the lumbar spine

Question 1

anatomy?

Answer 1

see the note I made on it

Question 2

what are the functions of the lumbar spine?

Answer 2

support (the T spine and pelvis) protection (of the spinal cord and cauda equina) movement haemoatopoesis

Question 3

what are the function of intervertebral discs

Answer 3

secondary cartilaginous joint - partially mobile they are a major shock absorber

very strong under compression (stronger than ventral body) it keeps the vertebrae separate under compression by transmitting the axial load

the annuls perpendicular layers helps maintain strength

Question 4

why do we stand straight?

Answer 4

tension on the posterior spine pulls us straight the compression on the anterior spine prevents hyper flexion (good diagram on slide 30)

Question 5

how to reduce force on spine?

Answer 5

hold things close to your body

Question 6

how does age change the force transmission?

Answer 6

young = 80% of body weight through ventral bodies and 20% facet joints old= disc dehydration, more force through the facet joints

Question 7

what are kyphosis? where are they? is it mobile?

Answer 7

a forward curve of the spine (concave anteriorly) sacral, thoracic, coccyx no its not mobile

Question 8

what are lordosis? where are they? is it mobile?

Answer 8

backyard curve of the spine (concave posteriorly) e.g. lumbar and cervical yes its mobile

Question 9

what is the vertebrae column like in the foetus?

Answer 9

single curve - C shaped kyphosis (concave anteriorly) this is known as the PRIMARY CURVATURE this retained in all kyphosis regions in the adult (sacral, coccyx and thoracic)

Question 10

what is the vertebrae column like after 18months?

Answer 10

the primary curvature is modelled into 2 secondary curvatures 1. cervical lordosis develops (posterior concave shape) this allows the baby to lift their head 2. lumbar spine loses primary kyphosis during crawling and then the lumbar lordosis develops when they start to walk

Question 11

how has the pelvis changed to help us stand on 2 legs?

Answer 11

broader and more vertical = stability

Question 12

how many curves are there in the spine?

Answer 12

5: 2 lordosis 3 kyphosis

Question 13

what shape does the spine take?

Answer 13

sinusoidal shape = flexible and resillent

Question 14

what happens to the spine shape in old age?

Answer 14

secondary curvatures start to disappear (lordosis) loss of disc height and osteoporotic fractures lead to a more prominent thoracic curvature continuous primary curvature of babies is re-established

Question 15

what happens to the spine shape in pregnancy?

Answer 15

exaggeration of lumbar lordosis foetus grows and lumbar lordosis increases to maintain centre of gravity

Question 16

what is mechanical back pain? what causes mechanical back pain?

Answer 16

it is the most common lumbar spine pathology its abnormal not to have episodes of this in your lifetime

poor posture- slouching increases pressure on lumbar and cervical spine - flexion means nucleus pulpous is pushed posteriorly and more likely for disc prolapse and back pain

too little exercise - exercise helps build muscles that support the spine

obesity - increased load on spine :(

Question 17

what is mechanical back pain relieved by? aggravated by? what is the nature of the pain?

Answer 17

when spine isn’t loaded e.g. lying down

exercise and loaded spine e.g. standing intermittent

• severity doesn’t correlate to pathological changes, triggered by activity

if overweight/unhealthy core muscles = predisposed

Question 18

how does mechanical back pain show on an Xray

Answer 18

simalr to ageing look

Question 19

what is a prolapsed intervertebral disc?

Answer 19

slipped disc

protrusion of the nucleus pulposus posteriorly into the spinal canal leading to compression of the nerves

Question 20

what are the 4 severities of prolapsed discs?

Answer 20

• degerneration = disc blulge
• prolapse = protrusion of nucelus pulposus with slight impingment to spinal cord
• extrusion = mucleus pulposus breaks through the annulus fibrosus but remains within disc space
• sequestration = nuclus pulposus breaks through the annulus fibrosus and separates from main body os disc to the spinal canal

Question 21

does the disc slip back in?

Answer 21

no it dosent!

it is degraded and dissolved but people think it slips back in

Question 22

what common age does prolapsed intervertbral discs occur?

how long does it take to resolve?

were on the lumbar spine is this common?

what direction does it herniate?

what to prescribe?

Answer 22

• 30 - 50 years
• most resolve themselves in 3 months
• common sites are L4/5 and L5/S1
• paracentrally

Question 23

what is sciatica?

where are the roots of tha sciatic nerve?

most common sites?

Answer 23

• pain caused from iritation or compression of nerve roots that contribute to the sciatic nerve
• L4, L5, S1, S2, S3

Question 24

where is the pain form siciatica felt?

Question 25

what is cauda equina syndrome?

symptoms

Answer 25

canal filling disc compressing lumbar and sacral nerve roots (the cauda equina)

2% of slipped discs are these

Question 26

what is lumbar canal stenosis?

what causes it?

what age group is most at risk?

Answer 26

• narrowing of canal for nervre roots
• this is due to disc bulges, facet joint osteooarthiritis, liagment flavum hypertrophy
• occurs in the elderly

Question 27

what does lumbar canal stenosis cause?

Answer 27

claudication :

• compression of nerve roots from lumbar canal steonosis
• venous engorment of nerve roots in exercise as the blood cant drain
• reduced arterial inflow (ischaemia)
• pain and paraethesia (pain when walking)

Question 28

what can claudication be relieved by?

Answer 28

flexion of spine - chnages posture subconciously

Question 29

what is spondylolisthesis

Answer 29

dissconection of vertebral body from vertebral arch - usually results in a forwatd displacement

Question 30

where should a needle for lumbar puncture be placed?

what structures will the needle pass from skin to sunarachnoid space?

Answer 30

• between L2 and 3, L3 and 4 or L4 and 5 - this is below the spinal cord and only mobile spinal roots exist here to decreases cahneg of neurological damage
• skin, subcutanous fat, ligamentum flavum, epidural fat, veins, dura mater, arachnoid mater then subarachnoid space