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Lumbar Spine Anatomy
Musculo Lumbar Spine Anatomy
144
Anatomy
Graduate
04/22/2012

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Term
define low back pain
Definition
pain, muscle tension, or stiffness localized below the ribs and above the inferior gluteal folds, with or without leg pain. Can be specific or non-specific.
Term
about what percentage of low back pain is specific
Definition
10.00000%
Term
what are some obvious sources of specific low back pain
Definition
tumor, fracture, cancer, infection, rheumatoid arthritis, disc herniated nucleus pulposis
Term
about what percentage of low back pain is non-specific
Definition
90.00000%
Term
about how many patients with non-specific LBP stop seeking care after 6 weeks because they are better
Definition
80.00000%
Term
about how many patients with non-specific LBP stop seeking care after 3 months because they are better
Definition
95.00000%
Term
can a patient with LBP get better without treatment
Definition
yes, sometimes. It depends. :)
Term
about how many patients who have non-specific LBP return to work within 1 week (after the pain first caused them to miss work)
Definition
67.00000%
Term
about how many patients who have non-specific LBP return to work within 2 months(after the pain first caused them to miss work)
Definition
90.00000%
Term
about how many patients who have non-specific LBP who are out of work because of the pain for > 6 months will ever return to work?
Definition
<50%
Term
about how many patients who have non-specific LBP who are out of work because of the pain for > 2 years will ever return to work?
Definition
virtually no one
Term
about how many patients with LBP will have recurrence again in their lifetime
Definition
85.00000%
Term
about how many patients with LBP will have recurrence within 1 year
Definition
20-44%
Term
is incidence of acute LBP greater in men or women
Definition
men
Term
is incidence of chronic LBP greater in men or women
Definition
women
Term
how does prevalence of LBP change with age
Definition
decreases
Term
why does the prevalence of acute LBP decrease with age
Definition
reduction in physical activity and reduced spine mobility
Term
what are 3 groups of risk factors for occurrence and chronicity of LBP
Definition
individual factors, psychosocial factors, occupational facotrs
Term
is bedrest helpful for LBP
Definition
no. it can be harmful
Term
is visceral pain a common pain complaint in general medical practice?
Definition
yes, one of the most common
Term
can visceral pain be misleading and lead you to an incorrect diagnosis?
Definition
yes
Term
do all viscera evoke pain
Definition
no
Term
describe the localization of visceral pain
Definition
diffuse; hard to localize
Term
can visceral pain be referred
Definition
yes
Term
what might accompany visceral pain
Definition
motor and autonomic reflexes such as nausea, vomiting, and lower back muscle tension
Term
what are 4 important clinical characteristics of visceral pain
Definition
1. not all viscera evokes pain; 2. visceral pain is effuse and poorly localized; 3. visceral pain can be referred to other locations; 4. visceral pain can be accompanied by motor and autonomic reflexes such as nausea, vomiting, and lower back muscle tnesion
Term
what is the convergence-projection theory
Definition
Visceral and somatic afferents converge on the same neurons at the spinal cord. Input to the cord from viscera may be misconstrued as originating from a somatic site or vice versa.
Term
what are viscerogenic sources of lumbo-pelvic pain
Definition
ovarian cancer, testicular cancer, pancreas, kidney stones, abdominal aortic aneurysm, duodenal ulcer
Term
what are warning signs for LBP
Definition
insidious onset of symptoms; symptoms that come and go regardless of posture or time of day; strong and painless muscle around a joint with full ROM despite being the primary site of symptoms
Term
what to include in screening in order to rule out red flags
Definition
blood pressure, heart rate, respiration rate, look for edema, infections
Term
what are risk factors that you will get from history
Definition
smoking, drinking, obesity, family history of disease
Term
describe lumbar spine vertebral bodies
Definition
large
Term
describe lumbar spine vertebral laminae (weak or sturdy)
Definition
sturdy
Term
are lumbar vertebrae large or small
Definition
large
Term
do lumbar vertebrae have costal facets
Definition
no
Term
how are articular facets of lumbar spine aligned
Definition
in sagittal plane
Term
describe the anterior pillar of lumbar spine
Definition
vertebral bodies offer passive support
Term
describe the posterior pillar of lumbar vertebrae
Definition
disc, IV foramen, articular processes, ligamentum flavum, and interspinous ligament provide dynamic support
Term
what is the functional purpose of the articular processes
Definition
act as fulcrum
Term
through what part of the vertebrae is the axial compression
Definition
through the bodies/anterior column
Term
what kind of absorption occurs at IV disc (direct or indirect? Active or passive?)
