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

See All 22 Episodes of "PA Study Sesh"