تارقف نوتس يبناج فارحنا
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كيتاپويديا
رلاوكسامورون
يدازردام
زوتاموربيفورون
) “ سولناد رلها “ نافرام ( يميشنازم ياهيراميب
ناناوجون ديوتامور تيرترا
) يتسلاپوكاروت , يموتكنيملا لابندب , يگتسكش ( امورت
, اتك فرپميا زنژوتسا , مسيفراود ( اهيفورتسيدوردنوكوتسا
) يزلاپوردنوكا
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تنوفع
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) ي رونوتسيسوموه , مسيفراود ( كيلوباتم ياهيراميب
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دصرد 3 2
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ت سا رت عياش اهرتخد رد دشاب رتلااب سوق هجرد هچره
.
دسريم ربارب 4 هب و
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Scoliosis Is a single gen disorder .?

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تسا رتلااب دصرد 100 اه هدشن نامرد ريم و گرم
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تسا لانوملوپروك گرم تلع نيرت عياش
Nachemson : 130 pat. For 38 years found that
100% more mortality according to general population (16 from 20 mortality was due to corpulmonal , 37% LBP , only 3 pat. Were idioscoliosis .
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ميرادن زويلوكساويديا رد يلو , ميراد
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تسا % 60 80 يمومع تيعمج رد سناديسنا
.
تسا % 86 اهزويلوكسا رد
تيعمج زا رتعياش اهزويلوكسا رد هنازور درد عويش هتبلا
.
تسا يمومع
.
تسا رتعياش رمك دردرابمولوكاروت و رابمول ياهسوق رد
.
درادن يطابترا سوق تدش اب درد تدش
% 90 هب نس شيازفا اب اهزويلوكسا يفارگويدار رد زورترا
.
دسريم
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دراد ميقتسم طابترا كيساروت ياهسوق رد طقف
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طابترا هير دركلمع اب hypokyphosis و راگيس
.
دراد
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سوق تدش شيازفا بجوم يگلماح هك تسين صخشم
خر يگلاس 20 ريز يگلماح هدش هيصوت يلو .
دوش
.
دهدن
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دشاب ىمن نيرازس نويساكيدنا طسوتم ياهسوق رد
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Cervical curve : apex between C1 &
C6 cervicothoracic curve :apex between C7 & T1 thoracic curve :apex between T2 & T11 thoracolumbar curve :apex between t12 &
L1
Lumbar curve :apex between L2& L4

) هنهرب ( تسوپ هنياعم
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ولج هب ندش مخ تست
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درد
مردنس رد قيمع واك , رنرت مردنس رد يندرگ web
يلپوكوم رد لاحط و دبك يگرزب , نافرام
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اهزوديراكاس
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غولب هنياعم
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يگلاس 14 10
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تست شور
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% 100 : تست تيساسح
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45 % : تست يصاصتخا
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, هتسشن يهاگ و هداتسيا .
تسا AP تروص هب نيلوا AP
.
دوريم راكب يفارگويدار نيلوا رد زجب اهدانگ ظفاح
.
تسا هداتسيا تروصب مه لارتلا يفارگ
–
–
–

