REIDER PART 201

Chaptf.k 9_Lumbar Spine 361

TAKE HOME POINTS

1.    Lumbar spine examination should include careful inspection, gait, rangę of motion testing, and a thorough neurologie examination.

2.    Palpation of the lumbar spine should be performed to identify any areas of tenderness or "step-off."

3.    Neurologie examination should include motor, sensory, and reflex testing in the distribution of the lumbar nerve roots.

4.    Nerve tension tests are helpful at identifying pressure on a nerve root such as that caused by a herniated disk. The straight-leg raising test is morę sensitive for nerve root compression, while the crossed straight-leg raising test is morę specific.

5.    Profound or progressive neurologie deficit mandates immediate patient work-up.

■ BIBLIOGRAPHY

Apley AG: A System of Orthopaedics and Fracturcs, 4th ed. London, Butterworths, 1973.

Beetham WP, Polley HF, Stocumb CM, Weaver VVF: Physical Kxamination of the loints. Philadelphia, WB Saunders, 1965. Borenstein DG, Weisel SW: Low Back Pain: Medical Diagnosis and Comprehensive Management. Philadelphia, WB Saunders, 1989. Breig A, Troup JDG: Biomechanical considerations in the straight-leg-raising test. Spine. 1979;4:242-250.

Christodoulides AN: Ipsilateral sciatica on femoral nerve strelch test is pathognomonic of an 1.4/5 disc protrusion. I Bonę Joint Surg Br. 1989;71:88-89.

Deville WL, van der Windt AW, Dzaferagic A, Bezemer PD, Bouter LM: The Test of Lasegue. Spine. 2000;25:1140-1147.

Dyck P: The femoral nerve traction test with lumbar disc protrusion. Surg Neurol. 1976;6:163-66.

Dyck P: Lumbar nerve root: the enigmatic eponyms. Spine. 1984;9:3-6. Estridge MN, Rouhe SA, Johnson NG: The femoral stretching test.

J Neurosurg. 1982;57:813-817.

Foerster O: The dermatomes in man. Brain. 1933;56;l-39.

Forst JJ: Contribution a DF.tude Clinique dc la Sciatique. [thesis], Thes No. 33. Paris, 1881.

Hoppenfeld S, cd: Physical F.xamination of the Spine and F.xtremities. New York, Appleton-Century-Crofts, 1976.

Hudgins WR: The crossed straight leg raising test: a diagnostic sign of herniated disc. J Ocćup Med. 1979; 21:407-408.

Inman VT, Saunders JB: The clinico-anatomical aspects of the lum-bosacral region. Radiology. 1942;38:669-678.

Keegan JJ, Garrett FD: The segmental distribution of the cutaneous nerves of the limbs of man. Anat Record. 1948;102:409-431.

Khuffash B, Porter RW: Cross leg pain and trunk list. Spine. 1989; 14:602-603.

MacNab J: Backache. Baltimore, Williams 8( Wilkins, 1977.

McCombe PF, Fairbank JC, Cockersolc BC, Pynsent PB: 1989 Volvo Award in dinical Sciences. Reproducibility of physical signs in low-back pain. Spine. 1989;14:908-918.

0’Connell JEA: Sciatica and the mechanism of the production of the clinical syndrome in protrusions of the lumbar intervertebral dises. Br J Surg. 1943;30:315-327.

Rothman RH, Simeone FA, eds: The Spine, 3rd ed. Philadelphia, WB Saunders.

Scham SM, Taylor TK: Tension signs of lumbar disc prolapse. Glin Orthop. 1971;75:195-204.

Schofferman J, Zucherman J: History and physical examination. Spine State Art Rev. 1986;1:13-20.

Smith SA, Massie JB, Chesnut R, Garfin SR: Straight leg raising: anatom-ical effects on the spinał nerve root without and with fusion. Spine. 1993;18:992-999.

Spangfort EV: The lumbar disc herniation. A computer-aided analysis of 2,504 operations. ACTA Orthop Scand Suppl. 1972;142:1-95.

Supik LF, Broom MD: Sciatic Tension Signs and Lumbar Disc Herniation. Spine 1994;19:1066-1069.

Thelandcr U, Fagerlund M, Friberg S, Larsson S: Straight leg raising test versus radiologie si/.e, shape, and position of lumbar disc hernias. Spine. 1992;17:395-399.

Troup JDG: Straight-leg-raising (SLR) and the qualifying tests for inereased root tension. Spine. 1981;6:526-527.

Vallfors B: Acute, subacute and chronic low back pain: clinical symp-torns, absenteeism and working environment. Scand J Rehabil Med. 1985;11:1-98.

Wisneski RJ, Garfin SR, Rothman RH: Lumbar disc disease. In Rothman RH, Simeone FA, eds. The Spine, 3rd ed. Philadelphia, WB Saunders, 1992.

Woodhałl B, Hayes GJ: The well leg raising test of Fajersztain in the diagnosis of ruptured intervertebral disc. J Bonę Joint Surg Am. 1950;32:786-792.

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