Lumbar Spine Anatomy and Motion Quiz

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Questions and Answers

What occurs to the nucleus pulposus during lumbar flexion?

It migrates posteriorly. (correct)

It remains in a neutral position.

It stays within the posterior annulus fibrosus.

It migrates anteriorly.

Which lumbar region exhibits the largest range of motion for lateral flexion?

L1 and L2

L2 and L3 (correct)

L4 and L5

L3 and L4

How does the motion of the superior vertebra differ during lumbar extension?

It glides anteriorly over the inferior vertebra.

It tilts and glides posteriorly over the inferior vertebra. (correct)

It rotates about the inferior vertebra.

It remains stationary against the inferior vertebra.

During which posture is the coupling of motion ipsilateral according to Fryette's principles?

Flexed posture Signup and view all the answers

Which of the following motions is least free in the lower lumbar region?

Lateral flexion Signup and view all the answers

What is the primary function of the vertebral column?

To transmit the weight of the upper body to the lower limbs Signup and view all the answers

Which correctly describes the structure of an intervertebral disc?

An outer annulus encasing a nucleus that allows movement Signup and view all the answers

What are the components of the lumbar ligamentum flavum?

Connects the laminae of adjacent vertebrae Signup and view all the answers

Which pathological condition is associated with pressure on lumbar nerve roots?

Radiculopathy Signup and view all the answers

How does the orientation of facet joints affect lumbar spine motion?

Directs movement primarily to flexion and extension Signup and view all the answers

What role do cartilaginous endplates play in the intervertebral discs?

They hold the discs in place Signup and view all the answers

What type of spinal curve is exhibited by the cervical region?

Secondary lordotic curve Signup and view all the answers

Which component does NOT contribute to the segmental stability of the lumbar spine?

Pelvic girdle Signup and view all the answers

What is the primary action of the psoas major muscle?

Flex and medially rotate the hip joint Signup and view all the answers

Which function is NOT associated with the quadratus lumborum muscle?

Medially rotate the hip joint Signup and view all the answers

What role does the thoracolumbar fascia play during lifting activities?

Facilitates extension forces Signup and view all the answers

What percentage of patients experience resolution of low back pain within six weeks?

90% Signup and view all the answers

Which of the following correctly describes mechanical low back pain?

Pain that varies with physical activity and time Signup and view all the answers

How does the latissimus dorsi contribute to spinal stability?

By compressing the lumbosacral region with the gluteus maximus Signup and view all the answers

What is a significant symptom reported by most patients with low back pain?

Leg pain Signup and view all the answers

Which muscle is known for causing anterior ilial rotation?

Psoas major Signup and view all the answers

What does the term 'listhesis' specifically refer to?

Slipping of one vertebra on another Signup and view all the answers

Which of the following is a common symptom experienced by individuals with spondylolisthesis?

Localized low back pain that worsens with activity Signup and view all the answers

What is a typical finding during the evaluation of children suspected of having spondylolitic changes?

Palpable step-off with restricted range of motion Signup and view all the answers

In the context of spondylolisthesis, which treatment approach is generally emphasized?

Pain relief and prevention of further slippage Signup and view all the answers

Which demographic group shows the highest prevalence of spondylolisthesis?

Young gymnasts and adolescents Signup and view all the answers

What is the primary function of the erector spinae muscles in the lumbar region?

To act as a dynamic stabilizing force and extensor Signup and view all the answers

What is one of the advantages of positional distraction?

It allows for patient-controlled treatment at home Signup and view all the answers

How do the intervertebral foramen behave during lumbar extension?

Right intervertebral foramen opens while left closes Signup and view all the answers

What is the primary role of the lumbar multifidus?

To provide segmental stability to the lumbar spine Signup and view all the answers

Which statement correctly describes positional distraction?

It combines lumbar flexion, lateral flexion, and rotation Signup and view all the answers

What muscle group contributes to lumbar spinal stabilization by inserting into both the lower lumbar spine and ilium?

Lumbar multifidus Signup and view all the answers

What happens to the spinal canal during lumbar extension?

It closes Signup and view all the answers

Which muscle is involved in lumbar extension and aids in dynamic stabilization?

Erector spinae Signup and view all the answers

What is primarily affected when the gluteus maximus is weak?

