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Mar 24 2018 22 mins   9
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