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Lumbar Spine

Functional Anatomy

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