Spine Examination

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Spine Examination
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Classification

1. Trauma
2. Non trauma

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Trauma

• Primary evaluation
• manage the life threatening conditions
• ABCD
• splinting
• Secondary evaluation
• complete evaluation
• spine mechanical neurological stability

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Neurological exam.
Spinal shock loss of function of the
spinal cord from level of injury to all of caudad
Clinical loss of motor, sensory reflex
The end of spinal shock 1. return of at least
1 reflex eg. Bulbocavernosus reflex or anal
wink reflex 2. time gt 48 hours
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Spinal cord injury

• Incomplete cord injuries
• - anterior cord syndrome
• - Brown-Sequard syndrome
• - Central cord syndrome
• - Dorsal cord syndrome
• 2. Complete cord injury

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Complete or incomplete cord injury triad of
sacral sparing 1. perianal sensation(S2-4) 2.con
trolling of rectal sphincter(S2-4) 3. toe
flexor(S1)
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Points to consider in primary assessment 1.Life-t
reatening conditions must be identified and
treated first 2.Hypotension and hypoxemia are
deleterious injured spinal cord 3.Assessment
initial treatment must be performed with due care
protection of the spine because of potential
spinal injury
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Secondary assessment complete assessment
Points to consider in secondary assessment 1. An
alert, conscious patients is the best spinal cord
monitor 2.Spinal cord motor deficit above C5
often will lead to respiratory insufficiency 3.Ne
urogenic shock hypotension bradycardia 4.Spin
al shock sacral areflexia 5.Prognosis is
uncertain until spinal shock has abated.
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6. Identifying any distal motor sensory
sparing is critical. 7.Unconscious patient should
be assumed to have spinal injury. 8.Spinal cord
injury can mask other ass. injury.
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Non trauma
Clinical presentation

• Spine pain neck pain, back pain
• radiculopathy
• myelopathy

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Pattern of neck pain
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C2-3
C3-4
C4-5
C5-6
C6-7
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Common level of compression
Spinal cord is shorter than spinal
column.
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Cervical radiculopathy
Pain radiating into arm sensory/motor changes
in a radicular distribution
Muhle, spine 2001 Flexion widen foramen
18-31 Extension narrowed foramen
16-20
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Symptoms
Depend on level of cervical nerve root
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Spurling test
Cervical compression test
Positive pain along nerve root
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Cervical distraction test
Positive relieve symptom of nerve root pain
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Shoulder abduction sign move dorsal root
ganglion more cephalolaterally
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Cervical myelopathy
Spinal cord dysfunction developed long tract
sign Most common cause is cervical spondylotic
myelopathy
Breig A, J Neurosurg 1966 Neck flexion stretch
spinal cord Neck extension shorten thicken
spinal cord
Edwards W, Spine 1985 Concormittant CSM
L-stenosis 15-30
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Cervical spondylotic myelopathy dynamic factors
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Symptoms of cervical myelopathy
Weakness muscle wasting Loss of hand
dexterity Numbness paresthesia Spasticity Loss
of balance
The early symptom spastic gait Bowel bladder
involvement not usually complaint
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Physical examination
Spastic gait Lower limb spasticity Myelopathic
hand signs Hoffmans sign 10 seconds
test finger escape sign inverted radial
reflex Lhermitte sign Test the cranial nerves
Myelopathy UMNL of lower limbs LMNL of upper
limbs
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The reflex arc
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Absent abdominal reflex in UMNL
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Scapulohumeral reflex
Positive in spinal cord dysfunction above C3 level
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spondylolisthesis
LBP Claudication
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Physical examination

• Gait foot drop gait, spastic gait
• Standing posture, ROM, heel or toe gait,
  step-off
• Sitting power, root tension sign
• Lying supine neuro exam., root tension sign
• Lying prone femoral stretch test
• Stoop test

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Reflex Sensation Strength
L4 Knee jerk Medial foot Knee extension Ankle inversion Dorsiflexion
L5 Hamstrings Tibialis posterior 1st web space Hip abduction Dorsiflexion Great toe extension
S1 Achilles Lateral border of foot Plantar flexion Hip extension
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Root tension sign

• Straight leg raising test
• Bowstring test
• Lasegues test
• Sitting root test
• Contralateral SLRT
• Femoral stretch test

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Thank you
for your attention