Definition
direct and passive
Term
what kind of absorption occurs at paravertebral muscles
Definition
indirect and active
Term
why is the most anterior portion of the vertebral bodies weak?
Definition
trabeculae are aligned vertically
Term
how many articular processes are on a lumbar vertebrae
Definition
4
Term
how many transverse processes are on a lumbar vertebrae
Definition
2
Term
where is the basivertebral vein
Definition
passes through anterior and posterior foramen
Term
what are 3 functions of the IV disc
Definition
provide the strongest attachment between IV bodies; plays a leading role in weightbearing and shock absorption; provides mobility to the spine
Term
is the IV disc vascular or avascular
Definition
avascular
Term
how is the IV disc innervated
Definition
nucleus is not innervated. Annulus may have a few sinuvertebral fibers. Lateral aspect innervated by anterior rami and gray rami communicantes.
Term
what are pain sensitive structures around the IV discs
Definition
anterior longitudinal ligament, posterior longitudinal ligament, vertebral body, nerve root, facet joint cartilage
Term
what is the anterior longitudinal ligament and where is it
Definition
strong, broad fibrous band connecting the anterior aspects of vertebral bodies and discs. Extends from pelvic surface of the sacrum to the anterior tubercle of C1 and the occipital bone anterior to the foramen magnum
Term
what is the function of the anterior longitudinal ligament
Definition
maintains the stability of the joints between the vetebral bodies and helps prevent hyperextension of the vertebral column
Term
is the posterior longitudinal ligament weaker or stronger than the anterior longitudinal ligament
Definition
weaker
Term
is the posterior longitudinal ligament wider or more narrow than the anterior longitudinal ligament
Definition
more narrow
Term
where is the posterior longitudinal ligament
Definition
runs along posterior aspect of the vertebral bodies; within the vertebral canal
Term
where is the posterior longitudinal ligament broadest
Definition
superiorly where it is continuous with the tectorial membrane/attaches to the occipital bone on internal aspect of the foramen magnum. Also broad in the thoracic and and lumbar regions where it is related to the IV discs
Term
what are the functions of the posterior longitudinal ligament
Definition
helps prevent hyper flexion of the vertebral column; helps prevent posterior protrusion of the nucleus pulposus of the disc
Term
what does ligamentum flavum mean
Definition
yellow ligament
Term
where is the ligamentum flavum
Definition
attached superiorly to the anterior surfaces of the inferior borders ofa pair of laminae and attached inferiorly to the posterior surfaces of the superior border of the next vertebra's pair of laminae. Some ligamentum flavum fibers extend to the articular capsules of the facet joints
Term
what are the functions of the ligamentum flavum
Definition
helps preserve the normal curvature of the vertebral column; helps straighten the column after it has been flexed
Term
is the interspinous ligament weak or stron
Definition
weak
Term
function of the interspinous ligament
Definition
joins adjacent spinous processes
Term
describe the supraspinous ligament
Definition
strong, cord-like ligament
Term
what is the shape of the iliolumbar ligament
Definition
triangular
Term
is the iliolumbar ligament strong or weak
Definition
strong
Term
what are the attachments of the iliolumbar ligament
Definition
connects the tip of the transverse process of L5 and sometimes L4 to the iliac crest posteriorly. Inferior fibers are attached to the lateral part of the sacrum.
Term
what is the function of the iliolumbar ligament
Definition
limit rotation of the L5 vertebra on the sacrum; assist the vertebral articular processes in preventing anterior gliding of L5 on the sacrum
Term
what is the origin of the psoas major
Definition
T12-L5 vertebrae
Term
what is the insertion of the psoas major
Definition
lesser trochanter
Term
what muscle is often weak with unilateral back pain and why
Definition
ipsilateral psoas major because they flex toward that side. The psoas major attaches to the 5 bones that hurt in the lower back. You're going to avoid using/inhibit that muscle because when you use it, it hurts.
