This week on PA Study Sesh, we’ll be covering disorders of the spine and demystifying the dermatomes.

* Cauda Equina

* SURGICAL EMERGENCY

* Symptoms

* Urinary/bowel retention/incontinence

* Saddle anesthesia

* Decreased anal sphincter tone (no anal wink)

* Tx: steroids (decrease inflammation) and emergent surgery

* Spinal stenosis (pseudoclaudication)

* Narrowing of spinal canal

* > 60 y.o. (but can be congenital)

* low back + BIL leg pain

* increased with walking/standing (extension)

* Dcreased with sitting/walking uphill (flexion)

* Diagnose with Xray or MRI

* Tx:

* Injections

* PT

* Sy

* Sprain/Strain

* MOI: lifting/twisting (or whiplash)

* Muscle spasms

* Decreased ROM 2/2 pain

* NORMAL NEURO

* Tx:

* Brief rest (1-2 days)

* Nsaids scheduled

* +/- muscle relaxants

* pt for prolonged pain & to improve mechanics

* majority recover by 4 weeks

* Scoliosis

* Females >10 y.o.

* >10 degrees of lateral curvature

* Typically not painful

* 90% are to the right, left curve requires further evaluation

* Look for shoulder or pelvic obliquity & LLD

* Adams forward flexion exam

* Xrays indiciated if scoliometer >5 degrees

* Evaluate Cobb angle

* Tx:

* Observe if small

* Brace at 20 degrees

* Sy greater than 40 degrees

* Kyphosis

* Increased convex curvature of T spine

* 1/3 also have scoliosis

* brace >60

* Spondylolysis

* Repetitive hyperextension injury (gymnasts, football players)

* Defect of pars interarticularis

* #1 form of back pain in children/adolescents

* Most commonly L5-S1

* X ray:

* Scotty dog sign

* Oblique view x ray

* + dog has a collar

* May progress to spondylolisthesis

* Spondylolisthesis

* Vertebrae slips forward

* Possible step off

* >50% displacement = surgical

* Conservative (same for spondylolysis)

* Symptomatic

* PT

* Bracing

* Happens at C2=hangman’s fx

* Jefferson Fracture

* C1 fx (Atlas)

* Burst fx

* Associated with axial loading (shallow dive or certain MVAs)

* Compression fx

* Fall from a height or non-traumatic

* X-ray: vertebral height narrowing

* Risk factors: chronic steroid use, tobacco use, postmenopausal, osteoporosis, low body weight

* Point tenderness

* Ankylosing Spondylitis (ankly=stiff, spondyl=spine, itis=inflammation)

* White males 15-30

* Axial skeleton & SI joint with increasing stiffness

* Progresses from inferior to superior

* AM stiffness with decreased ROM

* Decreases with activity (most autoimmune arthropathies do)

* Labs

* Increased ESR

* + HLA B-27

* Negative ANA & RF (seronegative)

* X ray:

* Bamboo spine (squaring of vertebral bodies)

* Tx:

* NSAIDS

* PT

* TNF alpha blockers

* Herniated Disc

* Herniation of nucleus pulposus

* Most often posterolateral

* Pain in a dermatomal pattern

* Increases with coughing, sitting

* L5-S1#1

* Physical Exam Tests:

* + SLR

* + Crossover Test