common spine disorders

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Notes and research on common spine problems. Management of certain spinal problems and assessment of common spinal problems.

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Common Conditions of the Spine

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Learning Objective

Given a scenario describing a patient with symptoms suggestive of an orthopedic or musculoskeletal condition, formulate a treatment plan after ordering and interpreting diagnostic tests and making a preliminary diagnosis.

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Learning Objective

Identify the etiology, clinical presentation, lab/radiologic studies, evaluation, and treatment for the following spine conditions:Back Strain/Sprain Ankylosing Spondylitis Cauda Equina

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Learning Objective

Identify the etiology, clinical presentation, lab/radiologic studies, evaluation, and treatment for the following spine conditions:Herniated Nucleus Pulposus (HNP) Spinal Stenosis Kyphosis/Scoliosis Low Back Pain (LBP): Spondylolysis, Spondylolisthesis4

Disorders Of The Back/SpineBack Strain/Sprain Ankylosing Spondylitis Cauda Equina Herniated Nucleus Pulposus (HNP) Spinal Stenosis Kyphosis/Scoliosis Low Back Pain (LBP): Spondylolysis, Spondylolisthesis5

Back Strain/SprainLBP is the most frequent cause of lost work time and disability in adults 50 Sciatica: Classic for HNP vs Atypical for Stenosis Aggravated: Flexion/Sitting vs Extension & Standing

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HNP/Spinal Stenosis Comparisons

HNP vs Stenosis (cont)Nerve Tension Signs (SLR): Usual vs Unusual Prognosis: Worse, More Chronic in Stenosis

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HNP and Spinal StenosisTreatmentNSAIDs (COX-2 inhibitors), Tylenol or ASA Muscle relaxants Narcotics Tramadol [generic] Corticosteriods (including spinal injections)51

HNP/Spinal Stenosis Treatment

DecompressionLaminectomy Foraminotomy Fusion

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KyphosisDefined: abnormally increased convexity in the curvature of the thoracic spine as viewed from side Scheuermanns Disease

Hyperkyphosis that does not reverse on attempts at hyperextension53

Scheuermanns DiseaseMost common in adolesce nt males

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Scheuermanns DiseaseDx made by X-ray45 degrees With 5 degrees or more of vertebral wedging at 3 sequential vertebrae

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Scheuermanns Disease (cont)TreatmentObservation +/- Bracing Spinal Fusion

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Scoliosis

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Scoliosis - DefinedLateral curvature of the spine of greater than 10 degrees, usually thoracic or lumbar, associated with rotation of the vertebrae and sometimes excessive kyphosis or lordosis

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ScoliosisIdiopathic scoliosis Lateral deviation and rotation of the spine without an identifiable cause

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ScoliosisAssoc. rib hump with forward bending

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Scoliosis

Assoc. rib hump with forward bending

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Scoliosis

Curve description curve described by its apex (position and direction [right or left] that it points to

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Scoliosis

Right thoracic curves -apex at T7 or T8 (MC) Double major curves -right thoracic curve with left lumbar curve Left lumbar curves, Right lumbar curves63

Scoliosis

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Scoliosis

Curve measurement Most common method used is Cobb method Measurements are made on standing PA X-rays65

Scoliosis

Determination of skeletal maturityRisser staging -- based on ossification of iliac crest apophysis Risser staging is graded 0 (least mature) to 5 (most mature)

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ScoliosisAdolescent idiopathic scoliosis Presents between ages 10 & 18 MC form of idiopathic Scoliosis Curve progression is most likely with

Curve > 20 degrees Age at dx < 12 Risser stage of 0 or 167

ScoliosisApprox. 75% with curves of 20 - 30 degrees progress at least 5 degrees Severe curves of 90 degrees or more are assoc. with cardiac & pulmonary impairment Left thoracic curves are rare and require eval of spinal cord with MRI68

Scoliosis

Treatment options include: Observation Bracing

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Scoliosis

SurgeryBased on likelihood of curve progression Curve Magnitude Age at DX Skeletal Maturity Presence of Menarche Curve progression during observation period70

Scoliosis

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Scoliosis

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Scoliosis

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Scoliosis

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Scoliosis

Adolescent idiopathic scoliosis is typically not painful, and the child presenting with a painful curvature should be given a thorough w/u

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Low Back Pain

SpondylolysisDefect in pars interarticularis (Unilateral) MC cause of lower back

pain in and adolescents

children

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Low Back Pain

Spondylolysis

Unilateral Pars defect is the result of a fatigue fx from repetitive hyperextension

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Low Back PainMost common in gymnasts and football lineman

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Low Back Pain Spondylolysis

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Low Back PainSpondylolysis

TreatmentModification of activity NSAIDs, Tylenol/ASA Physical therapy Flexibility

& strengthening exercises Thoracolumbosacral orthosis

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Low Back Pain

SpondylolisthesisBilateral Pars Interarticularis defect Forward slippage of one vertebra on another Usually L5-S1

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Low Back Pain

Spondylolisthesis

Most common in children involved in hyperextension activities

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Low Back Pain

Spondylolisthesis

Meyer Classification

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Low Back Pain

Spondylolisthesis Treatment

Modification of activity NSAIDs, Tylenol, ASA Physical therapy Flexibility & strengthening exercises Thoracolumbosacral orthosis84

Low Back PainSpondylolisthesis Treatment

Severe pain not responding to non-operative management requires surgical decompression and/or stabilization

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Summary

Symptoms suggestive of an orthopedic or musculoskeletal condition, formulation of a treatment plan after ordering and interpreting diagnostic tests, and making a preliminary diagnosis

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Summary

Etiology, clinical presentation, lab/radiologic studies, evaluation, and treatment for the following spine conditions:Back Strain/Sprain Ankylosing Spondylitis Cauda Equina

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Summary

Etiology, clinical presentation, lab/radiologic studies, evaluation, and treatment for the following spine conditions:Herniated Nucleus Pulposus (HNP) Spinal Stenosis Kyphosis/Scoliosis Low Back Pain (LBP): Spondylolysis, Spondylolisthesis88

The End

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