BACK & SPINE CONDITIONS

WHIPLASH INJURY- MC cause of cervical sprain & strain COCCYGODYNIA/COCCYALGIA- pain on lower part of
- MOI: hyperextension followed by flexion of neck (acc to sacrum & coccyx; Mx- proper sitting
dec) d/t MVA SPINA BIFIDA- incomplete closure of the post. neuropore
- MC affected: ALL - Types:
- S/Sx: (+)AP neck pain, (+)AP tenderness, LOM, headache Closed spina bifida; Mild; Tuft of
- (-)Neurological findings: Spurling’s/Foraminal Test & Spina Bifida Occulta
hair; Most common
Lhermitte’s Sign Spina Bifida Cystica: Meninges + CSF; Meningeal cyst;
Meningocele Least common
SPONDYLOSIS- OA of the spine, MC affected: C5-C6 Meninges + CSF + SC; Bowel &
- S/Sx: (+)post. neck pain, (+)post. tenderness, LOM bladder dysfunction; SCI like
- (+)Neurological findings: Spurling’s/Foraminal Test & Lher Myelomeningocele
symptoms (motor dysfunction);
mitte’s Sign Most severe
SPONDYLOLYSIS- fx of Pars interarticularis *Brain Anencephaly= mental retard *Vit. Def: Folic acid
- “Scotty dog c collar”
SPONDYLOLISTHESIS- ant. slippage of superior VB over the BACK PAIN SOURCES
inferior VB; “Scotty dog decapitated” Innervated structures of the spine:
- Bias: flexion - Z-joint - Interspinous ligament
- RETROLISTHESIS- post. slippage - Joint capsule - Erector spinae
X-ray: “FOLS” Fx- Oblique view, Slippage- Lateral view - Outer AF - Multifidi
- ALL, PLL - Periosteum of vertebral bone
MEYERDING CLASSIFICATION Viscerogenic Internal organ disease
Grad Vasculogenic Obstruction of blood flow
Percentage
e Neurogenic Nerve root compression
1 1-25% Mechanical/Postural MC d/t faulty posture; reversible
2 26-50% Psychogenic Malingering/Hysterical; “Waddell
3 51-75% sign”
4 76-100% Spondylogenic Bony disorders/problem
5 >100%= total displacement- Spondyloptosis
DISC HERNIATION “BuPES”
WILTSE CLASSIFICATION “DIDTraP” STAGES
Classification Definition Bulging/Protrusion NP herniates through intact AF
Dysplastic Congenital abnormality of pars NP herniates through incomplete
Isthmic MC, Loss of (N) continuation of pars Prolapse
tear AF
Degenerative Degeneration of pars NP herniates through complete tear
Traumatic Fx other than pars (lamina, pedicle, facets) Extrusion
AF
Pathologic Destructive bone loss (Pott’s dse, Osteoporosis) NP bulges out from the disc;
*Isthmus- narrowest part of neural arch Sequestration
(+)Separated fragments
Schmorl’s Node: NP herniates through the vertebral body
SPINAL STENOSIS- narrowing of spinal canal
- Diameter: Spinal canal: 17mm, Spinal cord: 10mm ABNORMAL POSTURES
- Causes: “FoLDS” Facet jt. hypertrophy, Ligamentous 1) Forward Head- ↑AO & Upper cervical extension, ↑ Lower
hypertrophy, Disc protrusion (posterolateral direction), Spur cervical flex & Upper thoracic, (+) Mandibular retrusion
formation 2) Flat Neck- ↑AO & Upper cervical flexion, ↓Cervical
- Types: Severity- Relative: <12mm, Absolute: <10mm lordosis, (+) Mandibular protrusion
- Bias: flexion 3) Structural Kyphosis “COGS”
a) Congenital Kyphosis- defect of segmentation, failure of
ANKYLOSING SPONDYLITIS- kyphotic posture; Fusion of formation of ant. elements of spine
