Diseases of Spinal Cord and Roots (Surgical)

Question 1

Describe the clinical features of upper motor neuron lesions.

Answer 1

• No muscle wasting
• Hyperreflexia, hypertonia

Pyramidal pattern of weakness;

• Decreased control of active movement
• Spasticity (in stronger muscle groups: arm flexors, leg extensors)
• ‘Clasp-knife’ response (faster movement, higher resistance)

Question 2

Describe the clinical features of lower motor neuron lesions.

Answer 2

• Muscle wasting
• Flaccidity
• Hyporeflexia, hypotonia
• Weakness
• Fasciculations

Question 3

Describe a disc prolapse.

Answer 3

Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord.

Question 4

Describe the clinical presentation of a disc prolapse.

Answer 4

• Younger patients
• Acute onset pain down limb
• Numbness/weakness in distribution of nerve root involved

(Central lumbar = cauda equina syndrome.)

Question 5

Describe the investigation and management of a disc prolapse.

Answer 5

• MRI
• Rehabilitation
• Nerve root injection
• Lumbar/cervical discectomy

Question 6

Describe the red flags, investigation and treatment of cauda equina syndrome.

Answer 6

• Bilateral sciatica
• Saddle anaesthesia
• Urinary dysfunction
• Urgent MRI
• Emergency lumbar discectomy

Question 7

Describe degenerative spinal disease and its causes.

Answer 7

Loss of normal spinal structure.

Seen in older patients.

Product of;
- Disc prolapse
- Ligamentum hypertrophy
- Osteophyte formation
All lead to myelopathy/radiculopathy.

Question 8

Give a brief overview of cervical spondylosis.

Answer 8

• Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
• Patient can present with either myelopathy and/or radiculopathy
• Onset is usually months to years

Question 9

Describe the management of cervical spondylosis.

Answer 9

• Conservative if no/mild myelopathy
• Surgery for progressive moderate/severe myelopathy
• Anterior and posterior approaches

Question 10

Describe lumbar spinal stenosis.

Answer 10

• Pain down both legs: ‘spinal claudication’
• Worse on walking/standing and relieved by sitting or bending forward
• Manage with lumbar laminectomy

Question 11

Describe the prevalence of spinal tumour types.

Answer 11

55% extradural;

• Metastases: lung, breast, prostate
• Primary bone tumours: chrodomas, osteoblastomas, osteoid osteoma

40% intradural;

• Meningioma
• Neurofibroma
• Lipoma

5% intramedullary;

• Astrocytoma
• Ependymoma
• Teratoma
• Haemangioblastoma

Question 12

Describe the presentation, investigation and management of malignant cord compression.

Answer 12

• Pain, weakness, sphincter disturbance
• If known cancer, urgent MRI if back pain present
• Surgical decompression
• Radiotherapy

Question 13

Define osteomyelitis.

Answer 13

Infection within vertebral body.

Question 14

Define discitis.

Answer 14

Infection of intervertebral disc.

Question 15

Define epidural abscess.

Answer 15

Infection of epidural space.

Question 16

Epidural abscess: a patient should get an urgent MRI if they present with a triad of what symptoms?

Answer 16

• Back pain
• Pyrexia
• Focal neurology

Question 17

Describe the risk factors of epidural abscess.

Answer 17

• IV drug abuse
• Diabetes
• Chronic renal failure
• Alcoholism

Question 18

What organisms usually cause an epidural abscess?

Answer 18

• Staph. aureus
• Streptococcus
• E. coli

Question 19

Describe the management of an epidural abscess.

Answer 19

• Urgent surgical decompression

- Long term IV antibiotics.

Question 20

Describe the risk factors of osteomyelitis

Answer 20

• IV drug abuse
• Diabetes
• Chronic renal failure
• Alcoholism
  (Same as epidural abscess plus)
• AIDS

Question 21

Describe the management of osteomyelitis.

Answer 21

• Antibiotics

- Surgery if neurology affected