Spine examination

Suitably undressed, usually down to underwear. Start with the patient standing, then lying prone and finally lying supine.

1. STANDING

Look

• Scars: previous surgery
• Lumps: abscess, tumour (e.g. sacral lipoma), prominent paravertebral muscle spasm
• Sinuses: deep infection
• Cafe au lait spots / nodules: Neurofibromatosis
• Hairy patch (spinal dysraphism)
• Mongolian blue spot (more common in Asians: no clinical significance)
• Low hairline due to short neck: Klippel-Feil syndeome: fusion or absence of cervical vertebrae; may be associated with Sprengel shoulder (undescended scapula)
• Down / Morquio syndromes: Atlanto-axial instability
• Asymmetry of shoulder height / trunk balance / loin crease: scoliosis (lateral curvature with rotational deformity of vertebral bodies)
• Leg length discrepancy (check level of iliac crests)
• If patient consistently stands with one knee bent in spite of equal leg lengths, this may indicate nerve root tension, as knee flexion relieves the pull on the nerve root(s)
• Lateral deviation of spine (known as 'list' or 'tilt'): may be a sign of prolapsed intervertebral disc causing nerve root ompression
• Associated anomalies of hands/feet, e.g. syndactyly, pes cavus: may be part of a syndrome
• Kyphosis and lordosis (best assessed from side): may be exaggerated or reduced
• Round backing / hunched shoulders: Schuermanns disease/kyphosis
• Gibbus (aka kyphos): acute angular deformity with bony prominence, e.g. tuberculous vertebral collapse
• Observe gait

Feel

• Tenderness: may be bony, intervertebral or paravertebral
• Bony prominence or steps