1. Spine Examination รศ.นพ. สุรชัย แซ่จึง ภาควิชาออร์โธปิดิกส์
คณะแพทยศาสตร์
มหาวิทยาลัยขอนแก่น

2. Classification
Trauma
Non trauma

3. Trauma Primary evaluation: manage the life threatening conditions ABCD
splinting
Secondary evaluation :
complete evaluation
spine : mechanical & neurological stability

4. Neurological exam. Spinal shock : loss of function of the spinal
cord from level of injury to all of caudad
Clinical : loss of motor, sensory & reflex
The end of spinal shock :
1. return of at least 1 reflex : eg.
Bulbocavernosus reflex or anal wink reflex
2. time > 48 hours

6. Spinal cord injury Incomplete cord injuries - anterior cord syndrome
- Brown-Sequard syndrome
- Central cord syndrome
- Dorsal cord syndrome
2. Complete cord injury

7. Complete or incomplete cord injury
triad of sacral sparing
1. perianal sensation(S2-4)
2.controlling of rectal sphincter(S2-4)
3. toe flexor(S1)

9. Points to consider in primary assessment
1.Life-treatening conditions must be
identified and treated first
2.Hypotension and hypoxemia are
deleterious injured spinal cord
3.Assessment & initial treatment must be
performed with due care & protection of the
spine because of potential spinal injury

10. Secondary assessment
complete assessment
Points to consider in secondary assessment
1. An alert, conscious patients is the best
spinal cord monitor
2.Spinal cord motor deficit above C5 often
will lead to respiratory insufficiency
3.Neurogenic shock : hypotension + bradycardia
4.Spinal shock = sacral areflexia
5.Prognosis is uncertain until spinal shock
has abated.

11. 6. Identifying any distal motor & sensory sparing
is critical.
7.Unconscious patient should be assumed to
have spinal injury.
8.Spinal cord injury can mask other ass. injury.

12. Non trauma Spine pain : neck pain, back pain radiculopathy myelopathy
Clinical presentation
Spine pain : neck pain, back pain
radiculopathy
myelopathy

13. Pattern of neck pain

14. C2-3
C3-4
C4-5
C5-6
C6-7

15. Common level of compression
Spinal cord is shorter than
spinal column.

16. Cervical radiculopathy
Pain radiating into arm + sensory/motor changes in
a radicular distribution
Muhle, spine 2001
Flexion : widen foramen
18-31%
Extension: narrowed foramen
16-20%

17. Symptoms
Depend on level of cervical nerve root

20. Spurling test
Cervical compression test
Positive= pain along nerve root

21. Cervical distraction test
Positive =relieve symptom of nerve root pain

22. Shoulder abduction sign : move dorsal root ganglion
more cephalolaterally

23. Cervical myelopathy Breig A, J Neurosurg 1966
Spinal cord dysfunction :developed long tract sign
Most common cause is cervical spondylotic myelopathy
Breig A, J Neurosurg 1966
Neck flexion: stretch spinal cord
Neck extension: shorten & thicken spinal cord
Edwards W, Spine 1985
Concormittant CSM & L-stenosis = 15-30%

24. Cervical spondylotic myelopathy : dynamic factors

25. Symptoms of cervical myelopathy
Weakness & muscle wasting
Loss of hand dexterity
Numbness & paresthesia
Spasticity
Loss of balance
The early symptom = spastic gait
Bowel & bladder involvement : not usually complaint

26. Physical examination Spastic gait Lower limb spasticity
Myelopathic hand signs :
Hoffman’s sign
10 seconds test
finger escape sign
inverted radial reflex
Lhermitte sign
*** Test the cranial nerves
Myelopathy
UMNL of lower limbs
LMNL of upper limbs

27. The reflex arc

30. Absent abdominal reflex in UMNL

31. Scapulohumeral reflex
Positive in spinal cord dysfunction above C3 level

32. spondylolisthesis
LBP
Claudication

33. Physical examination Gait: foot drop gait, spastic gait
Standing: posture, ROM, heel or toe gait, step-off
Sitting: power, root tension sign
Lying supine: neuro exam., root tension sign
Lying prone: femoral stretch test
Stoop test

35. Reflex Sensation Strength L4 Knee jerk Medial foot Knee extension
Ankle inversion
Dorsiflexion L5
Hamstrings
Tibialis posterior
1st web space
Hip abduction
Great toe extension S1
Achilles
Lateral border of foot
Plantar flexion
Hip extension

36. Root tension sign Straight leg raising test Bowstring test
Lasegue’s test
Sitting root test
Contralateral SLRT
Femoral stretch test

38. Thank you
for your attention