Acute Management: Lumbar Spine

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Author:
dmshaw9
ID:
262129
Filename:
Acute Management: Lumbar Spine
Updated:
2014-02-15 15:37:58
Tags:
Acute Management Lumbar Spine
Folders:
MS2
Description:
MS2
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  1. Normal Spinal ROM
    • Most flexion = C5/6 to C6/7
    • Most extension = OA joint
    • Least flexion/ext = T12 (pretty stiff)
    • Most rotation = C1-2
    • Least rotation/sidebending = T5-6
  2. Innervation - Intervertebral Disc
    • Posteriorly = sinuvertebral nerve (also innervates ant aspect of dura; segmentally innervated)
    • Laterally = gray rami communicantes

    • Dorsal Primary Rami (medial branch (coming off post ramus))
    • --> Goes to facet joints, interspinous ligaments, and back muscles
  3. Fauns' Beard
    • Hairy patch over lumbosacral region 
    • Seen in Spina Bifida Occulta (not sufficient for diagnosis) 
  4. Cafe Au Lait Spots
    • Benign pigmented birthmarks
    • Can be related to many different conditions
  5. Facet Tropism
    • A.k.a. facet asymmetry
    • Asymmetrical facet growth
    • Could be adaptive symmetry - not always problem
  6. Sacralization
    • L5 fused into sacrum
    • Only 4 moving lumbar segments
  7. Lumbarization
    • Failure of S1 to fuse to sacrum
    • Referred to as "L6" vertebra
  8. Hemisacralization/Hemilumbarization
    Half of the vertebra is fixed/lumbarized
  9. The Lumbar Spine: Coupled Motions
    • L1-2, L2-3, L3-4: rotation/sidebending to opp sides
    • L4-L5: variable
    • L5-S1: usually rotation/sidebending to same side
  10. Degenerative Disc Disease (DDD): Factors
    • Genetics (composition/thickness of annulus)
    • Stress (repetitive stress injury)
    • Aging (collagen cross-linking weakens the annulus; clogging and eventual ossification of nutrient channels)
  11. Degenerative Disc Disease: Types
    • Protrusion: nucleus bulges w/in annulus
    • Prolapse: nucleus causes bulge in the annulus but is still contained w/in annulus
    • Extrusion: nucleus pushes through annulus (NP will swell once exposed to fluid in the area)
    • Sequestration: nucleus pushes through annulus and bits of nuclear material break free & become loose bodies in neural canal
  12. Fusion Complications
    • Psuedoarthrosis (false joint)
    • Donor site pain
  13. Disc Replacement Rehabilitation: Precautions
    • 0-3 weeks: no extension, no rotation
    • 3-6 weeks: no extension
    • After 6 weeks: allow some extension
  14. Zygapophyseal Joint Pathology
    • Arthritis - excessive loading, Wolff's law
    • Sprain
    • Loose body - meniscoid tissue torn free
    • Subluxation (meniscoid) - stays out of normal alignment
  15. Ligaments in order from anterior to posterior
    ALL --> annular ligamnet --> PLL --> facet capsule --> LF (ligamentum flavum) --> interspinous ligament --> supraspinous ligament
  16. Treatment of Nerve Root Compression
    • Fenestration: creating a window around exiting here roots by trimming LF
    • Facetectomy: removal of zygapophyseal joint (remove facet completely)
    • Laminotomy: removal of a segment of lamina
    • Hemilaminectomy: removal of a lamina on one side
  17. Mushroom Phenomenon (Cyriax)
    Usually seen in elderly

    • Concavity in cartilaginous end plate produces:
    • Narrowing of intervertebral foramen 
    • Inferior gliding of superior facet on inferior facet
    • Contact of superior facet w/ the lamina below
    • Slackening of PLL (may bulge into neural canal)
  18. Spinal Stenosis
    • Narrowing of neural canal 
    • Usually a result of soft tissue hypertrophy w/ aging
    • Extension reduces volume in neural canal and relaxes PLL and LF
  19. Effects of Lower Quarter Muscle Imbalance: Tight Hamstrings
    • PPT 
    • CKC hip extension
    • Reduce lumbar lordosis
    • Puts facets into flexion
    • Creates A-P pressure gradient on disc
    • Moves line of gravity posterior to hip
    • Decreased WB through facets and increased WB through discs
  20. Effects of Lower Quarter Muscle Imbalance: Tight Iliacus (Hip Flexors)
    • APT
    • CKC hip flexion
    • Increase lumbar lordosis
    • Puts facet joints into extension
    • Narrowing intervertebral foramen
    • Move line of gravity ant to hip joint

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