Spine

Question 1

Describe the lumbar vertebrae and the motions available in the lumbar region.

Answer 1

5 massive vertebrae built to support the load of the body. Motions are flexion/extension, rotation, and side bending.

Question 2

Describe the parts of the intervertebral disc.

Answer 2

The annulus fibrosis is the out rings of the disc. The rings run in different directions for stability.
The nucleus is the center part-filled with gag molecules (water) which get less and less after the age of 40.

Question 3

Describe the intervertebral end plate.

Answer 3

Made of thin fibrol cartilage. On both sides of the body-help pass nutrients to disc since there is no blood supply to them. Usually the most damaged part of spine and thus causes problems to discs when they don’t get the nutrients they need for repair.

Question 4

Describe the spinal motion segment.

Answer 4

There is the vertebral body of each vertebrae with the intervertebral disc sandwiched in between, with an end plate on each side of the vertebral body.
In extension the facet joints and intervertebral foramen close and the nucleus of the disc shifts anteriorly. In flexion the facets and foramen open and the disc shift posteriorly.

Question 5

Describe the intervertebral foramen and the nerve structure passing through.

Answer 5

The intervertebral foramen is the space on the lateral side of the vertebrae. This is where the spinal chord branches out into nerve roots which then becomes the spinal nerve.

Question 6

Describe the vertebral foramen and the nerve structure

found within.

Answer 6

The vertebral foramen is the space at the center of the vertebrae and allows the spinal chord to pass through it.

Question 7

Describe degenerative joint disease.

Answer 7

Osteoarthritis of the spine. DJD starts with damage to the articular cartilage. This progresses to inflammation, nerve root compression, potentially bone spurs, and of course arthritis.

Question 8

Describe disc herniation.

Answer 8

When all or part of the nucleus is forced through the torn annulus fibrous. This protrusion may impinge on the nerve root as it exits the spinal chord.

Question 9

Describe facet joint syndrome.

Answer 9

Is the break down of the articular cartilage of the facet joint-or arthritis.

Question 10

Describe spondylolethesis.

Answer 10

The forward translation of a vertebral body with respect to the vertebra below. Mostly in lumbar region at L5/S1.. Often caused by a fracture of the posterior arch.

Question 11

Describe the components of and the primary function of the facet joint.

Answer 11

Inferior/superior articular processes. They are the articulation of the spine, control the motion of the spine..

Question 12

Describe the differences in the vertebral body, and transverse and spinous processes found in the lumbar
and thoracic spines.

Answer 12

Cervical designed for motion, lumbar designed for stability. The vertebral body of the lumber is much larger to be able to hold the load of the body and provide the stability, the cervical is much smaller for motion.

The transverse and spinous process are larger in the cervical.

Question 13

Describe the anterior and posterior longitudinal ligaments and ligamentum flavum and their importance to spinal function.

Answer 13

• The anterior longitudinal ligament runs the entire anterior side of the spine and helps limit extension and provides stability.
• The posterior longitudinal ligament runs the length of the posterior side of the spine inside the vertebral canal. This ligament limits flexion and reinforces the intervertebral discs.
• The ligmentum flavum connects the laminae of adjacent vertebrae.

Question 14

Describe why the quadrutus lumborum is the workhorse of the spine.

Answer 14

Because it helps extend the back after bending forward, also provides lateral flexion.

Question 15

Describe the importance of the multifidi as intersegmental spinal stabilizers.

Answer 15

BC they attach at each vertebrae, they provide individual stabilization.

Question 16

Describe the importance of the “Lumbar Protective Mechanism” and how it protects the spine.

Answer 16

It’s all the muscles of the trunk working together to protect from outside forces.

Question 17

Describe the function and importance of dermatomes and myotomes.

Answer 17

They are the areas of the body and patterns that are innervated by the various spinal roots.

Question 18

List the three key concepts in MET management of degenerative joint disease.

