Diseases of Spinal Cord and Nerve Roots (Surgical) Flashcards
Features of upper motor neurone lesions
Muscle weakness – pyramidal weakness in the extensors of upper limbs or flexors of lower limbs
Decreased control of active movement
Spasticity
Clasp-knife response
Babinski sign – big toe extended rather than flexed on stimulation of sole of foot
Increased deep tendon reflex
Pronator drift
Features of lower motor neurone lesions
Muscle paresis/paralysis
Fibrillations
Fasciculations – caused by increased receptor concentration on muscles to compensate for lack of innervation
Hypotonia/atonia
Hyporeflexia
Strength not affected – weakness limited to segmental or focal pattern
Muscle wasting in end-stage
Upper motor features of spinal cord compression
Weakness Increased tone Increased reflexes Upgoing plantar repsonse Clonus
Lower motor features of peripheral nerve root compression
Wasting of muscle Fasciculation Weakness Decreased tone Decreased reflexes Plantar response decreased or absent
What is myelopathy?
Non-specific description of a pathology in the spinal cord
What is myelitis?
Inflammatory pathology in the spinal cord
Medical causes of myelopathy/myelitis
Demyelination Ischaemic Transverse myelitis Metabolic e.g. B12 deficiency Neurodegenerative Malignancy/infiltration Infective Inflammatory
Surgical causes of myelopathy/myelitis
Degenerative
Tumour
Vascular abnormality
Trauma
What is radiculopathy?
Pathology in the nerve rood
What is radiculitis?
Nerve root inflammation
Causes of spinal cord ishchaemia
Atheromatous disease Thromboembolic disease Arterial dissection Systemic hypotension Thrombotic haematological disease Hyperviscosity syndromes Vasculitis Venous occlusion Endovascular procedures Decompression sickness Meningovascular syphilis
Presentation of spinal cord stroke
Sudden or progressive onset Back/radicular pain Visceral referred pain Weakness - paraparesis Numbness and parasthesia Urinary retention Bladder and bowel incontinence
Spinal stroke treatment
Supportive Reduce risk of recurrence Occupational therapy Physiotherapy Manage vascular risk factors
What is spondylosis?
Degenerative changes in the spine e.g. degenerative intervertebral disc disease
Can occur in cervical, thoracic or lumbar spine
Causes of spondylosis
Ageing
Investigation of spondylosis
X-rays
MRI
CT
Treatment of spondylosis
Chronic condition Surgical treatment controversial Spinal decompression surgery Physical therapy and analgesia Steroids
Presentation of prolapsed intervertebral disc
Numbness, tingling, weakness
Pain in shoulder, neck, arm, hand
Pain down the back of each leg from the bottom to the knee
Pain with movement, straining and coughing
Difficulty controlling bladder and bowel
Investigations of prolapsed disc
History Examination X-ray CT MRI
Treatment of prolapsed disc
Rest/limited activity Ice/cold packs, then heat packs Physical therapy Exercise Anti-inflammatories Steroids Gabapentin
Spinal tumour presentation
Dependent on site Back pain, sometimes radiating to other parts of the body Loss of sensation Difficulty walking Decreased sensitivity Loss of bladder/bowel function Muscle weakness
Risk factors for spinal tumour
Neurofibromatosis type 2
Von Hippel-Lindau disease
PMH of cancer
Investigations for spinal tumour
Spinal MRI
CT
Biopsy
Treatment of spinal tumour
Remove tumour completely, if possible Monitoring Surgery Radiation therapy Stereotactic radiosurgery Chemotherapy Corticosteroids
Cause of osteomyelitis
Most commonly staphylococcus aureus
Chronic conditions e.g. diabetes may increase risk
Risk factors for osteomyelitis
Diabetes Sickle cell disease HIV/AIDS Rheumatoid arthritis IV drug abus Alcoholism Long-term use of steroids Haemodialysis Poor blood supply Recent injury Bone surgery
Symptoms of osteomyelitis
Fever, irritability, fatigue Nausea Tenderness, redness and warmth in area of infection Swelling around the affected bone Loss of range of motion Severe back pain if in the vertebrae
Treatment of osteomyelitis
X-ray, bloods, MRI, bone biopsy
Antibiotics
Surgery
Combination therapy
Causes of epidural abscess
Direct extension of local infection e.g. vertebral osteomyelitis, psoas abscess
Haematogenous seeding
Invasive procedures/instrumentation
Risk factors for epidural abscess
Diabetes mellitus Spinal trauma Surgery IV drug abuse Alcoholism Renal insufficiency Immunosuppression Pregnancy Spinal/epidural anaesthesia or injection
Presentation of spinal abscess
Localised spinal pain Radicular pain Parasthesia Muscle weakness Sensory loss Sphincter dysfunction Paralysis Back strain/mild injury
Symptoms of spinal abscess
Fever Localised back pain Radiculopathy with radiating/lancinating pain Chest/abdominal pain Spinal cord syndromes Central cord syndrome Paraparesis Paraplegia Sphincter dysfunction Headache and neck pain
Treatment of spinal abscess
Surgical decompression and drainage
Antibiotics
CT-directed needle aspiration
Causes of Cauda Equina syndrome
Herniation of spinal disc into lumbar area pressing on the nerves
Stenosis of spinal canal
Spinal lesion/tumour
Spinal inflammation, infection, haemorrhage or fracture
Complication from severe lumbar spine injury
Birth defect
Symptoms of cauda equina syndrome
Severe lower back pain
Pain, numbness, weakness in one/both legs – causes stumbling, difficulty getting up from a chair
Loss of/altered sensations in legs, bottom, inner thighs, back of legs or feet – severe and worsening (saddle anaesthesia)
Loss of bladder/bowel control
Sexual dysfunction – come on suddenly
Investigations for cauda equina syndrome
Full history and examination
MRI
Myelogram
CT
Treatment of cauda equina syndrome
Relieve pressure on nerves
Surgery within 48 hours
Corticosteroids
Antibiotics if infection present
