Lumbar spine (lumbar spine)

Synonyms

• Lumbar spine
• Lumbar vertebrae
• Lumbar vertebrae
• Lordosis - hyperlordosis
• Lumbar pain
• lumbago
• Lumboischialgia
• Lumbar spine syndrome

anatomy

The lumbar spine (lumbar spine) is part of the spine. It usually consists of 5 lumbar vertebrae.
The lumbar vertebrae are numbered 1-5 from head to rump. As a mostly harmless standard variant, the 5th lumbar vertebrae can be fused with the first sacral vertebra. In this case, the doctor speaks of a sacralization (from Os sacrum = sacrum).
The lumbar spine in this case consists of only 4 vertebral bodies. Alternatively, the natural fusion of the first sacral vertebra with the remaining 4 sacral vertebrae can fail to occur. In this case one speaks of a lumbarization.

The lumbar spine naturally has a slight curvature (lordosis) when viewed from the side. If this curvature increases, a hollow back develops (hyperlordosis), if it flattens out, a flat back develops (hypolordosis).

Lumbar spine illustration

Lumbar spine (blue)

1. First cervical vertebra (carrier) -
   Atlas
2. Second cervical vertebra (turner) -
   Axis
3. Seventh cervical vertebra -
   Vertebra prominent
4. First thoracic vertebra -
   Vertebra thoracica I
5. Twelfth thoracic vertebra -
   Vertebra thoracica XII
6. First lumbar vertebra -
   Vertebra lumbalis I
7. Fifth lumbar vertebra -
   Vertebra lumbalis V
8. Lumbar cruciate ligament kink -
   Promontory
9. Sacrum - Sacrum
10. Tailbone - Os coccygis

You can find an overview of all Dr-Gumpert images at: medical illustrations

The only one Lumbar vertebrae consists of one Lumbar vertebrae (Corpus vertebra), a Lumbar vertebral arch (Arcus vertebra), 4 small vertebral joints (right and left, above and below), one Spinous process (Processus spinosus), a transverse process and a vertebral hole (foramen vertebrale). Together with the neighboring vertebral bodies (above and below) there is an outlet opening for the Spinal nerves shaped (neuroforamen).

The vertebral hole of a single vertebral body, together with the other vertebral holes, forms a bony canal, the vertebral canal or spinal canal (spinal canal).
The spinal cord runs in the spinal canal, and in an adult it ends approximately at the level of the second lumbar vertebrae. Below the second lumbar vertebra is the so-called horse's tail (cauda equina). The horse's tail consists only of nerves that swim in the cerebrospinal fluid (liquor cerebrospinalis) and are surrounded by the hard skin of the spinal cord (dura mater) in a kind of tube.

Lumbar spine x-ray

1. Intervertebral disc (blue)
2. Vertebral bodies
3. Sacrum (red)

CT image of the spine

1. Vertebral bodies
2. Transverse process
3. Articular process / vertebral joint
4. Spinous process
5. Vertebral hole

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me live every 6 weeks on "Hallo Hessen".
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of all treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

You can find me in:

• Lumedis - your orthopedic surgeon
  Kaiserstrasse 14
  60311 Frankfurt am Main

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You can find more information about me at Dr. Nicolas Gumpert

function

In the lumbar spine, mainly bending, straightening and sideways movements are possible.
Due to the special structure of the vertebral bodies and the position of the vertebral joints in relation to one another, there is hardly any rotational movement.
A healthy lumbar spine can be bent and stretched 70 °, the sideways incline is 25 °, the ability to rotate is approx. 2 °. In the course of the aging process, mobility decreases

The smallest functional (movable) unit of the spine is the movement segment. A movement segment is understood to be the unit between two neighboring vertebral bodies, which are connected to one another via two vertebral joints, as well as the intervertebral disc between the vertebral bodies and all muscular structures, ligament and nerve structures that are located in this area.

Spinal anesthesia

A Spinal anesthesia (Spinal anesthesia) is performed in the area of ​​the cauda equina. A needle is inserted into the horse's tail. The nerves easily evade the needle, which is why they are not injured.
In spinal anesthesia, the nerves are washed with a local anesthetic, which can be used to create an artificial Paraplegia are generated, which ends again with the end of the drug's effectiveness (after a few hours).

You can find more information on this topic at: Spinal anesthesia

Figure spine

The red colored area shows the different sections of the spine.