Answer 18

• improve spinal stability
• teach neutral spine in all movements
• strengthen LE and do cardio

Question 19

List the three key exercises in MET management of degenerative joint disease.

Answer 19

• spinal stabilization exercises
• LE extremity strengthening
• cardio

Question 20

List the muscles associated with the L3, L4 and L5 myotomes .

Answer 20

L3-quads-knee extensors
L4-tibialis anterior-ankle dorsiflexors
L5-long toe extensors

Question 21

Explain the terms “radiating pain” and “referred pain”.

Answer 21

Radiating pain-pain that travels the length of the nerve

Referred pain-pain felt in a part of the body other than its’ source

Question 22

Identify three locations in the lumbar spine where DJD usually begins.

Answer 22

Facet joint
end plate
disc

Question 23

Explain the degenerative cascade.

Answer 23

Begins with initial damage or injury to the facet joint, intervertebral end plate, or disc. The injury begins a process progressing from spinal stability to instability and finally to stability. The arthritis changes are the body attempting to stabilize the spine.

Question 24

Explain spinal stenosis and the differences in lateral and

central stenosis.

Answer 24

Central-usually elderly, bilateral LE pain diminished with sitting, flexion bias
Lateral-younger population, unilateral LE pain, neutral feels best

Question 25

Explain multifidi changes with chronic pain, disc herniation and back surgery.

Answer 25

It becomes weak and atrophies.

Question 26

List the conditions that may cause sciatica.

Answer 26

``` DJD Stenosis Herniation Spondylolethesis Piriformis syndrome ```

Question 27

Explain Nachemson’s study with disc compression in sitting and standing.

Answer 27

Lying supine is the lowest, then prone, then standing. Sitting and sitting with slouched posture are much higher, as well as bending over with weight.

Question 28

List the MET criteria for lumbar disc herniation, DJD, and spondylolethesis. All-(3), Each (2)

Answer 28

ALL: - full LE motor function - medical clearance - less than 4 on pain scale Herniation: - full lumbar ROM - sensation intact DJD: - no radicular pain or some if ok'd by Dr. - full ROM Spondy: - slippage less than 5mm - bowel and bladder control

Question 29

Describe the importance of lower extremity motor function testing when assessing lumbar conditions.

Answer 29

The absence of full motor control could indicate nerve compression, and would require a referral.

Question 30

Describe the importance of a positive “straight leg raise test

Answer 30

This could show a disc herniation

Question 31

List the MET precautions for the lumbar disc herniation client. (3)

Answer 31

- avoid activities that cause radiating pain - avoid prolonged static postures - avoid flexion and uncontrolled rotation

Question 32

Describe the most common cause of spondylolethesis.

Answer 32

Motor vehicle accident-rear end collision causing a fracture of the posterior arch.

Question 33

Describe the grading process used to assess the spondylolethesis.

Answer 33

``` 1-< 25% slippage 2-25-50% 3-50-75% 4-75-100% 5-> 100% ```

Question 34

Explain the spinal extension ROM limit with spondylolethesis.

Answer 34

Keep it less than 10 degrees extension

Question 35

Explain the differences in the “Straight Leg Raise Test” and “Laseuge Sign”.

Answer 35

With SLR-foot is in neutral | With Laseuge-foot is dorsiflexed

Question 36

Describe the “Hoover Test” and its indications during the spinal assessment.

Answer 36

You them do a straight leg raise but put your hands under their heels to see if you get pressure from opposite leg. If not, this indicates that are not putting forth effort.

Question 37

Describe contraindications for the “Thomas Test” during spinal assessment.

Answer 37

Do not use with acute back pain or recent surgery.

Question 38

How do symptoms of a nerve root compression progress?

Answer 38

It starts with the first component of the root-the sensory one. Symptoms will be numbness, tingling, and pain. As it progresses to the second component-which affects motor control, this is where they can loose function of their muscles and will often require surgery at this point.