Term
why do many patients have back pain when flexing their hip
Definition
psoas major pulls on the painful lumbar vertebrae
Term
what are the actions of the psoas major
Definition
flex and outwardly rotate (a little) femur; hip stability; when femur is fixed, it flexes and ipsilaterally sidebends lumbar spine
Term
what is the principle vertical muscle of the anterior abdominal wall
Definition
rectus abdominis
Term
describe the rectus abdominis
Definition
long, broad strap muscle
Term
what is the origin of the rectus abdominis
Definition
xiphoid process and 5-7 costal cartilages
Term
what is the insertion of the rectus abdominis
Definition
pubic symphysis and pubic crest
Term
what are the actions of the rectus abdominis
Definition
compres abdominal viscera; depress ribs; stabilize pelvis
Term
what is the largest and most superficial of the 3 flat abdominal muscles
Definition
external oblique abdominis
Term
in what direction do the fibers of the external oblique abdominis run
Definition
infero-anteriorly and medially
Term
what is the orgin of the external oblique abdominis
Definition
external surfaces of ribs 5-12
Term
what is the insertion of the external oblique abdominis
Definition
linea abla, pubic tubercle, anterior half of iliac crest
Term
what are the actions of the external oblique abdominis
Definition
compress and support abdominal viscera; flex and rotate trunk
Term
what is the intermediate of the 3 flat abdominal muscles/
Definition
internal oblique abdominis
Term
in what direction do the fibers of the internal oblique abdominis run
Definition
supero-anteriorly
Term
what is the origin of the internal oblique abdominis
Definition
thoracolumbar fascia, anterior 2/3 iliac crest, lateral half of inguinal ligament
Term
what is the insertion of the internal oblique abdominis
Definition
inferior borders of ribs 10-12; linea alba, pubis
Term
what are the actions of the internal oblique abdominis
Definition
compress and support abdominal viscera; flex and rotate trunk
Term
what is the innermost of the 3 flat abdominal muscles
Definition
transverse abdominis
Term
in what direction do fibers of the transverese abdominis
Definition
horizontally
Term
what are the origins of transverse abdominis
Definition
internal surfaces of costal cartilages 7-12; thoracolumbar fascia; ilica crest; lateral inguinal ligament
Term
what are the insertions of transverse abdomins
Definition
linea abla, pubic crest, pubis
Term
what are the actions of the transverse abdominis
Definition
compresses and supports abdominal viscera; tightens thoracolumbar fascia; increases intra-abdominal pressure; contributes to spinal stiffness/intersegmental control
Term
is the quadratus thick or thin
Definition
thin
Term
where is the quadratus lumborum
Definition
posterior abdominal wall; adjacent to the transverse processes of the lumbar vertebrae
Term
what is the origin of the quadratus lumborum
Definition
medial half of inferior border of the 12th rib, tips of lumbar transverse processes
Term
what is the insertion of the quadratus lumborum
Definition
iliolumbar ligament and internal lip of iliac crest
Term
what are the actions of the quadratus lumborum
Definition
extends and laterally flexes vertebral column; fixes 12th rib during inspiration
Term
are the intertransversarii and interspinales muscles large or small
Definition
small
Term
where are the intertransversarii and interspinales well developed (what part of the vertebral column)
Definition
cervical region
Term
where are interspinales muscles
Definition
between the spinous processes of consecutive vertebrae
Term
where are intertransversarii muscles
Definition
between the transverse processes of consecutive vertebrae
Term
what do interspinales muscles do
Definition
aid in extension of the spine
Term
what do intertransversarii muscles do
Definition
unilaterally produce lateral flexion of superior vertebra; bilaterally aid with extension
Term
what are the attachments of the multifidi
Definition
fibers pass superomedially from vertebral arches to spinous process, spanning one to 3 vertebrae
Term
which vertebrae have multifidi
Definition
S4-C2
Term
what are the unilateral actions of multifidi
Definition
laterally flexes trunk and rotates to opposite side
Term
what are the bilateral actions of the multifid
Definition
extend trunk, stabilize, vertebral column
Term
what are multifidi important for
Definition
segmental stability of lumbar spine
Term
is there evidence that the multifidus is dysfunctinoal in patients with LBP
Definition
yes
Term
what/where are rotatores
Definition
short, deep muscles in the groove between the spinous and transverse processes throughout the spinal column
Term
what are the attachments/what is the path of the rotatores
Definition
transverse processes of one vertebra to the base of the spinous process of the vertebra superior to it.
