Diseases of the Spinal Cord and Nerve Roots (Surgical) Flashcards
Which tissues do you penetrate during a lumbar puncture?
Supraspoinous ligament
Interspinal ligament
Ligamentum flavum
Posterior longitudinal ligament
Where does spinal cord compression stop?
Can’t happen below the level of the spinal cord (L1/L2)
Where on the body is dermatomes
C5
C6
C7
C8
L3
L4
L5
S1?
L4 - knee and medial malleolus
What spinal level are elbow flexors?
C5
What level are Elbow extensors?
C7
What level are wrist extensors?
C5
What level are Finger extensors?
C8
What level are intrinsic muscles of the hand?
T1
What level are ankle dorsiflexors / plantarflexors?
Dorsiflexors - L4
Plantar flexors - S1
What level are hip flexors?
L2
What level are knee extensors?
L3
What level are long toe extensors?
L5
What are the spinal levels of the biceps, supinator and the triceps reflex?
Biceps - C5/C6
Supinator - C6
Triceps - C7
What are the spinal levels for reflexes for knee and ankle?
Knee - L3/L4
Ankle - S1
State wether the following are absent / present or increased/decreased in UMN/LMN lesions
What are the features of a C6 spinal cord lesion?
Weakness in the elbow below sensory level at C6
Increased tone in legs
Brisk reflexes
Babinski positive
What is myelopathy?
Neurological defecit due to compression of spinal cord
Myelopathy is UMNL
What is the definition of clonus?
Clonus is 5 beats or more for it to be positive – upper motor neurone response
What are the features of L4 nerve root lesion?
Pain down ipsilateral leg
Numbness in L4 dermatome
Weakness in ankle dorsiflexion
Reduced knee jerk
What is meant by radiculopathy?
Compression of nerve root leading to dermatomal and myotomal defecits
What are the main types of aetiology associated with spinal pathology?
Degenerative
Tumour
Infection
Trauma
Congenital
Differentiated by history examination and investigations
What is disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
Who is normally affected by disc prolapse?
Younger patients
Describe the onset of pain in disc prolapse?
Tends to be acute onset pain
What is central cervical disc prolapse konwn as?
Cervical myelopathy
What is lateral cervical disc prolapse known as?
Cervical radiculopathy
What is central lumbar disk prolapse known as?
Cauda equina syndrome
What is lateral disk prolapse known as?
Lumbar radiculopathy
Describe the pain in sciatica?
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
What are the symptoms of disc prolapse?
Acute pain down leg / arm
Numbness and weakness in distribution of nerve root involved
What is the investigation for disc prolapse?
MRi
What is the management of disc prolapse?
Rehabilitation
Nerve root inject - injection of steroids around nerve root, lasts a week or two
Lumbar / cervical discectomy
What are the red flag symptoms for cauda equina syndrome?
Bilateral sciatica
Saddle anaesthesia
Urinary dysfunction - incontinence, altered retention, altered sensation
How is the diagnosis of cauda equina syndrome achieved?
Clinico - radiological diagnosis
MEDICAL EMERGENCY - REQUIRES URGENT MRI
REQUIRES EMERGENCY LUMBAR DISCECTOMY
What causes degenerative loss of normal spinal structure?
Disc prolapse
Ligamentum hypertrophy
Osteophyte formation
What is meant by cervical spondylosis?
Umberella term for degenerative change in cervical spine leading to spine and nerve root compression (myelopathy or radiculopathy or both)
What is the speed of onset for cervical spondylosis?
Months to years
What is the management of cervical spondylosis?
–Conservative if no/mild myelopathy
–Surgery for progressive moderate to severe myelopathy
–Anterior and posterior approaches
What are the features of lumbar spinal stenosis?
Pain down both legs ‘spinal claudication’
Worse on walking / standing and releived by sitting or bending forward
What is the management of lumbar spinal stenosis?
Lumbar laminectomy
What are the names of extradural spinal tumours?
Metastases
Primary bone tumours (chrodomas, osteoblastomas, osteiud osteoma)
What are the most likely cancers to metastasise to the spinal cord?
Lung, prostate and breast
What are the intradural tumours?
Meningioma
Neurofibroma
Lipoma
What are the intramedullary tumours?
Astrocytoma
Ependymoma
Teratoma
Haemangioblastoma
What are the features of malignant cord compression?
Patient presents with pain, weakness and sphincter disturbance
If someone with known cancer develops back pain, what is the first line investigation?
Urgent MRI
What is the management of malignant cord compression?
Surgical decompression and radiotherapy
What are the common spinal infections?
Osteomyelitis
Discitis
Epidural abscess
What is osteomyelitis?
Infection within vertebral body
What is discitis?
Infection of the intervertebral disc
What is epidural abscess?
Infection of the epidural space
What is the triad for epidural abscess that indicates the need for an urgent MRI?
Back pain
Pyrexia
Focal neurology
(Treatment for epidural abscess is laminectomy and long term IV antibiotics)
What are risk factors for epidural abscess?
IV drug abuse
Diabetes
Chronic renal failure
Alcoholism
What organisms are responsible for epidural abscess?
•staph aureus, streptococcus, e coli
What are the risk factors for oseomyelitis?
IV drug abuse
Diabetes
Chronic renal failure
ALcoholism
AIDS
What is management of osteomyelitits?
Antibiotics
Surgery if evidence of neurology