Left to right:

• Cervical spine and upper thoracic spine
• Thoracic spine
• Lumbar spine

Side view of a movement segment

1. Vertebral bodies
2. Intervertebral disc
3. Spinal nerve root
4. Intervertebral hole (neuroforamen)
5. Vertebral joint
6. Spinous process of the vertebra (palpable on the back as the rear end of the vertebra)

Isolated disturbances are often found in a single movement segment (e.g. blockages, Herniated discs). For a local description of a spinal disease, the individual vertebral bodies are counted, e.g. HWK 5 for the 5th cervical vertebra, BWK 9 for the 9th thoracic vertebra, LWK 3 for the 3rd lumbar vertebra, etc.
It is the same with the intervertebral discs and the movement segments. The description HWK 4/5 refers to the movement segment between the 4th and 5th cervical vertebrae.

In addition to its function as a static organ and as an organ of movement, the spine also has another important function as a protective and conducting organ for the spinal cord. The spinal cord basically represents the extension of the brain and is therefore also the central nervous system assigned ..

Diseases

The Lumbar spine Due to its static load and great mobility, it is prone to wear and tear.

Back pain
Back pain are a widespread disease. Everyone knows them, but the frequency at which back pain occurs varies greatly from person to person.

Back pain can come in different forms:

• The Lumbago caused by sudden nerve root irritation or vertebral joint blockage, causing severe pain.
• If back pain occurs in combination with radiating pain in the legs, this is referred to by the doctor as Lumboischialgia.
• Pain that is felt exclusively in the legs but has its cause in the spine is called Sciatica designated.
• There are many causes of back pain. In most cases it is age-related diseases of the spine (degenerative spinal disease).
  You can find more about this under our topic: Causes of Back Pain.
  
• The best-known degenerative spinal disease that can occur as early as the third decade of life is the Lumbar disc herniation. In the case of a disc disease without a prolapse of disc tissue, one speaks of a Discopathy. As a therapy option for this type of disc disease, there is now one Intervertebral disc prosthesis more and more in question.
• As the wear and tear of the spine progresses, further changes and clinical pictures develop on the intervertebral discs (Osteochondrosis), the vertebral joints (Facet Syndrome), the spinal canal (Spinal stenosis) and the vertebral body (spondylolisthesis), which are often only due to a stiffening operation (Spinal fusion) the spine are to be treated.
• This is also often found osteoporosis as a cause of back pain. It is not uncommon for the initial diagnosis to be made by one Vertebral fracture posed. In these cases, modern surgical procedures such as the Vertebroplastic and kyphoplasty.
• In exceptional cases, tumors (tissue growth), congenital changes in the spine (e.g. Spina bifida (open spinal canal)), for adolescents Scheuermann's disease or one Scoliosis lead to back pain.

Adjust the lumbar spine

Lumbar spine pain can be caused by a wedged zygapophysial joint between the vertebral bodies or a slipped vertebral body, among other things.

In the treatment, straightening is often used. The concept of straightening comes from chiropractic. Here, using certain techniques and hand movements, such as traction or adjustment, slipped vertebrae are to be brought back to their original location, whereby the resulting pain and movement restrictions in the lumbar region can be eliminated.

These techniques are primarily based on reducing the pressure load on the joint by pulling or by targeted pressure to restore the anatomically correct position. The success of the treatment can usually be seen immediately. The famous "cracking noise" that can arise here, however, is not a sign of success, although many patients mistakenly believe it is one.

Read more on the topic: Adjust vertebrae

Relieve the lumbar spine

The Lumbar spine is exposed to very strong forces in daily life, which arise from certain movements as well as when standing or sitting in an upright position. Since the weight that each individual vertebral body has to withstand increases from the head downwards, this is the lumbar spine special burdens exposed.

Therefore, it makes sense to relieve the lumbar spine of additional and avoidable forces in order to prevent early signs of wear and tear. The lumbar spine can be relieved by using the Musculature Part of the forces acting on the ligaments of the lumbar spine takes over. Here is one Strengthening the back muscles advisable. A good example of how to relieve the lumbar spine by changing movement habits is lifting heavy objects. If you simply bend forward, the anterior parts of the vertebral body and the posterior ligament structures on the spinous processes are more stressed. If you go to the squat With a straight back, the weight is evenly distributed over the vertebral body and the muscles of the thighs and spine are used for support. Scientific studies have also shown that the "Gammel" attitude can relieve the lumbar spine.

