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MBChB - Y2 - Systems - Nervous System > Diseases of the Spinal Cord and Nerve Roots (Surgical) > Flashcards

Diseases of the Spinal Cord and Nerve Roots (Surgical) Flashcards

1
Q

Which tissues do you penetrate during a lumbar puncture?

A

Supraspoinous ligament

Interspinal ligament

Ligamentum flavum

Posterior longitudinal ligament

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2
Q

Where does spinal cord compression stop?

A

Can’t happen below the level of the spinal cord (L1/L2)

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3
Q

Where on the body is dermatomes

C5

C6

C7

C8

L3

L4

L5

S1?

A

L4 - knee and medial malleolus

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4
Q

What spinal level are elbow flexors?

A

C5

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5
Q

What level are Elbow extensors?

A

C7

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6
Q

What level are wrist extensors?

A

C5

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7
Q

What level are Finger extensors?

A

C8

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8
Q

What level are intrinsic muscles of the hand?

A

T1

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9
Q

What level are ankle dorsiflexors / plantarflexors?

A

Dorsiflexors - L4

Plantar flexors - S1

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10
Q

What level are hip flexors?

A

L2

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11
Q

What level are knee extensors?

A

L3

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12
Q

What level are long toe extensors?

A

L5

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13
Q

What are the spinal levels of the biceps, supinator and the triceps reflex?

A

Biceps - C5/C6

Supinator - C6

Triceps - C7

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14
Q

What are the spinal levels for reflexes for knee and ankle?

A

Knee - L3/L4

Ankle - S1

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15
Q

State wether the following are absent / present or increased/decreased in UMN/LMN lesions

A
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16
Q

What are the features of a C6 spinal cord lesion?

A

Weakness in the elbow below sensory level at C6

Increased tone in legs

Brisk reflexes

Babinski positive

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17
Q

What is myelopathy?

A

Neurological defecit due to compression of spinal cord

Myelopathy is UMNL

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18
Q

What is the definition of clonus?

A

Clonus is 5 beats or more for it to be positive – upper motor neurone response

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19
Q

What are the features of L4 nerve root lesion?

A

Pain down ipsilateral leg

Numbness in L4 dermatome

Weakness in ankle dorsiflexion

Reduced knee jerk

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20
Q

What is meant by radiculopathy?

A

Compression of nerve root leading to dermatomal and myotomal defecits

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21
Q

What are the main types of aetiology associated with spinal pathology?

A

Degenerative

Tumour

Infection

Trauma

Congenital

Differentiated by history examination and investigations

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22
Q

What is disc prolapse?

A

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

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23
Q

Who is normally affected by disc prolapse?

A

Younger patients

24
Q

Describe the onset of pain in disc prolapse?

A

Tends to be acute onset pain

25
Q

What is central cervical disc prolapse konwn as?

A

Cervical myelopathy

26
Q

What is lateral cervical disc prolapse known as?

A

Cervical radiculopathy

27
Q

What is central lumbar disk prolapse known as?

A

Cauda equina syndrome

28
Q

What is lateral disk prolapse known as?

A

Lumbar radiculopathy

29
Q

Describe the pain in sciatica?

A

Pain goes all the way down to the ankle

Sciatica - pain affecting the back, hip, and outer side of the leg, caused by compression of a spinal nerve root in the lower back, often owing to degeneration of an intervertebral disc.

Cervical radiculoapthy – shooting pain right down into the hands

30
Q

What are the symptoms of disc prolapse?

A

Acute pain down leg / arm

Numbness and weakness in distribution of nerve root involved

31
Q

What is the investigation for disc prolapse?

A

MRi

32
Q

What is the management of disc prolapse?

A

Rehabilitation

Nerve root inject - injection of steroids around nerve root, lasts a week or two

Lumbar / cervical discectomy

33
Q

What are the red flag symptoms for cauda equina syndrome?

A

Bilateral sciatica

Saddle anaesthesia

Urinary dysfunction - incontinence, altered retention, altered sensation

34
Q

How is the diagnosis of cauda equina syndrome achieved?

A

Clinico - radiological diagnosis

MEDICAL EMERGENCY - REQUIRES URGENT MRI

REQUIRES EMERGENCY LUMBAR DISCECTOMY

35
Q

What causes degenerative loss of normal spinal structure?

A

Disc prolapse

Ligamentum hypertrophy

Osteophyte formation

36
Q

What is meant by cervical spondylosis?

A

Umberella term for degenerative change in cervical spine leading to spine and nerve root compression (myelopathy or radiculopathy or both)

37
Q

What is the speed of onset for cervical spondylosis?

A

Months to years

38
Q

What is the management of cervical spondylosis?

A

–Conservative if no/mild myelopathy

–Surgery for progressive moderate to severe myelopathy

–Anterior and posterior approaches

39
Q

What are the features of lumbar spinal stenosis?

A

Pain down both legs ‘spinal claudication’

Worse on walking / standing and releived by sitting or bending forward

40
Q

What is the management of lumbar spinal stenosis?

A

Lumbar laminectomy

41
Q

What are the names of extradural spinal tumours?

A

Metastases

Primary bone tumours (chrodomas, osteoblastomas, osteiud osteoma)

42
Q

What are the most likely cancers to metastasise to the spinal cord?

A

Lung, prostate and breast

43
Q

What are the intradural tumours?

A

Meningioma

Neurofibroma

Lipoma

44
Q

What are the intramedullary tumours?

A

Astrocytoma

Ependymoma

Teratoma

Haemangioblastoma

45
Q

What are the features of malignant cord compression?

A

Patient presents with pain, weakness and sphincter disturbance

46
Q

If someone with known cancer develops back pain, what is the first line investigation?

A

Urgent MRI

47
Q

What is the management of malignant cord compression?

A

Surgical decompression and radiotherapy

48
Q

What are the common spinal infections?

A

Osteomyelitis

Discitis

Epidural abscess

49
Q

What is osteomyelitis?

A

Infection within vertebral body

50
Q

What is discitis?

A

Infection of the intervertebral disc

51
Q

What is epidural abscess?

A

Infection of the epidural space

52
Q

What is the triad for epidural abscess that indicates the need for an urgent MRI?

A

Back pain

Pyrexia

Focal neurology

(Treatment for epidural abscess is laminectomy and long term IV antibiotics)

53
Q

What are risk factors for epidural abscess?

A

IV drug abuse

Diabetes

Chronic renal failure

Alcoholism

54
Q

What organisms are responsible for epidural abscess?

A

•staph aureus, streptococcus, e coli

55
Q

What are the risk factors for oseomyelitis?

A

IV drug abuse

Diabetes

Chronic renal failure

ALcoholism

AIDS

56
Q

What is management of osteomyelitits?

A

Antibiotics

Surgery if evidence of neurology

57
Q
A

MBChB - Y2 - Systems - Nervous System (48 decks)

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