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Lumbar Spine
Functional Anatomy
| Term | Definition |
|---|---|
| lumbar spine spondylosis | degenerative changes to the facet joints, vertebral bodies, & intervertebral discs of the lumbar spine; usually present w/ aging |
| open-packed position of the lumbar spine | flexion |
| close-packed position of the lumbar spine | extension |
| Management of lumbar spondylosis | postural education, traction/distraction, core stabilization,epidural injection, surgery to shave off osteophytes, etc... |
| lumbar spine stenosis | central or lateral narrowing of the lumbar vertebral foramen or intervertebral foramen |
| central lumbar spine stenosis | narrowing of the A/P diameter of the vertebral foramen; can compress the spinal cord itself (usually higher vertebrae) or the spinal nerve roots (usually lower vertebrae |
| lateral lumbar spine stenosis | narrowing of the IV foramen |
| s/s of lumbar spine stenosis | Signs: postural adjustments (will use UE's for support & bend forward), walk w/ a flexed posture, pain w/ lumbar extension Symptoms: Radicular ache/cramp into the lower limbs caused by neurogenic claudication |
| neurogenic claudication | compression of a nerve or a temporary interruption of blood supply to a nerve; will improve w/ trunk flexion |
| intermittent claudication | pain in lower limbs due to an interruption of blood supply bc of muscle contractions |
| management of L-spine stenosis | flexion progression, stretch hip flexors, laminectomy |
| flexion progression | Start in PPT in hooklying; have pt bring 1 knee to their chest & then both knees to their chest |
| lumbar spine spondylolysis | a fatigue/stress fracture of the pars interarticularis due to repetitive extension motions, congenital bone structure problems, traumatic events, degenerative bone changes, or pathologic bone changes, such as OA and osteopenia |
| single leg hyperextension test | standing leg being tested is on the same side as the fracture; extend the spine; positive test- if pt's sxs are reproduced |
| management of spondylolysis | bracing in slightly flexed position which prevents extension of the spine, core stability retraining, stretching of the hip flexors, and modified movement training (which motions to avoid) |
| sponylolisthesis | ant slippage of 1 sup vert as a result of instability caused by a bilateral defect in the pars interarticularis; most common locations: L4-L5 or L5-S1; 4 grades of slippage |
| s/s of spondylolisthesis | pain w/ extreme motion, especially extension; may complain of neurological symptoms |
| management of spondylolisthesis | sx management, lumbar stabilization, fusion surgery (usually only for grades III & IV) |
| compression fractures | usually occur more frequently in the thoracic spine due to the wedge-shaped bodies of the vertebrae |
| management of a vertebral fracture | flexibility, strentgh of the core & lower limbs, surgery (vertebroplasty or kyphoplasty) |
| intervertebral discs | very thick in lumbar spine to absorb shock from weight-bearing; 3 parts: 1. nucleus pulposus, 2. annulus fibrosis, 3. vertebral endplates |
| nucleus pulposus | mostly water, proteoglycans, & collagen type II fibers; loads like a balloon |
| annulus fibrosis | more collagen > elastin; adjacent lamellae (rings) have opposite orientations to each other in order to facilitate constant tension during any movement; weakest portion is posterolaterally; fxn's to decrease compressive & traction loads |
| annulus fibrosis (cont...) | attaches to the cartilagenous endplates of the vertebral bodies |
| lumbar disk injury | injury to lamella allow nucleus to protrude; pain due to either pressure on a nerve root or chemical irritation of a nerve root; 5 stages |
| anterior longitudinal ligament (ALL) | ant surfaces of all vert bodies & the sacrum; well developed along lumbar lordosis; resists anterior shear, axial rotation, extension, distraction; slacks with flexion |
| iliolumbar ligaments | prevent ant displacement of L5 on the sacrum; resists motion in all planes |
| lumbar mobilizers | rectus abdominus, abdominal obliques, ant fibers of psoas major, iliocostalis, longissimus, quadratus lumborum |
| lumbar stabilizers | multifidus, transverse abdominus, post fibers of psoas major, internal abd oblique (post fibers), musc attachments to Thoracolumbar Fascia |
| innervated structures of the lumbar spine | post & lateral disc, PLL, ALL, superficial surface of ligamentum flavum, interspinous ligaments, facet joints |
| scoliosis | most commonly curvature is in frontal plane; name curve by convexity; strengthen convex side; stretch concave side; surg for curves> 50-60 degrees; spinal fusion w/ or w/o Harrington Rods |
| side glide | named in direction the shoulders travel |
| quadrant tests | combined gross motion in multiple planes simultaneously |
| Iliac crests | between L4 & L5 |
Created by:
MeganFultz2
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