Strengthen the lumbar spine

Since the Lumbar spine has to bear a comparatively high load, that is Strengthen the back muscles particularly important in this area. The so-called "autochthonous back muscles", which are located directly on the spine, make a very large contribution to this.
But also that Abdominal muscles as an opponent to this is not to be neglected. Last but not least, the bone structure and the Tape strength for a strong lumbar spine. All of these components are in the so-called Back school takes into account in which the strengthening of the lumbar spine through preventive measures, such as learning a back-friendly posture in everyday movement sequences, is in the foreground.
There you will be shown which posture you should take when ironing or at work, for example, in order to have a strengthening effect on the lumbar spine. In addition to this, the training of the lumbar spine is through physical therapy or Fitness training an important element. This is primarily about the targeted strengthening of the above-mentioned muscle compartments.

The back muscles can be used with various Fitness equipment Strengthen all-round so that the lumbar spine is surrounded by strong muscles and at the same time maintains its mobility. The Abdominal muscles can be done through simple exercises like Sit-ups exercise, which supports the stability of the lumbar spine from the front. A briefing by a trained trainer or physiotherapist is recommended, as the exercises, if performed incorrectly, can cause more damage to the lumbar spine than they are beneficial.
Nevertheless, one also has to do this Cost factor note. In an acute case, you can get from the health insurance company Back school and physical therapy get supported. However, if you want to use Self-directed the lumbar spine im Gym strengthen and train, you have to pay for it yourself.

Nevertheless, it is very important to do something for your back as a precaution to avoid damage later. Simple exercises that can be incorporated into everyday life, such as walking for half an hour every day, can also train the lumbar spine and show positive effects.

Tap the lumbar spine

Taping the lumbar spine can be used as a supplement to a treatment of the existing problem. Although it cannot remedy the source of the pain, taping the lumbar spine can help, especially with discomfort when moving, for example pulling pain when bending over.
Tapes are used for various diseases. Indications range from slight tension in the muscles to back pain and herniated discs in the lumbar spine.

The tapes are offered in different colors, the meaning of which is explained in kinesiology. The tape is usually attached to the lower back in a slightly bent position, so that in an upright position the tape lifts the tissue under the skin in a wave-like manner, which is supposed to promote blood circulation.
The course of the tape should be based on the muscles and tendons. Nevertheless, there are different variants of the tape course for the lumbar spine. Usually, a tape is attached from the bottom to the top, directly to the right and left of the spine. For this purpose, another tape can be applied horizontally. Some of the tapes are also used in a star shape.

For the application in a herniated disc, we have published a separate topic under "Taping a herniated disc".

Stretch the lumbar spine

The lumbar spine provides the attachment surface for numerous muscles and ligament structures, which means that there is constant tension on the lumbar spine, both in movement and in the resting position. As this ideally takes place symmetrically, i.e. the same structures act on both sides with the same forces, there should be a certain balance between them.

Stretching the lumbar spine should have a balancing effect. This can prevent the muscle attachment tendons from shortening on one side, which can happen through certain habitual motion sequences, and thus exerting more tension than on the other side. The hips play an important role here, as they are connected to the lumbar spine via particularly strong muscles.
Here, too, stretching the lumbar spine helps to prevent the associated hip malpositions. In addition, stretching the lumbar spine ensures that mobility is maintained in all directions. Stretching exercises not only involve flexing and stretching movements forward and to the side, but rotating movements are also important. You should make sure to stay in the respective positions for a few seconds so that the tendons and ligaments are effectively stretched. Excessive stretching should be avoided due to the risk of strains.

You may also be interested in this topic: Ligaments of the spine

blockade

As blockade is called a for various reasons structure out of balance out Muscles, Ribbons and bone.
You can imagine that through Overload or to severe irritation one structure, for example through repetitive motion sequences, another in its place has to carry the load and the mobility more. Because of this unusual situation, it comes to in the region concerned Irritation of nerves, too strong Pain and the feeling in the Limited mobility to be. This is expressed by one hardened muscle or one swollen tendonwhich are, so to speak, "blocked" in their function.

A classic example is that Blockage of the cervical spineIf, for example, you have slept in a position that is tense for your muscles and the next morning you can no longer turn your neck completely without triggering a painful stimulus that prevents further movement.

