Spinal Clinic Referrals and Assessments

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Questions and Answers

What are the main reasons for referral to a spinal clinic?

The common reasons for referral to a spinal clinic are pain and spinal deformity.

What vital historical information should be gathered during a spinal assessment?

Important historical information includes the site, type, severity, duration, frequency of pain, and any aggravating factors.

What is the significance of identifying 'red flags' during spinal evaluations?

Identifying 'red flags' helps in triaging patients with serious spinal pathologies like fractures and infections.

How does skeletal maturity affect the assessment of spinal deformity progression in children?

Assessing skeletal maturity can indicate whether a child's spinal deformity is likely to progress, especially after a growth spurt. Signup and view all the answers

What does the Adam's forward bend test reveal in patients suspected of scoliosis?

The Adam's forward bend test reveals trunk asymmetry and can accentuate rib or loin prominence on the convex side of the curve. Signup and view all the answers

Which skin conditions are indicative of neurofibromatosis during a spinal examination?

Conditions such as cutaneous neurofibromata, café-au-lait patches, or axillary freckling are indicative of neurofibromatosis. Signup and view all the answers

Why is palpation an important part of a spinal examination?

Palpation is important for locating specific areas of tenderness and assessing the condition of the spine. Signup and view all the answers

What are the normal ranges of motion for the cervical spine?

The normal ranges of motion in the cervical spine are 45° of flexion, 55° of extension, 70° of rotation, and 40° of lateral bend. Signup and view all the answers

What is the normal range of motion for lumbar spine flexion?

The normal range of motion for lumbar spine flexion is 40–60°. Signup and view all the answers

What does a Schober's test measure?

Schober's test measures spinal mobility by assessing the distance between marked points on the skin during bending. Signup and view all the answers

List two neurological examination areas that should be focused on in patients with back pain.

Tone and power are two areas to focus on during neurological examination. Signup and view all the answers

What might a distance of less than 5 cm in Schober’s test indicate?

A distance of less than 5 cm may indicate ankylosing spondylitis. Signup and view all the answers

What is one possible consequence of absent or asymmetrical abdominal reflexes?

Absent or asymmetrical abdominal reflexes may suggest upper motor neuron lesions. Signup and view all the answers

Identify two 'red flags' that suggest serious underlying pathology in patients with back pain.

Age over 50 years and unexplained weight loss are two red flags. Signup and view all the answers

What symptoms should healthcare providers inquire about to assess for cauda equina syndrome?

Providers should inquire about perineal numbness and difficulties passing urine or feces. Signup and view all the answers

Name one non-spinal cause that may result in low back pain.

Mesothelioma is a non-spinal cause that may lead to low back pain. Signup and view all the answers

Study Notes

Spinal Clinic Referral Reasons

Common reasons for referral include pain and spinal deformity.
Detailed pain history is crucial, including location, type, severity, duration, frequency, and aggravating factors.
Trauma history, night pain, associated pain (brachalgia/sciatica), numbness, tingling, weakness, gait difficulties, and family history of ankylosing spondylitis/rheumatoid arthritis should be assessed.
Concurrent medical conditions (diabetes, vascular diseases, hip OA, previous malignancies) and systemic symptoms (weight loss, chills, fever) are also important.
Table 33.1 lists "red flags" for serious spinal pathology (fractures, tumors, infection, cauda equina syndrome).

Spinal Deformity Assessment in Children

Assess the progression rate of spinal deformity.
Evaluate skeletal maturity and recent growth spurts.
Puberty indicators (menstruation, voice change) should be noted.

Physical Examination

Assess posture (frontal and sagittal planes) for asymmetry (scoliosis).
Adam's forward bend test accentuates trunk asymmetry, identifies rib/loin prominence.
Skin examination should look for neurofibromatosis markers (cutaneous neurofibromata, café-au-lait patches, axillary freckling).
Neurological examination should include abdominal reflexes, leg length measurement, and sagittal alignment/forward gaze (for kyphosis).

Spinal Mobility Assessment

William Adams described the forward bend test for scoliosis (1865).
Palpation for tenderness and range-of-motion assessment are necessary.
Normal cervical range of motion: flexion (45°), extension (55°), rotation (70°), lateral bend (40°).
Normal lumbar range of motion: flexion (40-60°), extension (20-35°), lateral bend (15-20°), rotation (3-18°).
Schober's test assesses spinal mobility by measuring distance between points on the spine during flexion (at least 5cm increase expected).

Neurological Examination

Neurological examination focuses on tone, power, coordination, reflexes, sensation, and gait (Tables 33.4 and 33.5).
Rectal examination is necessary if cauda equina integrity is suspected.
Superficial abdominal reflexes should be symmetrical (umbilical movement follows stroking and should be bilateral).

Red Flags and Serious Pathology

Table 33.1 outlines "red flags" indicating potential serious spinal pathology.
Age, trauma history, malignancy history, weight loss, constitutional symptoms (fever, chills), immunosuppression, progressive sensory/motor issues, urinary/fecal difficulties, and perineal numbness should be carefully assessed.

Non-Spinal Pain Considerations

Non-spinal causes of low back pain must be considered (Table 33.2), including respiratory, vascular, renal, gastrointestinal, and urogenital issues (e.g., mesothelioma, aneurysm, pyelonephritis, peptic ulcer).

Patient History and Concerns

Evaluate the impact of pain on the patient's ability to work.
Inquire about existing treatments.

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Description

This quiz covers key aspects related to spinal clinic referrals, including common reasons for referral such as pain and spinal deformity. It also addresses assessment methods for spinal deformity in children and the importance of detailed physical examinations. The quiz emphasizes the significance of recognizing 'red flags' in spinal pathology.