Spinal examination

Follow the scheme below:

• Inspection
• Palpation 
• Measurement 
• Movement

Before starting

• Introduce yourself
• Ask permission to perform examination
• Explain what the examination entails
• Expose the patient appropriately - the patient should undress to their undergarments including the lower limbs.  
• Tell the patient to let you know if anything you do is uncomfortable
• Remember - always watch the patients face 

Inspection

• General observation
  • Does the patient look well?
  • Assess the patient's posture - any obvious conditions?

Patient Standing

Remember to inspect from all sides (front, laterally and from behind):

• Skin
  • Scars (surgical scars)
  • Sinuses (deep infection)
  • Unusual skin creases
  • Pigmentation
    • Cafe au lait spots (Neurofibromatosis)
    • Hairy patch (spinal dysraphism)
    • Mongolian Blue spot (no clinical significance - more common in asians)
• Spine
  • Kyphosis (exaggerated or reduced)
  • Lumbar lordosis (exaggerated or reduced)
  • Scoliosis (asymmetry of shoulder height / trunk balance / loin crease)
  • List ( may be sign of prolapsed intervetrbral disc causing nerve root irritation)
• Asymmetry of the pelvis (leg length discrepancy)
• Any chest deformity

The wall test will mask even small fixed flexion deformities: Ask the patient to stand with the back straight against a wall. Observe whether the following are in contact with the wall:

• Occiput
• Shoulders
• Buttocks
• Heels

Patient Walking

• Observe the gait

Palpation