Thoracic & Lumbar Spinal Conditions

PTA 160

L1

L2

L3

L4

L5

L

S1`

S2

S3

S4

S5

Compression Fracture

Stable fracture → collapse of vertebral body

• !!! Most oftenly in thoracic spine - anterior aspect !!!

• Causes :
  1. Osteoporosis (most common cause)
  2. Trauma, fall, cancer

  • Risk increases w/ age & postmenopausal women

• Symptoms : Sharp pain in mid-to-low back that is relieved by lying down, ribs may become closer to pelvis, due to compression - increased thoracic kyphosis

• Intervention : Core stab/proprioception/balance training, strengthen spinal extensors, EXTENSION BIAS

  • Surgery : Vertebral augmentation

• Special Tests : Rib-pelvis distance & wall-occiput distance

Rib-pelvis distance

Position : Standing facing the wall with arms up (ARRESTED)

Test : Palpate the number of fingertips between the iliac crest & bottom rib

Positive : <2 fingertips between crest and bottom rib

For : Compression fracture

Wall-Occiput Distance

Position : Standing with scapulas & heels against the wall

Test : Measure in cm’s the distance between the occiputs & wall

Positive : >7 cm

For : Compression fracture

Vertebral Augmentation

For : Compression fractures

Vertebroplasty : Injecting bone cement into vertebral body & maintain vertebral body height

Kyphoplasty : Prior to injecting bone cement, a small inflatable balloon is placed into vertebral body & inflated (compacts bone & creates space for cement)

Pain relief usually within 24 hours

Hyperkyphosis

Abnormal increase in thoracic kyphotic curve

Normal curve ::

(children age 10) : 20 degrees

(women >65 years) : 45 degrees

(men >65 years) : 35 degrees

• Causes : Compression fracture, DDD, cystic fibrosis, COPD, muscle weakness in back extensors/tightness in hip flexors

  • Scheuermann’s disease in adolescents can lead to this

  • Males 2 : Females 1

• Symptoms : Pain & stiffness

• Intervention :

• Special Tests : Rib-pelvis distance, wall-occiput distance, & flexicurve kyphosis index

Flexicurve Kyphosis Index

Patient stands in usual best posture, & examiner marks C7 & L5/S1

• Patient holds chair & examiner molds flexicurveto the shape of patient’s thoracic & lumbar curves

• Markings for C7 & L5/S1 are placed on the ruler, & then the ruler is placed on graph paper

• The curve is traced & a kyphosis index is calculated

• Over 13 indicates abnormal kyphosis

Scoliosis

Curvature of spine in the frontal spine causing an ‘S’ or ‘C’

• Can be structural or nonstructural (Ex. Nonstructural - leg length discrepancy)
  !!! NAMED BY WHICH SIDE IS THE CONVEXITY = Right bends to the right !!!

• Causes : Most often idiopathic, but can also be from a neuromuscular disorder (cerebral palsy, muscular dystrophy, spina cord injury)

• Symptoms : Mild is asymptomatic / Severe may be cardiopulmonary or neurologically compromised

• Intervention : Bracing, stretching the concave side & strengthening the convex side

  • Surgical : Spinal fusion

• Special Tests : Adams Forward Bend Test

Adams Forward Bend Test

Position : Standing in full thoracic flexion

Test : PTA takes two fingers on either side of spine and superiorly moves up spine, looking for an abnormal curvature

Positive : A curve within the horizontal plane

For : Scoliosis

Lumbar Strain/Sprain

3 GRADES:

1. Grade I : Microtearing

2. Grade II : Partial tear

3. Grade III : Complete tear

• Causes : Trauma or stressful postures

• Symptoms : Pain with stretch OR contraction of affected muscles

  • Specifically in sitting or standing from seated

• Intervention : modalities, stretching/strengthening, core stab, avoid prolonged poor posture

Degenerative Disc Disease (DDD)

Disc space narrowing / Disc desiccation or fibrosis / small tears in the annulus fibrosis

• Causes : Hereditary or aging (90% of people >65 years have in some degree)

• Symptoms : Generalized lower back pain

• Intervention : Coordination / core strengthening / endurance

Facet Joint DJD

• Causes :

• Symptoms :

• Intervention :

• Special Tests :