Spinal Exam 4 Curvatures of the spine

What direction does a primary curve face?

posteriorly

What does a primary curvature persist in adults as?

thoracic and pelvic curves

What was does a secondary curve face?

anteriorly

What does the secondary curve persist as in adults?

cervical and lumbar curves

When does the secondary curves become apparent?

no apparent until postnatal period

What does the secondary curves allow?

allow for erect posture in humans

When does cervical lordosis begin?

begins in intrauterine life

When does cervical lordosis become apparent?

apparent when infant lifts head from prone position (3-4 months)

When is a cervical lordosis further accentuated?

when child begins to sit upright, stabilizes head while looking around in seated positions (9 months)

What maintains the adult cervical curve?

increased anterior dimensions of IVD

What is unique about the cervical lordosis?

least distinct spinal curve

increases significantly with age

What age group commonly lacks cervical lordosis?

children and adolescents younger than 17

Lack of cervical lordosis in adults may be a sign of what? (EXCEPT TQ)

1. ligamentous injury

2. anterior cervical muscular hypertonicity

3. hyperplastic articular pillars

When does lumbar lordosis develop?

9-18 months after birth

What causes lumbar lordosis?

Erector spinae muscles pull lumbar spine erect to achieve position necessary for walking (creates posterior concavity)

Lumbar lordosis is more pronounced in __

females

Where is lumbar lordosis prominent?

L3-L5/S1

Lumbar lordosis is taller __ than ___

anteriorly; posteriorly

What position is the zygopophysis in infants?

coronally positioned

What position is the zygapophysis after maturation?

sagittal position

What factors into the development of posture, ability to walk, transference of weight from vertebral body to zygophysis, and formation of lumbar lordotic curvature?

facet movement

What is the position of nucleus pulposus?

posterior shift of nucleus pulposus in annulus fibrosus at L4 level

sitting in erect position increases __ lordosis and decreases __ lordosis

lumbar; cervical

lumbar forward flexion decreases ___ lordosis and increases __ lordosis

lumbar; cervical

lumbar extension increases __ lordosis and decreases __ lordosis

lumbar; cervical

Lateral curvature was originally thought to be associated with ___

handedness

Where is the lateral curvature normally observed?

thoracic and lumbar regions

Where is the convexity of the lateral curve in left handed people?

left

Why does a lateral curvature occur?

results from asymmetrical muscle use/tone

What are some colloquial terms used to describe posterior bending condition?

humpback, hunchback, roundback

What is the natural thoracic kyphotic curve?

20-45 degrees

Increased thoracic curve greater than 50 degrees is called

hyperkyphosis

What are examples of some postural or structural abnormalities in children?

1. postural kyphosis

2. Scheuermann’s kyphosis

3. congenital kyphosis

   all examples of hyper kyphosis

What is another word for straight back syndrome?

hypokyphosis

What is the most common type of hyper kyphosis in children?

postural kyphosis (female bias)

Is postural kyphosis associated with severe structural abnormalities?

no

When is postural kyphosis corrected?

corrected once patient stands up straight

no pain or problems

What is the typical weight of backpacks?

30% of weight of the child

Recommended safety load is __ of child’s body weight

10-15%

Is Scheuermann’s kyphosis a structural abnormality?

yes

What causes scheuermann’s kyphosis?

disruption of cartilaginous endplates and epiphyseal rims

When does Scheuermann’s kyphosis begin?

begins at 10-12; seeks treatment at 12-15 due to aching back pain and increased thoracic kyphosis

What are the treatments for Scheuermann’s kyphosis?

1. bracing spine in extension

2. palliative treatment for pain and discomfort

3. exercises

When does congenital kyphosis present?

present at birth

What is congenital kyphosis?

vertebrae do not form properly or may fuse together

Does congenital worsen or get better with age? Treatment?

worsens with age

surgical intervention at young age

_{What additional birth defects may occur with congenital kyphosis?}

heart and kidney issues

neurological symptoms

weakness and numbness in legs

What is almost completely absent with straight back syndrome?

thoracic kyphosis

What does the straightening of thoracic kyphosis result in?

narrowing of anterior-posterior dimensions of thoracic cage= decreases space available for heart

What is straight back syndrome associated with?

1. systolic heart murmurs

2. distorted cardiac silhouette on x-ray

3. simulate organic heart disease

4. Idiopathic mitral valve prolapse (life-threatening)

What is a lordosis abnormality?

deviation of a curve anteriorly

What causes lordosis abnormalities?

1. posture

2. overweight

3. trauma

4. surgery

5. pregnancy

6. hip problems

What is the typical cervical lordotic curve?

20-40 degrees

What is hyperlordotic?

greater than 40 degrees

What is hypolordotic?

fewer than 20 degrees

What is the typical lumbar lordotic curve?

40-60 degrees

What groups are more likely to be affected by lordotic abnormalities?

1. adults older than 50

2. Kids going through growth spurts

3. Pregnancy

What is military (straight) neck?

decreased anterior curve in cervical region (hypolordotic)

What is swayback?

increased anterior curve in lumbar region (hyperlordotic)

What region is most prominently affected with scoliosis? Why?

thoracic region due to its attachment to thoracic cage

What is scoliosis?

forward flexion of spine

posterior elevation on one side of thorax

posterior elevation on one side of thorax __ mm or greater is a primary indicator of ____.

6; scoliosis

What is lateral curve progression/worsening linked to?

skeletal growth spurts especially from birth to two

What is risser sign?

test used to determine bone maturity

What does risser sign measure?

measures growth left of spine by looking at iliac apophysis, may help determine potential progression of scoliosis

Spinal deformity is classified based on:

1. Magnitude

2. Location

3. Direction

4. Etiology

5. Structural or non-structural

What is magnitude of curve measured using?

length and angle of curve using COBB METHOD

What is scoliosis location determined by?

determined by location of the vertebra at apex of curvature

What apex is the most lateral and the most horizontal vertebra within the curve?

T12

What is scoliosis direction?

direction refers to the side the convexity of the curve bends

What is non-structural scoliosis?

Mild deviation, unlikely to worsen; not associated with structural deformities

What is non-structural scoliosis linked to?

poor posture, unequal leg length, and muscle spasm

What is more common structural or non-structural scoliosis?

structural scoliosis

What are possible causes of structural scoliosis?

1. disease state

2. birth defects

3. injury

4. infection

5. abnormal growth

What type of scoliosis does the largest number of patients suffer from?

idiopathic scoliosis

What is infantile idopathic scoliosis?

uncommon

resolve spontaneously

56% males

left thoracic deviation predominates

What is juvenile idiopathic scoliosis?

after age 6, more likely seen in females

right thoracic deviation- tends to worsen

What is adolescent idiopathic scoliosis?

80% idiopathic scoliosis

primary in females

90% single thoracic curves deviate to the right

double curves include right thoracic and left lumbar deviations

linked to autosomal dominant inheritance