Overview_of_the_Back - Overview of the (Low) Back The...

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Overview of the (Low) Back The vertebral column is comprised of 33 vertebrae in 5 regions: 7 cervical; 12 thoracic; 5 lumbar; 5 sacral (fused in adult), and 4 coccygeal (fused in adult). The curvatures of the spine include the anterior concavities of the thoracic and sacral regions which are primary curvatures present since the fetal stage; and the posterior concavities of the cervical and lumbar regions that are secondary curvatures which develop during infancy as the child first, raises the head and later, walks. The three abnormal curvatures are: kyphosis, lordosis, and scoliosis. Scoliosis is an abnormal lateral curvature of the spine with associated rotation of the vertebrae. The spinous processes rotate toward the concavity of the curvature. The ribs rotate posteriorly, thus protruding on the side of increased convexity. Scoliosis is the most common vertebral deformity in adolescent girls. The sacrum transmits the weight of the body from the lumbar vertebrae to the pelvic girdle. The sacral canal is a continuation of the vertebral canal and contains the cauda equina which consists of the nerve roots of all spinal nerves inferior to the L1 vertebra. Important landmarks on the sacrum include the sacral promontory on the anterior surface that serves as an important reference point in obstetrical pelvic measurement. The sacral hiatus is created by the absence of the lamina and spinal process of S5 vertebra, and serves as an entryway to the sacral portion of the spinal cord. The sacral cornua (inferior articular processes of S5) serve as a guide to the sacral hiatus. Caudal epidural anesthesia (block) is administered via the sacral hiatus in order to anesthetize the S2-S4 nerve roots. Sacralization of the the L5 vertebra refers to fusion of L5 to the sacrum. Lumbarization of S1 refers to fusion of S1 to L5. The most common type of back pain is referred to as “mechanical back pain” which is due to an anatomic or functional abnormality. The most common cause of mechanical back pain is lumbar sprain or strain. Other causes of mechanical back pain are: herniated disc, degenerative disc or facet, spinal stenosis, and spondylolisthesis. The non-mechanical causes of back pain are noted by their red flag symptoms or history (fever, pain at night or while lying down, unexplained weight loss, age > 50, chronic corticosteroid use, history of cancer, and palpable abdominal pulsatile mass). The non- mechanical causes include: cancer, infection, fracture, and an abdominal aortic aneurysm. For any cause of back pain, it is important to note whether the motor and sensory deficits are becoming worse, or if there is failure to improve after 4-6 weeks of
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This note was uploaded on 02/17/2012 for the course MPAS PA 602 taught by Professor Dr.laird during the Fall '10 term at Chatham University.

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Overview_of_the_Back - Overview of the (Low) Back The...

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