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Flashcards in Chapter 4 - Lumbar Deck (30):
1

Why are disc herniations common in the lumbar area?

Posterior longitudinal ligament begins to narrow at L1

2

Thoracic and lumbar - nerve root is (above/below)

BELOW

3

Lumbar nerve roots - exit through the ___ aspect of the intervertebral foramina

SUPERIOR (because they are extending down from the conus medullaris)

4

Erector spinae group - muscles

Spinalis, Iliocostalis, Longissimus

5

Psoas - origin and insertion

O = T12-L5 vertebral bodies
I = lesser trochanter

6

Psoas syndrome - other findings (3)

Precipitated by ____

Pelvic side shift
Positive Thomas test
Upper lumbar vertebral SD

Prolonged shortening

7

Iliac crest - level?

L4-L5 disc

8

Umbilicus - level?

L3-L4 disc

9

Facet trophism - define

Cause?

Importance?

Asymmetry of the facet joint angles - one may point more medially or laterally than normal

Congenital anomaly (MC in lumbar spine)

VERY difficult for the vertebrae to move against each other -- THUS EARLY DEGENERATIVE CHANGES

10

Sacralization - define

Cause?

Importance?

One or both TPs of L5 get fused with the sacrum

Congenital anomaly

Altered L-S junction --> early disc degeneration

11

Lumbarization - define

Failed fusion of L5 to S1

12

Spina bifida - what is the structural defect?

Failed closure of LAMINA (connects TP to SP)

13

Main motion of lumbar spine

Flexion, Extension

14

L5 SB --> sacral ____

OBLIQUE axis engaged on SAME side

15

L5 Rot --> sacral ____

Rotation to OPPOSITE side

16

Ferguson's angle

Normal?

Angle between HORIZONTAL axis and axis of SACRAL BASE

25-35 degrees

17

Acute back pain - options?

Fracture
Strain
Herniation
Infection (osteomyelitis, meningitis)
Referred pain

18

Pain in low back, buttock, posterior lateral thigh
Increased with activity or prolonged standing or sitting
Increased muscle tension

Diagnosis?
Treatments?

Lumbosacral SD (back strain/sprain)

Counterstrain, ME, HVLA

19

L4-L5 disc herniation - which nerve root affected?

L5-S1 disc herniation - which nerve root affected?

L5

S1

20

Numbness/tingling w/ sharp, burning, shooting pain down leg, worse with flexion of lumbar spine
Decreased reflexes and strength and sensory

Diagnosis?
Test that will be positive?
Radiology?
Treatment (for most)?

Herniated disc

Straight leg raise

MRI (gold standard)

Bed rest, indirect OMT, gentle direct OMT

21

Organic causes of psoas syndrome (6)

Importance?

Appendicitis
Sigmoid colon dysfunction
Ureteral calculi
Ureter dysfunction
Metastatic prostate carcinoma
Salpingitis

Must be ruled out before treatment for mechanical cause

22

Low back pain radiating to groin, achy
Increased when standing or walking

Positive test?
**Tenderpoint?
***Lumbar SD?
Pelvic finding?
Sacral finding?
Other muscular finding?

Psoas syndrome

Positive Thomas test
**Tenderpoint medial to ASIS
****L1-L2 Flexed, R and SB to SAME side
Pelvic shift test to CONTRALATERAL side
Sacral dysfunction on OBLIQUE axis
CONTRALATERAL piriformis spasm

23

Psoas syndrome - treatment

Ice (NOT heat)
**Counterstrain to tenderpoint
**ME or HVLA to high lumbar dysfunction
Stretching (ONLY if CHRONIC)

24

Pain in low back, achy, shooting to leg w/ paresthesias
Worsened by extension (standing, walking, supine)

3 causes?
Radiology findings?
Treatments?

Spinal stenosis

1. Hypertrophy of facet joints
2. Calcium deposits w/in ligamentum flavum and PLL
3. Loss of intervertebral disc height

Osteophytes, decreased disc space, foraminal narrowing

- OMT to decrease restrictions and improve ROM
- PT, NSAIDs, Low dose tapering steroids
- Surgery

25

Low back, buttock, and/or posterior thigh pain, achy
Increased w/ extension
Tight hamstrings bilaterally
Stiff leg, short stride, waddling gait
NO neurologic deficits

Positive exam finding?
Radiology finding?
Treatments?

Spondylolisthesis

Step-off sign (forward displacement of a SP)

Forward displacement of one vertebrae on another

OMT - reduce lumbar lordosis and SD (NO HVLA)
Weight loss, no high heels, avoid flexion
Heel lifts, lumbo-sacral orthotics

26

Define...
- Spondylolisthesis
- Spondylolysis
- Spondylosis

Listhesis = forward displacement of vertebrae

Lysis = defect in pars interarticularis w/o displacement

Losis = degenerative changes w/in intervertebral disc + ankylosing of adjacent vertebral bodies

27

Scotty dog

What view?

SpondyloLYSIS - the black "collar" on the dog is the fracture

OBLIQUE view

28

**Diagnosing spondylolisthesis vs. spondylolysis on X-ray

Listhesis = LATERAL view
Lysis = OBLIQUE view

29

Sharp low back pain
Saddle anesthesia
Decreased DTRs
Decreased rectal sphincter tone
Loss of bowel and bladder control

Cause?
Treatment?
Danger?

Cauda equina syndrome

Massive CENTRAL (directly posterior) disc herniation

Emergent surgical decompression

Irreversible paralysis

30

Grading spondylolisthesis...

Grade 1
Grade 2
Grade 3
Grade 4

1 = 0-25%
2 = 25-50%
3 = 50-75%
4 = 75+%