Deep lumbar spine & disc anatomy

The best post on internet I have found related to lumbar spine & disc anatomy. Offered by Dr. Douglas M. Gillard, DC, Associate Professor of Clinical Sciences, Published Spine Researcher.

Assessment & treatment guidelines_2

After "Assessment & treatment guidelines_1", I am posting the next file with assessment and treatment guidelines for the following cases:

Cervical radicular syndrome
Lumbar radicular syndrome
Collum femoris fracture
Esophagectomy
Coronary artery bypass
WAD
COPD
Scoliosis
L4 fracture
Subcapital humerus fracture
Acute myocardial infarction

Factors that favor a herniated nucleus pulposus in the L spine

1. Preexisting disc degeneration with tears in the posterior annulus that allow a path for the flow of nuclear material

2. Sufficiently hydrated nucleus capable of exerting high intradiscal pressure

3. Inability of the posterior annulus to resist pressure from the migrating nucleus

4. Sustained or repetitive loading applied over a flexed and rotated spine

source: Donald A. Neumann, Kinesiology of The Musculoskeletal System, Foundations for Rehabilitation

Schober & Ott test for thoracic and lumbar spine RoM

In the method of Schober & Ott, the patient stands erect while the examiner marks the S1 spinous process and a second point 10 cm higher. Regarding the thoracic spine, the examiner marks the C7 spinous process and a second point 30 cm lower (1st figure).

Then the examiner asks the patient to bend as forward as possible and measures the distance between the points again (2nd figure). A normal range of motion (RoM) at the lumbar spine will result in an increased distance of about 15 cm (+5 cm). A normal RoM at the thoracic spine will result in an increased distance of about 38 cm (+8).

Following the same logic, extension in both thoracic and lumbar spine can be assessed (3rd figure).

An alternative method is to measure the smallest finger-to-floor distance with the knees extended.

Lumbar spine assessment - a complete guideline

One of the most complete online guidelines for the lumbar spine assessment, broad to us by 3 ESP students of the Hogeschool van Amsterdam - Julie and her two Sara’s.

"The goal of the website is to guide students during the assessment of certain lumbar spine conditions. Therefore, we advise you to first take a look at the anatomy of the lower back to understand the conditions and gain sufficient knowledge on the subject.

The examination page talks about the general examination of the low back, including general patient history, observation as well as active and passive range of motion (ROM) and neurological testing.  This page insures you get the general knowledge you will need to assess a patient with low back problems.

Next to a-specific low back pain and malingering, the website includes lumbar spinal stenosis (LSS), disc herniation, lower crossed syndrome, lumbar instability and scoliosis as low back pathologies. All these conditions are described and subdivided into the different examination parts: patient history, assessment and treatment. The first two subcategories tell you what you should look for/what you might find in a patient with that specific pathology; questions you should ask, what tests to do and what the findings might be. Also in the assessment parts, different assessment tests will be mentioned. When clicking on the test, a link will forward you to the video of the test. The video will show how to perform the test with explanations. The treatment part is only a treatment suggestion and should only be taken as an orientation".

source: http://lumbarspineassessment.wordpress.com

Spondylolisthesis

What is Spondylolisthesis?

The word spondylolisthesis refers to the anterior slippage of one vertebral body with relation to the one below it. The word is derived from two parts - 'spondylo' means spine and listhesis means slippage. A common reason for this type of slippage is weakness or fracture of the portion of the neural arch that connects the lamina with the pedicle, facet joints, and transverse process. This area is the isthmus or pars interarticularis (area between the bony protrusions which articulate to form the joint). As the bridging element between spinal vertebral bodies, these protruding joints are key to the integrity of spinal segments. isthmic spondylolisthesis results from a spondylolisthetic defect in the pars interarticularis, which may lead to the subluxation of a vertebral body.

source: morphopedics