PPT Presentation

ROLE OF COMPLETE NEUROLOGICAL EXAMINATION IN FINDING OUT MISSED DORSAL SPINE LESION IN PATIENTS WITH BACK PAIN

Dr K. K. Pandey,

Assistant Professor

Dr L.S. Maravi,

Associate Professor

DEPARTMENT OF ORTHOPEDICS

NSCB MEDICAL COLLEGE & HOSPITAL , JABALPUR(M.P.)

INTRODUCTIONBack pain is a common problem noticed in adolescent

to elderly age group. Sometimes dorsal spine pathology in

low back pain are missed in the centers where MRI facilities

are not available.

In the patients with compressive lumbar lesion,

exaggerated deep tendon reflexes and other upper motor

neuron signs of the lower extremities due to dorsal

compressive lesion, tend to be masked.

AIM : To evaluate the neurological examination in the

detection of missed dorsal spinal cord lesion in outdoor

patients with back pain.

We did neurological examination in outdoor patients with back pain from 10 to 60 years of age in 6 months duration from 1st May 2014 to 31st October 2014.

The neurological examination includes gait assessment, motor and sensory examination. In motor examination we assessed strength, tone, coordination, and reflexes. In sensory examination we assessed soft touch, pin-prick sensation.

Patients with suspected dorsal lesion are sent for MRI examination.

Exclusion criteria:(1) Patients with history of injury to back. (2) Patients with history of neck pain and upper limb

weakness.(3) Patients with osteomalacic myopathy, thyrotoxic myopathy.

MATERIAL AND METHOD

Serial No.

Diagnosis Number

1 Spinal epidural abscess in upper dorsal spine 12 Extramedullary intradural tumour 23 Primary bony neoplastic lesion

(giant hemangioma) of D6 vertebra1

4 Intradural spinal arachnoid cyst from D10 – L1 15 Metastatic collapse of vertebral body

compressing spinal cord3

6 Idiopathic epidural lipomatoses extending from C7 to L1 with significant dorsal canal stenosis

1

7 Pott’s spine with compression of the spinal cord

3

We found 12 cases of dorsal spine lesion in subsequent MRI investigation.

Posterior Epidural Abscess in upper dorsal spine in

30 year male

Extradural intramedullary tumour with lumbar canal stenosis

In 54 year female

Primary bony neoplastic lesion ( giant hemangioma ) of

D6 vertebra in 12 year female

Posterior epidural fibrolipomatoses

from C7 - T1 in 22 year female

There are few reports of neurological deterioration due to a missed compressive lesion in the spinal cord above the level targeted for lumbar decompression surgery.

Takeuchi et al reported three cases of thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery.

(J Neurosurg. 2004;100:71–74).

  Ko SB et al reported two cases of paraplegia due to missed thoracic meningioma after laminotomy for lumbar spinal stenosis.

(Asian Spine J. 2011;5:253–257)

Complete neurological examination is helpful

to detect missed dorsal lesion earlier with

subsequent MRI investigations when the patients

with back pain do not complain of muscle weakness

and other upper motor neuron sign subjectively .

CONCLUSION