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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 33

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 33. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 302 Section Patient Assessment Several clinical tests can be applied to distinguish between these disorders. In polyneuropathy the most specific finding is a pattern of loss of reflexes and sensory deficit in a distal and sock like distribution below the knee and or in the area covered by socks of impaired light touch sensation and reduction of proprioception. The latter is clinically tested by passively moving the foot or toes up and down and asking the blindfolded patient to describe the direction of movement. The impairment of dorsal column function is clinically tested by Romberg s test. This test is named after the German neurologist Moritz Heinrich Romberg 1795-1873 . Romberg s test is performed in two stages First the patient stands with feet together eyes open and hands by the sides. Second the patient closes the eyes while the examiner observes for a full minute. Romberg s test is not a test of cerebellar function Unterberger stest identifies labyrinth dysfunction Because the examiner is trying to elicit whether the patient falls when the eyes are closed it is advisable to stand ready to catch the falling patient. For large patients a strong assistant is recommended. Romberg s test is positive if and only if the following two conditions are both met The patient can stand with the eyes open and The patient falls when the eyes are closed. The test is not positive if either The patient falls when the eyes are open or The patient sways but does not fall when the eyes are closed. Maintaining balance while standing in the stationary position relies on intact sensory pathways sensorimotor integration centers and motor pathways. The main sensory inputs are joint position sense proprioception carried in the dorsal columns of the spinal cord vision Crucially the brain can obtain sufficient information to maintain balance if either the visual or the proprioceptive inputs are intact. Sensorimotor integration is carried out by the cerebellum. The first stage of the .