Looks like no one added any tags here yet for you.
where does the lumbar lordosis begin and end
begins at T12 and ends at L5
where is the most prominent part of the lumbar lordosis
L3-L5
why is the L5 vertebral body smaller
it has to fit in between the iliac crests
what are the ossification centers of the lumbar spine
primary: body and each vertebral arch (3)
secondary: endplates (2), tips of TPs (2), tip of SP (1), mammillary process (2)
total secondary: (7)
what is the shape of the lumbar vertebrae
kidney shaped
do lumbar vertebrae get good blood supply
vertebral bodies have extensive blood supply
what structures attach to the lumbar vertebral bodies
anterior: ALL
posterior: PLL
Lateral: L1-L3 has right and left crus of the diaphragm
posterolateral: psoas major
what is the crus of the diaphram
a tendon that anchors the diaphragm to the lumbar spine
where is the pars interarticularis
in between the superior and inferior articular processes
what are the attachments of the TPs in the lumbar spine
anterior: psoas major, quadratus lumborum, and anterior layer of thoracolumbar fascia
medial and lateral arcuate ligaments of the diaphragm at L1
apex: middle layer of thoracolumbar fascia and iliolumbar ligament (L5)
superior and inferior border: lateral intertransversarii
posterior surface: deep back muscles
what direction do mammillary processes project
posterior for the attachment of the multifidus lumborum
what is facet tropism and where is it most common
noticeable asymmetry between right and left facets
most commonly seen at L5-S1
what degrees is the lumbar facets and what way do they face
90 degrees from vertical
inferior facet faces laterally, superior facet medially
what kind of joints are the facets
synovial planar
what innervates the facet joints
medial branch of the dorsal primary rami
what is the synovial fold aka Meniscoid fold
provides fluid and lubrication for facets
what do the facets limit
range of motion
where does the cauda equina start
about L1/L2
does motion increase or decrease as you go down the lumbar spine
increase
what does flexion vs. extension do for the lumbar spine
flexion: more CFS circulation; increases canal space
extension: less CSF circulation; decreases canal space
what is the lumbar cistern
a large arachnoid space
what are the borders of the IVF
inferior and superior vertebral notches,
articular pillars
vertebral bodies and IVDs
lateral border surrounded by attachment of the psoas major
what shape are the lumbar IVFs
inverted pear shape or inverted teardrop
how much of the IVF does the spinal nerve take up
1/3 and it is close to the superior pedicle
Kemp’s test
forcefully laterally flex and rotate until feet are off the floor, indicates whether pathology is in facets or not
flexion: incr height of IVD, decr IVD buldge, decr thickness of ligamentum flavum
extension: decr height and width of IVD, incr pressure within IVF
how does the lumbar nerve root exit
ex. L4 root enters Dural sleeve just beneath L3-4 disc the goes inferior and lateral to exit the L4-5 IVF
Scottie dog
visualization of pars interarticularis on oblique x-ray
nose= TP
eye= pedicle
ear= superior articular facet
front leg= inferior articular facet
neck= pars interarticularis
body= lamina
what does the black line at the neck of the Scottie dog mean
the patient likely has a fracture of the pars interarticularis
spondylosis
degenerative changes in the spine
spondylolysis
a defect of the lamina between the superior and inferior processes (pars)
spondylolisthesis
bilateral compromise of the pars which allows the vertebra to slide forward
spondyloptosis
complete anterior slippage of L5 off the sacrum
what is the grading of spondylo
called the meyerding scale, grades the degree of slips or translational displacement
grade 1: less than 25%
grade 2: 25-50%
grade 3: 50-75%
grade 4: 75-100%
grade 5: L5 completely off the sacrum
lumbosacral junction
most movable are of spine: 5 unilateral rotation, 3 lateral bending, 10 flexion, 10 extension (these are the percentages of TOTAL ROM of the lumbar spine; so 5 degrees of total lumbar unilateral rotation happens at the lumbosacral junction
sacralization
L5 starts to look like the sacrum so it looks as though there are only 4 lumbar
lumbarization
S1 fails to fuse with the rest of the sacrum so it appears that there are 6 lumbar
ligaments of the lumbar spine
interspinous, supraspinous, ligamentum flavum, PLL, ALL, iliolumbar
what direction does a disc herniation usually go
posterior and lateral because PLL is partially attached to IVD
dural sac aka thecal sac
area of dura mater where the cauda equina is
what does the recurrent meningeal nerve aka Sinu vertebral nerve innervate
PLL, facets, and meninges
