Flashcards in L-Spine Pathology Deck (66)
What 3 ligaments are continuous systems that wrap the lumbar spine in a "stocking"?
- Supraspinous ligament
- Interspinous ligament
- Ligamentum Flavum
What is the function of the ligamentum flavum in the lumbar spine?
- Forms a roof for the vertebral canal that doesn't buckle with flexion or extension
What are the 4 key muscles/ muscle groups that stabilize the lumbar spine?
- Transverse abdominus
- Pelvic floor muscles
What force do the multifidi resist?
What is a protrusion of a disc?
- Posterior disc buldge without rupture of the outer annulus
What is a prolapse of a disc?
- Nucleus contained only by the outermost fibers of the disc's annulus fibers
What is an extrusion of a disc?
- Disc material enters the epidural space due to a ruptured annulus
What is a sequestration of a disc?
- Disc material within the epidural space fragments
What are the 3 types of spinal stenosis?
- Lateral recess
Where does lateral recess stenosis occur?
- On the lateral aspect of the spinal canal
What is the major symptom of lumbar spinal stenosis? What makes it better? What makes it worse?
- Neurogenic claudication (pain in the legs when walking
- Static standing, walking, and coughing make it worse
- Spinal flexion makes it better
What are 2 ways that arterial ischemic claudication can be differentiated from neurogenic claudication?
- Assess pulse (a neurogenic claudication will have normal pulses)
- Have the patient ride a stationary bike (will provoke arterial; neurogenic will be mostly unchanged)
What muscles should be trained to manage lumbar spinal stenosis?
- Transverse abdominis
- Pelvic floor
- Diaphragm (?)
What muscles should be stretched when managing lumbar spinal stenosis? Why?
- Stretch hip flexors to reduce lumbar lordosis
How can posture be corrected to help manage lumbar stenosis?
- Encourage flexion when possible, and avoid extension postures/ movements
How can the patient be educated to manage lumbar stenosis?
- Avoid extension of the lumbar spine, as well as quadrant like positions
What type of orthotic can be used to help manage lumbar stenosis?
- If the symptoms are unilateral, put a heel lift in the contralateral shoe
What is a spondylolisthesis?
- Forward subluxation of one vertebra on the vertebra below it
What are 4 subjective reports that are common with spondylolisthesis?
- Generalized back ache
- Gluteal pain
- Lower back weakness
- Lower quarter weakness
What specific movement can be used a clinical sign for spondylolisthesis?
- A pain with return to an extended position from flexion that is made better by contracting the glutes and core before performing the motion
What muscles are strengthened, and which are stretched when managing spondylolisthesis?
- 4 key core muscles trained
- Careful stretching of the iliopsoas to avoid an anterior shear force on the spine
How is the patient educated in managing a lumbar spondylolisthesis?
- Avoid extension movements/ positions and movements that cause shear
What is one of the most common diagnoses in an outpatient setting?
- A sprain-strain of the iliolumbar ligament
How a sprain of the iliolumbar ligament treated during the acute stage? (4 main components)
- Pt education to avoid reinjury/ aggravation
- Modalities and manual therapy for pain control
- Gentle stretching
- Aerobic activities as tolerated
What is the treatment for a ligament sprain of the lumbar region past the acute stage?
- Core training and conditioning
What are 5 red flags that may seem present as lumbar pain?
- Aortic aneurism (Pulsate pain in abdominal region)
- Pyelonephritis (kidney infection)
- Nephrolithiasis (kidney stones)
- Malignant tumors of the spinal column (cords or meninges)
- Metastatic tumors (from: thyroid, prostate, breast, colon, lung...)
How can a metastatic tumor easily be differentiated from a metastatic tumor?
- It is outside of the dura
Where are the 2 locations a tumor may appear as a primary cancer?
- Within dura, but outside of cord
- Within the spinal cord
What are examples of what a job task inventory may entail during an intake/ physical exam of a patient with lumbar spine impairments?
- Environmental exposures