spine

BACK

Commonest symptom after common cold is Backache It might be in or either side of midline. It might extent to buttock and lower limb. Pain when extent to thigh and calf called sciatica, commonly it is referred pain. Pain of back should analyzed carefully. Low backache the most common disability in industrialized countries. 14% of population developed episode of backache for more than two weeks

Backache

Backache is frequent cause of disability. Careful clinical examination is essential. Backache is common symptom of febrile and systemic disease. Back strain is very common and respond to simple treatment. Backache in children should taken seriously. In 20-40 prolapsed disc is common. Chronic low backache might result from osteoarthritis. Very sever constant backache arose suspicion of infection or tumor. Backache with claudication result from spinal stenosis. Backache might associated with psychomotor ailment.

back symptoms

Stiffness Deformity Numbness and paraesthesia Limb weakness. Associated symptoms.

Back examination

Look ( skin ,shape, posture). Feel (skin , soft tissues and bone). Move ( flexion, extension, lateral flexion, rotation) examination of power. Examination in prone Examination in supine position and abdominal examination. . Detailed neurological examination of reflex, power, sensation, straight leg raising test and femoral stretching test.

back Imaging

The imaging used in back examination are: x-ray, CT, MRI, Mylography , and radioactive bone scan.

Scoliosislateral (sideway) curvature of spine. In fact it is not only lateral curvature but in the commonest form of scoliosis it is triplanar deformity (lateral , antero-posterior and rotational )There is two types of scoliosis :
1- postural scoliosis Sciatic scoliosis Compensatory scoliosis
2- Structural scoliosis Adolescent idiopathic. Infantile idiopathic Osteopathic Neuropathic Myopathic.


Postural scoliosis
Postural scoliosis : lateral (sideway) curvature of spine in this type of the deformity is secondary or compensatory to some conditions outside the spine such as short leg , pelvic tilting , postural deformity result from muscle weakness in children, and disc prolapse . When the patient set the deformity disappear

Structural scoliosis

Structural scoliosis: Adolescent idiopathic, Juvenile idiopathic, Infantile idiopathic, Osteopathic, Neuropathic, Myopathic, and Other form of scoliosis

adolescent idiopathic scoliosisit is the commonest and most important type. Usually presented before puberty, it occur any where in vertebra, lateral tilting usually associated with rotation and rib deformity and hump. Clinical feature :Symptoms 1- deformity . 2- pain .

Imaging of scoliosis:

plain x- ray : full length postero-anterior and lateral views of the spine and iliac crest should be taken in erect position . The upper and lower ends of the curve are identified as the levels where vertebral symmetry is regained . The degree of the curve is measured by (cobb`s angle) . Right thoracic curve is the commonest . Common age is 10-16 years, clinical examination by bending test which used for scoliosis screening.

Common age is 10-16 yearsclinical examination by bending test.screening

For 20-40 degree

Above 40 degree or progressive curve

Other form of scoliosis
Juvenile scoliosis. Infantile scoliosis. Osteopathic scoliosis Neuropathic scoliosis. Myopathic scoliosis.

Kyphosis

Abnormal forward bending of spine. Normally kyphosis is seen in the thoracic spine .Excessive curvature might be better described as hyperkyphosis , kyphos or gibbus which is sharp posterior angulation due to localized collapse or wedging of one or more vertebrae . Abnormal forward bending of spine. Normally kyphosis is seen in the thoracic spine .Excessive curvature might be better described as hyperkyphosis , kyphos or gibbus which is sharp posterior angulation due to localized collapse or wedging of one or more vertebrae .

kyphosis

Abnormal forward bending of spine.Postural kyphosis.Structural kyphosis.Congenital kyphosis.Adolescent kyphosis (scheurmann’s disease).Kyphosis in the elderly.Angular kyphosis may follow infection like tuberculosis or trauma. Rounded kyphosis occur in senile kyphosis or adolescent kyphosis .

Adolescent kyphosis (scheurmann’s disease). It is growth disord;er in which the vertebral shape become more wedge. It occur in several thoracic spine. It occur in puberty as round kyphosis with Backache. The deformity is fixed. X-ray show irregularity in vertebral end plate and mild wedging of vertebral body. Mild cases treated by exercise , moderate cases treated by braces for 1-2 years, sever cases with curvature more than 60 degrees need surgical correction.

kyphosis

Angular kyphosis Infection Trauma

Rounded kyphosis.