the spine; aka Marie Strumpell disease, Von Bechterev b) Osteoporosis
- X-ray: Bamboo spine Primary Secondary
- (+)Schober’s Test (10cm above & 5cm below S2) Type 1: Post-menopausal Type 3: Idiopathic
= (N): >5cm, (+): <5cm, Hypermobile spine: >10cm - F>M, 40-55y/o - any age
- Bias: extension; Best exercise: swimming - ↓ estrogen - Nutritional deficiency
- Hormone Replacement - Endocrinopathy
TIETZE’S SYNDROME- aka Costochondritis/ Costal Therapy (HRT) - Drug induced
Chondritis- painful inflammation of the costochondral jt Type 2: Senile (corticosteroids)
- d/t aging >60y/o - Immobility
 - ↓ calcium absorption - Nephropathy
- 1,200mg of Ca++ per day “NEDIN”
c) Gibbus Deformity- collapsed of single vertebra
- (+)Dowager’s hump SEVERITY
d) Scheuermann’s Dse- aka Juvenile, Adolescent Kyphosis, Severity Degrees
JDD (Juvenile Discogenic Dse); Boys (12-16y/o) Mild <20°
- ant. vertebra wedging of at least 5” of 3 consecutive Moderate 20-40°
vertebrae Severe >40°
4) Postural Kyphosis/Round Back- ↑Thoracic kyphosis, - Pain & DJD of spine >40-50°
Protracted scapulae, Forward head - Cardiopulmonary >60-70°
5) Flat Upper Back- ↓Thoracic kyphosis, Depressed clavicle & manifestation & ↓life
scapulae, Flat neck posture expectancy
6) Lordotic Posture- ↑Lumbar lordosis, ↑Ant. Pelvic Tilt Surgical approach: Harrington Rod
(counternutation), ↑Lumbosacral angle, ↑Hip flexion
7) Slay Back/Slouched Posture- excessive ant. pelvis shift, CLINICAL MANIFESTATIONS
↑Lumbar lordosis, ↑Hip extension, ↑Thoracic kyphosis CONVEX CONCAVE
8) Flat Back- ↓Lumbar lordosis, ↑PPT (nutation), - high shoulder - low shoulder
↓Lumbosacral angle, ↓Hip extension, Drooping of Sh - low pelvis - high pelvis
- vertebral body - spinous process
SCOLIOSIS- lateral curvature of the spine c rotation - post. rib hump - ant. rib hump
- 2 Types:
a) Structural/Non-functional- irreversible (more prominent ORTHOSIS
rotation) Levels of Apex Orthosis
- Causes: “NOI” Neuromuscular, Osteopathic, Idiopathic Above T6 Milwaukee T6
Neuromuscular- e.g CVA, CP, SCI, PMD, Poliomyelitis
Below T6 Miami T7
Osteopathic- MC; Hemivertebra, Defect of segmentation
Boston, Wilmington,
Idiopathic: Infantile (1-3y/o), Juvenile (4-14y/o), Below T8 T8
Yamamoto
Adolescent (10-16y/o, MC)
- MC: Idiopathic Dextroscoliosis
- Screening: Female- 9-11y/o; Male- 11-13y/o
b) Non-structural/Functional/Postural- reversible
- Lateral Bending Test
- Causes: “MuHaL “Ms spasm/guarding, Habitual
Asymmetric Posture, Leg Length Discrepancy

CURVES
Primary- 1st curve to appear
Secondary- 2nd curve to appear p or in response to 1° curve
- Major: larger curve, Minor: smaller curve

ASSESSMENT
> Apical Vertebra- most rotated & farthest vertebra from the
midline
> End Vertebra- superior & inferior; Most tilted vertebra
1) Cobb’s Method- the most accurate method
- orthopedic gold standard
- superior & inferior end vertebra
2) Risser-Ferguson- the easiest method
- sup & inferior end vertebra & apex

3) Nash & Moe (Pedicle) Method- rotation of the vertebra

(pedicle)
GRADE
0 Normal
+1 Pedicle moves towards midline (1/3)
+2 Pedicle moved towards middle (2/3)
+3 Pedicle is in the midline
+4 Pedicle is beyond the midline