Diseases of Spinal Cord/Nerve Roots (Surgical) Flashcards
What are the specific upper and lower motor neuron signs?
UMN:
- Hypereflexia
- Spastic Weakness
- Increased Tone
- Babinski’s sign (Plantar extension)
- Clonus
LMN:
- Hyporeflexia
- Weakness
- Fasciculations
- Decreased Tone
- Atrophy
If someone has the following symptoms where is the lesion?
- Weakness in elbow & below
- Sensory level at C6
- Increased tone in legs
- Brisk reflexes
- Babinski & Hoffmans +ve
- Clonus
Lesion in the spinal cord at C6
If someone has the following symptoms where is the lesion?
- Pain in right leg
- Numbess in the right L4 dermatome
- Weakness in right ankle dorsiflexion
- Reduced right Knee Jerk Reflex
Radiculopathy at L4
What conditions are in this deck?
- Cauda Equina Syndrome
- Herniated Disc
- Spinal Cord Tumours
- Degenerative (Cervical Spondylosis & Lumbar spinal stenosis)
- Spinal Infections (Osteomyelitis, Discitis & Epidural abscess)
What is a herniated disc?
The nucleus pulposes of the disc herniates out through the annulos fibrosus medially (compressing the cord) or laterally (compressing the nerve roots)
How do we manage a herniated disc?
Conservatively with analgesia and rehabilitation
Or invasively with anaesthetic nerve root injection or a discectomy
What would a centrally herniated lumbar disc cause?
Cauda equina syndrome
How do we diagnose cauda equina syndrome?
By its specific clinical presentation AND radiology
Whats the typical presentation of Cauda Equina Syndrome?
- Bilateral Sciatica
- Saddle Anaesthesia (No feeling in their but)
- Urinary Dysfunction (Retention, incontinence or altered urge)
How do we manage Cauda Equina Syndrome?
Since its due to a prolapsed disc:
- Emergency Lumbar Discectomy
What age get prolapsed discs vs degerenative disorders?
Prolapsed discs affect young males most and are acute onset
Degenerative spinal disorders generally affect the elderly and are slow onset
How does a degenerative spinal disorder develop?
Through osteophyte formation
Ligament hypertrophy
Disc Prolapse
What are the two main types of degenerative spinal disorders?
Cervical Spondylosis:
Degenerative changes in the cervical spinal cord leading to cord/nerve root compression
Lumbar spinal stenosis:
Stenosis leading to compression of the spinal cord/cauda equina
How does lumbar spinal stenosis present?
Pain down both legs which worsens when walking/standing (spinal Claudication)
Its relieved when sitting/bending forward as it opens up the spine
How do we treat cervical spondylosis?
A radiculopathy can be managed conservatively or with elective surgery
A progressive or severe myelopathy requires urgent surgery
How do we manages Lumbar spinal stenosis?
Lumbar laminectomy
Cuts open the lamina of the vertebrae to open up the column reducing the effects of stenosis
What types of tumour commonly metastasise to the spinal cord?
Lung breast and prostate
What are the types of spinal cord tumour?
Extradural (primary and metastatic)
Intradural (meningioma, lipoma & neurofibroma)
Intramedullary (Astrocytoma, ependymoma, teratoma & haemangioblastoma)
How do you spot a malignant cord compression?
Back pain (particularly thoracic), weakness and sphincter disturbance
Should look out for these things in anyone with lung, breast or prostate cancer.
How do approach a malignant cord compression?
If you spot the symptoms and you know they have cancer do an urgent MRI
Then surgical decompression and radiotherapy
What are the risk factors for spinal cord infections?
- IV drug abuse
- Diabetes
- chronic renal failure
- Alcoholism
- AIDs (osteomyelitis)
How do we manage osteomyelitis
Its an infection in the vertebral body so antibiotics
If its causing neuro symptoms then surgical intervention
How would an epidural abscess present?
- Back pain from compression of the cord
- Focal neuro symptoms
- Pyrexia
What organisms cause epidural abscesses?
Staph aureus
Streptococcus
E. Coli
How do manage an epidural abscess?
Emergency MRI when someone presents with that combo of symptoms
Urgent surgical decompression and long-term IV Abx
