Module 4 Lumbar Spine Assessment Flashcards

Question

What is the aetiology of idopathic scoliosis?

Answer 1

* Abnormalities of visual, vestibular, proprioceptive and postural control involving the brain stem, cerebral hemispheres and corpus callosum have been identified  Involved children tend to show subtle changes in proprioception and vibratory sensation, suggesting that abnormalities of spinal cord posterior column function may have a causative role. * Abnormal asymmetries of brain structure and function are found in AIS girls for each of cerebral hemispheres, brain stem and, in preliminary research for left thoracic AIS, on MR brain scans, reduced white matter density in the left internal capsule and corpus callosum * The autonomic nervous system through its hypothalamic neuroendocrine control of puberty, menarche and skeletal growth contributes importantly to the pathogenesis of AIS.  Melatonin and its signaling pathway dysfunction and platelet- calmodulin dysfunction detected in AIS subjects involve the autonomic nervous system.  In AIS girls, autonomic nervous system activity was reported to be higher than controls

Answer 2

https://www.youtube.com/watch?v=v4FyZydgHs0 What is a sensitive test for syringomyelia and how do you perform it?* AbnormalSuperficialabdominalreflex(SAR)(defined as unilateral or bilateral absence of SAR or hyporeflexia) yielded 89% sensitivity for syringomyelia. * Furthermore,ifSARofapatientwithscoliosisis abnormal, the patient has a 90% of probability of being non-idiopathic scoliosis. * IfpatientswithscoliosishadabnormalSAR,we recommend MRI of the whole spine to differentiate syringomyelia as well as myogenic enzyme to differentiate myopathy. * All cases of myopathicscoliosishadbilateralabsence of SAR

Answer 3

* A careful neurologic evaluation is essential, especially in patients with apparent juvenile-onset scoliosis, atypical curve patterns, or back pain. * Thepresenceof  café au lait spots  sacral dimpling  midline hairy patches  shoe size asymmetry  foot deformity  history of back pain  urinary incontinence suggest a non-idiopathic cause for the deformity.

Answer 4

* Premenarchal girls with curves between 20 and 30 degrees have a significantly higher risk for progression than do girls 2 yr after menarche with similar curves; curve progression is likely in the first group, and uncommon in the second. * Boys with curvature of the same magnitude appear to have similar risks of progression when judged by other maturation standards. * Curves less than 30 degrees rarely progress after skeletal maturation is complete; * Curves greater than 45 or 50 degrees often continue to progress during adult life. * Adolescent idiopathic scoliosis is a lifetime, probably systemic condition of unknown cause, resulting in a spinal curve or curves of ten degrees or more in about 2.5% of most populations. However, in only about 0.25% does the curve progress to the point that treatment is warranted. * The risk for curve progression varies according to sex, age, menarchal status, and curve magnitude at initial discovery.

Answer 5

* There is no evidence that exercise programs alter the outcome of scoliosis; * Transcutaneous electrical stimulation has been shown to have no effect. * Most or thopaedic surgeons recommend a trial of brace treatment for immature patients with curves less than 40 degrees. * Althoughtheefficacyofbracetreatmenthasbeen questioned, current studies suggest a small decrease in the likelihood of progression for patients treated with bracing when compared with age-, sex-, and curve-matched peers followed by observation alone.

Answer 6

* Surgical treatment for scoliosis is indicated, in general, for a curve exceeding 45 to 50 degrees by the Cobb’s method on the basis that: 1. Curves larger than 50 degrees progress even after skeletal maturity. 2. Curves larger than 60 degrees cause loss of pulmonary function, and much larger curves cause respiratory failure. 3. Greater the curve progression, the more difficult it is to treat with surgery.

Answer 7

WHAT IS THE 9 PRINCIPLES OF SUBLUXATION ASSESSMENT OF LUMBO-PELVIC SPINE 1. The subluxation always occurs in a predictable pattern of kinesiopathology, neuropathology and compensation (PREDICTABLE) 2. Vertebral Subluxation Complex in “yet to ambulate” children is mainly of the dural tension type and is therefore found at the points of dural attachment (upper cervical complex & lumbopelvic) (MOSTLY L5/S1 + C0, C1+C2) 3. Accurate diagnosis of the Lumbopelvic Subluxation Complex is absolutely dependent upon precise identification of kinesiopathology in flexion/extension at the L5/S1 motion segment 4. In the Pelvic Subluxation Complex, the sacrum may be involved in its entirety, or any one of the sacral segments may be involved singularly, therefore, one must examine the sacral motion segments on an individual basis 5. When the sacrum is involved in its entirety in the Pelvic Subluxation Complex, kinesiopathology will be found at the lumbosacral junction, one or both sacroiliac joints and usually the pubic symphysis 6. When the sacrum is involved in any capacity in the Pelvic Subluxation Complex, the most likely compensation pattern will be bilateral loss of lateral flexion and rotation at the upper cervical complex without neurological deficit, hypermobility of long axis condylar movement & “crane neck” posture 7. Bilateral diminution or loss of the S1 reflex may be due to midline subluxation at L5/S1, midline subluxation at one or more of the sacral segments or reverse rotation between two adjacent sacral segments 8. Innominate subluxation in the “yet to ambulate” patient is extremely rare and is not associated with changes to the S1 reflex 9. Kinesiopathology in the pelvis which is not associated with changes in the S1 reflex is never due to sacral or L5 subluxation, but rather the upper cervical complex, cranials, innominates, pubis or lower extremity, predominately the hip, tibiofemoral or the tibiofibular joint

