DISORDERS OF THE SPINE Flashcards
What is back pain in infants and pre-adolescent children usually indicative of?
Connective tissue disorder
Scoliosis
Torticollis (if in the neck)
What is the main cause of back muscle spasm or soft tissue pain in an adolescent?
Sports injury
What are the differentials for back pain in an adolescent?
Sports injury
Scheuermann’s disease
Spondylolysis
Spondylolisthesis
Vertebral osteomyelitis or discitis
Tumours
Scoliosis
Spina bifida
Idiopathic
What is the aetiology of Scheuermann’s disease?
Considered part of osteochondrosis family. This means that it is characterised by avascular necrosis to the epiphysis and later regrowth of the bone.
What are the clinical features of Scheuermann’s disease?
Marked lower kyphosis in thoracic spine (at least 3 vertebrae must be involved)
Pain
Stiffness
What will x-ray of someone with Scheuermann’s disease show?
Epiphyseal plate disturbance
Anterior wedging
How do we treat Scheuermann’s disease?
Mild cases: Physio and analgesia
More severe cases: Bracing and surgical stabilisation
What is the aetiology of spondylolysis?
Congenital or acquired deficiency (defect or stress fracture) of the pars interarticularis of the neural arch of of a particular vertebral body.
What are the vertebrae most commonly affected by spondylolysis?
L4/L5
Almost always lumbar
What proportion of the population are affected by a degree of spondylolysis?
Up to 5%, most cases are asymptomatic and therefore do not require treatment
What is the main risk factor for acquired spondylolysis in adolescents?
Over-training causing a stress fracture eg during a landing in ice dance
What are the clinical features of spondylolysis?
Unilateral back pain
Pain may radiate to buttocks or legs
Restricts daily activities
Worsens with strenuous activity and lumbar hyperextension
Pain on completion of stork test - see next slide
Unilateral tenderness on palpation
What is the stork test?
Patient stands on one foot and then lumbar spine is extended and rotated by examiner arching them backwards
What imaging should be done for someone with signs and symptoms consistent with spondylolysis?
X-ray
CT or MRI
Bone scintigraphy
What is the gold standard in terms of imaging and diagnosing spondylolysis?
Bone scintigraphy
How do we manage symptomatic spondylolysis?
Activity restriction
Abdominal exercise to increase core strength and stabilise spine
Bracing - Boston brace - most common treatment of acute spondylolysis
Surgery - used especially if condition progresses to high grade spondylolisthesis
What is the aetiology of spondylolisthesis?
Displacement (normally anteriorly) of one vertebra relative to its immediately inferior vertebral body
What is the most common cause of spondylolisthesis in adolescents?
Spondylolysis
Is spondylolisthesis the same as a slipped disc?
No. A slipped disc is more correctly termed a spinal disc herniation and refers to when one of the discs in between the vertebrae has ruptured. This is not the case in spondylolisthesis where the vertebrae itself has moved.
Where is the spine is spondylolisthesis most commonly found?
Lumbar spine
What are the clinical features of spondylolisthesis?
Generalised lower back pain - intensified on sneezing or coughing
Stiffening of the back
Leaning forwards (kyphotic) posture - compensatory change
Waddling gait
What is the radiological sign associated with traumatic spondylolisthesis?
Scotty dog appearance
How do we manage someone with spondylolisthesis?
Mild: Physio and analgesia
More severe: surgery (spondylolisthesis with spinal stenosis is one of the most common indications for spine surgery (laminectomy) among older adults)
What is vertebral osteomyelitis?
Infection of the vertebral body
