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Spine examination

Suitably undressed, usually down to underwear. Start with the patient standing, then lying prone and finally lying supine.



  • Scars: previous surgery
  • Lumps: abscess, tumour (e.g. sacral lipoma), prominent paravertebral muscle spasm
  • Sinuses: deep infection
  • Cafe au lait spots / nodules: Neurofibromatosis
  • Hairy patch (spinal dysraphism)
  • Mongolian blue spot (more common in Asians: no clinical significance)
  • Low hairline due to short neck: Klippel-Feil syndeome: fusion or absence of cervical vertebrae; may be associated with Sprengel shoulder (undescended scapula)
  • Down / Morquio syndromes: Atlanto-axial instability
  • Asymmetry of shoulder height / trunk balance / loin crease: scoliosis (lateral curvature with rotational deformity of vertebral bodies)
  • Leg length discrepancy (check level of iliac crests)
  • If patient consistently stands with one knee bent in spite of equal leg lengths, this may indicate nerve root tension, as knee flexion relieves the pull on the nerve root(s)
  • Lateral deviation of spine (known as 'list' or 'tilt'): may be a sign of prolapsed intervertebral disc causing nerve root ompression
  • Associated anomalies of hands/feet, e.g. syndactyly, pes cavus: may be part of a syndrome
  • Kyphosis and lordosis (best assessed from side): may be exaggerated or reduced
  • Round backing / hunched shoulders: Schuermanns disease/kyphosis
  • Gibbus (aka kyphos): acute angular deformity with bony prominence, e.g. tuberculous vertebral collapse
  • Observe gait


  • Tenderness: may be bony, intervertebral or paravertebral
  • Bony prominence or steps

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