Thoracolumbar Complaint

Question 1

Scoliosis

Answer 1

most often idiopathic-mostly in adolescent girls

curvature of the spine in the CORONAL PLANE

Question 2

Compensatory scoliosis

Answer 2

occurs w/ torticollis, thoracoplasty, congenital dislocation of hip & shortened lower limb

Question 3

Structural scoliosis

Answer 3

congenital deformities & paralysis of back or ab muscles

Question 4

Minor functional scoliosis

Answer 4

forms a single lateral curve (convexity to right)

Question 5

Epidemiology of scoliosis

Answer 5

if Cobb angle >10=3%

males & females equally affected

risk of curve progression is 10x higher for females

Question 6

Adult Scoliosis

Answer 6

develop “de novo” degenerative scoliosis

can be progression from earlier onset scoliosis

secondary to another condition

Question 7

Adult spinal deformity

Answer 7

encompasses scoliosis, kyphosis, lordosis, & spondylolisthesis (all lead to imbalance of structural support of spinal column)

Question 8

Screening during PE

Answer 8

Differences in height of shoulders or scapulae

Asymmetry of waistline

Asymmetry in distance that arms hang from trunk

Head shifted to 1 side & not centered over sacrum

Question 9

Forward Bending test

Answer 9

looking for scoliosis…observe posteriorly for accentuation or improvement of spinal curve (functional curves will improve w/ side bending)

Question 10

What is the scoliometer?

Answer 10

run it along the pt spine when pt is forward bending

look if side of scoliometer deviates to R or L

Question 11

Treatment for scoliosis

Answer 11

consider risk of progression & symptoms

bracing (depends on Cobb angle, deformity, risk of progression)

surgery

Question 12

Surgery for scoliosis

Answer 12

if Cobb angle>50

posterior spinal fusion & instrumentation & bone grafting

anterior spinal fusion & instrumentation

combo of anterior & posterior

growth modulation techniques

Question 13

CC for acute lower back pain

Answer 13

if duration<6 weeks then is acute

if duration>6 weeks then subacute LBP

Question 14

What is a red flag with lower back pain?

Answer 14

findings assoc w/ cauda equina syndrome (surgical emergency)

progressive motor or sensory deficit, saddle anesthesia, bilateral sciatica, fecal incontinence, nerve root problems

Question 15

What are some other important considerations for lower back pain?

Answer 15

red flag finding when <20yo

pain that is unrelenting @ night or unrelated to activity

widespread neuro symptoms

unexplained weight loss

feeling unwell/fever or chills

trauma or penetrating wound near spine

structural spinal deformity

previous history of illness

Question 16

To diagnose fracture in spine…

Answer 16

Age, drug use, trauma

age>50 years has sensitivity of 84% & specificity 61%

corticosteroid use has sensitivity 6% & specificity 99.5%

trauma has sensitivity 30% & specificity 85%

Question 17

To diagnose herniated disk

Answer 17

sciatica has sensitivity 95% & specificity 88%

Question 18

To diagnose spinal stenosis

Answer 18

pseudoclaudiation has sensitivity 60% (painful cramps NOT caused by peripheral artery disease but by SPINAL or neuro or orthopedic disorders)

Question 19

To diagnose ankylosing spondylitis

Answer 19

age @ onset <40 yo (100% sensitivity, specificity 7%)

pain not relived supine (80%, 49%)

morning back stiffness (64%, 59%)

pain duration >3 months (71%, 54%)

4 of 5 positive responses (23%, 82%)

Question 20

Sciatica

Answer 20

refers to pain or discomfort associated w/ the sciatic nerve (sharp or burning pain that radiates from lower back or hip)

Question 21

Nerve involvement in back pain

Answer 21

suggested w/ sciatica or pseudoclaudication (pain radiating BELOW KNEE, history of numbness or weakness)

Question 22

What should you prioritize for DDX for lower back pain?

Answer 22

acute or chronic functional LBP

muscular strain (acute v chronic)

OA

Sciatica

Herniated disk

Spinal stenosis

Question 23

Pseudoclaudication

Answer 23

lumbar spinal stenosis (causes impingement or inflammation of nerves leaving spinal cord)