Spinal

Systematic spinal examination combines provocative maneuvers with neurological testing to differentiate radiculopathy, myelopathy, and mechanical back pain. Key examination techniques: (1) Straight Leg Raise (SLR/Lasègue test): patient supine, hip flexed with knee extended. Positive: reproduction of radicular pain (shooting pain below knee in dermatomal distribution) at 30-70° of hip flexion. Mechanism: stretches the L4-S1 nerve roots, reproducing symptoms if a herniated disc is compressing these roots. Sensitivity 91% for L4-S1 disc herniation; specificity only 26%. Crossed SLR (raising the contralateral leg reproduces symptoms in the affected leg) has low sensitivity (29%) but HIGH specificity (88%) — strongly suggests disc herniation. (2) Spurling test: for cervical radiculopathy. Patient extends and laterally flexes the cervical spine toward the affected side while the examiner applies axial compression to the head. Positive: reproduction of radicular arm pain. Mechanism: axial loading narrows the neural foramen, compressing an already irritated nerve root. Sensitivity 50%, specificity 86%. (3) Schober test: measures lumbar flexion range of motion. Mark the lumbosacral junction (S1) and 10 cm above. Patient bends forward maximally. Normal: distance increases to ≥15 cm (≥5 cm...