Lumbar Spine Anatomy and Movement Quiz

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Questions and Answers

What type of coupling occurs in the lumbar spine when in a neutral posture?

Ipsilateral coupling

Uncoupled movement

Quadrilateral coupling

Contralateral coupling (correct)

Which statement accurately describes the movement of the nucleus pulposus during lumbar extension?

The nucleus pulposus migrates anteriorly. (correct)

The nucleus pulposus remains stationary.

The nucleus pulposus migrates laterally.

The nucleus pulposus migrates posteriorly.

Where is the largest range of motion for lateral flexion and axial rotation found in the lumbar spine?

Between L1 and L2

Between L2 and L3 (correct)

Between L4 and L5

Between L3 and L4

During lumbar flexion, which structural change occurs at the annulus fibrosus?

Bulging occurs at the anterior annulus fibrosus. Signup and view all the answers

What happens to the inferior facet of the superior vertebra during lumbar flexion?

It glides up and forwards. Signup and view all the answers

Which ligament primarily limits excessive lordosis in the lumbar region?

Anterior longitudinal ligament Signup and view all the answers

What is the main function of the posterior longitudinal ligament in the lumbar spine?

Reinforces the annulus fibrosus and limits flexion Signup and view all the answers

What orientation do the superior facets of the lumbar zygapophyseal joints have?

Medially and backward Signup and view all the answers

Which ligament limits contralateral lateral flexion in the lumbar region?

Intertransverse ligament Signup and view all the answers

In the lumbar spine, what is the effect of degeneration of the intervertebral disc on the facet joints?

Increases their compressive load Signup and view all the answers

What does the coupling mechanism in the lumbar spine indicate about side bending?

It is accompanied by rotation Signup and view all the answers

Which position of the lumbar spine is considered the close-packed position?

Full extension Signup and view all the answers

What role do the facet joints of the lumbar region play during load transmission?

They provide a significant posterior load-bearing helper Signup and view all the answers

What does 'listhesis' refer to in relation to the vertebrae?

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

Which group is most at risk for developing spondylolisthesis?

Women and young gymnasts Signup and view all the answers

What is a common sign associated with diagnosed spondylolisthesis?

Palpable 'step-off' in the sacral region Signup and view all the answers

What type of exercises are recommended for managing spondylolisthesis?

Lumbar stabilization exercises and stretching Signup and view all the answers

What is the estimated degree of forward slippage associated with Grade 1-Grade 2 spondylolisthesis?

Equal to about 1/4 to 1/2 of the AP diameter of S1 Signup and view all the answers

What is a common source of nerve root pain such as sciatica?

Disc herniation Signup and view all the answers

Which of the following is NOT classified as a risk factor for low back pain?

High fluid intake Signup and view all the answers

In which stage of low back pain does the condition last for more than 12 weeks?

Chronic Signup and view all the answers

Which presentation age is indicated as a red flag for probable serious spinal pathology?

70 years Signup and view all the answers

What symptom is not typically associated with nerve root pain?

Muscle rigidity Signup and view all the answers

Which condition is a known cause of cauda equina syndrome?

Prolonged use of steroids Signup and view all the answers

What is the characteristic symptom of Lower crossed syndrome?

Muscle strength imbalances in the lower segment Signup and view all the answers

Which of the following is a potential consequence of vertebral fractures in older adults?

Increased risk of nerve root compression Signup and view all the answers

What is indicated by the 'black' appearance of herniated discs on an MRI?

Disc desiccation and lack of proteoglycan Signup and view all the answers

Which vertebral level shows a normal disc with no posterior projection into the epidural space?

L3/4 Signup and view all the answers

What is a typical feature of pain associated with lumbar spondylosis?

Pain occurs acutely with extension and rotation of the lumbar spine Signup and view all the answers

What can contribute to the narrowing of the inter-vertebral space in disc degeneration?

Approximation of the facet joints Signup and view all the answers

What condition is best defined as a stress fracture of the pars interarticularis?

Spondylolysis Signup and view all the answers

Which factors contribute to the development of intervertebral disc degeneration?

Advanced age and sedentary lifestyle Signup and view all the answers

What typically characterizes the pain experienced by individuals with facet joint pathology?