Term
what are the actions of the rotatores
Definition
rotate the superior vertebra to the opposite side; aid in stabilizing vertebral segments
Term
at what vertebral level does the spinal cord end
Definition
L1-2
Term
where do the sinuvertebral nerves branch from
Definition
recurrent from ventral ramus
Term
what type of nerve is the sinuvertebral nerve
Definition
mixed: somatic, autonomic
Term
from where do the somatic nerves in the sinuvertebral nerve come from
Definition
ventral ramus
Term
from where do the autonomic nerves in the sinuvertebral nerve come from
Definition
gray rami communicantes
Term
what does the sinuvertebral nerve innervate
Definition
innervates outer third of annulus fibrosus, posterior longitudinal ligament, basivertebral vein of vertebral canal, ventral dura mater to disc at its level and one above
Term
which part of the IV discs is innervated
Definition
outer annulus fibrosus, greater innervation laterally
Term
what innervates the lumbar intervertebral discs
Definition
sinuvertebral nerve, gray rami communicantes
Term
what part of the IV disc does the sinuvertebral nerve innervate
Definition
outer annulus fibrosus at level and one above
Term
what part of the IV disc does the gray rami communicantes innervate
Definition
lateral disc, also Anterior Longitudinal Ligament
Term
is innervation to lumbar intervertebral discs more affected by mechanical or chemical noxious stimuli associated with disc degeneration or from the actual connection to the disc
Definition
innervation to lumbar intervertebral discs is more affected by mechanical and chemical noxious stimuli associated with disc degeneration
Term
how are the ventral rami of all spinal nerves connected to the sympathetic trunk
Definition
through gray rami communicantes and through white rami communicantes
Term
when does a patient need an MRI
Definition
if they're losing baldder and bowel or if they're a surgical candidate
Term
when might there be abnormal innervation of lumbar intervertebral discs in the form of nerve ingrowths into the nucleus pulposus
Definition
after damage to the annulus fibrosus
Term
what is supposed to be the purpose of nerve ingrowths into the nucleus pulposus following damage to the annulus fibrosus
Definition
pain and subsequent immobilization to promote healing
Term
what is the actual result of nerve ingrowths into the nucleus pulposus following damage to the annulus fibrosus and why
Definition
poor healing in this area results in unproductive nerve ingrowths resulting only in pain.
Term
what prevents further anterior translation in flexion
Definition
facets
Term
what part of the disc is compressed in flexion
Definition
anterior
Term
what are the movements of each segment in flexion
Definition
anterior rotation and anterior translatio
Term
what does the inferior facet of the superior vertebra do in flexion (what movements)
Definition
glides up and slightly backwards
Term
does the IV foramen get wider or more narrow in flexion
Definition
wider
Term
what is the movement of vertebral bodies in extension
Definition
posterior sagittal rotation, posterior translation
Term
what is the motion of the inferior facet of the superior vertebra in extension
Definition
inferior
Term
is the intervertebral foramen widened or narrowed in extension
Definition
narrowed
Term
what is the motion of spinous processes in extension
Definition
downward
Term
when does the facet joint become weightbearing
Definition
in extension
Term
what happens to the disc in axial rotation
Definition
twisting, torsion
Term
with axial rotation to the left, what will happen to the right inferior facet
Definition
it will impact with the right superior facet of the vertebra below
Term
how much motion in axial rotation occurs before impaction of facets
Definition
not much
Term
where is the annulus fibrosus compressed in lateral flexion
Definition
on the concavity of the curve
Term
where is the annulus fibrosus stretched in lateral flexion
Definition
on the convexity of the curv
Term
lateral flexion is coupled with what other movement
Definition
contralateral rotation
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