LUMBAR SPINE

Bony Anatomy Made of two parts - vertebral body and vertebral arch Pedicles – attach body to arch Vertebral foramen – space where spinal nerves exit Articular process (facets) – junction of pedicle and laminae Pars interarticularis – area between facets

Transverse process – attachment site for muscles Spinous process – attachment site for muscles and ligaments

Vertebral Ligaments Anterior longitudinal Posterior longitudinal extends anterior region of spine thin in cervical and thickens as it moves inferior strongly attaches to periosteum Posterior longitudinal extends skull to sacrum widest in cervical region loosely attaches to vertebral bodies

Spinous Ligaments Interspinous ligaments Intertransverse ligaments between spinous processes Intertransverse ligaments between transverse processes

Intervertebral Disc Makes up ¼ of the spine Components Nucleus Pulposus Annulus Fibrosus

Nucleus Pulposus Occupies central portion of disc Large water content and small amount of collagen fibers Highly viscus; strong affinity to water (hydrophilic) Water amount decreases with age Creates internal disc pressure – pushes against vertebrae and annulus fibrosus major function is to redistribute compressive forces pathology = herniation

Annulus Fibrosus made up of concentric fiberous rings Firmly attached to vertebral body Movements of compression, torsion, and shearing to spine increase tension on annulus Pressure of nucleus is important because it maintains pressure on annulus which enhances stability

Types of Disc Pathology Protrusion disc bulges (nucleus pulposus) posterior without rupture of annulus Extrusion annulus fibrosus is perforated and disc material moves into epidural space

Extrusion

Activites that increase disc pressure Coughing Walking Side Bending Small jumps Laughing Lifting with knees bent Forward bending Lifting 20 lbs. with back bent and knees straight 5% 15% 25% 40% 40-50% 73% 150% 169%

Range of Motion Flexion Extension Lateral Flexion Rotation 40-60 20-35 15-20 3-18

Lower Quarter Exam

Myotomes L2 L3 L4 L5 S1 S2 Hip Flexion Knee Extension Ankle Dorsiflexion Great Toe Extension Ankle Eversion Knee Flexion

Dermatomes L4 L5 S1 Medial Ankle Dorsal Ankle Lateral Ankle

Reflex L3-L4 Patella S1 Achilles Tendon

Special Tests

Straight Leg Raise lie supine, lift leg by supporting foot, knee straight If experience pain, lower leg and dorsiflex foot If pain is induced, tight hamstrings

Well straight leg raise raise uninvolved leg If pain, herniated disc

Hoovers test lie supine and place heels into hands have patient lift leg opposite heel should drop in hand determine malingering

Kernig Test lie supine lift leg and flex head to chest Positive finding – pain with stretched spinal cord

Valsalva Maneuver increase intrathecal pressure by having a bowel movement

Stork Standing Test stand on involved leg and lean back

Babinski Test draw line up plantar surface of foot calcaneus to forefoot; toes spread

Bowstring Test Straight leg test with knee bent

Slump Test sit in chair stretch involved leg out and slump over