Answer 8

* MuscleStretchReflexes * Scapulo-humeralReflex(Shimizu1993) * Myotomes * Sclerotomes * Dermatomes * AbdominalReflex:T8-10,T10-12

Answer 9

The Ten Steps for the Pelvis 1. L5 Flexion and Extension 2. SI Flexion 3. SI Extension 4. L5 Rotation 5. L5 Lateral Flexion 6. SI Internal and External Rotation 7. S2-4 Flexion 8. Coccyx 9. Connective tissue 10. Neurology and Compensation patterns The Lumbar Spine Also see video on phone. 1. L5 Flexion and Extension Interpretation Loss of flexion: L5 or anterior sacrum Loss of extension: Posterior sacrum Normal: Check innominates, pubis, sacral segments, lower extremities, upper cervical & cranial 2. SI Flexion Interpretation When L5/S1 flexion is lost: SI extension will be normal when L5 is subluxated. Proceed to step 4 to quantify the Y & Z-axis vectors. SI extension will be impaired on the side of the anterior sacrum. Extension will be impaired at both SI’s when the sacrum is base anterior 3. SI Extension Interpretation When L5/S1 extension is lost: SI flexion will be impaired on the side of the posterior sacrum. Flexion will be impaired at both SI’s when the sacrum is base posterior 4. L5 Rotation Interpretation Impaired movement with right pelvic rotation implies a spinous right fixation and with left pelvic rotation a spinous left fixation 5. L5 Lateral Flexion Define L5/S1 vectors in Z-axis rotation when there is loss of extension and normal SI movement Interpretation Impaired movement to either side implies an open wedge between L5 and S1 on that side 6. SI Internal and External Rotation Define SI rotation when there is loss of flexion or extension with normal L5/S1 movement Interpretation Impaired internal rotation implies an external fixation (Ex) and impaired external rotation implies an internal rotation fixation (In) 7. S2-4 Flexion Examine the individual sacral motion segments starting at S1/S2 and moving to S4/S5 Interpretation Impaired movement in flexion implies posteriority of the lower component of the motion segment being examined. 8. Coccyx Interpretation Impaired movement in flexion implies posteriority of the lower component of the motion segment being examined. 9. Connective tissue Examine the point specific connective tissue and muscle locations related to the vectors of kinesiopathology identified in steps 1-7. Pain is indicated by an involuntary extensor response, spontaneous pupillary constriction, facial wincing, crying or a change in the pitch of the cry. 10. Neurology and Compensation patterns Elicit the muscle stretch reflexes at L4 and S1 in addition to the perianal reflex and the cremasteric reflex in boys Identify the compensation pattern associated with the subluxation vectors

Answer 10

1. Increased lumbar & cervical lordosis 2. Craned neck posture 3. Loss of lateral flexion at the upper cervical complex, often bilaterally 4. Loss of rotation at the upper cervical complex, often bilaterally 5. Hypermobility at C0/C1 along the long axis of the occipital condyles, invariably bilateral 6. Contralateral hamstring hypertonicity

Answer 11

1. Decreased lumbar & cervical lordosis 2. Craned neck posture 3. Loss of lateral flexion at the upper cervical complex, often bilaterally 4. Loss of rotation at the upper cervical complex, often bilaterally 5. Hypermobility at C0/C1 along the long axis of the occipital condyles, invariably bilateral

Answer 12

1. Decreased lumbar & cervical lordosis 2. Decreased A-P &/or P-A glide in the hip on the side of the open wedge 3. Hypermobility at L4/L5 in flexion

Answer 13

1. Decreased lumbar & cervical lordosis 2. Low iliac crest ipsilaterally 3. Elevated gluteal bulk ipsilaterally 4. Elevated SI “dimple” ipsilaterally

Answer 14

1. Increased lumbar & cervical lordosis 2. Elevated iliac crest ipsilaterally 3. Low gluteal bulk ipsilaterally 4. Low SI “dimple” ipsilaterally 5. Involuntary knee flexion ipsilaterally 6. Decreased A-P glide in ipsilaterally hip joint

Answer 15

* Inferior pubic ramus produces the same compensation pattern as the anterior innominate subluxation * Superior pubic ramus produces the same compensation pattern as the posterior innominate subluxation

Answer 16

Vertebral subluxation. 1. Define the vectors of kinesiopathology 2. Define the associated hypermobility 3. Define the neurology of the VSC 4. Define the connective tissue pain patterns 5. Provide the adjustment 6. Confirm the correction of the hypomobility, hypermobility and neurology * The most common pelvis VSCs are: BAS, R/LAI Sacrum, BPS, PI-L/R Sacrum, PI S2-4. * The anterior sacral component can only be corrected by using a Logan Contact * It is our clinical aim to identify and correct the primary subluxation. * It is the median in children under 1 years of age for 5-6 adjustments to be required to correct the VSC. * Promote Well Baby and Well Child checks.

Module 4 Lumbar Spine Assessment Flashcards

(41 cards)