Spine

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    Spine - Presentation Transcript

    1. SPINE
    2. Examination of Spine
      • SYMPTOMS
      • Pain
      • Sciatica
      • Stiffness
      • Deformity
      • Numbness or paraesthesia
      • Urinary symptoms
      • Other
    3. Examination of Spine
      • Signs with the patient standing
      • Look
        • Skin
        • Shape and posture
      • Feel
        • Tenderness
      • Move
        • Flexion / Extension
        • Rotation / Lateral flexion
    4. Examination of Spine
      • Signs with patient lying face downwards
        • Bony outlines
        • Tenderness
        • Sensations and Power
        • Femoral stretch test
      • Signs with patient lying on his back
        • Straight leg raising test (sciatic stretch)
        • Neurological examination of lower limbs
        • Circulation in the limbs
        • Rectal examination
    5. Cutaneous distribution of nerve roots
    6. Muscle Power Testing (MRC Scale
      • 0 Total paralysis
      • 1 Barely detectable contracture
      • 2 Not enough to act against gravity
      • 3 Strong enough to act against gravity
      • 4 Still stronger but less than normal
      • 5 Full power
    7. Imaging
      • Plain x-rays
        • AP and lateral views
        • Oblique views
        • PA view of S.I. Joint
      • Computed tomography (with mylography)
      • MR imaging
      • Radioisotope scanning
      • Discography and facet joint arthrography
    8. Low back pain
      • Lifetime incidence ranges from 60 -80%
      • Most cases resolve spontaneously
      • D/Dx:
        • Simple back pain (non specific low back pain)
        • Nerve root pain
        • Possible serious spinal pathology
    9. Simple back pain
      • Presentation 20 - 50 years
      • Lumbosacral, buttocks and thigh
      • “Mechanical” pain
      • Patient well
      • Specialist referral not required
    10. Treatment for acute low back pain
      • Vast majority improve within 2 months
      • Symptomatic Rx with Aspirin/NSAIDs
      • Bed rest should be limited to 1-2 days
      • ? Corsets, TENS, Traction
      • Exercise - Stretching & range of motion active
    11. Chronic low back pain
      • Pain that persists after 3 months
      • < 5% of patients with L.B.P develop Ch.L.B.P
      • Multiple factors
        • Disc, facet joints, annulus fibrosis, ligaments
      • Psychosocial factors
      • Surgery is rarely helpful
      • Functional restoration programme
    12. Acute disc prolapse
      • Uncommon in very young and the very old
      • Nerve root pain follows the dermatome of the involved nerve
      • Pain is generally worse in the leg than in the back
      • Exacerbation of leg pain by straining, sneezing or coughing
      • Localised neurological signs
    13. Cauda Equina Syndrome
      • Large midline disc prolapse
      • Compresses several nerve roots
      • Sphincter disturbance
      • Saddle anaesthesia
      • Prompt surgical intervention
    14. Treatment acute disc prolapse
      • Conservative
        • Bed rest for 48-72 hours
        • NSAIDs
        • Epidural steroids
        • 85% relief rate
      • Surgical treatment
        • 10-15% of patients ultimately require surgery
        • More rapid relief but the ultimate end point is the same regardless of treatment
    15. Spinal Stenosis
      • Commonest cause of neurologic leg pain in older patients
      • Symptoms
      • Neurogenic claudication - Vascular claudication
      • Treatment
    16. Red flags for possible serious spinal pathology
      • Presentation under age 20 or onset over 55
      • Thoracic pain
      • Past hx of carcinoma, steroids
      • Unwell, weight loss
      • Widespread neurology
      • Structural deformity
      • Abnormal blood parameters
    17. Spondylolisthesis
      • Forward slippage of one vertebral body on another
      • Causes
        • Congenital
        • Isthmic
        • Traumatic
        • Pathologic
        • Degenerative
      • Treatment
    18. Spondylolisthesis
      • Forward slippage of one vertebral body on another
    19. Spondylolysis Spondylolisthesis
    20. Discitis
    21. Spinal Deformity
      • Deformity may occur in either coronal or sagittal plane
      • Scoliosis - Lateral curvature of the spine
        • Structural
        • Nonstructural
      • Kyphosis - Sagittal plane deformity in the thoracic or thoracolumbar spine
    22. Scoliosis
      • Idiopathic Scoliosis
      • 80% of all scoliosis
      • Adolescent - age 10 or over
      • Juvenile - age 4 to 9
      • Infantile - age 3 or under
    23. Scoliosis - Cobb angle
    24. Adolescent idiopathic scoliosis
      • Structural scoliosis presenting at or about the onset of puberty and before maturity
      • 80 % of cases of idiopathic scoliosis
      • Mostly (90%) in girls
      • Predictors of progression
      • very young age
      • marked curvature
      • Risser sign
    25. Adolescent idiopathic scoliosis
      • Treatment
      • Prevent a mild deformity from becoming severe
      • Correct an existing deformity
      • Nonsurgical treatment
      • Curves between 20-40 when spinal growth is incomplete
      • Curves > 30 (Risser 2 or less) even if no progression
      • Surgical treatment
      • Curves >40 in skeletally immature
      • Unbalanced curves between 20 - 40 in skeletally immature
      • Curves >50
    26.  
    27. Congenital scoliosis
      • Due to congenital anomalous vertebral development
      • Hemivertebrae
      • Wedged vertebrae
      • Fused vertebrae
      • Absent or fused ribs
      • Treatment
      • Early fusion in progressive curves
    28. Congenital Hemivertebra
    29. Neuromuscular scoliosis
      • Causes
      • Poliomyelitis
      • Cerebral palsy
      • Syringomyelia
      • Friedrich’s ataxia
      • Muscular dystrophies
      • Typical paralytic curve is long, convex towards
      • the side with weaker muscles
    30. Neuromuscular scoliosis
      • Treatment
      • Mild curves No treatment
      • Moderate curves with spinal stability
      • As for idiopathic scoliosis
      • Severe curves Fitting a suitable sitting support
      • Surgical stabilization of the entire spinal segment
    31. Kyphosis
      • Postural (Round back)
      • Compensatory
      • Structural
    32. Kyphosis
      • Causes
      • Postural kyphosis Postradiation kyphosis
      • Scheuermann’s disease Metabolic disorders
      • Myelomeningocele Skeletal dysplasias
      • Traumatic kyphosis Tumourous conditions
      • Postsurgical Infections
    33. Scheuermann’s disease
      • Excessive thoracic kyphosis (Cobb angle >45° with wedging of 5° or more) of at least 3 adjacent apical vertebrae and vertebral end plate irregularities
      • Aetiology unknown
      • Incidence 1% of general population with slight female dominance
    34. Scheuermann’s disease
    35. Scheuermann’s disease
      • Treatment
      • Orthotic treatment
      • Skeletally immature - Milwaukee brace (poor compliance)
      • Surgical (rare)
      • Severe deformity in skeletally mature
      • Severe deformity and neurologic signs
    36.  

    + Chris  OliverChris Oliver, 3 years ago

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    Common Orthopaedic Spinal Problems

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