Unit Two Exam Lumbar Vertebrae Flashcards
What are the typical lumbar vertebrae
L1 through L4
What are the ten descriptive characteristics of typical lumbar vertebrae
Kidney shaped bodies, broad club like SP, TVP are thin and blade like, accessory processes, TVP’s are anterior to articular process but posterior to IVF, mammillary process, interlocking articular processes, broad short laminae, deep inferior pedicle notch and a shallow superior pedicle notch, neural foramen is triangular
Describe superior articular facet of typical thoracic
Concave and are located on outside
Inferior articular process of typical thoracic
Convex and located on the inside
Why is L5 a peculiar
Wedge shaped body, small SP that tips upward toward L4, TVP arises from the body and not the lamina/ pedicle junction
What is the 4th transitional segment of the spine
L5
Describe inferior facets of L5
Face more coronary rather than sagittally
What is the active ROM of flexion of the lumbar
Lumbar only is 60 degrees with help of pelvis then 105 degrees
Active ROM of lumbar for extension
25 degrees, first 15 degrees from pelvis and last 10 is lumbar spine alone
Active ROM of lumbar for lateral bending
25 degrees
Active ROM of lumbar for rotation
45 degrees
Spondyl means
Vertebra
Lysis means
Break
What is spondylolysis
A break in the pars interarticularis (part of laminae) without anterior slippage
Is spondylolysis unilateral or bilateral
Both
Bilateral spondylolysis can turn into what
Spondylolisthesis
What causes stress fractures of the pars interarticularis
Secondary to repeated minor trauma
What does listhesis mean
Slippage
What is spondylolisthesis
Considered a break in the pars interarticularis with anterior slippage
What is anterolisthesis
Anterior slippage
What is retrolisthesis
Posterior slippage
Spondylos mostly occurs where
70 to 75% occur ass L5 slips anterior on S1
In spondylolisthesis or spondylolysis what forms in the crack of the pars
Fibrous tissue
The fibrous tissue forming in the crack of the pars contains what and causes what
Nerve fibers and pain carrying free nerve endings and are capable of transmitting pain
What is a stress fracture
Injuries to vertebra happen faster or more often than the body can keep up with needed repairs, a crack may form in the weakened bone
If the crack in the vertebra reaches both sides what happens
The vertebra is no longer held firmly in place by the facet joints allowing for the body to slip anterior
Spondylolisthesis in early stages is unstable but then becomes stable due to what
Fibrous tissue forming
True congenital spondylolisthesis occurs with who and when
Pars defects increases with age
What are the five types of spondylolisthesis
Isthmic, degenerative, traumatic, pathological and dysplastic
Aka of isthmic spondylolisthesis
Lytic spondylolisthesis
What is isthmic spondylolisthesis
Fatigue or stress fracture of the pars of L5, L5 slips on S1
What is the most common type of spondylolisthesis
Isthmic
Most common spondylolisthesis below age 50
Isthmic
What is degenerative spondylolisthesis
Fracture/pars defect but is secondary to long standing degenerative process
Degenerative spondylolisthesis primarily what type of degeneration
Posterior joint
Who do you see degenerative spondylolisthesis with
Female over 40
Degenerative spondylolisthesis is a slippage on what
L4 slips on L5
Degenerative spondylolisthesis is most common with what age
Above age 50
What is traumatic spondylolisthesis
Acute fracture anywhere in the posterior arch except at the pars interarticularis
What is pathological spondylolisthesis
Found secondary to pathology such as metastatic carcinoma, Paget’s disease, etc.
What is dysplastic spondylolisthesis
Rare congenital malformation in which L5 may be lacking inferior articular processes to articulate with S1 thus slides anterior
Dysplastic spondylolisthesis AKA
Congenital spondylolisthesis
Both spondylolysis and spondylolisthesis are considered __________ conditions
Acquired
What percentage of population has spondylolisthesis
5 to 7%
Is canal stenosis more common or foraminal stenosis
Foraminal stenosis
As many as 50% of young athletes have this symptom which may indicate they have spondylolysis or spondylolisthesis
Pain in the lumbar for over three months
Spondylolisthesis is most often associated with sports that have a lot of
Hyperextension such as football, weight lifters, divers, pole vaulters, high jumpers, gymnastics and wrestlers
Isthmic spondylolisthesis is most often found between what ages in athletes
9 and 13
The majority of spondylos occur asymptomatically by what age and symptomatic at what age
12 and 13
What sex is more prone to spondylolisthesis in sports
Males
What sex appears to be severe with spondylolisthesis in sports
Females
Signs and symptoms of spondylos
Low back pain (chronic), tight hamstrings causing hyperlordosis, loss of flexibility (due to altered biomechanics and pain)
Typical X-ray views for the lumbar spine
A-P lumbar and lateral lumbar
If you suspect spondylo, what X-ray series
A-P lumbar, lateral lumbar, and obliques
What X-ray do you use to measure or grade the amount or degree of slippage in spondylolisthesis
Lateral lumbar X-ray
What are the two ways to measure or grade the amount or degree of slippage of spondylolisthesis
Ullman’s line and meyerding classification
What is ullman’s line
Uses anterior aspect of the vertebral bodies to measure slippage
What is meyerding classification
Uses posterior aspect of the vertebral bodies to measure slippage
How many grades are there in the meyerding grading
1 through 5
Grade one of meyerding
1-25% anterior slippage
Grade 2 meyerding
26 to 50% anterior slippage
Grade 3 meyerding
51 to 75% anterior slippage
Grade 4 meyerding
76 to 99% anterior slippage
Grade 5 meyerding
Vertebra has slipped totally off the segment below and anterior to it and may fuse to the segment below called spondyloptosis
What is greatest segmental motion in the lumbar spin
Flexion and extension
75% of flexion of lumbar spin is where
L5/S1
What is the least segmental motion in the lumbar spine
Rotation
Greatest amount of overall motion in the lumbar spine occurs where
L4/L5
Greatest amount of lateral bending in the L spine is where
L3/L4
Least amount of lateral bending in the L spine occurs where
L5/S1
What is the most common anomaly of the spine
Trophism
What is baastrup’s disease
Kissing spinouses
What is trophism
Asymmetrical facets at L5/S1
What is sacralization
Last lumbar assumes the characteristics of the sacrum, spatulated TVP or fusion to sacrum in some form
What is lumbarization
First sacral segment assumes characteristics of the lumbar. Usually separated and called L6
Disc herniations occurs where in the L spine
L4/L5 and L5/S1
If more mobility then less
Stability
What is knife clasp syndrome
Elongated spinous process of L5 (with hyperlordosis) and a spina bifida at S1
Symptom of knife clasp syndrome
Will have pain upon extension that is centrally located
What occurs in tropism
Joints are faced different and only move with great stress which leads to disc wearing and pain
What is spondylosis
A pathological stimulation of new bone formation at the attachments of the longitudinal ligaments
What are the two types of spondylosis
Syndesmophyte and spondylophyte
What is an osteophyte
Spur found on any bone
What is syndesmophyte
Vertical spurs, calcification of the longitudinal ligaments
What is spondylophyte
More horizontal spurs off the vertebra (usually true bone). May end up with fusion
What are the three types of fusion
Arthrodesis, ankylosis, synostosis
What is arthrodesis
Surgical fusion
What is ankylosis
Pathological fusion
What is synostosis
Congenital fusion
