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PATIENT HISTORY The commonest reasons for referral to a spinal clinic include pain and spinal deformity . A detailed history of the pain, including site, type, severity , duration, frequency and aggravat - ing factors, should be sought. Has there been any his...

PHYSICAL EXAMINATION The patient should be undressed and posture should be eval uated in both frontal and sagittal planes. Shoulder or waist asymmetry suggests the presence of scoliosis. The Adams forward bend test will accentuate trunk asymmetry and allow app...

Plain radiographs It is not appropriate to order spine radiographs for every patient presenting with neck or low back pain. Patients with red flag signs or symptoms and those who have not responded to conservative treatment require imaging, with most units in r...

Primary tumours of the spine Primary bone tumours of the spine account for only 2% of all spinal tumours. They arise de novo in the bone, cartilage, neural or ligamentous structures of the spine. They may be benign, intermediate or malignant. Benign primary ...

Provocative discography This investigation involves the placement of a 24-gauge needle into the centre of the intervertebral disc in a conscious patient. Radio-opaque contrast agent (1–3.5 /uni00A0 mL) is then injected into the disc. The contrast pattern wil...

Red flags After taking a history and examining the patient it is important to consider ‘red flags’ ( Table 37.5 ), which allow diagnostic triage into those with serious pathology of the spine, such as CES, fractures, tumours and infection, and those without. - ...

SPINAL DEFORMITY Spinal deformity may be categorised into a coronal plane deformity (scoliosis) or a sagittal plane deformity (kyphosis and lordosis). Further classification may be made on the basis of aetiology into congenital, neuromuscular, idiopathic or sy...

SPONDYLOL YSIS AND SPONDYLOLISTHESIS Spondylolysis This is a unilateral or bilateral defect in the pars interarticu - laris without vertebral slippage. The incidence is reported in approximately 6% by the age of 14 years, but is much higher in the young athle...

Scheuermann’s kyphosis Typically , in this condition, there is wedging of the seventh to 10th thoracic vertebrae. The patient presents with both apical pain and low back pain (due to attempts by the lumbar musculature to compensate for the thoracic hyperkypho...

Spina bifida Spina bifida is caused by a failure of fusion of the vertebral arches and possibly the underlying neural tube. Spina bifida cystica has an incidence of 1 in 300 live births and is associated with hydrocephalus. It is now decreasing as a consequenc...

Spinal biopsy Either CT-guided or open biopsy is often performed to obtain tissue for diagnostic study in cases of suspected tumour and/ or infection. Figure 37.1 Lumbar discography. Antero posterior (a) and lateral (b) radiographs following injection of cont...

Spinal dysraphism This is a group of disorders arising from abnormal embryo- logical formation of tissues; all are associated with a progressive neurological deficit as the result of spinal cord tethering and traction or cord compression. There is a strong a...

Spinal stenosis Spinal stenosis may be defined as any type of narrowing of the spinal canal, nerve root canal or intervertebral foramen. The resultant nerve root compression leads to nerve root - ischaemia, presenting with back, buttock or leg pain provoked by...

Spondylolisthesis Spondylolisthesis is a forward slippage of the vertebral body engendered by a break in the continuity or elongation of the pars interarticularis and presents in 4% of the adult population. Spondylolisthesis can be classified into six types ...

Syringomyelia Patients may present with sensory disturbance, weakness of the hands, loss of pain and temperature sensation, asym metrical abdominal reflexes or progressive kyphoscoliosis. It is associated with Arnold–Chiari malformation and spinal cord tumours...

TUMOURS OF THE SPINE Metastatic tumours The commonest malignancies that metastasise to the spine are shown in Table 37.10 . Red flags picked up on history or examination will alert the clinician to this possible diagnosis. Over 80% of patients with spinal meta...

The lack of trained spinal surgeons In the last 25 years high-income countries have seen the rapid development of spinal surgery , and the rapid development of spinal surgery as a complete career. It is now normal in such countries for spinal surgeons to pra...

Thoracic disc herniation Thoracic disc herniations that require surgical intervention are rare, accounting for less than 2% of all discectomy procedures. Typically , the patient presents with axial pain, radiculopathy or myelopathy . Conservative treatment inc...