SPINE DEFORMITIES

Deformities of the spine are of four types: scoliosis (lateral curvature of the spine), lordosis (lumbar concavity of the spine), kyphosis (thoracic convexity of the spine or “hunchback”), and kyphoscoliosis (curvature with a “hunchback”). The differential diagnosis of all of these is essentially the same and may be best recalled by the mnemonic VINDICATE.

V—Vascular disorders suggest a large aortic aneurysm that may damage the vertebrae by compression, but this category is used with the prime purpose of recalling the spinal deformities associated with various congenital heart diseases (e.g., tetralogy of Fallot). I—Inflammatory disorders recall osteomyelitis and tuberculosis of the spine; one should also remember infectious diseases of the nervous system such as poliomyelitis. N—Neoplasms include metastatic tumors, myeloma, Hodgkin lymphoma, and primary tumors of the spinal cord. D—Degenerative and deficiency diseases include degenerative disk disease, osteoarthritis, and spondylosis along the spine. In this category should be mentioned the kyphosis associated with pulmonary emphysema and fibrosis. Vitamin D deficiency will cause kyphoscoliosis. I—Intoxication includes kyphosis associated with pneumoconiosis and osteoporosis from menopause or long-term corticosteroid therapy. C—Congenital disorders are perhaps the largest category, including congenital scoliosis, kyphoscoliosis, Hurler disease, hemivertebra, muscular dystrophy, Friedreich ataxia, achondroplasia, and spondylolisthesis. A—Autoimmune disease suggests rheumatoid spondylitis with the characteristic “poker spine.” T—Trauma indicates fractures, ruptured discs, and spinal cord injuries, all of which may leave a residual deformity of the spine. E—Endocrine diseases remind one of the kyphosis associated with menopausal osteoporosis and osteomalacia of hyperparathyroidism. Acromegaly may also cause a kyphosis from the osteoarthritis and osteoporosis.

Approach to the Diagnosis

Obviously, a good family history and a thorough physical and neurologic examination are essential. The busy physician who does not have the time to perform a neurologic examination should refer the patient to a neurologist or orthopedist. A spine x-ray will often reveal the lesion, but a bone scan or CT scan and bone biopsy may be necessary. The bone scan has become especially useful in diagnosing early rheumatoid spondylitis.

Other Useful Tests

1. CBC (osteomyelitis)
2. Chemistry panel (Paget disease)
3. Tuberculin test (tuberculosis of the spine)
4. Urine for mucopolysaccharides (Hurler disease)
5. HLA-B27 typing (rheumatoid spondylitis)
6. Urine creatinine and creatine levels (muscular dystrophy)
7. Serum protein electrophoresis (multiple myeloma)
8. Serum growth hormone assay (acromegaly)
9. Pulmonary function tests (emphysema)
10. Urine for homogentisic acid (ochronosis)

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

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