DIAG 2730 Lumbar Spine - Chapter 25 Lumbar Spine Overview...

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Chapter 25 Lumbar Spine
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Overview At some time in their lives, 80% of the general population will experience some type of low back pain (LBP) - it is second only to the common cold as a reason for physician visits, and the most expensive source of compensated work related injury in modern industrialized countries Despite the frequency of LBP and the many studies examining LBP, LBP is a difficult problem to investigate and several key issues concerning its occurrence, natural history and prognosis remain unanswered
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Inspection Skin markings such as lipomatas, hairy patches, café-au-lait spots or birth marks often denote underlying neurologic or bony pathologies
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Lipomata, and Café-au-Lait Patches
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Neurofibromatosis A heredity (autosomal dominant trait) disorder that produces pigmented spots, and pedunculated soft-tissue nodules clustered along nerve sheaths 2) Nodules develop during childhood, growing to more than 0.5 cm in size 3) Nodules grow throughout individuals life reaching 1.5 cm or more in size
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Neurofibromatosis Cafe-au-lait patches are usually seen over the trunk, pelvis and flexor creases of the elbows and knees 5) Bone changes may result in skeletal deformities: Scoliosis, Vertebral body scalloping, Fibrous dysplasia, Tibial Pseudoarthrosis, Sphenoid bone deformity, Mental impairment, seizures, hearing loss, exophthalmosis, decreased visual acuity, and GI bleeding eventually occur
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Observation When a patient is standing an inclination or listing to one side or the other may be a sign of a possible sciatic scoliosis, secondary to a herniated disc
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Observation A gibbus deformity may be present This is a sharp kyphosis in the lower thoracics, affecting the normal lordosis of the lumbar spine
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Bony Palpation The lumbar spine consists of 5 lumbar vertebrae Between each of the lumbar vertebrae is the intervertebral disc (IVD) The top of the iliac crest is followed towards midline of the spine at the L4/L5 interspinous space (this may vary from individual to individual) Palpate inferiorly and medially to the S2 spinous process
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Bony Palpation A palpable or visible step-off from one process to another may be indicative of a spondyloslisthesis (anterior or posterior displacement of a vertebrae on the adjacent lower vertebrae) If there is a pars interarticularis defect then it is a spondylolysis present (seen on oblique x-rays)
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Spondyloly…… Spondylolytic Spondyloslisthesis = A unilateral or bilateral defect in the pars interarticularis with anterior or posterior displacement of a vertebrae on the adjacent lower vertebra
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Spondylolisthesis Measurements The Meyerding’s Scale is used to measure spondylo’s Ranges from grade one to grade 4 The grades represent 25 % of the measurement of the sacrum to L5
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Bony Palpation The articulations between two consecutive lumbar vertebrae form three joints One joint is formed between the two vertebral bodies and the intervertebral disc (IVD)
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DIAG 2730 Lumbar Spine - Chapter 25 Lumbar Spine Overview...

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