Lumbar spine

Ligaments: Ligament PLL Action resists flexion Innervation Recurrent meningeal/ventral rami Symps/ant rami Dorsal rami Affects Buckling/ Calcification/ Discal Whiplash Elderly thickening > Spinal stenosis

ALL Ligamentum flavum

Interspinous Supraspinous

iliolumbar

resists extension Resists flexion and allows spine to resist extension (elastic) Resists flexion Attachment point for interspinous Resists flexion

Dorsal rami Dorsal rami

Whiplash Whiplash

Anterior (L1/L2) Posterior L5/S1

Traumas

Disc Anatomy Annulus fibrosus: CT collagen fibres in different directions. It is very strong and withstands forces applied to it. Txx and compression forces > it transmits and shock absorbs of these forces > in time it will degenerate/tear with trauma. Has blood supply to periphery of disc by anterior posterior spinal artery. Affected by: Obesity, trauma, postural change, sports, LLD, function/structural changes. Nucleus pulposus: GAGs (glucosaminoglycans) which are hydrophilic, chondrocytes and collagen fibrils. It requires Txx and compression for transynovial pump and fluid exchange. Has little direct blood supply, requires mechanical pump. Development of disc: 0-15: Disc is stronger than vertebrae - any damage > end plate ~ (Schmorls nodes) more in upper lumbar area. 30+: fissures and cyctic spaces in the nucleus. Annulus degeneration > fibres swell. 50+: nucleus degeneration > granular crumbling and fibrosis. Annular cysts common. 50++: annulus fissures larger > atrophy of nucleus 60+: fissures in annulus 70+: nucleus: cellular degeneration, tissue necrosis, fibrosis, granular crumbling of intercellular matrix. Annulus: fibrosis, swelling in fibres, cyst & fissure formation.

1. Protrusion: Disc bulge in EDS > Irritation of sinuvertebral nerve. Pt p/w: LBP, sciatic pain, nerve root pain/sinuvertebral nerve pain. 2. Extrusion: Disc bulge into EDS/damage of PLL. Pt p/w: severe LBP, K pain, intensity with referral down post thigh to calf. Pt should get better in 6 weeks. 3. Sequestration: Herniation of NP into EDS. Pt p/w: LBP, NRI, cauda equine syndrome, foot drop.

Disc: stability, force transfer, cushioning, postural support, Facet: Function: mvt (force transferring 30% to pre-tense the disc. Resists forward movement. Creates a locking mechanism. Facet direction: L1-L4/L5 is parasagittal mvts flex/ext & SB with Rot at 1 each segment, L5/S1 frontal flex/ext/ deals with Rot force from LEx and thorax. Mvt: S/B, sliding, gliding, rotation 1. Innervation: recurrent meningeal nerve Joint: synovial joint capsular ligaments, meniscoid fat pad, hyaline cartilage 2mm thick. Dysfunction: Apophysitis/zygopophytis/capsular strain - inflammation of facet. Patient p/w: +ve quadrant, ipsilateral pain on EXT, mm spasm, acute onset and acute duration of s, caused possible of flexion trauma, motor/sensory s unless inflammation, inflammatory picture worse AM. Spondyloarthrosis wear and tear not in inflammatory phase Patient p/w: age, trauma, pain in AM (30 mins) better on EXX (when warmed up), stiffness & hypertonic LSp mms, SB of LSp active test, pain on EXT and SB, on passive ROM in LSp at early stages / ROM later stages. Spondyloarthritis wear and tear of cartilage and is inflamed, pain on active and passive.

MM LSP:

Erector and spinal mms Longissimus lateral sacrum > ribs 12/11 Iliocostalis thoracis sacrum > ribs Spinalis thoracis L1 & L2 SPs > T12 & T11 SPs Multifidus sacrum lateral to SP > mammillary processes Lsp Rotatores TP > SPABOVE Interspinales SP > SP (deep spinal) Intertransversarii TP > TP QL 12th rib, TPs of L1-L4, iliolumbar lig, iliac crest (n. T12 & L1) Psoas bodies of L1-L5, intervertebral discs of T12 and L1-L5 > medial trochanter of femur (n. L1-L4) Iliacus iliac fossa, ala of sacrum > medial trochanter of femur (n. femoral L2 & L3) Rectus abdominis pubic crest to ribs 5,6,7 and linea alba Transversus abdominus lower 7 ribs, linea alba, pubic creat, iliac crest and inguinal ligament External oblique ribs 4-12 to linea alba, inguinal ligament, iliac & pubic crest. Internal oblique ribs 8-12 to linea alba, inguinal ligament, pubic & iliac crest.

Lumbosacral plexus