Lumbar Spine

The first episode of LBP usually resolves within what time period?

6- 52 weeks

What are the velcro like attachments of the annulus fibrosus to the vertebral body?

sharpey fibers

Anterior Longitudinal Ligament

runs anterior vertebral bodies, limits hyperextension

Posterior longitudinal ligament

runs posterior to vertebral bodies in the spinal canal; about 1/3 the size of ALL, covers bursa and vertebral a. and v., limits hyper flexion, highly innervated

Ligamentum flavum

runs lamina to lamina in the spinal canal, limits hyper flexion

Interspinous ligament

runs between spinous processes, fibers oriented at an angle

supraspinous ligament

runs spinous process to spinous process, limits hyperflexion, commonly sprained/ torn

iliolumbar ligament

starts out as a muscle then becomes a ligament with age, iliac crest to lumbar transverse processes

intertransverse ligaments

span transverse process to transverse process, limit hyper lateral flexion and rotation

3 groups of erector spinae muscles

iliocostalis, longissimus, spinalis

Red flags of the lumbar spine

AAA, Cauda equina, malignancy, fracture

Differential diagnoses of the lumbar spine

inflammation, disc herniation, lumbar radic, stenosis, neurogenic claudication, vascular, spondylosis, spondylolisthesis, facet syndrome

s/s AAA

onset of intense pain in chest, abdomen, or LB; often asymptomatic until at or near rupture

Modifiable risk factors of AAA

smoking, HTN, hypercholesterolemia, obesity, atherosclerosis

Non- modifiable risk factors AAA

male > female, increased age (males >50, females >60-70), family hx

Causes of cauda equina

trauma, disc herniation, spinal stenosis, tumor, infection, ankylosing spondylitis, post- surgery

s/s cauda equina

bowel/ bladder dysfunction, saddle paresthesia, LE motor weakness, absent/ diminished ankle/ knee reflexes, radic, **normal UMN signs (typically)

CPR for malignancy

absence of all 4 can rule out cancer

prior hx of cancer, failure to improve within 1 mo of therapy, >50 yo, unexplained weight loss >10lbs in 6 mo

Possible contributing factors to fracture

>65 yo, prolonged corticosteroid use, severe trauma, contusion or abrasion

Characteristics of inflammatory LBP

age of onset <45, duration >3 mo, insidious onset, morning stiffness >30 min, improves with exercise, no improvement with rest, awakening from pain, alternating butt pain

CPR for inflammatory LBP

> 2 suspect

>4 diagnostic for inflammatory LBP

Classifications of disc herniation

protrusion, prolapse, extrusion, extrusion, sequestration

Types of disc herniation

central, lateral recess, foraminal, extraforaminal

s/s of lumbar radiculopathy

LBP and leg pain, muscle weakness, sensation impaired, reflexes impaired, possible + neural tension tests

What are causes of lumbar radic?

disc herniation, lateral stenosis, localized inflammation

Causes of lumbar stenosis

congenital or acquired

Types/ location of stenosis

central or lateral

Cluster for neurogenic claudication

increased pain with standing, relief with sitting, s/s located above knees, + shopping cart sign

Cluster for vascular

decreased symptoms from walking, with a standing rest, s/s below knees

Define spondylolysis

stress fracture of posterior vertebral arch

Define spondylolisthesis

forward translation of vertebral body secondary to spondylolysis

Causes of spondylosis

stress or traumatic fx, developmental anomaly

Causes of facet syndrome

OA

Presentation of facet syndrome

localized pain in a radiating pattern from at/ near the level of origin, often radiates into proximal butt or thigh; provocation UPA >CPA, hyper extension, extension and rotation

Types of spondylolisthesis

congenital, isthmic, degenerative, traumatic, pathologic

Most common location for spondylolisthesis

L5/ S1

Key differences between radicular, radiating, and referred pain

radicular: follows dermatome pattern, nerve symptoms present (numbness, weakness, reflex changes), worsened by neural tension tests; burning, electric, sharp/ shooting pain

radiating: pain spreads from its origin to another area, can be nerve or MSK pain and s/s (EX: LBP—> buttock, groin, legs)

referred: **NOT dermatomal, NO nerve root involvement, pain perceived at a location distant from the source of the pathology, often due to shared neural pathways; deep, achy pain (EX: CVD presents as shoulder pain)

Special tests for radicular pain

slump, SLR, wells- crossed, prone knee bed

Special test for lumbar instability

prone instability test