5. ā¢ Pedicles : short and thick and project posterolaterally
ā¢ Laminae : short and broad
ā¢ Transverse Process : long, slender; extends
horizontally
5
6. ā¢ Accessory processes : small, irregular bony
prominences, located on posterior surface of transverse
process near its attachment to the pedicle
ā¢ Attachment sites for multifidus
ā¢ Spinous process : broad, thick, extends horizontally
6
7. ā¢ Mamillary processes : located on posterior edge of
each superior zygapophyseal facet
ā¢ Attachment sites for multifidus
7
9. ā¢ Vertebral foramen : triangular, larger than thoracic
vertebral foramen but smaller than cervical vertebral
foramen
9
10. ā¢ Fifth lumbar vertebra is a transitional vertebra: wedge-
shaped body
ā¢ Superior diskal surface area 5% greater
ā¢ Inferior diskal surface area smaller
ā¢ Spinous process is smaller, transverse processes are large
and directed superiorly and posteriorly
10
11. Intervertebral Disks
ā¢ Largest
ā¢ Collagen fibers of anulus fibrosus are arranged in sheets:
lamellae
ā¢ Concentric rings surrounding nucleus
11
12. ā¢ Resist tensile forces in nearly all directions
ā¢ Shape of each disk is not purely elliptical but concave
posteriorly
ā¢ Provides greater cross-sectional area of anulus fibrosus
posteriorly and hence increased ability to resist tension
that occurs with forward bending
12
13. 1. Interbody Joints
ā¢ Capable of translations and tilts in all directions
2. Zygapophyseal articulation
ā¢ True synovial joints
ā¢ Fibroadipose meniscoid structures 13
ARTICULATIONS
15. 3. Lumbosacral articulation
ā¢ 5th lumbar vertebra and 1st sacral segment.
ā¢ 1st sacral segment is inclined slightly anteriorly and
inferiorly, forms an angle with horizontal: lumbosacral
angle
15
16. ā¢ Increase in angle : increase in lumbar lordosis
ā¢ Increase shearing stress at lumbosacral joint
16
18. ļ¶Supraspinous ligament
ā¢ Well developed only in upper lumbar region
ā¢ Most common termination site - L4
ā¢ May terminate at L3
ļ¶ Intertransverse ligaments are not true ligaments in
lumbar area and are replaced by the iliolumbar
ligament at L4
ļ¶Interspinous ligament has least overall stiffness and joint
capsules the highest
18
19. ļ¶ Anterior longitudinal ligament
is strong and well developed in
this region
ļ¶Posterior Longitudinal Ligament
is only a thin ribbon in lumbar
region, whereas ligamentum flavum
is thickened here
19
20. ļ¶Iliolumbar Ligaments
ā¢ Series of bands extend from tips and borders of transverse
processes of L4 and L5 to attach bilaterally on iliac crests of
pelvis
ā¢ 3 bands: ventral / anterior
dorsal / posterior
sacral
20
23. Muscles of lower spine region serve roles of :
ā¢ Producing and controlling movement of trunk
ā¢ Stabilizing trunk for motion of lower extremities
ā¢ Assist in attenuating extensive forces that affect this area
POSTERIOR MUSCLES
3 layers: superficial
intermediate
deep
1. Thoracolumbar fascia
ā¢ Most superficial structure
23
24. 3 layers: posterior, middle, and anterior
ā¢ Posterior layer : large, thick arises from spinous
processes and supraspinous ligaments of the thoracic,
lumbar, and sacral spines.
ā¢ Gives rise to latissimus dorsi cranially, travels caudally to
sacrum and ilium, and blends with fascia of
contralateral gluteus maximus
ā¢ Also gives rise to internal and external abdominal
oblique, and transversus abdominis
24
25. ā¢ Anterior layer : passive part - transmits tension
produced by contraction of hip extensors to spinous
processes
ā¢ Posterior layer : active part - activated by a contraction
of transversus abdominis muscle
ā¢ Tension on TLF will produce a force that exerts
compression of abdominal contents ā external corset
ā¢ Compress lumbosacral region and impart stability
25
26. 2. Erector spinae
ā¢ Iliocostalis,
longissimus
spinalis
ā¢ Each having lumbar portion
(pars lumborum) and thoracic portion (pars thoracis)
ā¢ Primary extensors of lumbar region when acting
bilaterally
ā¢ Acting unilaterally, they are able to laterally flex trunk
and contribute to rotation
26
27. 3. Multifidus
ā¢ Not truly transverso spinales in lumbar region
ā¢ Run from dorsal sacrum and ilium in region of PSIS to
spinous processes of lumbar vertebrae
ā¢ Line of pull in lumbar region is more vertical
ā¢ Greater cross sectional area
ā¢ Produce lumbar extension
ā¢ Add compressive loads to
posterior aspect of
interbody joints.