Pain is aggravated by lumbar extension Signup and view all the answers

Which of the following signs or symptoms is NOT characteristic of spondylolysis?

Low back pain with neurologic deficit Signup and view all the answers

Which muscle group is typically weak in individuals suffering from low back pain due to muscular imbalances?

Abdominals and gluteus maximus Signup and view all the answers

What is a common symptom of degenerative lumbar spinal canal stenosis?

Pain radiating into the lower extremities Signup and view all the answers

Which of the following conditions contributes to acquired lumbar spinal stenosis?

Herniated intervertebral disc Signup and view all the answers

Which factors contribute to the overactivity of the hamstrings in muscle imbalances?

Weak gluteals and weak abdominals Signup and view all the answers

Which of the following statements about lumbar herniated discs is true?

95% involve the L4-L5 or L5-S1 levels. Signup and view all the answers

What are the characteristics of lumbar spinal stenosis?

Pain aggravated by standing or walking and reduced by forward flexion Signup and view all the answers

Which condition is frequently associated with upper crossed syndrome?

Layer syndrome Signup and view all the answers

What is the primary cause of nerve root impingement?

Stenosis of the intervertebral foramen Signup and view all the answers

Study Notes

Lumbar Spine Problems

The lumbar spine consists of five vertebrae (L1-L5), facet joints, and the sacrum.
The vertebral column supports the upper body and protects the spinal cord.
It transmits weight, helps with movement, and maintains stability.
It's composed of 33 vertebrae and 23 intervertebral discs.
The lumbar spine is divided into five categories: cervical, thoracic, lumbar, sacral, and coccygeal.

Objectives

Students should know the clinical anatomy and biomechanics of the lumbar spine.
Define low back pain syndrome (LBP).
Students should be able to describe pathological classifications of LBP and common conditions.
Students should understand the red flags for lumbar problems.

Facet Joint Orientation

Superior facets face medially and backward, generally concave.
Inferior facets face laterally and forward, generally convex.

Spinal Curves

The spine has primary and secondary curves.
The spinal cord runs through the spinal canal, containing the nerves and spinal cord.
The primary curves are present at birth, while the secondary curves develop later.

Lumbar Ligaments

Ligamentum flavum: Connects adjacent laminae, limiting flexion.
Supraspinous and interspinous ligaments: Limit flexion.
Intertransverse ligaments: Limit contralateral lateral flexion.
Posterior longitudinal ligament: Limits flexion and reinforces annulus fibrosus.
Anterior longitudinal ligament: Limits extension and reinforces the annulus fibrosus.
Capsule of apophyseal joint: Supports facet joints.
Iliolumbar ligament: Stabilizes L5/S1.

Normal Lumbar Disc

Acts as a shock absorber between lumbar vertebrae.
Represents 20-25% of the vertebral column's total length.
Cartilaginous endplates hold the disc in place.
Annulus fibrosus (outer band): Encases gel-like nucleus pulposus (inner substance).

Intervertebral Disc Function

Allows for tilting of vertebrae, increasing range of motion at the inter-body joint.
Without discs, only translatory motion would be possible.

Effect of Posture on Discal Pressure

Sleeping positions have the lowest pressure on the discs.

Nerve Roots

Nerve roots exit the spinal canal within small passageways between vertebrae and discs.
Pain and symptoms develop when a damaged disc presses on the spinal canal or nerve roots. This can be called radiculopathy.

Low Back Pain (LBP)

LBP is often self-limiting, resolving in 6-12 weeks in most cases.
Less than 1% of LBP cases are due to serious conditions like tumors or infection.
Common symptoms include back pain, leg pain, neurological symptoms, and spinal deformity.

Mechanical Low Back Pain

Characterized by pain related to physical activity and time.
LBP is commonly located in the lumbosacral region, buttocks, and thighs.

Nerve Root Pain (Radiculopathy/Sciatica)

Pain originating from the spine affecting the leg or foot.
Causes of nerve root pain include disc herniation, spinal stenosis, nerve root inflammation, tumors, Piriformis Syndrome, and postoperative scarring.

Risk Factor Evidence

Age, heavy manual labor, repetitive lifting, postural stress, whole body vibration, monotonous work, poor physical fitness or trunk strength, smoking, and psychological factors (depression, stress, anxiety) influence lumbar problems.