Help here physical therapy and warmthin order to loosen the structure again and to be able to move it painlessly and also to strengthen the structures. A blockage does not mean a bone that is wedged in the figurative sense. However, real bone displacements, such as a vertebral herniation in the lumbar spine, can occur that cause similar symptoms but require urgent treatment.

Herniated disc of the lumbar spine

Definition:

The intervertebral disc, which is located between the individual vertebral bodies, consists of two parts: the outer fibrous ring "Anulus fibrosus" and the gelatinous core "Nucleus pulposus".
In the well-known herniated disc, the gelatinous nucleus pulposus breaks through and exits through the anulus fibrosus. The herniated disc either penetrates in the direction of the spinal cord, laterally to the nerve root, or both combined and exerts pressure on the structure in question. Thus, not the entire intervertebral disc slips out of the spinal structure, but only the core. The people concerned have different symptoms depending on the pressure of the herniated disc.
Most herniated discs occur in the lumbar spine, especially between lumbar vertebrae 4 and 5 (herniated disc L4 / 5) and between 5 and the 1st sacrum (herniated disc L5 / S1). Nevertheless, the thoracic spine is not spared either.

Causes:

The widespread herniated disc can have a variety of causes and can affect people at any age. Age-related degradation processes, vigorous physical work (e.g. lifting heavy objects), poor posture, excessive strain (e.g. due to heavy weight) or even sport (especially over long periods of time) are responsible for the eruption of the fibrous ring of the intervertebral disc. But disposition also plays a major role here.
Furthermore, an accident in which strong forces act on the spine, for example a spinal rotation, can lead to a herniated disc. Bone tumors or metastases in vertebral bodies also damage the bones and the surrounding structures and make the spine more prone to injury.

Symptoms:

In the case of a herniated disc, the focus is on severe pain in the spinal column (depending on the location of the herniated disc), which vary from person to person and, for example, radiate into the foot. The pain leads to relieving posture and tension, which causes further pain and restricts mobility. In addition, those affected feel paresthesia, i.e. a mixture of numbness, tingling and feeling cold, due to the nerve irritation. Certain skin areas can feel numb, and some muscles can be restricted in their function.
Read more on the topic: Symptoms of a herniated disc in the lumbar spine

Diagnosis:

There are various methods of diagnosing a herniated disc. First of all, it is helpful to ask the person concerned about symptoms and any events that could be related to the pain. Next, an extensive physical examination, especially of the spine and legs, provides information about pathological changes. Here you pay particular attention to whether heel walking (L5) and toe walking (S1) are possible, which gives an indication of the height of the herniated disc.
In addition, one checks whether all reflexes can still be triggered or whether these have been weakened or even completely extinguished by the pressure on the nerve root. The same applies to the assessment of the muscle function of the quadriceps, for example, and the resulting stability of the joints. In the Lasègue test, the spinal nerve roots of segments L4 to S1 and the sciatic nerve are stretched by flexing the hip joint with the leg extended. If this stretch causes pain, the test is positive and there is compression or irritation of the nerve root due to a herniated disc.
In order to confirm the suspicion of a herniated disc and to find out the localization, imaging methods are used:

• roentgen
• Computed tomography (for bony structures)
  and
• Magnetic resonance imaging (for soft tissue) of the lumbar spine.

Read more about this at:

• Magnetic resonance imaging of the lumbar spine
  and
• MRI for a herniated disc

Therapy:

The herniated disc usually causes severe pain, which can be minimized with pain relievers and anti-inflammatory drugs. In addition, applying heat or cold to the affected area can provide relief from the pain. Exercise therapy, such as back training to strengthen muscles and posture, or massages can also have a positive effect.
The so-called “step bed”, in which you lie horizontally and place your lower legs at an angle on a cube, relieves the spine and can be used from time to time.
If there are serious nerve deficits that limit the sensitivity and motor skills of those affected, or if the pain persists for longer than six weeks despite treatment, surgical treatment, in which the leaked intervertebral disc material is removed, can help. Depending on the case, the operation can be open or minimally invasive ("keyhole surgery").

Read more on this topic at:

• Herniated disc of the lumbar spine
  and even more special:
  • Herniated disc L4 / 5
  • Herniated disc L5 / S1
• Exercises after a herniated disc of the lumbar spine