27
28. LATERAL MUSCLES
1. Quadratus lumborum
ā¢ Deep to erector spinae and multifidus
ā¢ Acting bilaterally:frontal plane stabilizer
ā¢ Also stabilization in horizontal plane
ā¢ Acting unilaterally, laterally flex spine
and control rotational motion
28
29. ā¢ If lateral flexion occurs from erect
standing, force of gravity will continue
motion, and contralateral quadratus
lumborum will control movement by
contracting eccentrically.
ā¢ If the pelvis is free to move, quadratus
lumborum will āhike the hipā or
laterally tilt pelvis in frontal plane
29
30. ANTERIOR MUSCLES
1. Rectus abdominis
ā¢ Prime flexor of trunk
ā¢ Contained within abdominal fascia;
separates rectus abdominis into sections and attaches
it to aponeurosis of abdominal wall.
ā¢ Abdominal fascia also has attachment to aponeurosis
of pectoralis major.
ā¢ These fascial connections transmit forces across
midline and around trunk.
ā¢ Provide stability in a corset type of manner around
trunk.
30
31. 2. Abdominal wall
ā¢ External oblique, internal oblique, transversus
abdominis muscles
ā¢ Forms āhoopā with TLF posteriorly
ā¢ Stability to lumbo-pelvic region
3. Psoas major
ā¢ Runs from lumbar transverse processes, anterolateral
vertebral bodies of T12 to L4, lumbar intervertebral disks
to lesser trochanter of femur
ā¢ Distal tendon merges with that of iliacus.
31
32. ā¢ Flexion of hip
ā¢ At lumbar spine, buttress forces of iliacus, which, when
activated, cause anterior ilial rotation and thus lumbar
spine extension
ā¢ Also provides stability to lumbar spine during hip
flexion activities by providing great amounts of lumbar
compression during activation
ā¢ Some anterior shear is also produced when it is activated
32
33. ā¢ Spinal cord ends at approximately L1āL2
ā¢ Bundle of spinal nerves extends downward: cauda
equina
The Lumbar Plexus
ā¢ Formed by T12āL5nerve roots
ā¢ Supplies anterior and medial muscles of thigh
region
ā¢ Posterior branches of L2āL4nerve roots form
femoral nerve - Quadriceps
33
35. ā¢ Four paired lumbar arteries that
arise directly from posterior aspect of aorta
ā¢ Venous system is valve less, draining internal and
external venous systems into the inferior venacava
35
36. ā¢ Sinuvertebral nerve - major sensory
nerve.
ā¢ Innervates : posterior longitudinal ligament,
superficial layer of annulus fibrosus,
blood vessels of epidural space,
anterior but not posterior dural space
(posterior dura is devoid of nerve endings),
dural sleeves surrounding spinal nerve roots,
and posterior vertebral periosteum.
36
40. Lumbar Range of Motion
Flexion: 50
Extension: 15
Axial rotation: 5
Lateral flexion: 20
Donald A. Neumann
40
41. 1. Lumbar flexion
ā¢ More limited than extension
ā¢ Maximum motion at lumbosacral joint
ā¢ Anterior tilting and gliding of superior
vertebra occurs
ā¢ Increases diameter of intervertebral foramina
41
42. ā¢ Flexion generates compression forces on
anterior side of disc tending to migrate nucleus
pulposus posteriorly
ā¢ Limited by tension in posterior annulus fibrosus and
posterior ligament system 42
43. 2. Lumbar Extension
ā¢ Increase in lumbar lordosis
ā¢ Posterior tilting , gliding of superior vertebra
ā¢ Lumbar extension reduces the diameter of
intervertebral foramina
43
45. 3. Lateral Flexion
ā¢ Superior vertebra laterally tilts, rotates
and translates over vertebra below
ā¢ Annulus fibrosus is compressed on
concavity of curve and stretched on
convex side
ā¢ Nucleus pulposus migrate slightly
towards
convex side of bend
45
46. 4. Spinal Rotation
ā¢ Rotation causes movement of vertebral arch
in opposite direction
ā¢ Ipsilateral facet joints go for gapping and
contralateral facet joints for impaction
ā¢ Axial rotation to right, between L1 and L2 for instance,
occurs as left inferior articular facet of L1 approximates or
compresses against left superior articular facet of L2.
