Lumbar spine

There are three important components to the examination of the lumbar spine. The first is to inspect for the presence of deformity (see Disorders box), the second is to assess the movements of the spine, and the third is to assess the effects of lumbar spinal pathology on the spinal cord or nerve roots.


Some causes of abnormal lumbar posture

• Loss of lordosis - advanced age, ankylosing spondylitis, acute disc prolapse

- if lateral to nerve root, patient leans away from lesion

- if medial to nerve root, patient leans towards lesion

Examination sequence

□ With the patient standing, observe the posture from behind, checking that the spine is straight, and from the side checking that there is a normal lordosis.

□ Observe the effect of flexion on any abnormal lateral curvature (scoliosis).

□ Perform light percussion with the fist or tendon hammer. Note the presence of tenderness over the spinous processes and the paraspinal muscles.

□ Whilst keeping the iegs straight, ask the patient first to bend backwards, then forwards and then to each side. Note the range of movement in each direction and the contour formed by the spine.

I Carry out Schober's test where appropriate to quantify the range of lumbar spinal flexion (Fig. 8.10).

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