History AMPLE Mechanical pain OPQRST Extension vs flexion Positional improvement Back vs buttock, midline vs paramidline Back dominant vs leg cominant Deformity Noticed change to ribs or spine Myelopathy Changes in gait Balance Fine motor (buttoning shirt, handwriting) Neuro Changes to sensation or moto funcion Claudicant Vascular vs neuro Neuro Better with flexion Radicular BowelContinue reading “History and Physical Schpeels”
Category Archives: Topics
Cervical Osteology and Kinematics
Axial does 50% of flex ex Subaxial does the remaining flex ex an all the latereal bend
Scheuermann’s Kyphosis
Background Rigid spinal kyphosis cause by anterior wedging Definition: Thoracic kyphosis with anterior wedging >5 degrees of at leas 3 consecutive vertebral bodies Adolescents (onset age 10) M>F Autosomal Dominant 2 forms Typical Apex T6-8, curve T1-L1 Non structural lumbar hyperlordosis Atypical Apex TTL More progressive and sympomatic Pathophys Unknown Osteonecrosis of anterior apophyseal ring Continue reading “Scheuermann’s Kyphosis”
Sagittal Alignment
Importance of Sagittal Alignment Cone of Economy (Conus of Debousset) Narrow range in shape of cone formed between the head and the pelvis Outside this cone – energy consumption to maintain upright posture goes up Sagittal malalignment (PT >25 SVA >5) main driver of HRQOL and construct failure after spine surgery Glassman et al LinearContinue reading “Sagittal Alignment”
Cervical Spondylosis
Background Natural degenerraiotn Starts age 40 85% of asymptomatic patientst >65 have spondylotic changes C56 RF Excessive driving Lifting Athletes Smoking Pathophys Natural aging Degeneration Disc: Dessication, height loss, bulding, herniation Joints: Uncinate spurring, facet arthrosis Ligamentum flavum: thicken, infold due to disc height loss Deformity: kyphosis – disc height loss, shift load to uncinatesContinue reading “Cervical Spondylosis”
Spinal Cord Anatomy
Long Tracts (DC ST CT) DC Dorsal Tract (Posterior) Proprioceptive Cross at brainstem Ipsilateral deficit Central LE Sensory enters distally first (distal to proximal) so sacral is central CT Corticospinal Tract (Lateral) Pyramidal Motor Crosses at brainstem Ipsilateral deficit Central – UE Sensory enters distally first so sacral WAS central but then it crossed STContinue reading “Spinal Cord Anatomy”
Spinal Cord Injury
Background Injury to spinal cord resulting in temporary or permanent change to sensory, motor or autonomic function Bimodal Young – high energy Elderly – minor trauma + degenerative narrowing of canal M:F 4:1 Race Caucasian > Black > Hispanic Types Incomplete tetraplegia (34%) – Central Cord Complete paraplegia (25%) Complete tetraplegia (24%) Incomplete paraplegia (17%) Continue reading “Spinal Cord Injury”
The Spine Book 