Scoliosis/Acute Back Pain Flashcards
What is the most common form of scoliosis?
adolescent idiopathic scoliosis (AIS)
What are 2 risk factors for developing severe scoliosis?
- females are 5-10x more likely
- kids are 50x more likely if both parents have AIS
Does screening for scoliosis carry any risk?
- screening itself does not carry risks
- if screening is positive, radiographs and referrals can lead to expense and risk of harm
What is the definition of scoliosis?
lateral curve of the spine greater than 10 degrees w/ vertebral rotation
Name 4 things you could observe on PE of a pt w/ scoliosis
- shoulder height difference
- posterior scapula
- crease at waist
- leg lengths are usually equal
Describe what would be seen on a positive Adam’s forward bending test
lateral bending of spine, but curve will cause rotation and eventually rib hump
What is Risser sign?
amount of calcification present on iliac apophysis; measures progressive ossification
Describe the Risser grading scale
- grade 1: up to 25% ossification of iliac apophysis
- grade 2: 50% ossification
- grade 3: 75% ossification
- grade 4: 100% ossification
- grade 5: iliac apophysis has fused to iliac crest after 100% ossification
Name 5 red flags for scoliosis
- onset before age 8
- severe pain
- rapid curve progression > 1 degree per month
- unusual left thoracic curve (convex to the left)
- neurological deficits or findings
How do you manage a pt w/ a curve less than 10-15 degrees?
monitor unless pt’s bones are immature and progression is likely (Risser sign)
How do you manage a pt w/ a curve between 25-45 degrees
bracing
How do you manage a pt w/ a curve greater than 45 degrees in adolescents and greater than 50 in adults?
require surgery, rod placement and bone grafting may be necessary
Milwaukee brace vs boston brace vs charleston nighttime brace
- milwaukee: 23 hours/day; used in growing pts
- boston: apex of curve must be below T10
- charleston: worn only at night
What is ATR? At what point do you obtain scoliosis radiographs?
- angle of trunk rotation
- > /= 7 degrees -> obtain radiographs
- < 7 degrees -> repeat scliometry every 6 months
What is the definition of acute low back?
6 to 12 weeks of pain between the costal angles and gluteal folds that may radiate down one or both legs (sciatica)
Give a differential dx of acute low back pain (
- compression fx
- herniated disc
- lumbar sprain/strain
- spinal stenosis
- spondylosis
- spondylolysis
- spondylolisthesis
- CT disease
- malignancy
- AAA
- GI conditions: pancreatitis, PUD, cholecystitis
- pelvic conditions: endometriosis, PID
What is important to note during the Hx portion of a pt w/ acute back pain?
- whether it is a first episode or recurrent episode
What are 8 red flags for back pain?
- TUNA FISH
- trauma
- unexplained weight loss
- neurological sxs
- age > 50
- fever
- IVDU
- steroid use
- Hx of cancer
How would SD of lumbosacral spine (back strain) present?
- usually starts w/ mild trauma (twisting)
- muscle ache/spasm
- strain may become chronic
- discrete tender points in lumbar tissue
- no neurological deficits
How would flexion contraction of iliopsoas (psoas syndrome) present?
- initiated by positions that shorten psoas (sitting, bending, getting up quickly from squatting position)
- dull ache in low back (sometimes radiates to groin)
- tender point at iliacus
- positive Thomas test
How would a herniated nucleus pulposus (herniated disc) present?
- pain will originate in lumbar spine and radiate to leg/foot
- sharp burning pain - electric quality
- weakness in affected myotome (decreased reflexes/sensation)
- usually positive straight leg raise
- MRI gold standard for dx
Where will L1-L3 nerve roots radiate pain to?
hip and/or thigh
Where will L4-S1 nerve roots radiate pain to?
below the knee
Which nerve root is impinged at the L4/L5 disc?
L5
Which nerve root is impinged at the L5/S1 disc?
S1
What is cauda equina syndrome?
large central disc herniation compressing the tail of the lumbar spine
How would cued equina syndrome present?
- similar pain to a herniated disc
- impingement of S2-S4 causes bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia
What is spinal stenosis? How would a pt present?
- narrowing of the space around the spinal cord
- pain originates in low back and radiates down the leg
- leg numbness and weakness
- diminished reflexes
What is spondylolysis? How is it dx?
- defect in par interarticularis w/o anterior displacement of vertebral body
- dx made w/ oblique view of lumbar spine (scotty dog present usually at L5/S1)
What is spondylolithesis? How would a pt present?
- vetebral body slips in relation to the one below at pars interarticularis (usually between L5/S1)
- back pain radiating to or below the knee
- often worse when standing
- Exam - lumbar spinous process step off
What should the pt avoid doing to tx acute low back pain?
bed rest not helpful for acute low back pain
What is considered an effective tx for acute low back pain?
NSAIDs and non-BZD muscle relaxants, stay active and avoid twisting/bending/lifting
