Spine Examination- Spinal Surgery

Why examination of spine is required?

Spine examination is essential for detection of any pathological conditions of the spine. The examination of the spine does not require any special equipment. Systematic assessment of the patient is required to detect pathology.

Spine examinations are generally performed by an orthopedic surgeon i.e. a doctor who specializes in diseases of the bones and the musculoskeletal system.

What to expect during spine examination?

Before the spine examination begins, the doctor would ask the patient about any existing back pain, spinal issues, trauma or any sort of movement is contributing in back pain or not.

Patient would be examined in following positions: Standing, lying on the back, and lying on the front

Examination of spine involves:

• Inspection
• Palpation
• Range of motion
• Neurovascular examination
• Psychosocial factors

Special tests are done in order to isolate specific pathology of spine. Various tests such as Tension sign/Bowstring test, Hoover test, Femoral nerve stretch test, Stork/Single stance test, Babinski sign, Oppenheim test, Valsalva test, Milgram test, Passive neck flexion, Vertebral artery test, Spurling test - Foraminal compression, Neck distraction test - Manual traction test, Shoulder abduction test, Swallowing test, Tinel’s sign - Brachial plexus test, Brachial plexus stretch test, Roo’s test, Straight leg raise, Lasegue test, Bragard’s test, Kernig/Brudzinski Test, Well straight leg raising test, Slump test are done to examine the spine. It is important to temember that no special equipment is required to perform any of these tests.

Inspection: The entire spine is inspected during the examination of any spinal disorder. Doctor would look for any surgical scars or swelling as well as any shoulder asymmetry and pelvic tilt. Patient’s walking style would also be evaluated to determine any abnormalities of gait. Doctor would also evaluate for any deformity such as kyphosis, scoliosis, hyperlordosis of the lumbar spine or loss of lumbar lordosis.

Palpation: Palpation is a simple method that helps to determine any changes in tissue tension, texture and thickness. It also helps to detect any tenderness as well as to appreciate abnormalities in the anatomical structures. Each vertebra is carefully examined by applying a light pressure onto the lateral muscles.

Range of motion: In order to determine the type and severity of a spinal pathology, it is important to know whether the movement of spine is flexible or not. Patient would be asked to move through a set of active movements by bending backward, forward, as well as twisting laterally on both sides. The doctor would calculate changes in spinal function by using the available standard range of normal motion.

Neurovascular examination: Doctor would also perform a detailed examination of tone, power, sensation, and reflexes. Doctor would also check all peripheral pulses.

Psychosocial factors: Psychological, occupational and socio-economic factors may play a role in the cause of back problems.

References:

• https://www.ncbi.nlm.nih.gov/pubmed/26646344
• http://examinations.lexmedicus.com.au/pathologies/spine
• https://patient.info/doctor/examination-of-the-spine

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