Overactivity of hamstrings and erector spinae Signup and view all the answers

Which condition is characterized by narrowing of the spinal canal, often presenting with pain aggravated by standing or walking?

Lumbar spinal canal stenosis Signup and view all the answers

What is a common symptom of neurogenic claudication associated with lumbar spinal stenosis?

Pain radiating into lower extremities Signup and view all the answers

Which factor is NOT typically associated with the degenerative causes of lumbar spinal stenosis?

Congenital spinal malformation Signup and view all the answers

What percentage of lumbar herniated discs resolve spontaneously within six months?

75% Signup and view all the answers

What is the typical location of involvement for most herniated discs in the lumbar region?

L4-L5 Signup and view all the answers

Which muscle's weakness is associated with increased activity of the quadratus lumborum and tensor fasciae latae?

Gluteus medius Signup and view all the answers

Which of the following conditions is least likely to contribute to the narrowing of intervertebral foramen?

Advanced osteoporosis Signup and view all the answers

Study Notes

Lumbar Spine Problems

The lumbar spine comprises five vertebrae (L1-L5), facet joints, and the sacrum.
The vertebrae and intervertebral discs transmit weight, help with posture and movement.
Objectives for the lecture include memorizing clinical anatomy and biomechanics, defining low back pain syndrome, describing pathological classifications of LBP and common conditions, and identifying red flags.

Objectives

Learn the clinical anatomy and biomechanics related to the lumbar spine.
Understand the characteristics of low back pain syndrome.
Learn different classifications of low back pain and associated conditions.
Identify red flags of possible serious underlying conditions.

Facet Joints and Lumbar Spine Motions

Facet joint orientation influences lumbar spine movements.
Questions to consider: How do facet joints direct lumbar spine motions? What are common pain types? What are common lumbar pathological conditions?

Vertebral Column Function

The vertebral column transmits the upper body's weight to the lower limbs.
It protects the spinal cord and supports trunk movement.
It provides stability, flexibility, and protection.
The vertebral column consists of 33 vertebrae and 23 intervertebral discs.
The 33 bones are categorized into cervical, thoracic, lumbar, sacral, and coccygeal.

Spinal Curves

The spine has primary and secondary curves.
The colored areas represent the two primary curves.

Normal Lumbar Vertebra

The anterior portion is the vertebral body.
The posterior portion is the neural arch, divided into pedicles and posterior elements.
The pars interarticularis is the portion of the lamina between the articular processes.

Normal Lumbar Disc

Discs are tough fibrous shock-absorbing pads between lumbar vertebrae.
They account for 20-25% of the vertebral column's total length.
Cartilaginous endplates hold the discs in place.
Each disc is composed of an outer tire-like band (annulus fibrosus) surrounding a gel-like substance (nucleus pulposus).

Intervertebral Disk and ROM

Intervertebral discs allow vertebra tilting, increasing range of motion (ROM) at the inter-body joint.
Without discs, only translational motions are possible.

Effect of Posture on Discal Pressure

Posture significantly impacts discal pressure.
Disc pressure varies by position: Sleeping, sitting, leaning, etc.
Standing positions are used as the comparative baseline for compression.

Lumbar Nerve Roots

Nerve roots exit through small canals between vertebrae and discs.
Pain and other symptoms can result from damaged discs pressing on spinal canals or nerve roots (radiculopathy).

Lumbar Ligaments

Ligamentum flavum limits flexion,
Supraspinous and interspinous ligaments limit flexion.
Intertransverse ligaments limit contralateral lateral flexion.
Anterior longitudinal ligament limits extension and reinforces anterior aspect of annulus fibrosus.
Posterior longitudinal ligament limits flexion and reinforces posterior aspect of annulus fibrosus.
Capsule of facets strengthens and supports the apophyseal joint.
Iliolumbar ligament stabilizes L5/S1.

Lumbar Vertebrae Movements

Movements occur in three planes: Sagittal (flexion/extension), Coronal (side bending), and Transverse (rotation).
During flexion, anterior tilting and gliding cause compression of the anterior annulus fibrosus and stretching of the posterior annulus fibrosus. The nucleus pulposus moves posteriorly.
During extension, superior vertebras tilt and glide posteriorly over inferior vertebras, stretching the anterior annulus fibrosus and bulging the posterior portion of the disc. The nucleus pulposus moves anteriorly.

