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)
