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Spinal Tx 600 > Lumbar > Flashcards

Flashcards in Lumbar Deck (70):
1

How many facet joints in lumbar spinal segments?

Five pairs
Apophyseal or zyoapophyseal (facet)

2

What direction do lubar facets face?

Superior: medial and posterior
Inferior: lateral and anterior

3

Which movements are limited by facet joints

Side flexion
Flexion
Extension

4

Relationship between lumbar TVPs and SPs

Same level

5

Lumbar joints: Capsular pattern

Side flexion = rotation, then extension

6

Degrees of AROM: lumbar flexion

40-60º

7

Degrees of AROM: lumbar extension

20-35º

8

Degrees of AROM: lumbar lateral flexion

15-20º

9

Degrees of AROM: Rotation

2-18º

10

Lumbar: IL side flexion increases pain; no radicular symptoms

Problem probably intra-articular (since muscles and ligaments relaxed)

11

Lumbar: IL side flexion increases pain and radicular symptoms

Likely disc protrusion lateral to nerve root

12

Lumbar: CL side flexion increases pain and radicular symptoms

Likely disc protrusion medial to nerve root

13

Lumbar: coupled movements

side flexion + rotation

14

Ligament unique to lumbar spine

Iliolumbar ligament
TVP of L5 to posterior ilium
Stabilizes L5, prevents anterior displacement

Commonly injured with flexion + twisting

15

Anterior longitudinal ligament

Occiput --> sacrum
Strongest ligament in body
Prevents hyperextension

16

Posterior longitudinal ligament

Occiput to sacrum
Anterior aspect of neural canal
Attaches to IVD but not vertebral bodies
Limits forward bending

17

Ligamentum flavum

Ant-inf border of superior lamina --> posterior border of inferior lamina
C2 --> S1
Most elastic tissue in the body
Prevents meninsci and synovial lining from being caught in articular joint surfaces

18

Intertransverse Ligaments

Limit lateral flexion and rotation

19

Interspinous ligaments

Go up and backwards, not up and forwards
--> allow for flexion but within control

20

Supraspinous ligaments

Connect aspices of spines C7-L4
Most superficial, most likely to sprain

21

Nuchal Ligament

Supraspinous ligament from C7--> occiput

22

Lumbar: Each nerve root is named for ...

The vertebra above it.

(Thoracic: same; Cervical: named for below)

23

Two components of Intervertebral Discs

Nucleus pulposes
Annulus pulposes

24

Function of IVD

1. shock absorption
2. hold vertebrae together while allowing movement
3. separate vertebrae into functional segments
4. separate vertebrae to allow passage of nerve roots through intervertebral foramina

25

Lumbarization

Unfused S1 --> additional lumbar segment

Lower stability, increased mobility

26

Sacralization

Fused L5 --> additional sacral segment

Lower mobility, increased stability

27

Spondylosis

Degeneration of IVD

28

Spondylolysis

Defect in pars interarticularis

29

Spondylolisthesis

Forward displacement of one vertebral segment over another

30

Retrolisthesis

Backwards displacement of one vertebra on another

31

Motion segment

Facet joints + IVDs

32

Four stages of disc herniation:

1. protrusion
2. prolapse
3. extrusion
4. sequestration

33

Protrusion

Nucleus bulges without rupture of annulus fibrosus

34

Prolapse

"Only outermost fibres of annulus contain nucleus" (I think it's a big protrusion)

35

Extrusion

Annulus is perforated and discal material moves into epidural space

36

Sequestration

Formation of discal fragments from annulus and nucleus outside the disc proper

37

Most common herniation locations

L4-5 (affects 5th lumbar nerve root)
then L5-S1 (affects first sacral root)
then L3-4

38

Common presentation of disc herniation

-- few days after excessive activity or mild injury
-- aggravated by coughing, sneezing, reaching or stooping
-- lumbar muscle spasm --> decreased lordosis
-- lateral truck shift in standing
-- restricted active flexion and extension

39

Most common herniation direction

Posterolateral
(PLL prevents it from going directly posterior)

40

Herniation: Pain and position

Worse with sitting, lifting, twisting, bending, sustained posture

Morphs to severe pain radiating down one limb

Often better with extension

41

Herniation: pain in anterolateral leg

L4

42

Herniation: pain radiating to posterior foot

L5

43

Cauda equina syndrome

Lesion affecting cauda equina
Loss of bladder and bowel function, saddle anaesthesis

44

Schmorl's Nodules

Herniations of nucleus pulposus into vertebral body
Results from direct vertical pressure

45

Paresthesia

Pins and needles, burning

46

Herniation vs Facet Lock

Herniation:
-- immediate pain, posterior thigh, leg, foot, glutes,

Facet Lock
-- pain doesn't go distal to knee
-- back may get locked into position

47

Mechanical LBP

aka lumbago
Unilateral pain with no referral below knee
Possible strain, sprain, facet joint or SI joint problem

48

Back/buttock pain.
Worse in flexion. Better with extension.
Stiff in am

Mechanical LBP
Likely disc involvement (minor herniation, spondylosis, sprain, strain)

49

Back/buttock pain
Worse with extension/rotation
Better with flexion

Mechanical LBP
Likely facet joint involvement, strain

50

Leg pain below knee
Myotomes affected, dermatome pain
Worse with flexion, better with extension

Nonmechanical LBP
Nerve root irritation -- most likely herniation

51

Leg pain below knee, maybe bilateral
Myotomes affected, dermatome pain
Pain with walking, better with rest

Neurogenic
intermittent claudication
Stenosis

52

What refers pain to the low back?

Pancreatic tumours

53

Looks mechanical, but DDx of disc involvement

Pain on standing, flexion
Improvement when walking
No muscle tenderness

54

Normal lordotic curve

50º

55

What happens to lumbar SPs during flexion

(Anterior roll, posterior glide)
Move further apart and posteriorly

56

What happens to lumbar SPs during extension

(Posterior roll, anterior glide)
Move closer together and anteriorly

57

Three grades of DDD

1. dysfunctional
2. unstable
3. stabilization

58

Dysfunctional DDD

Phase 1
Tearing around outer surface of annulus
Disc begins to shrink

59

Unstable DDD

Phase 2
Joint loses strength
Continued tearing on horizontal axis of didsc
Cartilage degeneration

60

Stabilization (DDD)

Phase 3
Surface of vertebral bodies above and below of IVD showing damage. Disc thin and fibrotic.
Formation of arthritic osteophytes (spurs)

61

Constant ache

Inflammatory process, venous hypertension

62

Pain on movement

Noxious mechanical stimulus (stretch, pressure, crush)

63

Pain accumulates with activity

Repeated mechanical stress
Inflammation
DDD

64

Pain increases with sustained posture

Muscle fatigue
Gradual tissue creep

65

Latent nerve root pain

Movement has produced an acute and temporary neuropraxia

66

IVD's make up how much of the length of the vertebral column

20-25%

67

Lumbar resting position

Between flexion and extension

68

Lumbar close packed position

Full extension

69

If lumbar lesion is medial to nerve root:

Patient may list to same side as lesion

Demonstrate pain during SLR of unaffected leg

70

Most important signs of disc herniation

History
Decreased ROM
Neuro dynamic tests