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ديوريت , اهدانگ , ناوختسا زغم , ناتسپ
AP or PA (5-10 )
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يكيرتكلا كيرحت
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رظن تحت
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زوترا
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يحارج لمع
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درادن نويساكيدنا رگيد هزورما
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دنناد يم سيرب دنمزاين ناراميب رد ارنا دروم اهنت يضعب
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دنرادن سيرب زا هدافتسا ناكما يليلدب هك
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دراد دربراك هجرد 20 ريز ياهسوق رد
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هام
هام
12 6 ره يكدوك نينس رد 20 ريز ياهسوق
AP يفارگ
4 3 ره يناوجون نينس رد 20 ريز ياهسوق
AP يفارگ
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ماد قا هب جايتحا غولب زا دعب نينس رد 20 ريز ياهسوق
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درادن صاخ
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هجرد 5 (.
دنشاب هتشاد تفرشيپ هك يا هجرد 29 20 ياهسوق
) هام 6 يط رد
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دروخرب نيلوا رد 30 45 ياهسوق
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: زوترا ياهزاين شيپ
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دشاب هدنام يتلكسا دشر زا هام 12 لقادح 1
دشاب رتمك اي 3 رسير 2
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دشاي زاب يزيقوپا گنير 3
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دشاب هتشذگن كرانم زا هام 6 زا شيب 4
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يتلكسا غولب
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كيساروت زودرول
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هجرد 45 يلااب سوق
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شور هب
.
تسا ينوخ قورع دقاف end plate يزكرم لخلختم شخب قيرط زا
.
ددرگيم هيذغت راشتنا
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كسيد يوقلح يگراپ )
.) 15 45 ( dysfunction ( : 1 هلحرم
تساف لصفم هتيليبومرپيه و تيوونيس
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, كسيد هدنورشيپ يگراپ ) instablity ( : 2 هلحرم
35 70 (.
نا نويساسكولباس و تساف لصفم بيرخت
.
يگلاس )
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فارطا يفورترپيه )
) يگلاس 60 stablization
يلااب
( : 3 هلحرم
(.
يرمك زوليكنا و لصفم
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L4-L5 & L3-L4
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درد تاصخشم , ندرگ ايرمك درد
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قاس هب هدنشك ريت درد
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يرمك تلاصع مساپسا
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يتكرح و يسح للاتخا
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يبصع سكلفر للاتخا
SLR
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نيگنس لغش
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هيلقن طياسو يور راك
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تراگيس
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دايز نامياز
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180 يلااب دق
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لااب نزو
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سرتسا هارمه لغش
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باصعا قيرط زا , هرهم دوخ هب طوبرم ميلاع
هب لايدم و يندرگ درد تروصب sinovertebral
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هناش و لاوپاكسا
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يبصع هشير هب راشف هب طوبرم ميلاع
MS رد lermit sign اب هك يتاپولويم هب طوبرم ميلاع
).
دوشيم هدهاشم ينايم ياهكسيد رد (.
دبايم قارتفا
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Generally not recommended in the first month of symptoms in the absence of “red flags”.
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The main purpose of plain x-ray is to detect serious underlying structural or pathologic conditions.

RED FLAGS
(POSSIBLE FRACTURE)
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Major trauma ,such as vehicle accident or fall from height
Minor trauma or even strenuous lifting
(in older or potentially osteoporotic patient)

RED FLAGS
(POSSIBLE TUMOR OR INFECTION)
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Age over 50 or under 20,history of cancer
Constitutional symptoms,such as recent fever or chills or unexplained weight loss
Risk factors for spinal infection :recent bacterial infection(U.T.I),IV drug abuse,or immunesuppression(from steroids,transplant or HIV)
Pain that worsen when supine ,severe nighttime pain

RED FLAGS
(POSSIBLE CAUDA EQUINA SYN.)
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Saddle anesthesia
Recent onset of bladder dysfunction:
(retention,frequency,overflow incontinence)
Severe or progressive neurological deficit in lower extremity
Anal sphincter laxity,perineal sensory loss
Major motor weakness :quadriceps,ankle plantar flexors,evertors, and dorsiflexors (foot drop)

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Are rarely indicated and increase both the cost and radiation exposure
The exception would include a young patient with an acute injury or repetitive extension activities, which can result in fracture of the pars interarticularis.

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Largely replaced by MRI
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Generally not indicated in the evaluation of acute low back pain except in cases where the clinical picture supports a progressive neurologic deficit and the MRI and EMG are nondiagnostic. .
Reserved as a preoperative test to correlate examination findings, often in conjunction with a CT scan.

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Rarely necessary in the evaluation of acute low back pain and certainly not recommended within the first 3 months of treatment.
Patients who have not responded to a wellcoordinated rehabilitation program or who have normal or equivocal MRI findings .
May have some benefit in localizing a symptomatic disc as the etiology of nonradicular back pain.

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Provides superior anatomic imaging of the osseous (bony) structures and good resolution for disc herniation.
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Its sensitivity for detecting disc herniation when used without myelography however is inferior to MRI.

Magnetic Resonance Imaging (MRI)
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Should not be overused
Has excellent sensitivity in the diagnosis of lumbar disc herniation and is considered the imaging study of choice for root impingement.
Its use should therefore be reserved for selected patients.

INDICATIONS OF MRI
(IMMEDIATE)
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Patients with progressive neurologic deficit
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Cauda equina syndrome
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Patients with a suggestive presentation and known history or high risk for malignancy or inflammatory disease.
Determining exact levels of pathology in the candidate for a selective nerve root block when physical examination and electrodiagnostic findings are not definitive.

