Spinal Dysfunction

INTRODUCTION

Spinal or vertebral dysfunction can be regarded as a masquerade mainly because the importance of the spine as a source of various pain syndromes has not been emphasised in medical training.

If a patient has pain anywhere it is possible that it could be spondylogenic and practitioners should always keep this in mind.

CERVICAL SPINAL DYSFUNCTION

If the cervical spine is overlooked as a source of pain (such as in the head, shoulder, arm, upper chest—anterior and posterior—and around the ear or face) the cause of the symptoms will remain masked and mismanagement will follow.

THORACIC SPINAL DYSFUNCTION

The most common and difficult masquerades related to spinal dysfunction occur with disorders of the thoracic spine (and also the low cervical spine), which can cause vague aches and pains in the chest, incl. the anterior chest.

Such referred pain can mimic symptoms of visceral disease such as angina and biliary colic.

LUMBAR SPINAL DYSFUNCTION

The association between lumbar dysfunction and pain syndromes is generally easier to correlate. The pain is usually located in the low back and referred to the buttocks or the backs of the lower limbs. Problems arise with referred pain to the pelvic area, groin and anterior aspects of the leg.

Typical examples of referral and radicular pain patterns from various segments of the spine are presented in Figure S2.

SPLENECTOMY PATIENTS

Main indications: ITP, hypersplenism, trauma, Hodgkin/non-Hodgkin lymphoma, haemolytic anaemia. Thrombocytosis is the immediate problem, but overwhelming infection is the life-long risk in asplenic and hyposplenic patients, esp. from S. pneumoniae, H. influenzae and N. meningitidis.

Prophylaxis

• Education about risks and infections, esp. malaria

• Pneumococcal and meningococcal vaccines: depend on age, refer to immunisation guidelines

• Haemophilus influenzae type b (once only if not immunised—2 wks prior to splenectomy)

• Influenza vaccine—annual after first doses 2 wks prior to splenectomy

• Long-term penicillin may be indicated: amoxicillin daily or phenoxymethyl penicillin bd; if sensitive, roxithromycin or erythromycin daily

• Urgent hospital admission if infection develops (refer: immunisation guidelines). Resource: Victorian Spleen Service, www.spleen.org.au