Pathologies of lumbar and thoracic spine and anatomy Flashcards
The hips, pelvis and lumbar spine are ____
an integrated unit
The lumbo-pelvic hip complex
-operates as an integrated functional unit
- assess in all types of movement dysfunction
Background and significance of low back pain
70-80% of adults experience LBP in their lives
Lordosis
increased anterior lumbar curve from neutral
kyphosis
increases posterior thoracic curve from neutral
Flat back
decreased anterior lumbar curve
sway back
decreased anterior lumbar curve and increased posterior thoracic curve from neutral
Scoliosis
lateral spinal curvature often accompanied by vertebral rotation
how many vertebrae are there
33 vertebrae (24 mobile, 9 fused)
Sacralization
occurs when the fifth lumbar vertebra becomes fused to the sacrum
Lumbarization
Occurs when the first sacral vertebra fails to unite with the remained of the sacrum
Intervertebral disks components
Annulus fibrosus
- multilayered fibers, thinner posteriorly
Nucleus pulposus
- 60-70% water (compression & dehyrdration)
- highly elastic, semi gelatinous substance
23 IV discs
- No disc between C0-C1 & C1-C2
Characteristics of intervertebral disc
Annulus fibrosus
- highly structured and innervated
Nucleus
- more like crab meat than jelly donut
Ligamentous anatomy
-anterior and posterior longitudinal ligaments
- supraspinous ligaments
-interspinous ligaments
- ligamentum flavum
-Facet capsule (can refer pain)
Anterior longitudinal ligament
-its role is to limit trunk extension
- provides shape to the disc
Posterior longitudinal ligament
-proximal attachment to the occiput
- limit spinal flexion
Supraspinous ligament
-attaches to each spinous process of the spine
- limit amount of flexion that occurs
Interspinous ligament
-feel the space between the spinous process
- limit amount of trunk flexion
Ligamentum flavum
-responsible for lining the posterior aspect of the vertebral canal
-connecting the lamina
-Travels C2-S1
Extrinsic muscles
Provide movement associated with UE and scapula
- latissimus dorsi
- external/internal oblique
-trapezius
-rhomboid minor/major
-rectus abdominis
Intrinsic muscles
directly influence motion and stability
- iliocostalis lumborum
-longissimus thoracis
- iliocostalis thoracis
-quadratus lumborum
-rotares
Lumbar plexus
-L1-L5: innervates anterior and medial muscles of the thigh, medial leg, and foot
-L2-L4: posterior branches form the femoral nerve, anterior branches form the obturator nerve
Sacral plexus
- Primarily L5-S2: innervates buttocks, posterior femur muscles, and the entire lower leg
Tibial nerve
- continues to descend in the posterior compartment of leg and foot
- gastroc, soleus, Tom, dick and harry
Common peroneal nerve
- travels down the lateral and anterior compartment of the leg and foot
- fibularis longus and brevis
L4-S3 (sciatic nerve)
- supply to biceps long head, semis, hamstrings
Constant LBP differential by pain pattern
-chemical pain, inflammation
Intermittent (70-80%) postural/mechanical dysfunction
Increased with sitting
- Disk, SI joint sprain/inflammation
Reduction with sitting
- spondy, facet syndrome, stenosis
Increased with standing
- ligamentous/muscular instability
Increased while side lyinh
- same side> facet or disk
-opposite side> disk
Bowel/ bladder incontinence
- disk extrusion/ sequestration
- stenosis
-cauda equina syndrome
Skin markings
Neurofibromatosis (cafe au lait)
-genetic disorder causing tumors on nerve tissue
- typically benign but sometimes malignant
- type 1 in children
Spina bifida (faun’s beard)
Mechanical Low back pain
- muscle strain (erector spinae, semispinalis, multifidus)
- spondylosis, spondylolysis, spondylolisthesis
- spinal stenosis
- osteoarthritis
Discogenic low back pain
- pain can be evident in MRI
-annular tears - herniated nucleus pulposus (HNP)
- types: protrusion, prolapse, extrusion, sequestration
Spinal stenosis
- common in 50-60 yrs old
s/s: - pain during walking
- weakness distal to insulting area
- radiating pain, N/T
Intervertebral disk syndrome “degenerative disk disease” (DDD) etiologies
- Poor posture chronically
- loss of water content with age, decreased protein, and altering of chemical structure - Faulty mechanics
- excessive flexion & rotation - Trauma
- violent twist w/flexion
Intervertebral disk syndrome pathoetiology
- degeneration of annulus fibrosis
- nucleus pulposes herniation- extrusion through the annulus fibrosus
- nerve impingement (root or cord)
Intervertebral disk syndrome s/s
Radiculopathy
- any disorder of spinal nerve roots
Sciatica
- any pain, N/T, affecting the distribution of the sciatic nerve
Sciatica
- affects 40% of population in their lifetime
- multiple causes of sciatica: herniated disc, stenosis, piriformis syndrome, diabetes
- could include dull, achy, sharp, radiating, tingling pain
(increased with flexion/tension)
Stages of disc herniation
- disc degeneration
- prolapse
- extrusion
- sequestration
Disc degeneration
chemical changes associated with aging causes discs to weaken, without herniation
Prolapse
disc position changes with some slight impingement into the spinal canal. (bulge or protrusion)
Extrusion
the nucleus pulposus breaks through the annulus fibrosus but remains within the disc
Sequestration
the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal
Special tests for DDD
s/s:
- regional pain/spasm
- radiating pain
- decreased patellar & achilles reflexes
- tests: SLR, bowstring, valsalva, milgram’s, brudzinskis, slump sit
Facet syndrome etiology
acute: forced extension (hyper) w/rotation
Chronic: repetitive extension, hyperlordosis
Facet syndrome pathology
articular lesion, inflammation, osteophytes
Facet syndrome s/s
pain w/extension & rotation
special test: + quadrant test
Spondylolysis etiology
congenital anomaly (pars defect) or repetitive extension causing degeneration & Fx
Spondylolysis pathology
degenerative fracture @ pars interarticularis
Spondylolysis s/s
regional, localized LBP that restricts extension
special test: Single leg stance (stork stand)
Spondylolisthesis etiology
chronic LBP extension strain, postural anomaly, rarely direct blow
Spondylolisthesis pathology
bilateral fracture, subluxation, luxation, anterior displacement (L5 on S1, L4 on L5)
Spondylolisthesis s/s
- lower cross syndrome
- step off deformity
- decapitated scotty dog on Xray
Vertebral fx/ luxation etiology
axial load, hyperflexion/rotation, blunt trauma
Vertebral fx/luxation s/s
- cervical, chest, extremity pain
- anesthesia, paresthesia in trunk/limbs
- weakness
- loss of bladder control
Scoliosis
-can be structural or functional
- structural is rigid and fixed
- usually diagnosed @ 10-15 yr old right after growth spurt
-special test: adams forward bend test
- brace as treatment
