Scoliosis and Acute LBP

Question 1

Scoliosis is defined as…

Answer 1

lateral curve of the spine greater than 10 degrees

*generally idiopathic

Question 2

Risk factors for scoliosis

Answer 2

• 2-4% of adolescents
• M=F for minor
• F»>M for major

Question 3

Screening for scoliosis

Answer 3

1. visual screen should always be done (but there is disagreement about this)
2. Radiographs and treatment to confirm/fix can hurt children

*severe scoliosis should be associated with symptoms

Question 4

What physical do you see with scoliosis?

Answer 4

• shoulder heigh difference, posterior scapula, cease at waist
• leg lengths are usually equal
• body adjust to get eyes equal levels

Question 5

What is the Adam’s forward bend test?

Answer 5

pt stands and bends forward at the was it, and dr exams for asymmetry

Question 6

What can be used to test degrees?

Answer 6

scoliometer

Question 7

What is risser sign?

Answer 7

• tells you how mature/immature their skeleton is

- the higher the score, the less likely they will progress to become worse

Question 8

Red flags of Scoliosis

Answer 8

1. onset before age 8
2. severe pain
3. rapid crude progression >1 degree per month
4. unusual left thoracic curve (right curve is more common)
5. neurological deficits or findings

Question 9

How do we deal with scoliosis curves less than 10-15 degrees? moderate with 25-45? severe greater than 45?

Answer 9

1. no active treatment; can be monitored
2. treated with bracing (though doesn’t prevent progression)
3. requires surgery

Question 10

How do we define acute LBP?

Answer 10

6-12 weeks of pain b/t the costal angles and gluteal folds that may radiate down one or both legs

*often non-specific, so can’t determine cause

Question 11

What are serious red flags of acute LBP?

Answer 11

cancer, cauda equina, syndrome, fracture, infection

*

Question 12

What are red flags for acute LBP?

Answer 12

T - trauma
U - unexplained weight loss
N - neurologic symptoms
A - age > 50

F - fever
I - IVDU
S - Steroid use
H - history of cancer

Question 13

What are some common causes of LBP?

Answer 13

SD of LS spine, psoas syndrome, herniated nucleus pulposus, spinal stenosis, spondylolysis, spondylolisthesis

Question 14

What causes psoas syndrome?

Answer 14

shortening/spasm of the iliopsoas m.

Question 15

What causes caudal equine syndrome?

Answer 15

large central disc herniation compression the tail of the lumbar spine

*emergeny surgery is imperative –> if not done irreversible paralysis

Question 16

What causes spinal stenosis?

Answer 16

narrowing of the space around the spinal cord

Question 17

What causes spondylolysis? spondylolisthesis?

Answer 17

1. defect in par interarticularis without anterior displacement
2. vertebral body slips; you’ll feel a step off

Question 18

What does heel walk test?

Answer 18

L5

Question 19

How helpful is bed rest for nonspecific LBP?

Answer 19

not at all

Question 20

Unless you suspect a serious red flag/neurological signs, when should you order a x-ray?

Answer 20

6 weeks