Clinical Pearl about Spinal Health

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18 Questions

What is the primary function of the transversus abdominis (TrA) muscle?

To provide rotational and lateral control to the spine while maintaining intra-abdominal pressure

Which muscle is considered to have the greatest potential to provide dynamic control to the motion segment, particularly in its neutral zone?

Lumbar multifidus

What happens to the intervertebral discs when the osmotic pressure within them is greater than the hydrostatic pressure from axial loading?

They imbibe fluid, causing the spine to increase in length

What is the recommended advice for patients regarding spinal movements shortly after rising from bed?

Avoid full-range spinal motions, particularly bending

Which muscle contributes to the control of sacroiliac movement?

Transversus abdominis

What is the function of the coactivation of the diaphragm and abdominal muscles?

To produce a sustained increase in intra-abdominal pressure

Which of the following statements about the intervertebral discs (IVDs) is correct?

The NP and inner AF act like a pressurized fluid, distributing compressive stress evenly

What is the clinical significance of the attachment of the annulus fibrosus (AF) to the vertebral end plates?

It strongly binds the end plates to the intervertebral disc (IVD)

Which of the following statements about the vertebral end plates is correct?

They are regarded as constituents of the intervertebral disc (IVD)

Which of the following statements about lumbar spine flexion is correct?

It can occur with a posterior pelvic tilt

What is the term used to describe the repetitive contact of the spinous processes during the extremes of lumbar extension?

Kissing spine

What is the consequence of the condition known as 'kissing spine'?

Ligamentous laxity and hypermobility of the affected segment

Where are the attachment sites for the multifidus muscle located?

On the mamillary processes of the lumbar vertebrae

Which statement about the zygapophyseal articular processes (facets) is correct?

Their shape and orientation vary along the lumbar spine.

What is the unique feature of the intervertebral disks in the lumbar spine?

They have a larger cross-sectional area of the anulus fibrosus posteriorly.

What is the characteristic shape of the vertebral foramen in the lumbar spine?

Triangular

Which statement about the fifth lumbar vertebra is correct?

It is a transitional vertebra with a wedge-shaped body.

What is the primary function of the intervertebral disks in the lumbar spine?

To resist tensile forces in nearly all directions

Study Notes

Osmotic Pressure and Disk Imbibition

  • When osmotic pressure within the intervertebral disk (IVD) is greater than hydrostatic pressure from axial loading, the disk imbibe fluid, causing the spine to increase in length.
  • This occurs when lying in bed, and patients should avoid performing full-range spinal motions (bending) shortly after rising from bed.

Transversus Abdominis and Spinal Control

  • The transversus abdominis (TrA) is the deepest abdominal muscle, which may have a presetting role in providing rotational and lateral control to the spine.
  • The TrA, along with the internal oblique, maintains adequate levels of intra-abdominal pressure and imparts tension to the thoracolumbar fascia, increasing the stiffness of the lumbar spine.

Diaphragm and Abdominal Muscle Coactivation

  • Coactivation of the diaphragm and abdominal muscles produces a sustained increase in intra-abdominal pressure.
  • Activity of the diaphragm and TrA is initiated before rapid limb movements and is tonic during repetitive movements of the arm and walking.

Lumbar Multifidus and Dynamic Control

  • The lumbar multifidus is considered to have the greatest potential to provide dynamic control to the motion segment, particularly in its neutral zone.

Intervertebral Disk Function

  • The intervertebral disk (IVD) acts to provide flexibility at low loads and stability at high loads.
  • The IVD distributes compressive stress evenly between adjacent vertebrae due to the nucleus pulposus and inner anulus fibrosus acting like a pressurized fluid.

Vertebral End Plates and Attachment

  • The vertebral end plates are strongly bound to the IVD, whereas they are only weakly attached to the vertebral bodies.
  • The end plates are considered constituents of the IVD, rather than part of the lumbar vertebral body.

Age-related Changes in Intervertebral Disk

  • The IVD becomes drier, stiffer, less deformable, and less able to recover from creep with age.

Lumbar Spine Flexion and Posterior Pelvic Tilt

  • Flexion of the lumbar spine can occur with a posterior pelvic tilt, which can be performed voluntarily or as a result of weak paraspinal extensor muscles or adaptively shortened hamstring and gluteal muscles.

Repetitive Contact and Periostitis

  • Repetitive contact of the spinous processes during the extremes of lumbar extension can lead to a periostitis called "kissing spine", resulting in ligamentous laxity and hypermobility of the segment.

Vertebral Anatomy

  • The lumbar vertebra has a massive body, pedicles, laminae, transverse process, accessory processes, and spinous process.
  • The fifth lumbar vertebra is a transitional vertebra, with a wedgeshaped body and specific characteristics.

Intervertebral Disk Structure

  • The intervertebral disk consists of anulus fibrosus and nucleus pulposus, with collagen fibers arranged in concentric sheets (lamellae).
  • The disk resists tensile forces in nearly all directions and provides a greater cross-sectional area of anulus fibrosus posteriorly, increasing its ability to resist tension.

Learn about the importance of avoiding full-range spinal motions shortly after rising from bed to maintain spinal health. Discover how osmotic pressure affects the spine's length and the role of the transversus abdominis muscle.

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