Lecture 5: Scoliosis and Acute Low Back Pain Flashcards
What is the definition of Scoliosis?
Lateral curve of the spine >10 degrees w/ vertebral rotation
How is scoliosis classified; which is the most common form?
- Congenital, Neuromuscular, or Idiopathic
- Adolescent Idiopathic Scoliosis (AIS) is most common form
What is the USPSTF screening recommendation for scoliosis?
- Grade: I recommendation
- Most cases detected thru screening do not progress to clinically significant scoliosis.
What would you see during the physical exam that would make you suspect scoliosis?
- Body tried to keep eyes level
- Shoulder height difference
- Posterior Scapula
- Crease at waist
*Leg lengths are usually equal
What are the 2 most common ways that scoliosis can be tested for during PE?
1) Adams forward bend test
2) Scoliometer
What is needed for the official diagnosis of Scoliosis?
Cobb angle measurement using radiography
What is Risser Sign/Grades?
- Visual grading of degree to which iliac apophysis has undergone ossification and fusion
0 - No ossification
1 - Up to 25% ossification
2 - 26-50% ossification
3 - 51-75% ossification
4 - >76% ossification
5- Full bony fusion of the apophysis
What are the 5 Red Flags for scoliosis?
1) Onset before age 8
2) Rapid curve progression >1 degree/month
3) Unusual left thoracic curve (convex to L)
- R thoracic curve most common
4) Severe pain
5) Neurological deficits or findings
What degree of scoliosis curve requires surgery, rod placement, or bone grafting?
- Greater than 45 degrees in adolescents
- Greater than 50 degrees in adults
What are the treatment option using braces for scoliosis?
- Bracing (not often effective for large curves)
- Milwaukee brace (23 hrs/d)
- Boston brace (works on deformities such as lordosis and rotation as well as scoliosis)
- Charleston Nighttime brace (only at night)
What degree of curve requires surgery for scoliosis, to prevent pulmonary compromise, cardiac compromise?
- Adolescents with curve >40°
- Prevent pulmonary compromise >50°
- Prevent cardiac compromise >75°
What are the 2 surgical options for scoliosis?
1) Posterior Spinal Fusion
2) Harrington Rods
What is the 5th most common reason for all physician visits?
Low back pain
What is the definition of acute low back pain?
Up to 4 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs (sciatica)
What are the Red Flags symptoms in back pain (hint: there is a mnemonic)?
TUNA FISH
T = Trauma
U = Unexplained weight loss
N = Neurological sx’s
A = Age >50
F = Fever
I = IVDU (intravenous drug user)
S = Steroid Use
H = History of Cancer (Prostate, Renal, Breast, Lung)
A herniated nucleus pulposus impinging the lumbar roots of L1-L3 or L4-S1 will cause pain to radiate where?
L1-L3 = pain will radiate to the hip and/or thigh
L4-S1 = pain will radiate below the knee
What spinal levels do 98% of herniations occur at?
L4/L5 or L5/S1
With spinal stenosis where does the pain originate/radiate, what makes it worse, and what makes it better?
- Originates in low back and radiates down leg
- Pain worsened by standing, walking, lying supine
- Relieved by leaning forward
The L3 nerve root controls what motor, sensory, and reflex?
Motor: Hip Flex
Sensory: Ant/Medial Thigh
Reflex: Patella
The L4 nerve root controls what motor, sensory, and reflex?
Motor: Knee Ext
Sensory: Ant leg/ Medial Foot
Reflex: Patella
The L5 nerve root controls what motor, sensory, and reflex?
Motor: Dorsiflex/Great Toe
Sensory: Lat leg/Dorsal Foot
Reflex: Medial Hamstring
The S1 nerve root controls what motor, sensory, and reflex?
Motor: Plantar Flex
Sensory: Post Leg/Lateral Foot
Reflex: Achilles
What is the recommendation for doing imaging in a patient with low back pain?
- Don’t image for LBP in 1st 6 weeks, unless red flags present
What are the recommended treatments for LBP; which are level A and level B recommendations?
- Pt education: stay active, routing course of pain, avoidance of twisting/bending/lifting. Return to normal activity ASAP (Level B)
- Bedrest is NOT helpful for nonspecific acute low back pain (Level A)
- NSAIDs and non-BZD muscle relaxants are effective treatments (Level A)
- Little evidence of benefit to use opiates in severe acute LBP
- Pt may lessen the risk of recurrence and need for health care services (Level B)
Gold standard for diagnosing herniated nucleus pulposus?
MRI
Upon exam of a patient you find a tender point at iliacus (medial to ASIS), a (+) Thomas Test, and OSE nonneutral L1/2, what is the most likely cause of this persons LBP?
Flexion Contracture of the Iliopsoas (Psoas Syndrome)