what does the iliolumbar ligament attach to
to TPs of L5 to sacrum and iliac crest
what is imbibition
how the nucleus pulposus receives nutrients
movement
how many layers does the outer annulus have
15-20 layers
is the inner portion of disc innervated
no there is no neural supply so there is no pain until the nucleus pulposus breaks to the outer 1/3 of the annulus which is highly innervated
what ligaments are involved when a patient presents with pain with standing, sitting, and walking
standing: iliolumbar
sitting: sacrospinous
walking: sacrotuberous
what is normal range of motion of the lumbar spine
flexion: 60 degrees (39-55 in L1-4, 14-19 in L5)
extension: 20 degrees
lateral flexion: 25-20 degrees
axial rotation": 10-15 degrees
what exactly does the recurrent meningeal nerve innervate
the posterior IVD, PLL, periosteum of posterior vertebral bodies, epidural venous plexus, and anterior aspect of spinal dura mater
where does the dural sac end
at S2 then becomes the filum terminale externa
dorsal root ganglion
pseudounipolar sensory neurons
sacral base and apex shape
sacral base: wider and superior
sacral apex: smaller and inferior
difference of sacrum in men and women
males: slightly taller
women: slightly wider
when do the secondary ossification centers of the sacrum ossify
by 25 years of age
where is the sacral promontory
the anterior lip of the sacral body
what is the sacral canal a continuation of
the vertebral canal which is triangle shaped
the lamina in the sacrum fuse together to form what
the sacral tubercles
what muscle attaches to the sacral ala
psoas major
what fused to make the medial sacral crest
sacral spinous
what fused to make the lateral sacral crest
TPs and costal elements
what fused to form the intermediate sacral crest
articular pillars
what are the transverse lines on the sacrum
remnants of the sacral IVDs
what is at the level of S2
PSIS
is there a disc between the sacrum and coccyx
yes, sometimes its a synovial joint and other times its fused
where is the filum terminale/coccygeal ligament
it passes through the sacral hiatus to attach to the coccyx
what meninge is the filum terminale interna
pia mater only
what is special about S5
end of sacral hiatus
what ends at S2
dural sac and arachnoid and dura mater end here
what are the 5 distinct joints in the pelvic ring
right and left lumbosacral facet joints
anterior lumbosacral joint (L5-S1 IVD)
right and left coxal (hip joints)
right and left SI joints
pubic symphysis
how much do bones in the pelvis move
about 2 degrees or 2 millimeters
pelvic outlet borders
anterior= pubic symphysis
posterior= tip of coccyx
lateral= ischial tuberosities
nutation and counternutation
nutation: anteroinferior movement of sacrum (flexion)
counternutation: posterosuperior movement of the sacrum (extension)
what does the nervous system consist of
CNS and PNS nerves that control the systems of the body
what is the structural classifications of nerves
multipolar, pesudounipolar, unipolar, and bipolar
what are the parts of a neuron
cell body, dendrite, axon, synaptic cleft, myelin sheath, nodes of ranvier
three types of neurons
afferent, efferent, interneurons
what type of neuron makes up the most of the CNS
interneurons
classification of nerves
general (all over the body) vs. specific (in special areas)
somatic (skin/skeletal muscle) vs. visceral (organs/smooth muscle)
afferent (to the brain) vs. efferent (from the brain)
how would you classify CN II
SSA
CNS vs. PNS neuroglia
CNS: oligodendrocytes, astrocytes, ependymal cells, microglia
PNS: Schwann cells, satellite cells
what are cell bodies called in the CNS
nucleus
what are axons in the CNS called
tracts
what are cell bodies in the PNS called
ganglions
what are axons in the PNS called
nerves
how many spinal nerves are there
31 pairs
how many cranial nerves are there
12 pairs
are cranial nerves a part of the CNS or PNS
PNS
cranial nerve 1
I= olfactory (S)
cranial nerve 2
II= optic (S)
cranial nerve 3
III= oculomotor (M)
cranial nerve 4
IV= trochlear (M)
cranial nerve 5 and branches
V= trigeminal (B)
V1= ophthalmic (S)
V2= maxillary (S)
V3= mandibular (M/S)
cranial nerve 6
VI= abducens (M)
cranial nerve 7
VII= facial (B)
cranial nerve 8
VIII= vestibulocochlear (S)
cranial nerve 9
IX= glossopharyngeal (B)
cranial nerve 10
X= vagus (B)
cranial nerve 11
XI= spinal accessory (M)
cranial nerve12
XII= hypoglossal (M)
what are the two criteria for naming spinal nerves
a. spinal cord segment they arise from
b. the IVF they exit from
are named different depending on level of the spine
what happens when the ligamnetum flava affects the dorsal nerve root ganglion
patient has sensory issues but muscles are fine
where do cell bodies of the dorsal root ganglion come from
neural crest