Lumbosacral/Thoracic Complaint Flashcards
What commonly causes spina bifida?
Folate deficiency – neural tube closure defects
What are the 3 types of spina bifidia?
Spina bifida occulta
Meningocele
Myelomeningocele
Incomplete closure of vertebrae; often no other symptoms and usually a tuft of hair is present at the site
Spina bifida occulta
Only a sac of fluid protrudes through the incomplete vertebrae closure
Meningocele
A sac of fluid protrudes through the incomplete vertebrae closure that includes spinal nerve tissue
Myelomeningocele
A lateral curve of more than 10 degrees with vertebral rotation is what?
Scoliosis
What is the most common cause of scoliosis?
Adolescent idiopathic scoliosis (no known cause)
Which gender is more likely to develop a severe case of scoliosis?
Females
What are the first observations of a more severe case of scoliosis?
D of the back, shoulder height difference and crease at the waist – forms the D
Describe the Adam’s forward bending test for scoliosis?
Have pt bend forward at the waist, if scoliosis is present, there will be lateral bending of the spine and the vertebral rotation will produce a rib hump that is visible and measurable
Adam’s forward bending test numerical value
Angle of trunk rotation (ATR) has to be more than 7 degrees to declare scoliosis
What is the cobb angle measured from?
An x ray of the spine
Describe how to find the cobb angle
Draw a line from the most tilted vertebrae above and below the apex of curvature, then draw perpendicular lines from them towards eachother;
Once the perpendicular lines intersect they will create another angle that needs to be greater than or equal to 10 degrees to classify scoliosis
What does a Risser sign of 1 mean?
The bone is immature and not done growing, thus if scoliosis is already present then it will more than likely worse
What does a Risser sign of 5 mean?
The bone is mature and more than likely the scoliosis will not progress
What are the red flags of scoliosis?
Age less than 8
Severe pain
Rapid curve progression more than 1 degree per month
Unusual left spinal curvature (D is normal)
Neurologic defects
Common in elderly white females, point tenderness a spine that worsens with flexion
Compression fracture
Arm or leg pain, numbness, tingling, weakness, decreased reflexed and sensation
Herniated nucleus pulposus
What are the most common sites for herniated nucleus pulposus?
L4/L5 and L5/S1 = L5 and S1 nerve roots affected
What are red flag symptoms in back pain?
TUNAFISH
Trauma, unexplained weight loss, neurologic symptoms, age > 50
Fever, IVDU, steroid use, history of cancer
What can the red flag symptoms of back pain indicate?
Cancer, cauda equina, fracture, infection
Large central disc herniation compressing tail of lumbar spine and sacral nerve roots (S2-S4)
Cauda Equina
What can impingement of S2-S4 result in?
Bowel, bladder, sexual dysfunction and saddle anesthesia
Why is cauda equina considered an emergent surgery situation?
It can cause paralysis
What tests are positive with psoas syndrome?
Thomas test and FABER
What is sacroilitis?
Inflammation of sacroiliac joints, pain that runs down low back, butt and leg
+ faber test but with pain the the butt can mean what?
Sacroilitis
2 types of piriformis syndrome?
Butt pain = piriformis spasm
Pain that radiates down leg = spasming and irritating sciatic nerve
Spinal stenosis
Narrowing of spaces in spine, can involve neurologic claudication == leg pain is severe
What are you looking for on an oblique x-ray for spondylolysis?
Collar of scotty dog
What are you palpating for in pts with spondylolisthesis?
Anterior step off sign
What are spondyloarthropathies?
Forms of arthritis
Ossification of annulus fibrosis, bamboo spine seen on lateral x ray
Ankylosing spondylitis
