Back Pathologies

Question 1

What are the red flags for cauda equina syndrome?

Red flags for malignancy in spine?

Answer 1

• loss of perianal sensation
• saddle anasthesia
• urinary and bowel incontinence

Unrelenting pain that wakes up patients in night
Unintended weight loss etc.

Question 2

What investigation increases pain in sciatica?

Answer 2

Straight leg raise

Question 3

What is the pattern of sensory and motor loss that will occur in Brown-Sequard syndrome (cord hemisection)?

Explain why it occurs.

Answer 3

Motor - ipsilateral loss (corticospinal)

Sensory
ipsilateral - loss of vibration, deep touch and proprioception (dorsal column)
contralateral - loss of pain, temperature and light touch (spinothalamic)

Question 4

When trying to work out if vertebral collapse is caused by malignancy or infection what is a good guide when looking at Xray/CT?

Answer 4

Bone destroyed but disc intact - malignancy

Disc destroyed but bone intact - infection

Question 5

What impact does central cord syndrome tend to have?

How does it tend to occur?

Answer 5

Distal upper limb weakness

Hyperflexion/extension to ALREADY stenotic neck

Question 6

What drug can be used in cord compression caused by metastatic tumour?

Answer 6

Dexamethosone

Question 7

Spinal cord haemorrhage is a medical emergency. How should it be managed?

Answer 7

Decompression immediately

spine is pretty good at managing chronic compression but haemorrhage is so acute cord doesn’t have time to compensate