Approach to Thoracolumbar Complaint

Question 1

What are the three types of spina bifida?

Answer 1

1) Spina bifida occulta results in a small separation or gap in one or more of the bones of the spine (vertebrae).
2) Meningocele - a sac of fluid comes through an opening in the baby’s back.
3) Myelomeningocele - The spinal canal is open along several vertebrae in the lower or middle back. The membranes and spinal nerves push through this opening at birth, forming a sac on the baby’s back, typically exposing tissues and nerves

Question 2

What % of scoliosis is idiopathic?

Answer 2

(85%

Question 3

M or F more likely to have severe scoliosis?

Answer 3

Women

Question 4

Most common idiopathic scholiosis?

Answer 4

Adolescent Idiopathic Scoliosis (AIS) is most common (MC) form.

Question 5

Does detected cases through screening usually progress to clinical significance?

Answer 5

no

Question 6

Most common type of curve in scoliosis

Answer 6

D or right curve

Question 7

what is an Adam’s forward test?

Answer 7

The patient stands and bends forward at the waist, with the examiner assessing for symmetry of the back from behind and beside the patient
Can use scoliometer

Question 8

What is the Angle of trunk rotation and Cobb angle for scoliosis

Answer 8

angle of trunk rotation (ATR)>7

and Cobb angle >10

Question 9

What is the Risser Sign-Progression Prediction?

Answer 9

Risser sign is defined by the amount of calcification present in the iliac apophysis and measures the progressive ossification from anterolaterally to posteromedially. 1-5.
take home is Low riser scores (immature pts) are more likely associated with possible progression to severe disease. Higher riser s (maturity) are not.

Question 10

Red flags for scoliosis

Answer 10

Onset before age 8
Severe pain
Rapid curve progression >1 degree per month
Unusual Left thoracic curve
**Left curve associated with additional pathology

Question 11

Criteria for acute lower back pain

Answer 11

as 6 to 12 weeks of pain b/t the costal angles and gluteal folds that may radiate down one or both legs (sciatica).

Question 12

What are Compression Fractures

Answer 12

Compression fractures can cause the vertebrae to collapse, making them shorter in height.
This collapse can also cause pieces of bone to press on the spinal cord and nerves,
decreasing the amount of blood and oxygen that gets to the spinal cord.

Question 13

What are Herniated Nucleus Pulposus

Answer 13

is a fragment of the disc nucleus that is pushed out of the annulus, into the spinal canal through a tear or rupture in the annulus. Discs that become herniated usually are in an early stage of degeneration.

Question 14

Common Lumbar pain with Herniated Nucleus Pulposus

Answer 14

L1-L3 nerve roots pain will radiate to the hip and/or thigh

-L4-S1 nerve roots pain will radiate below the knee.

Question 15

Most common herniated disks?

Answer 15

98% of herniations occur between L4/L5, L5/S1

Question 16

What is Cauda Equina Syndrome

Answer 16

Large central disc herniation compressing the tail of the lumbar spine, causing compression of sacral nerve roots.
S2-S4
numbness around the anus, and loss of bowel or bladder control.

Question 17

Anatomical short leg

Answer 17

is when one leg is longer and can be corrected with a heel lift in the shoe of the short leg.

Question 18

Functional short leg

Answer 18

is an apparent short leg although structurally both legs are the same length when measured.

Question 19

What is Sacroiliitis

Answer 19

inflammation of one or both of your sacroiliac joints

Sacroiliitis can cause pain in your buttocks or lower back, and can extend down one or both legs.
Prolonged standing or stair climbing can worsen the pain.

Question 20

What is spinal stenosis

Answer 20

most often in the lower back and the neck
Spinal stenosis is a narrowing of the spaces within your spine,
which can put pressure on the nerves that travel through the spine

Question 21

What is Spondylosis

Answer 21

Osteoarthritis in the back

Question 22

What is Spondylolysis

Answer 22

Defect in par interarticularis (often unilateral) without anterior displacement of the vertebral body. Collar of Scotty dog.
Causes LBP in children. Pain worsens in extension

Question 23

What is Spondylolisthesis

Answer 23

Condition where the vertebral body slips in relation to the one below
at pars interarticularis (usually between L5/S1).

Question 24

What is Spondyloarthropathies

Answer 24

Spondyloarthropathies are forms of arthritis that usually affects the bones in your spine and nearby joints.

Question 25

Ankylosing spondylitis

Answer 25

Is a Spondyloarthropathies. Related to prevalence of HLA-B27. Bamboo spine!

Question 26

What is Vertebral diskitis

Answer 26

Discitis, or diskitis, is inflammation that develops between the intervertebral discs of your spine.
Swelling in these spaces can put pressure on the discs, leading to pain.

Question 27

How to test for piriformis syndrome?

Answer 27

Log roll (posterior pain) and FAIR test. (lateral recumbent with affected hip up)

Question 28

How to test for Psoas Syndrome?

Answer 28

Positive Thomas test and FABER
Negative Log roll
Tender medial to ASIS

Question 29

How to test for Herniated disk?

Answer 29

Positive Straight leg raise between 30-60

Question 30

How to test for Spondylolisthesis

Answer 30

Low midline sill (step-off) sign

Question 31

How to test for scoliosis

Answer 31

Positive Adam’s forward bend