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NON OPERATIVE TREATMENT
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OPERATIVE TREATMENT

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NON OPERATIVE TREATMENT
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OPERATIVE TREATMENT

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MODALITIES
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NON OPERATIVE TREATMENT
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OPERATIVE TREATMENT

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MODALITIES
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DECONDITIONING SHOULD BE AVOIDED AT
THE ONSET BY LIMITING BED REST AND
IMMOBILIZATION(2-3DAYS)
LYING IN THE MOST COMFORTABLE
POSITION(NOT RESTRICTED TO SEMI-
FOWLER OR LATERAL POSITION)
MOST PREFER CONTINUATION OF
ORDINARY ACTIVITIES WITHIN THE LIMITS
PERMITTED BY PAIN AS SOON AS POSSIBLE

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ACETAMINOPHEN
Nonsteroidal Anti-inflammatory Drugs
(NSAIDs)
Muscle Relaxants
Opioid Analgesics
Oral Steroids
Colchicine
Anti-Depressant Medications

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Are a reasonable first-line medication
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Theoretically offer additional antiinflammatory effects ( most prominent during the first week after injury)
By carefully prescribing therapeutic doses at regular intervals, the analgesic and antiinflammatory properties of these agents will be best realized by the patient
Prolonged use of these medications(greater than 4 weeks) should be avoided

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Muscle relaxants can be used as short-term adjunctive medications
Benzodiazepines (except low dose diazepam) do not appear to be helpful or indicated in patients with acute low back pain
Commonly experienced undesirable side effects include drowsiness and fatigue
Prescribed prior to bedtime to take advantage of their sedating effects and reduce daytime sedation .

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Generally not necessary in the treatment of acute low back pain
Tricyclic antidepressants, and in particular amitriptyline, have been well studied and supported as useful analgesics in patients with pain of neurogenic origin
They can be helpful as adjuncts for pain and sleep if used at bed time
Doses should begin low and slowly increased to minimize side effects

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Improvement in aerobic fitness can improve blood flow and oxygenation to all tissues including the muscles, bones and ligaments of the spine
Aerobic exercise may also decrease the psychological impact of low back pain by improving mood,decreasing depression, and increasing pain tolerance
Active exercise program that emphasizes restoration of normal lumbosacral motion, trunk strengthening, and instruction in proper body mechanics

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It is generally used in chronic pain conditions and not indicated in the initial management of acute low back pain
Success rates range greatly due to many factors including electrode placement, chronicity of the problem, and previous treatments
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Documentation of greater than 50% reduction in pain with a treatment trial may help substantiate its true beneficial effects as

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High voltage pulsed galvanic stimulation has been used in acute low back pain to reduce muscle spasm and soft tissue edema
(swelling)
Its Use should be limited to the initial stages of treatment, such as the first week after injury so that patients may quickly progress to more active treatment, which includes a restoration of range of motion and strengthening
It may often be combined with ice or heat to enhance its analgesic effects.

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It has been found to be helpful in improving the distensibility of connective tissue, which facilitates stretching
It is not indicated in acute inflammatory conditions where it may serve to exacerbate the inflammatory response
It is best use to improve limitations in segmental spinal range of motion following recurrent or chronic low back

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The use of ultrasound is contraindicated over a previous laminectomy or peripheral nerve secondary to alterations in membrane stability
It should be discontinued as segmental motion is improved with the patient then moved into an active strengthening program and eventual transference to an independent home exercise program.

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Superficial heat can produce heating effects at a depth limited to 1-2cm
It has been found to be helpful in diminishing pain and decreasing local muscle spasm should be used as an adjunct to facilitate an active exercise program
It is most often used during the acute phases of treatment when the reduction of pain and inflammation are the primary goals

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Ice packs or cryotherapy are generally more effective in terms of depth of penetration than other superficial thermal modalities
This is helpful in reducing local metabolism, inflammation, and pain
The analgesic effects of ice result from a decreased nerve conduction velocity along pain fibers and a reduction of the muscle spindle activity responsible for mediating local muscle tone.

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It is usually most effective in the acute phase of treatment
It is applied over an area for 15-20 minutes, 3-4 times per day initially and then on an as needed basis
Peripheral nerve injury and local frostbite secondary to prolonged cryotherapy has been previously described, emphasizing the need for monitoring of cryotherapy use.