Osteopathic considerations of
the lumbar spine.
So here, we wanna take a look at the lumbar spine
which is really important and plays a lot of
different factors to different
pathologies that affect the body.
So the lumbar spine connects
the thoracic and sacral region.
It consists of 5 vertebra and the vertebral
bodies are a little bit taller anteriorly
which contributes to the lordosis.
Kyphosis and scoliosis are other variations
that could occur in the lumbar spine
and the shape is affected by the different
forces that affect the lumbar spine.
So there are many different forces
that act on the spine.
There could be external forces
such as gravity
or any sort of trauma that
could affect the lumbar spine.
Internally, we have
We have different pulls from fascia and
ligaments which causes a passive force
or we could have active forces
to our muscles and tendons
and then the shape of the spine
plays a role to our posture
and could add to potential
There's axial compression so the lumbar spine
bears the forces from above it acting on it.
Lumbar spine anatomy.
There are 5 vertebral bodies and they're
separated by intervertebral disc.
The body's a little bit higher in the
front like we said forming a lordosis.
They have large, thick,
They're usually fairly easy to
find on palpation.
And the transverse processes, spinous processes
and the bodies are all in the same level.
The superior facets are oriented
in a way backwards and medial
and this allows primarily for sagittal
motion in flexion and extension.
The zygapophyseal joints where the superior and inferior
facets articulate each other are synovial joints.
There are some variations that
could occur in the lumbar spine.
You can have sacralization.
Usually this is a complete or partial
fusion of the L5 vertebra to the sacrum.
And the opposite could occur,
we have lumbarization.
So the sacral segments either
S1 or S2 could be separate
from the sacrum and act
more like a lumbar segment.
The lumbar spine has many ligaments
that connect between them.
We have the supraspinous ligaments
that connects more on the tips
of the spinous processes and
that usually ends around L3.
You have your interspinous ligaments which connect
between the spinous processes of the lumbar spine.
And you have the intertransverse ligaments which
connects between the transverse processes,
but at L4 and L5, they're
replaced by iliolumbar ligaments
cause it connects down to
the ilium or the pelvis.
You have the anterior longitudinal ligament.
This is a very wide ligament on the anterior aspect
of the lumbar spine and it prevents hyperextension.
Posteriorly, you have the
posterior longitudinal ligament.
This ligament is a little bit more narrow.
It attaches to the disc and at the margins.
It helps to prevent hyperflexion.
It's narrow, so what happens is there's
a little bit more of a weakness
for potential herniation of the disc posteriorly.
The ligamentum flavum connects to the
lamina, adjacent to the vertebrae
and extends along the joint
capsules to the spines.
There are several different
pathologies in the lumbar spine
and they all start with similar terms so
I wanted to try to clarify them for you.
So there is spondylolysis
Spondylo- means spine -lysis means separation.
So, spondylolysis is a fracture
of the pars in the spine.
Spondylolisthesis is anterior slippage.
So you can have a fracture
which causes anterior slippage
but when you have that anterior
slippage, then it becomes spondylolisthesis.
Spondylolisthesis is really graded by the
amount of slippage of the segments.
And so, if you have less that 25%, that's
a grade I, less than 50% is grade II,
and if it's up to a 100% anterior slippage
then that's a grade IV.
There's another term called spondylosis.
Spondylosis is a general term given to
gradual degeneration, kinda like wear and tear
of the spinal disc and facets and
this usually occurs with age
Sometimes we refer that as
Sometimes it could be found
It doesn't necessarily have
to be symptomatic.
Don't wanna confuse this with spondylolysis
because spondylolysis means fracture.
Whereas, spondylosis just