46
47. ā¢ Limited due to shape of zygapophyseal joints
ā¢ Also restricted by tension created in stretched capsule of
apophyseal joints and stretched fibres within annulus
fibrosus
ā¢ Amount of rotation available at each vertebral level is
affected by position of lumbar spine.
47
48. ā¢ When flexed, ROM in rotation is less than when in
neutral position
ā¢ The posterior anulus fibrosus and PLL limit axial
rotation when spine is flexed
ā¢ The largest lateral flexion ROM and axial rotation
occurs between L2 and L3
48
49. SPINAL COUPLING
ā¢ Kinematic phenomenon in which movt of the spine in
one plane is associated with an automatic movt in
another plane
ā¢ Most consistent pattern involves an association between
axial rotation and lateral flexion
ā¢ With lateral flexion, pronounced flexion and slight
ipsilateral rotation occurs
ā¢ With axial rotation, however, substantial lateral flexion
in a contralateral direction occurs 49
50. Lumbo-pelvic rhythm
ā¢ The kinematic relationship between
lumbar spine
and
hip joints
during sagittal plane movements
50
51. ā¢ Bending forward- lumbar flexion (40ā°) followed by
anterior tilting of pelvis at hip joint (70ā°)
ā¢ Return to erect- posterior tilting at pelvis at hips followed
by extension of lumbar spine
51
52. ā¢ Integration of motion of pelvis about hip joints with
motion of vertebral column:
- increases ROM available to total column
- reduces amount of flexibility required of lumbar region
ā¢ Hip motion:
- eliminates need for full lumbar flexion,
- protecting anulus fibrosus and posterior ligaments
from being fully lengthened
52
54. COMPRESSION
ā¢ Lumbar region provides support for weight
of upper part of body in static as well as in
dynamic situations
ā¢ Lumbar region must also withstand tremendous
compressive loads produced by muscle contraction
54
55. ā¢ Lumbosacral loads in erect standing posture in range of
0.82 to 1.18 times body weight
ā¢ During level walking in range of 1.41 to 2.07 times body
weight
ā¢ Changes in position of body will change location of LOG
and thus change forces acting on lumbar spine
ā¢ Lumbar interbody joints share 80% of load,
Zygapophyseal facet joints in axial compression share
20% of total load.
55
56. ā¢ This percentage can change with altered mechanics:
with increased extension or lordosis, Zygapophyseal
joints will assume more of the compressive load.
ā¢ Also, with degeneration of intervertebral disk,
Zygapophyseal joints will assume increased compressive
load.
56
57. SHEAR
ā¢ In upright standing position,
lumbar segments are subjected to
anterior shear forces caused by:
- lordotic position
- body weight
- ground reaction forces
ā¢ Resisted by direct impaction of inferior zygapophyseal
facets of the superior vertebra against superior
zygapophyseal facets of adjacent vertebra below
57
58. ā¢ PLL is most heavily innervated while anterior, sacroiliac,
and interspinous ligaments receives nociceptive nerve
endings.
ā¢ The lumbar intervertebral discs are innervated
posteriorly by sinuvertebral nerves
ā¢ Laterally by branches of ventral rami and gray rami
communicate.
58
59. 1. EXAGGERATED LORDOSIS
ā¢ Abnormal exaggeration of lumbar curve
ā¢ Weakened abdominal muscles
ā¢ Tight hip flexors, tensor fasciae latae,
and deep lumbar extensors
ā¢ ā compressive stress on posterior elements
ā¢ Predisposing to low back pain
59
PATHOMECHANICS
60. 2. SWAY BACK
ā¢ Increased lordotic curve and kyphosis
ā¢ Weak : lower abdominals, lower
thoracic extensors, hip flexors
ā¢ Tight : hip extensors,
lower lumbar extensors,
and upper abdominals
60
61. 3. FLAT BACK POSTURE
ā¢ Relative decrease in lumbar lordosis (20Ā°),
ā¢ COG shifts anterior to lumbar spine and
hips
61
62. 4. PARS INTERARTICULARIS FRACTURES
ā¢ Region between superior and inferior articular facets
ā¢ Weakest bony portion of vertebral neural arch
62
66. 6. LUMBAR CANAL STENOSIS
ā¢ Narrowing of lumbar canal
ā¢ Congenital OR Acquired
66
67. 7. LUMBAR FACET PATHOLOGY
ā¢ Subluxation or dislocation of facet,
Facet joint syndrome (i.e. inflammation),
Degeneration of the facet (i.e., arthritis)
8. LUMBAR CONTUSIONS, STRAINS, AND SPRAINS,
FRACTURES AND DISLOCATIONS
ā¢ 75 to 80% of population experiences low back pain
stemming from mechanical injury to muscles,
ligaments, or connective tissue
67
