CT. EXAM. OF A SPINAL DEFORMITY

Let us continue with the examination a spinal deformity.

HISTORY:

* look for obvious syndromes with associated nervous or renal disorders
*developmental milestones especially during first 2 years of life
*ask for previous operations or illnesses
* spinal deformity- onset, duration, progress, screening, function, gait, balance
*pain in back
* previous treatment - brace or surgery
*skeletal maturity - ask for menarche in girls and sec. sexual features in boys
max. risk during first 6 months affter menarche of progression

EXAMINATION:
posture of the child
manner of interactions with the parent or care provider

inspection in the standing position --
Body habitus - obese, tall, dwarf
Obvious asymmetries - back, shoulder, scapula, waist, ribhump
Cutaneous lesions
plumb line test - for balance of head over sacrum
LLD - measure limb lengths
Adam's test - in sitting position to eliminate effect of a LLD
sagittal curvatures
range of motion
passive side bending
clinical test of flexibility- passive side bending, clinical bending, traction test

palpation in standing position -
palpable step-off
lumbosacral kyphotic deformity
tight hamstrings
Adam's forward-bending test
truncal rotation
scoliometer - determine the ATR and the spirit level to measure in centimeters the height of the rib hump or lumbar prominence
gait or balance
heel and toe walking
Romberg's test
chest wall deformiries

full neurological examination -
higher functions
cranial nerves
motor system- tone, power, coordination
sensory - touch, pain, proprioception
reflexes - DTR and superficial, pathological
bladder and bowel function
special tests
root tension signs
signs of dural irritation
signs of spinal instability

LAB. STUDIES:
CBC, ESR
HLA-B27
ABG in severe curvature or neuromuscular curves
pulmonary function tests

RADIOGRAPHIC STUDIES:

To see - location, type and stage of deformity
36" film with entire spine including top of iliac crest

single AP view for diagnosis and follow-up

lateral view- pain or sagittal imbalance

oblique view - pars defects in standing position

special views - Stagnara view, bending and stretching views only before bracing or surgery

supine films - for better definition of structures

AVOID routine scoliosis series
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Today's link:

The Radiology of Acute Cervical Spine Trauma
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