Lumbar Spine and Deformities

Flashcards about Biomechanics of the Lumbar Spine, Sacroiliac Joint (SIJ), and Spinal Deformities

Lumbar Spine Motions

Motions at the lumbar spine joints can occur in three cardinal planes: Sagittal (flexion/extension), Coronal (side bending), and Transverse (rotation).

Six Degrees of Freedom

Available at the lumbar spine, influencing movement capabilities.

Flexion and Extension Location

Most flexion and extension occur at the lower segmental levels of the lumbar spine.

Side Bending Location

Most side bending occurs in the mid-lumbar area.

Rotation in Lumbar Spine

Rotation is minimal in the lumbar spine, with coupled motion with side bending, mostly at the lumbosacral junction.

Lumbar Flexion

Anterior roll and anterior glide of the vertebral body with straightening or minimal reversal of lordosis. L4-5 may have reversal, L5-S1 straightens unless pathology is present.

Lumbar Extension

Posterior roll and posterior glide of vertebra, posterior and inferior motion of zygapophyseal joints, but no change in the degree of lordosis.

Lumbar Side Bending

Coupled motion involving ipsilateral rotation and closing of facets, with contralateral opening of facets. Considered unknown and controversial.

Axial Rotation of Lumbar Spine

Approximately 1-3 degrees to both sides, with the greatest amount (about 5 degrees) occurring at L5 and S1 segment.

Nutation

Flexion of the sacrum.

Counternutation

Extension of the sacrum.

Acute Phase Goals (Lumbar)

Decrease pain, inflammation, and muscle spasm; promote healing of tissues; increase pain-free ROM; regain soft tissue extensibility and neuromuscular control; initiate postural education; promote correct breathing; educate the patient.

Functional Phase Goals (Lumbar)

Reduce/resolve pain, restore full ROM, integrate kinetic chains, restore respiratory function, and restore strength and neuromuscular control. Pain is not the only focus.

Kyphosis

Excessive kyphotic curvature of the thoracic spine. Can be anatomical (osteoporosis or vertebral deformation) or postural.

Dowager's Hump

Upper dorsal region kyphosis from anterior wedge compression fractures, often caused by osteoporosis or long-term corticosteroid therapy.

Humpback

Localized and sharp kyphotic angulation, usually congenital, from fracture, or infection (TB).

Round Back

Kyphosis caused by decreased pelvic inclination.

Compression Fractures (Spine)

Common in elderly, resulting from osteoporosis, trauma, or prolonged corticosteroid use; leads to progressive kyphosis, loss of height, and pain.

Compression Fracture Treatment

Reduce pain, maximize mobility, educate for posture and safety, provide assistive devices, and maintain breathing capacity.

Scoliosis

Rotation or lateral deviation of the spine, described as an S or C curve.