact with the disc and becomes fragment in the intervertebral canal
Complete disruption of the annular wall
Fragments can lead to cauda equina syndrome

Question 4

Strains

Answer 4

• Associated with a history of
trauma
• Caused by excessive muscle activity or muscle guarding
• Common locations
– Erector spinae common tendon just superior and lateral
to the PSIS
– Gluteal attachment on the
sacrum just lateral to the
PSIS
• Treatment: progressive movement and funtional
activities

Question 5

Piriformis Syndrome

Answer 5

• 15% of
the population have anatomic
anomaly
• Cardinal features
– Hx of trauma to the SI or
gluteal region
– Pain in the region of the SIJ,
greater sciatic notch, and
piriformis extending down
the leg
– Symptoms exacerbated
by stooping or lifting
– Tender, palpable mass over
the piriformis
– + SLR
– Gluteal atrophy
• Treatment: stretching and
massage

Question 6

Facet Joint Syndrome

Answer 6

• Pain from the joint and its
pain sensitive structures
– Meniscoid entrapment,
capsular tightness, muscle
strain
– Can result
from hyper-­‐or hypomobility
– Localized unilat. LBP
aggravated with specific
movements, may have referred
pain,
- (­‐neurosigns)

Question 7

Spinal Stenosis

Answer 7

• Causes
– Congenital, born with a smaller canal
– Acquired, osteophytes
from facets, laminae
or pedicle
• Signs and Symptoms
– Back and LE pain or
weakness
– Multiple level findings
are more common
– Single level findings
more common for HNP

Question 8

Central Stenosis

Answer 8

– Narrowing of the spinal canal
– Caused by: facet joint arthrosis, bulging of the disc,
thickening of the ligamentum
flavum

Question 9

Lateral Stenosis

Answer 9

– Spinal nerve compression in
the IVF or lateral recess of the
spinal canal
– Caused by: facet joint hypertrophy, dcreased disc height, bulging disc

Question 10

Spinal Stenosis

Answer 10

• Elderly population,
>50yo
• Long history of LBP
• Unilateral or bilateral leg pain
• Neurogenic claudication
pain with walking
and standing,
• Relief with siting
• Decreased lordosis

Question 11

Disc Disease

Answer 11

• With age the AF weakens and
the NP dehydrates aHer 25 yo.
• Trauma, combined with weakened muscles and stretched ligaments of the spine
– hernia<on can occur
• Risk is different depending on
the health of the person
– Smoking a significant risk factor for disc disease

Question 12

Amount of Body Weight will be increased with posture changes

Answer 12

25 lying supine
75 sidelying
100 standing
150 Foward Flexion
220 more foward flexion
140 sitting
185 tying shoes sitting
275 slumping

Question 13

Degenerative Disc Disease

Answer 13

Degenerative changes are the body’s attempts at healing as it ages.
Early dysfunction
–disc herniation occurs at theis stage, see splits in the AF
–End plate fractures and Schmorl’s nodes

Question 14

Degenerative Disc Disease

Answer 14

Immediate instability
–characterized by laxity of the posterior joint capule and posterior AF
–Increased loading results in increased fatigue damage
(episodes of back pain several times a year,,,instability tests poor responses…hyper mobility on central and unilateral PA’s…episodes of pain will get closer together and increase with time)

Question 15

Degenerative Disc Disease

Answer 15

Final Stabilization
–characterized by al loss of disc material, decreased disc height, redial tears in the AF, osteophyte formation, fibrosis of the facet joints and capsule
-Osteophytes increase load bearing surface, decrease available motion, stiffer segment
—end game of the degenerative cascade is loosing all motion at all and a great amount of stiffness in the effected segments–Stiffness can decrease pain though!
Cause irritability of the surrounding joints trying to overcome for lack of motion

Question 16

Spondylolisthesis

Answer 16

Bilateral pars defect resulting in an anterior slippage of the vertebral body and inability to resist shear forces

• -commonly at L5-S1
• -May or may not be unstable

Question 17

Sponsylolisthesis is graded according to the percent of slippage

Answer 17

Normal Spine
Grade 1 75% slippage
Grade 3 & 4 are surgery

Question 18

Spondylolisthesis Symptoms

Answer 18

1. Complaints or midline pain at the lumbosacral junction
2. Symptoms aggravated by extension
3. May have leg pain
4. Step off deformity
   (sunken spinous process anteriorly)

Question 19

Spondylolisthesis Treatment

Answer 19

Decreasing anterior pelvic tilt, stabilization\
minimize backward bending activities
Tighten Glutes, hamstrings, and abdominal muscles to create a more posterior pelvic tilt

Question 20

Posterior Shear

Answer 20

• Pt position:
Sidelying, hips flexed 90°
• PT position: Pt’s knees are placed against
PT’s ASIS; stabilize the superior
vertebra by pulling PA on the
spinous process; apply a AP force through the thighs
• Inferior vertebra will move
(knee on ASIS as shelf hips into flexion to segment that you want to shear…use pelvis to create a shear…Block the level above the one you ant to shear with both hands…PT leans forward to create posterior Pelvic shear) Do not create flexion that will block the shear motion.