Lumbar Spine

Question 1

the last rib articulates with what rib?

Answer 1

t12

Question 2

what XR view of the spine evaluates the pars interarticularis?

Answer 2

oblique

Question 3

loss of disc space height on XR evaluates for what etiology?

Answer 3

DDD

Question 4

stiffness after inactivity indicates what general type of lumbar spine pathology?

Answer 4

spondylosis

Question 5

pain with spinal extension / rotation indicates what etiology of pain?

Answer 5

spondylosis

Question 6

synovitis around the facet joint can compress what structure?

Answer 6

neuroforamina

Question 7

narrowing of joint space and sclerosis is indicative of what type of spine pathology?

Answer 7

spondylosis

Question 8

what are the grades of spondylolisthesis?

Answer 8

Grades 1-IV

Question 9

what XR views should you get to evaluate for lumbar spondylolisthesis?

Answer 9

flex/extend views

Question 10

how much segmental motion is considered significant displacement in spondylolisthesis?

Answer 10

3mm or greater

Question 11

what nerve roots make up the sciatic nerve?

Answer 11

L4-S2

Question 12

what nerve root provides motor innervation to the iliopsoas?

Answer 12

L3

Question 13

what nerve root level provides motor innervation to the tibialis anterior?

Answer 13

L4

Question 14

what nerve root provides sensory innervation to the dorsolateral thigh?

Answer 14

L5

Question 15

medial branches of the spinal nerves innervate what two structures?

Answer 15

facet joint and multifidus muscles

Question 16

what is the only true lateral flexor of the L-spine?

Answer 16

quadratus lumborum

Question 17

what is the primary type of collagen in the nucleus pulposus?

Answer 17

type II collagen

Question 18

what is the type of collagen that predominantly comprises the annulus fibrosus?

Answer 18

type I collagen

Question 19

t/f the pain from a foraminal disc herniation can be worse with lumbar spine extension

Answer 19

true

Question 20

what is the Kirkaldy-Willis Degenerative cascade of the lumbar spine?

Answer 20

the natural course of the interrelationship between disc and facet joint degeneration/instability/stenosis

Question 21

generally, what are the two types of intervertebral disc herniations?

Answer 21

protrusion and extrusion

Question 22

what is the difference between protrusion and extrusion?

Answer 22

protrusion - base is larger than amount of disc material
extrusion - base is smaller than amount of disc material

Question 23

what is the most common zone for disc herniation?

Answer 23

subarticular zone, just off midline anterior to the facet joint

Question 24

in a paramedian disc herniation, what nerve root is most likely to be affected?

Answer 24

the nerve root beneath the level of the herniation

Question 25

what is the typical MOI of annular fissure?

Answer 25

flexion combined with rotation

Question 26

what is the most common etiology of facet syndrome?

Answer 26

OA

Question 27

in a foraminal disc herniation, what nerve root is most likely to be affected?

Answer 27

exiting nerve root at the level of the disc

Question 28

t/f there is no consensus on the correct imaging for spondylolysis and oblique views have fallen out of favor

Answer 28

true

Question 29

how does spondylolysis start?

Answer 29

stress reaction

Question 30

other than bracing and physical therapy, what other modality has the potential to improve radiographic healing in spondylolysis?

Answer 30

bone stimulator

Question 31

what is the primary issue that generates pain at the SIJ?

Answer 31

hypermobility of the joint

Question 32

t/f there is no definitive diagnostic test for piriformis syndrome and it is actually very rare

Answer 32

true

Question 33

instead of piriformis syndrome, what is the preferred term for this pain pattern?

Answer 33

deep gluteal syndrome

Question 34

what is the rehab protocol with the most evidence for addressing lumbar spine pathologies with a directional preference?

Answer 34

mechanical diagnosis and therapy (MDT)

Question 35

what type of intervention injection for facet mediated pain has the most evidence?

Answer 35

medial branch block

Question 36

what is the difference between radiculitis and radiculopathy?

Answer 36

radiculitis - pain down a dermatome radiculopathy - pain with weakness or abnormal reflex(es)

Question 37

t/f facet joint pain can cause pain down a portion of the leg

Answer 37

true

Question 38

a paramedian disc herniation occurring at the L4-L5 level is most likely to cause nerve root involvement at what level?

Answer 38

L5

Question 39

what is the incidence of piriformis syndrome in a patient with buttocks pain with intermittent radicular symptoms?

Answer 39

6-8%

Question 40

T1 weighted images emphasize what type of tissue?

Answer 40

fat / adipose

Question 41

T2 weighted immages highlight what material?

Answer 41

water

Question 42

what ligament of the spine is located at the inner margins of the lamina?

Answer 42

ligamentum flavum

Question 43

what is the name for the degenerative end plate changes resulting from disc height loss and osseous changes?

Answer 43

Modic changes

Question 44

which portion of the annulus is most prone to tearing?

Answer 44

posterolateral

Question 45

what type of annulus tear is typically more likely to be symptomatic?

Answer 45

radial tear

Question 46

t/f circumferential or transverse annular tears are often not associated with clinical symptoms

Answer 46

true

Question 47

what are the three zones of nerve impingement?

Answer 47

1. lateral recess (medial to the pedicle) 2. foraminal 3. extraforaminal