Thoracic and Lumbar Spine Flashcards
Inspection of T/L Spine
Gait
Posture
Curve-> Thoracic: convex Lumbar: concave
Skin-> lesions or trauma
Percussion
id discrete areas of fracture and pain points
gentle then more intense
SI joint
Auscultation
used to see if other symptoms are associated with specific back complaint
Thoracic Spine Differentials
- Compression fracture
- Osteomyelitis
- Muscle spasm
- Strain/sprain
Lumbar Spine Differentials
- Compression fracture
- Osteomyelitis
- Muscle spasm
Scoliosis subtypes
-Congenital
-Early Onset: <10 can affect other areas ex ribs
-Adolescent Idiopathic: most common
IMP to treat as early s possible
Cobb Angle for Scoliosis
needs to be >10 degrees
Do females or males have higher risk of curve progression?
females
Scoliosis Adult causes
- de novo (degen) scoliosis
- secondary to another condition
- adult spinal deformity
Screening for Scoliosis
- difference height of shoulders
- asymmetry of waistline
- trunk shift: head shifted to one side
- forward bending test
Spondylolysis
stress fracture in pars interarticularis
-majority at L5
Spondylolisthesis
one vertebral body slipped forward
-often caused by spondylolysis
Spondylitis
inflammation of spinal joints
Spondylosis
degeneration of intervertebral discs
Scoliosis Treatment
- observation
- bracing dep on Cobb angle
- Surgery: angle >39-50
- > 50 is above surgical threshold
Cauda Equina Syndrome
EMERGENT
- saddle anesthesia
- bilateral sciatica or leg weakness
- incontinence
Red Flag Findings for Spinal Pathology
-fever
-IV drug use
- previous steroid use
-
Sensitivity and Specificity of Compression Fracture
- > 50 years sensitivity 84% specificity 61%
- trauma sensitivity 30% and specificity 85%
- corticosteroid use sensitivity 6% and specificity 99.5%
Sensitivity and Specificity of herniated disk symptom of Sciatica
-Sensitivity 95% and specificity 88%
Sensitivity and Specificity of Spinal Stenosis
- pseudoclaudication sensitive 60%
- age >50 sensitivity 90% and specificity 70%
Sensitivity and Specificity of Ankylosing Spondylitis
- age onset <40 yrs sens 100% specif 7%
- pain not relieved supine sens 80% specif 49%
- morning back stiff sens 71% specif 54%
What suggests sciatica or pseudoclaudication
pain radiation below knee compared to posterior thigh