Regional Differences in Lumbar Spine Movements

The largest lateral flexion and axial rotation happen in the mid lumbar region (L2-L3).
Lower lumbar levels (L4-S1) are primarily involved in flexion and extension.

Facet Joints Direction During Lumbar Motions

Superior facets face medially and backward (concave).
Inferior facets face laterally and forward (convex).

Lumbar Facet Joint Dysfunction

Facet joint pathology is a common cause of chronic low back pain, it is aggravated by lumbar extension, but relieved by lumbar flexion.
Pain commonly occurs acutely with extension and rotation tests.

No Localizing Neurologic Symptoms (Low Back Pain)

The pain is usually non-radiating.
Sudden-onset back pain (increasing intensity) is associated with disc lesions.
Facet joint manipulation often provides relief.

Risk Factors for Low Back Pain

Age, heavy manual labor, repetitive lifting/twisting, posture, whole-body vibration, monotonous work, poor physical fitness / strength, smoking, work-related psychological factors contribute to low back pain.

Spondylolysis

Defined as a stress fracture of the pars interarticularis (area between inferior and superior articular facets).
Common in young people, especially gymnasts, due to repetitive stress on the spine.
Unilateral or bilateral defects are possible.
Symptoms often include low back pain without neurological deficits.

Spondylolisthesis

The slipping of a vertebra from its normal position.
Often as a progression of spondylolysis.
Characterized by one vertebra sliding anteriorly relative to the vertebra immediately below.
Most common in women and adolescent/young gymnasts.

Stages of Low Back Pain

Acute: less than 4 weeks. Sub-acute: 4 to 12 weeks. Chronic: beyond 12 weeks.

Red Flags for Low Back Pain

Age (<20 or over 70), history of trauma, constant and progressive pain, history of carcinoma, steroids use, fever, infection, systemic illness, weight loss, bowel/bladder incontinence or loss of motor functions are all red flags that suggest serious underlying pathology.

Nerve Root Impingement:

Narrowing of intervertebral foramen can cause nerve root impingement, conditions include: stenosis, facet joint degeneration, herniated intervertebral disc.

Degenerative lumbar Spinal Canal Stenosis

Stenosis is a narrowing of the space in the spinal canal.
Symptoms may include pain that worsens with standing or walking and improves with forward flexion (neurogenic claudication).
It is not typically a problem for young people and more common in older people.

Causes/Types of Lumbar Spinal Stenosis

Congenital (idiopathic), Spondylosis (bone spurs), Spondylolisthesis, Scoliosis, Ossification of PLL, Hypertrophied facet joints, Hypertrophied ligamentum flavum, and herniated disc are examples of types of lumbar spinal stenosis.

Lumbar Disc Herniation

Rupture of the nucleus pulposus through the annulus fibrosus.
Common at the L4-L5 or L5-S1 levels.
75% of cases resolve spontaneously within 6 months.
Symptoms usually include leg pain and paresthesia more than back pain.

MRI Lumbar Images

MRI images show L5-S1 disc extrusion, while L4-5 has a protrusion contained by PLL.

Lumbar Spondylosis (Disc Degeneration)

Various degenerative changes in the spine.
Age-related, gradual onset, and often unknown cause. The black disc in this MRI indicates the disc has low water content, common with the degeneration of discs.

Loss of Water in Nucleus Pulposus (Disc Degeneration)

A loss of water in the nucleus pulposus leads to the reduction of its cushioning ability.
Disc bulges, and scar tissue formation may occur in the annulus fibrosus.
The intervertebral space narrows (approx. facet joints).

Lumbar Musculature

(Images show/list muscles: psoas major, transversus abdominus, rectus abdominus, quadratus lumborum, latissimus dorsi, iliolcostalis, longissimus, multifidus, lumbar fascia, etc.)

Posture and Movement

Posture is essential for assessing discal pressure and lumbar spine health.
Various positions, including sitting, standing, and leaned positions may influence compression or pressure.

Questions

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Description

Test your knowledge on lumbar spine anatomy, movement mechanics, and associated structures. This quiz covers various aspects including intervertebral discs, muscle function, and motion coupling principles in the lumbar region. Perfect for students studying anatomy or physiotherapy.