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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
