Approach to Thoracolumbar Complaint Flashcards
What are the three types of spina bifida?
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
What % of scoliosis is idiopathic?
(85%
M or F more likely to have severe scoliosis?
Women
Most common idiopathic scholiosis?
Adolescent Idiopathic Scoliosis (AIS) is most common (MC) form.
Does detected cases through screening usually progress to clinical significance?
no
Most common type of curve in scoliosis
D or right curve
what is an Adam’s forward test?
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
What is the Angle of trunk rotation and Cobb angle for scoliosis
angle of trunk rotation (ATR)>7
and Cobb angle >10
What is the Risser Sign-Progression Prediction?
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.
Red flags for scoliosis
Onset before age 8
Severe pain
Rapid curve progression >1 degree per month
Unusual Left thoracic curve
**Left curve associated with additional pathology
Criteria for acute lower back pain
as 6 to 12 weeks of pain b/t the costal angles and gluteal folds that may radiate down one or both legs (sciatica).
What are Compression Fractures
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.
What are Herniated Nucleus Pulposus
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.
Common Lumbar pain with Herniated Nucleus Pulposus
L1-L3 nerve roots pain will radiate to the hip and/or thigh
-L4-S1 nerve roots pain will radiate below the knee.
Most common herniated disks?
98% of herniations occur between L4/L5, L5/S1
What is Cauda Equina Syndrome
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.
Anatomical short leg
is when one leg is longer and can be corrected with a heel lift in the shoe of the short leg.
Functional short leg
is an apparent short leg although structurally both legs are the same length when measured.
What is Sacroiliitis
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.
What is spinal stenosis
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
What is Spondylosis
Osteoarthritis in the back
What is Spondylolysis
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
What is Spondylolisthesis
Condition where the vertebral body slips in relation to the one below
at pars interarticularis (usually between L5/S1).
What is Spondyloarthropathies
Spondyloarthropathies are forms of arthritis that usually affects the bones in your spine and nearby joints.
Ankylosing spondylitis
Is a Spondyloarthropathies. Related to prevalence of HLA-B27. Bamboo spine!
What is Vertebral diskitis
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.
How to test for piriformis syndrome?
Log roll (posterior pain) and FAIR test. (lateral recumbent with affected hip up)
How to test for Psoas Syndrome?
Positive Thomas test and FABER
Negative Log roll
Tender medial to ASIS
How to test for Herniated disk?
Positive Straight leg raise between 30-60
How to test for Spondylolisthesis
Low midline sill (step-off) sign
How to test for scoliosis
Positive Adam’s forward bend
