Common Clinical Syndromes and Pathologies of the Thoracolumbar Spines

Question 1

A 25 yo male comes into the clinic with lower back pain walking delicately. You diagnose them with HLA-B27, what disease do they have?

Answer 1

ankylosing spondylitis

Question 2

A patient comes in with AS (ankylosing spondylitis) what do you recommend for them?

Answer 2

stay active! get to the gym! :p

Question 3

A 14 year old patient comes in with a sharp angle change in their T7 through T10 spinal curve, what do you think they have?

Answer 3

Scheuermann’s disease (congenital disease)

Question 4

What vertebrae are most commonly effected by Scheuermann’s disease?

Answer 4

T7 to T10

Question 5

Osteoporosis is very common in post menopausal women, but can men get osteoporosis?

Answer 5

Yes! When they are > 50 yo.

Question 6

Which of the following is NOT a risk factor for osteoporosis

a) having a fracture or family hx of having a fracture
b) > 50 yo
c) post-menopausal woman
d) a smoker
e) weigh 72 kg

Answer 6

e) weight 72 kg [less than 70kh risk factor]

Question 7

Which of the following is NOT a risk factor for osteoporosis:

a) a drinker
b) sedentary
c) taken estrogen replacement
d) taken corticosteroids
e) Vitamin D deficiency/don’t drink a lot of milk

Answer 7

b) sedentary

Question 8

What is the curve in osteoporosis called?

Answer 8

Dowenger’s hump

Question 9

What is the definition of spondylolisthesis?

Answer 9

forward slippage of one vertebra on the next vertebra

ex. car accident

On XRAY: see dog decapitated and head shifted

Question 10

What is spondololysis?

Answer 10

a pars inarticularis defect fracture (between superior and inferior facets)

ON XRAY: see the collar on a dog

Question 11

A patient comes in with lower back pain that gets worse with extension, what do they have?

Answer 11

spondolylolisthesis

Question 12

If a patient is diagnosed with spondolyolisthesis, and has a 15% slippage, what grade spondylolisthesis do they have?

Answer 12

Grade 1 [0 - 25%]

Question 13

If a patient is diagnosed with spondolyolisthesis, and has a 45% slippage, what grade spondylolisthesis do they have?

Answer 13

Grade 2 [25% -50%]

Question 14

If a patient is diagnosed with spondolyolisthesis, and has a 55% slippage, what grade spondylolisthesis do they have?

Answer 14

Grade 3 [51 - 75%]

Question 15

If a patient is diagnosed with spondolyolisthesis, and has a 87% slippage, what grade spondylolisthesis do they have?

Answer 15

Grade 4 [76 - 100%]

Question 16

What is a spondolyolisthesis with over 100% slippage called?

Answer 16

spondlyopsis

Question 17

Pectus carinatus is also called…

Answer 17

pigeon chest

Question 18

Pectus excavatum is also called…

Answer 18

funnel chest

Question 19

T or F: In a fractured rib, the pain is along the entire rib

Answer 19

True!

Question 20

What is the most common type of disc herniation?

Answer 20

posterior lateral herniation in lumbar spine

Question 21

A patient presents with a positive SLR (straight leg test) of > 30 degrees, pain in their lower back, and pain that radiates down the leg below the knee. What do you think they have?

Answer 21

A herniated lumbar disc

Question 22

You suspect has a patient has a herniated lumbar disc, would you suspect they have more pain with sitting and Flexion or Extension? Why?

Answer 22

Increased pain with flexion b/c flexion causes disc to move posterior more.