The physical therapist should observe the lumbar area for prespiration, warmth, and redness, as well as palpate the lumbar vertebrae to access deformity. 3Įvaluation and special orthopedic tests for L4 and L5 fractures should consist of a full lumbar exam with overpressure, lower extremity neurologic exam, and a tension test in the form of a straight leg raise to differentiate from a disc injury. Low bone density increases the risk of spinal fractures. Dual Energy Radiographic Absorptiometry (DRA) scanning-Currently this type of imaging is the most commonly used to observe an individual's amount of bone density.This imaging is most useful in determining if postmenopausal women over the age of 50 and men over the age 50 who are osteoporotic and at an increase risk for low bone density.They also have the ability to display the best nueral images of the spine. This imaging has the greatest sensitivity in detecting bleeds, tumors, and infections. MRI-This type of imaging is required when a fracture with nerve root compression is suspected and the patient complains of radicular pain.This imaging is very helpful in displaying the posterior elements laminae of the neural arch. This is a useful tool in ruling out burst fractures in patients with compression fractures. Computed Tomography (CT) scanning-These scans display spinal canal deformities such as narrowing.The lateral view displays decrease height in the vertebral body and the anteroposterior view is useful in indicating unstable fractures by displaying increased interpedicular space. Radiography (X-Ray) -This is the standard imaging required to evaluate spine fractures in anteroposterior and lateral views of the lumbar spine.This usually occurs at L5 which translates forward on the sacrum, resulting in a step deformity. This fracture then widens and the entire vertebrae shifts forward. 3įracture Dislocations-Traumatic Spondylolisthesis-begins as a fracture in the pars interarticularis referred to as spondylolysis. 1īurst Fractures-these fractures are the result of a high-energy axial load to the spine which are classified according to the amount of vertebral body displacement, vertebral body height, and neurological involvement that detemines if the fracture is unstable. This is also known as a stable fracture that in most cases does not present with neurologic deficits. The following are types of fractures that can occur in the L4 and L5 vertebrae: Compression Fracture - a break down in the anterior portion of the vertebral body with a loss in height, while the posterior portion of the vertebral body stays intact. Patients with lumbar compression fractures usually present with kyphotic posture that is unlikely to be corrected, hip flexor contractures, and moderate pain at the level of the fracture. If the fracture has compressed the spinal nerve root, then the patient could have radiating symptons such as numbness and tingling, into the lower extemeties. With the presence of L4 and L5 fractures, the patient's primary complaint will be low back pain that worsens with movement. 3 Osteoporotic wedge compression fractures account for fractures in 75% of women over the age of 65 with scoliosis. 2 Osteoporosis accounts for the majority of lumbar compression fractures. 1 Fractures of the L4 and L5 lumbar vertebrae resulting in neurological or major biomechanical instability is extremely low and is least likey to occur. 1 Individuals with pathologies such as osteoporosis and tumors that result in weakened bone structure are more susceptible to fractures of the vertebral column. Men and the elderly populations are more likely to suffer from lumbar fractures. These type of fractures to the lumbar spine are not common and are caused by trauma such as motor vehicle accidents and falls. With high trauma impacts, patients cans also experience other assoiciated symptons due to head trauma or lost of consciousness. If compression of the spinal column is present, then the patient could have cauda equina symptons with complaints of numbness, tingling, weakness, or problems with bowel and bladder. Indications of L4 and L5 and lumbar fractures in general,consist of having the primary complaint of moderate to severe low back pain, which worsens with movement. For this reason, a high displacement of force is often needed for these spinal segments to become fractured. ![]() L4 and L5 lumbar vertebrae are stabilized by the pelvis, muscle, and ligament attachments. L4 and L5 verterbrae in addition to there discs account for 50% of lumbar lordosis. The lumbar vertebrae are the largest and strongest in the spinal column. 1 Treatment for L4 and L5 fractures tend to be incident specific and differ from treatments of thoracolumbar and upper lumbar fractures. L4 and L5 fractures are commonly the result of a high impact trauma from falls or motor vehicle accidents. Fractures of L4 and L5 vertebrae are uncommon.
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