Page 961 - TNFlipTest

Toronto Notes 2019 Pelvis Clinical Features
• activity-relatedbackpain,painwithunilateralextension(Michelis’test)
Investigations
• obliqueX-ray:“collar”breakinthe“Scottiedog’s”neck • bonescan
• CTscan
Treatment
• non-operative
■ activity restriction, brace, stretching exercise
ADULT ISTHMIC SPONDYLOLISTHESIS
Definition
• defectinparsinterarticulariscausingaforwardtranslationorslippageofonevertebraonanother, usually at L5-S1, less commonly at L4-5
Mechanism
• congenital(children),degenerative(adults),traumatic,pathological,teratogenic
Clinical Features
• lowerbackpainradiatingtobuttocksrelievedwithsitting • neurogenicclaudication
• L5radiculopathy
• MeyerdingClassification(percentageofslip)
Investigations
• X-ray(AP,lateral,obliqueflexion-extensionviews),MRI
Treatment
• non-operative
■ activity restriction, bracing, NSAIDS
• operative
Table 18. Classification and Treatment of Spondylolisthesis
Orthopedics OR27
Spondylolysis
Spondylolisthesis (anterior displacement)
Figure 30. Spondylolysis, spondylolisthesis
Figure 31. “Scottie dog” fracture
Class Percentage of Slip
1 0-25%
2 25-50
3 50-75
4 75-100
5 >100
Specific Complications
Treatment
Symptomatic operative fusion only for intractable pain Same as above
Decompression for spondylolisthesis and spinal fusion Same as above
Same as above
• maypresentascaudaequinasyndromeduetorootsbeingstretchedovertheedgeofL5orsacrum
Pelvis
Pelvic Fracture
Mechanism
• young:highenergytrauma,eitherdirectorbyforcetransmittedlongitudinallythroughthefemur • elderly:fallfromstandingheight,lowenergytrauma
• lateralcompression,verticalshear,oranteroposteriorcompressionfractures
Clinical Features
• pain,inabilitytobearweight • localswelling,tenderness
• deformityoflowerextremity • pelvicinstability
Anterior column
Posterior column
Figure 32. Pelvic columns
© Emilie McMahon 2005 © Ryo Sakai 2007