Back & Neurological
Examination
Dr Munir Saadeddin FRCSed
Back & Neurological examination
Which Patients?

Back Pain (- or +Leg Pain)

Back Deformity

Neurological symptoms of lower limb

Back Injury
Back & Neurological Examination

History

Examination whilst standing out of bed

Gait observation

Examination in supine position

Examination in prone position
Patient presenting & Back & Leg Pain
Patient presenting with deformity
Back Inspection (standing)
Back Inspection (Forward Flexion)
Back Inspection (Forward Flexion)
Back Inspection in LBP
Examination of forward flexion
Examination of Lateral Flexion
Examination of Back Extension
Examination of Rotation
Standing on Heels
Standing on Tiptoes
Back Examination in Supine Position

Does not include back inspection

SLR and Lasague maneuver should be done

Test the sensation (Dermatomes)

Test muscle power (Mainly EHL)

Test Reflexes
SLR : Straight Leg Raising Test
SLR: 0-80 degrees
Lasague Maneuver
Sensory Testing : Dermatomes
Sensory Testing : Dermatomes
Clinical Picture L4 Root Lesion
L4 Neurological Signs
Clinical Picture : L5 Root Lesion
L 5 Neurological Signs
S 1 Neurologic Level
Clinical Picture : S 1 Root Lesion
L4 & L5 Lesions
L5 & S1 Lesions
Investigations in Back Examination
Plain X rays: AP, Lateral, Oblique, Cone
View &Tomograms
 Blood Tests: CBC, ESR, Bone Biochemistry
 Ct scan
 Myelogram, Radiculogram
 MRI
 Biopsy (CT guided or Cannulated trocar
under fluoroscopy)

Plain X Ray : AP & Lateral
Plain X Ray : Oblique 45 degrees
Terry Dog & Scotty Dog appearance
Scotty dog appearance
Myelogram & radiculogram
Radiculogram Left L5 Root
Compression
C T Scan :(Spondylolysis)=Defect in
Pars Interarticularis
C T : Intervertebral Disc Protrusion
CT Myelogram
MRI Lumbar Spine
Isotope Bone Scan (Tc99m)
Closed Vertebral Biopsy
Closed vertebral biopsy
Closed Vertebral biopsy
Muscle Power Evaluation

Certain muscles at lower or upper limbs

We test Muscle Power NOT range of joint
movements!

We give result by 0 - 5
Hip Flexion : Iliopsoas Muscle
Iliopsoas Muscle power Test
Hip Adductor muscles( Obturator N)
Hip Adductors Test
Quadriceps Muscle (Femoral Nerve)
Quadriceps Muscle Test
Tibialis Anterior Test
Psychological Aspects in Back Exam