General Characteristics^[1][edit|edit source]

Verebral Bodies[edit|edit source]

The Lumbar Vertebrae are larger and heavier than vertebral bodies in other regions.The lumbar vertebral body is kidney shaped when viewed superiorly, so is wider from side to side than from front to back, and a little thicker in front than in back with a thin cortial shell which surrounds cancellous bone. The posterior aspect of the vertebral body changes from slightly concave to slightly convex from L1 - L5 with an increasing diameter due to the increased load carried at each body.^[1][2]

The main weight of the body is carried by the vertebral bodies and disks. The lamina, facets and spinous process are major parts of the posterior elements that help guide the movement of the vertebrae and protect the spinal cord.

Vertebral Foramen[edit|edit source]

The vertebral foramen is triangular in shape and is larger than in the thoracic vertebrae but smaller than in the cervical vertebrae.

Bony Structures[edit|edit source]

Pedicles[edit|edit source]

The pedicles originate posteriorly and attach to the cranial half of the body forming the vertebral arch with the laminae. The pedicles become shorter and broader becoming more lateral from L1 - L5 which narrows the anteroposterior diameter and widens the transverse diameter of teh vertebral canal.

Laminae[edit|edit source]

Forming the Vertebral Arch with teh Pedicles the each laminae is flat and broad blending in centrally with the spinous process.

Spinous Processes[edit|edit source]

在腰椎椎骨中，棘突短而坚固，通常被描述为“斧状形”。

Transverse Processes[edit|edit source]

The transverese process are long and slender in the Lumbar Vertebrae with accessory processes on teh posterior surface on the base of each process.

Articular Processes[edit|edit source]

下部或内侧定向时，在下部的关节面部的前侧或侧面定向，在每个上部关节过程的后表面上，在前外侧或侧面定向。

评估[edit|edit source]

Vertebral Causes of Spinal Pain:^[3]

• Developmental:Spondylolisthesis,Scoliosis, Hypermobility, Various uncommon disorders.
• Degenerative: Disc lesions without root compression, Disc lesions with root compression, Disc lessions with compression of spinal cord or cauda equina, Osteoarthrosis of apophyseal joint, Hyperostosis,不稳定.
• Trauma: Fracture, Stress fracture, Subluxation, Ligamentous injury.
• Tumour: Secondary carcinoma, Myelomatosis.
• Infection：葡萄球菌，结核病，大肠杆菌，布鲁氏菌梅利特西斯。
• Inflammatory arthropathy:Ankylosing spondylitis, Rheumatoid arthritis,Reiter´s disease, Ulcerative colitis,Crohn´s disease， 银屑病。
• 新陈代谢:Osteoporosis，骨瘤。
• Unknown:Paget´s disease.

Physical Examination[edit|edit source]

Sequence proposed byMaitland forthe physical examination of the intervertebral segment:^[3]

1.活跃测试

1.1.Active movements: in standing, except for rotation which is best tested in sitting.
1.2.Auxiliary tests associated with active movements tests.
Isometric testsin the lumbar area produces considerable intervertebral movement. It may be necessary to test the muscle isometrically in differents positions of the joint range and to compare the degree of pain produced by an active resisted movement with that of a passive movement.

2.Passive tests

2.1.Movement of the pain-sensitive structures in the vertebral canal and intervertebral foramen.
2.2.Palpation: The positions of the vertebrae should be assessed in relation to adjacent vertebrae. Palpation of the spinous process posteriolly and laterally is usefull both in regard to the position of the vertebra and to the state of the interspinous and supraspinous ligaments. No too much importance should be placed on abnormalities found on this assesment, only relevant if they are verified by radiology.
2.3.Passive range or intervertebral movement.

Computed Tomography (CT)[edit|edit source]

在一项将射线照相摄影与CT进行比较的研究中，低剂量CT的评分比X射线照相术高：圆盘谱和椎骨终板的急剧再现，椎间盘孔和椎弓根，椎骨关节，棘突和横向过程，Sacro-iliac关节，sacro-iliac关节，繁殖相邻的软组织，以及没有任何模糊的叠加胃肠道气体和内容物。审阅者可视化椎间盘变性，脊椎病/弥漫性特于特发性骨骼肌肌病（DIS）和椎间盘关节骨关节炎，并且更确定，低剂量CT。^[4]

Radiography[edit|edit source]

Lumbar spine radiography is often performed instead of CT for radiation dose concerns. In a study which compares radiography with CT, radiography scored better on sharp reproduction of cortical and trabecular bone.^[4]Other study showed that radiography is likely to be cost-effective only when satisfaction is valued relatively highly. Therefore, strategies to enhance satisfaction for patients with low back pain without using lumbar radiography should be pursued.^[5]

Magnetic resonance imaging (MRI)[edit|edit source]

Conceptual links between MRI findings and spine-related symptoms. Primary MRI predictors of interest on italic.^[6]

• MRI发现与腰痛有关：

椎骨端板更改
Annular Fissures
Facet Osteoarthritis
Disc dessication
光盘heigh缩小
Disc Bulging

• 与辐射症状有关的MRI发现

Central canal stenosis
Disc extrusions
Nerve root impingement

• MRI Findings Linked to Both

Spondylolisthesis
Disc protrusions

MR for new low back pain is of little value in making a diagnosis based on specific spinal pathoanatomic changes. With respect to chronic low back pain or radicular symptoms, MRI findings does not explain the vast majority of incident symptom cases.^[6]

治疗[edit|edit source]

Invasive treatment[edit|edit source]

• percutaneous vertebroplasty: percutaneous intraosseous methylmethacrylate cement injection to treat osteoporotic vertebral compression fractures and spinal column neoplasms.^[7]
• kyphoplasty: Kyphoplasty椎增大的一种for compression fractures.^[8]
• Lumbar Fusion: The goal of a lumbar fusion is to stop the pain at a painful motion segment in the lower back. Most commonly, this type of surgery is performed for pain and disability caused by lumbar degenerative disc disease or a spondylolisthesis.^[8]

There are also many surgical approaches to performing spinal fusion, such as ALIF, PLIF, XLIF, TLIF, posterolateral gutter fusion, anterior/posterior fusion, and certain minimally invasive approaches.^[8]

理疗[edit|edit source]

• 牵引力: Large forces are not required to separate the vertebrae. Vertebral separation could provide relief from radicular symptoms by removing direct pressure or contact forces from sensitised neural tissue.^[9]
  
• 手动动员: Physiotherapists use manual mobilisation for differents patologies of the lumbar spine. Good knowledge of the appropriate technique is needed as well as take into account some contraindications, for example, high velocity spinal manipulation techniques are contraindicated in individuals with osteoporosis.

• 治疗运动: Exercise interventions, alone or in combination with other treatments, have a positive effect on diverse patologies, for example, low-back pain due to spondylolysis and spondylolisthesis.^[10]Exercise interventions can be considered aswell a preventive treatment because it has positive effects on bone mineral density, and exercise programs can prevent fractures due to falls.^[11]
• Postural tapinguses tape applied to the skin to provide increased proprioceptive feedback about postural alignment, improve thoracic extension, reduce pain and facilitate postural muscle activity and balance.
  

参考[edit|edit source]