Scoliosis and Acute Low Back Pain Flashcards
Scoliosis is lateral curvature of the spine greater than ___ degrees with vertebral rotation
10
What form is scoliosis most commonly found in?
Idiopathic (85%)
Risk factors for progressive scoliosis
Female
Both parents have adolescent idiopathic scoliosis
What population is recommended for screening for scoliosis?
Children and adolescents 10-18
What is a positive Adam’s forward bend test?
Pt stands and bends at the waist, with a rib hump unilaterally because of spine rotation
Why is screening for scoliosis a controversial topic?
Radiographs and referrals for scoliosis can lead to significant expense and risk of harm to patient and most scoliosis cases do not progress to clinically significant state
What classifies as rapid curve progression in a patient with scoliosis?
Curve progression >1 degree per month
What are the red flags associated with scoliosis?
Onset before age 8
Severe pain
Rapid curve progression > 1 degree per month
Unusual Left thoracic curve
Neurological defects (midline hairy patch, cafe au lait spots)
Angle of trunk rotation greater than ___ degrees and Cobb angle of greater or equal to ___ degrees will determine if a pt needs radiography for scoliosis
ATR >7 degrees
Cobb > or equal to 10 degrees
What is Risser sign?
Amount of ossification present in the iliac apophysis
What grade would a Risser sign be if a scoliotic patient is more likely to progress in severity?
Grades 1-3
The less ossified bones are, the more likely a case will progress
What is the curve angle for scoliosis that requires no active treatment?
Less than 10-15 degrees
What is the curve angle for scoliosis in patients that may need a brace?
25-45 degrees
What is the curve angle for scoliosis that needs surgery?
50 degrees
When would a scoliotic curve cause pulmonary compromise?
>50 degrees
When would a scoliotic curve cause cardiac compromise?
>75 degrees
How is acute back pain classified?
6-12 weeks of pain between costal angles and gluteal folds
May radiate down one or both legs (sciatica)
Nonspecific
What are the differential diagnoses for acute back pain of the intrinsic spine?
Compression fracture
Herniated nucleus pulposus
Lumbar sprain/strain
Spinal stenosis
Spondylolisthesis
Spondylolysis
Spondylosis
What are the differential diagnoses for acute back pain that has spread systemically?
Connective tissue disease
Inflammatory spondyloarthropathy
Malignancy (pain in prone position)
Vertebral diskitis/Osteomyelitis
What are the differential diagnoses for acute back pain that are referred?
Abdominal aortic aneurysm
GI conditions (retroperitoneal, peptic ulcer, and cholecystitis)
Herpes zoster
Pelvic conditions
What are the 4 main red flags for serious etiology of acute low back pain?
Hx of Cancer
Hx of Cauda Equina
Fracture
Infection
What are the red flags to look for in a patient’s history when they present with low back pain?
T - Trauma
U - Unexplained weight loss
N - Neurologic sx
A - Age >50 y/o
F - fever
I - IVDU (intravenous drug use)
S - Steroid use
H - History of CA
Steps of a physical exam for acute low back pain?
Inspection
Palpation
Percussion (Lloyd’s punch)
ROM
Strength/sensation
Specialty testing
What is the motor, sensory, and reflex innervation of L3?
Motor: Hip flexion
Sensory: Anterior/Medial thigh
Reflex: Patella
What is the motor, sensory, and reflex innervation of L4?
Motor: Knee extension
Sensory: Ant leg/Medial foot
Reflex: Patella
What is the motor, sensory, and reflex innervation of L5?
Motor: Dorsiflexion/Great toe
Sensory: Lateral leg/Dorsal foot
Reflex: Medial hamstring
What is the motor, sensory, and reflex innervation of S1?
Motor: Plantar flex
Sensory: Posterior leg/lateral foot
Reflex: Achilles
How does back strain present?
Onset with mild trauma (twisting)
Muscle ache or spasm
May become chronic
Discrete tender points in lumbar tissue on exam
No neurological defects
How does Psoas Syndrome Present?
Shortening/spasm of iliopsoas muscle
Dull ache in low back, sometimes refers to groin
What is the main risk factor for psoas syndrome?
Desk jobs
A herniated disc in the lumbar region will compress the nerve root of which vertebrae?
The vertebrae below
How will herniated nucleus pulposus present?
Pain radiating down the leg (sciatica)
Sharp burning pain - like electricity
Weakness in affected myotome
What is cauda equina syndrome?
Large, central disc herniation compressing tail of lumbar spine, compressing sacral nerve roots
Impingement of what nerve roots in Cauda Equina syndrome cause bowel/bladder dysfunction, decreased rectal tone, and saddle anesthesia?
S2-S4
A delay in surgery to treat cauda equina can result in what?
Irreversible paralysis
Spondylolysis is caused by a defect in what?
Defect in par interarticularis without anterior displacement
Spondylolisthesis is caused by what?
Vertebral body slips in relation to the one below at the pars interarticularis
What is the management of low back pain for the first two visits?
1st visit: Patient education, avoid exacerbating movement, stay active, NSAIDs, muscle relaxant
2nd visit: Different NSAIDs, refer to PT, refer to spine subspecialist
