Assessment of the Thoracic and Lumbar Spine

Question 1

Describe percussion

Answer 1

Used to identify pain points or discrete areas of fracture ***SI joint is an example

Question 2

What are possible thoracic spine differential diagnoses?

Answer 2

Compression fracture Osteomyelitis Muscle spasm Strain/sprain (ligaments stretch/tear or muscle stretch/tear) Other SDs

Question 3

What are possible lumbar spine differential diagnoses?

Answer 3

Compression fracture Osteomyelitis Muscle spasm Strain/sprain Other SDs

Question 4

Differentiate between the 1. congenital 2. Early onset 3. Adolescent idiopathic forms of scoliosis

Answer 4

1. Congenital occurs in utero: rare 1 in 10,000 births 2. Early onset means that it is diagnosed prior to 10 years of age 3. Adolescent is the most common form of scoliosis

Question 5

Why is the early onset of scoliosis more concerning?

Answer 5

because children under the age of 10 are still growing and it is possible to affect more than just the spine; can affect the ribs which can result in lung development issues spinal growth begins to slow at age 10; so any child that has a significant curve in childhood has the potential to get worse into adulthood

Question 6

Define scoliosis

Answer 6

Curvature of the spine in the coronal plane with rotation in the spinal column defined by >10 degrees of curvature

Question 7

Describe scoliosis in adults

Answer 7

can happen de novo, as a progression from childhood, or secondary to another injury

Question 8

Define adult spinal deformity

Answer 8

Encompasses scoliosis, kyphosis, lordosis, and spondylolithesis which can lead to an imbalance of the spinal column

Question 9

What are the screening tools that are used to diagnose scoliosis?

Answer 9

1. differences in shoulder height or scapula 2. asymmetry of the waistline 3. asymmetry in distance that the arms hang from the trunk 4. head is shifted to one side and not centered over the sacrum (trunk shift) 5. A plumb line dropped from the spinous process of the seventh vertebrae should pass through the gluteal cleft

Question 10

Describe the forward bending test for scoliosis

Answer 10

Patient bends forward with the knees extended and then side bends left and right while looking for worsening or improvement of symptoms

Question 11

If you have a spinal curvature that improves with side bending, what kind of dysfunction is it?

Answer 11

Functional Structural curves do not improve with side bending

Question 12

What is a scoliometer?

Answer 12

It is a tool that is ran down the patients spine and measures the curvature that is present within the spine (it kind of looks like a level almost)

Question 13

Describe spondylolysis

Answer 13

defect or stress fracture in the pars interarticularis of the vertebral arch; typically occurs in the lumbar vertebrae (L5) but can occur in the neck as well

Question 14

Describe spondylolithesis

Answer 14

the vertebral body is slipped forward over another; caused by an underlying spondylolithesis

Question 15

Describe spondylitis

Answer 15

inflammation of the spinal joints

Question 16

Describe spondylosis

Answer 16

degenerative; intervertebral discs are inflamed

Question 17

What are the treatments of scoliosis?

Answer 17

Observation Bracing Surgery (for curvatures that are 39-50 degrees

Question 18

What are the “red flag” findings that are consistent with caudal equina syndrome

Answer 18

-progressive sensory motor deficits -saddle anesthesia -bilateral sciatica or leg weakness -difficulty urinating -fecal incontinence

Question 19

Define sciatica

Answer 19

pain or discomfort that is associated with the sciatic nerve sharp burning pain that radiates from the lower back or hip, possibly following the path to the foot

Question 20

What are the concave structures of the back?

Answer 20

Cervical and lumbar curves

Question 21

What are the convex structures of the back?

Answer 21

Thoracic and sacral

Question 22

When inspecting the spine clinically, what are things that you should look for?

Answer 22

1. spinous processes (C7 is the most prominent) 2. Paravertebral muscles on either side 3. iliac crests 4. Posterior iliac spines (skin dimples) 5. A line drawn above the posterior iliac crests at the spinous process of L4

Question 23

When do step offs occur?

Answer 23

Spondylolithesis

Question 24

If a patient has tenderness over the sacroiliac joints what could be the cause?

Answer 24

Sacroilitis ankylosing spondylitis

Question 25

Describe spina bifida occulta

Answer 25

Small split in the vertebrae with NO spinal cord protrusion Most common in L5-S1 can find a coarse patch of hair or a birthmark

Question 26

Describe meningocele

Answer 26

form of spina bifida Meninges are forced out between vertebra surgically repaired

Question 27

Describe myelomeningocele

Answer 27

Most common form of spinabifida unfused portion of the spinal cord protrudes through the opening severe

Question 28

What is fergusons angle?

Answer 28

Normally 30-40 degrees that is evaluating the stability of the lumbosacral region measured via the lumbosacral angle and the lumbar gravity line

Question 29

What is pictured?

Answer 29

Spondylolysis

Question 30

What is pictured?

Answer 30

Spondylolithesis

Question 31

What is pictured?

Answer 31

Osteoarthritis; spondylosis

Question 32

What is pictured?

Answer 32

herniated disc