Stages of Low Back Pain

Acute LBP: Less than 4 weeks.
Subacute LBP: 4-12 weeks.
Chronic LBP: More than 12 weeks.
Evaluation involves ruling out emergent or non-musculoskeletal causes first.

Red Flags

Presentation age <20 years or onset >70 years.
History of trauma.
Constant, progressive, non-mechanical pain.
Previous history of carcinoma, prolonged steroid use, or back-related infections (spinal osteomyelitis).
Fever or recent infection.
Systemically unwell or weight loss.
Widespread neurologic symptoms, Cauda Equina Syndrome (urinary retention/incontinence, bowel incontinence), progressive motor weakness in the legs, gait disturbance, and inflammatory disorders (e.g. Ankylosing Spondylitis).

Lower Crossed Syndrome

Results from muscle imbalances in the lower back.
Characterized by weak abdominal and gluteus maximus muscles, and strong hip flexors (iliopsoas) and back extensor muscles.
Weak gluteal muscles cause overactivity of hamstrings and erector spinae.
Weakness of gluteus medius influences quadratus lumborum and tensor fascia latae.
This is sometimes seen in conjunction with the upper crossed syndrome, and together are sometimes referred to as layer syndrome.

Nerve Root Impingement

Narrowing of the intervertebral foramen caused by stenosis, facet joint degeneration, or herniated intervertebral disc.

Degenerative Lumbar Spinal Canal Stenosis

Reduction of space in the spinal canal affecting nerve elements.
Typically seen in older athletes.
Symptoms include pain aggravated by standing or walking, radiating pain into the buttocks and lower extremities, and neurogenic claudication.
Pain relief may come with forward lumbar flexion.

Causes or Types of Lumbar Spinal Stenosis

Idiopathic (congenital/developmental).
Acquired: Spondylosis(bone spurs), spondylolisthesis, scoliosis, ossification of the posterior longitudinal ligament, hypertrophied ligamentum flavum, and hypertrophied facet joints, and herniated disc.

Lumbar Disc Herniation

Abnormal rupture of the nucleus pulposus (central portion of the disc) through the outer ring (annulus fibrosus).
Typically involves L4-L5 or L5-S1 disc levels.
75% of lumbar herniated discs resolve spontaneously. - Leg pain and paresthesia are more symptomatic than back pain.

Lumbar Spondylosis

Used to describe degenerative disorders of the spine.
Disc degeneration is a common disorder associated with spondylosis.
Onset is often gradual with no known cause.

Facet Joint Dysfunction

Pathology of facet joints cause 40% of chronic LBP.
Symptoms include pain aggravated by lumbar extension (compressing the posterior joint), pain relieved by lumbar flexion (separating the joint surfaces), typically clinical diagnosis, and pain occurring acutely with extension and rotation of lumbar spine.

No Localizing Neurological Symptoms

Pain is typically non-radiating.
Sudden onset or steadily increasing pain may indicate disc lesions.
High response to facet manipulation is common.
Advanced age, intervertebral disc degeneration, and degenerative spondylolisthesis are also possible risk factors.

Spondylolysis

A stress fracture of the pars interarticularis.
Commonly seen in young people who perform repetitive flexion and extension motions (ex: gymnasts).
Often painless, unilateral or bilateral defects, low back pain, and occasionally posterior buttock/thigh pain but without neurological deficits.

Spondylolisthesis

Vertebral body slipping on another, often inferiorly toward another vertebrae.
Progression of spondylolysis may cause separation of vertebrae.
Superior vertebrae slide anteriorly on the one below.
Most notable in women and adolescents.

Lumbar Spine Signs and Symptoms

Restricted range of motion is common.
Sacral prominence and palpable "step-off"
Loss of lumbar lordosis and development of lumbosacral kyphosis.
Common occurrence of low back pain (75%) and occasional absence of symptoms altogether.

Questions (Page 51)

List of open-ended questions for discussion were presented that the students could ask to clarify or expand on the material.

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Description

Test your knowledge on the anatomy and movement mechanics of the lumbar spine. This quiz covers topics such as coupling in neutral posture, movement of the nucleus pulposus, and the role of various ligaments. Perfect for students of anatomy or physical therapy.