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NEURO > Diseases of the spinal cord and nerve roots (surgical) > Flashcards

Diseases of the spinal cord and nerve roots (surgical) Flashcards

1
Q

what are the 4 sections of the spinal column

A

cervical
thoracic
lumbar
sacrum/coccyx

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2
Q

what are the vertebral ligaments

A 
anterior longitudinal
posterior longitudinal
ligamentum flavum 
interspinal ligament 
supraspinal ligament
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3
Q

where does the spinal cord extend from and to

A

from C1-L2

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4
Q

what is the end of the spinal cord called

A

conus medularis

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5
Q

what is the portion of spinal nerves that hang down from the conus medularis called

A

cauda equina

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6
Q

what are the UMN lesion signs

A

weakness
increased reflexes
increased tone
babinski sign

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7
Q

what are LMN lesion signs

A 
weakness
atrophy
decreased reflexes 
decreased tone
fasciculations
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8
Q

what are 4 aspects that can enable you to localise a lesion

A

pain
sensory
weakness
UMN vs LMN

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9
Q

what is myelopathy

A

UMN lesion

neurological deficit due to compression of spinal cord

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10
Q

EXAMPLE: what would be affected in C6 spinal cord lesion

A 
UMN
weakness in elbow below
sensory level at C6
increased tone in legs 
brisk reflexes
babinski +ve
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11
Q

what is radiculopathy

A

LMN lesion

compression of nerve root leading to dermatomal and myotomal deficits

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12
Q

EXAMPLES: what would be affected in L4 nerve root lesion

A 
LMN
pain down ipsilateral leg 
numbness in L4 dermatome
weakness in ankle dorsiflexion
reduced knee jerk
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13
Q

what can cause surgical spine and nerve root problems

A 
degeneration
tumour
infection
trauma
congential
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14
Q

how can a surgical spine problem be diagnosed

A

history
- pain, speed of onset, PMH

examination

investigations
- bloods, X-rays, CT, MRI

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15
Q

what is disc prolapse

A

acute herniation of an intervertebral disc causing compression of spinal roots or spinal cord

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16
Q

when does disc prolapse usually present

A

younger patients

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17
Q

what would disc prolapse in the central cervical region cause

A

cervical myelopathy

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18
Q

what would disc prolapse in the lateral cervical region cause

A

cervical radiculopathy

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19
Q

what would disc prolapse in the central lumbar region cause

A

cauda equina syndrome

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20
Q

what would disc prolapse in the lateral lumbar regions cause

A

lumbar radiculopathy

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21
Q

what is the presentation of disc prolapse

A

acute onset

pain down arm/leg

numbness and weakness in distribution of nerve root involved

22
Q

how would a disc prolapse be investigated

A

MRI

23
Q

what is the management of disc prolapse

A

rehabilitation
nerve root injection
lumbar/cervical discectomy

24
Q

what is cauda equina syndrome

A

compression of the cauda equina in the lumbar region

medical emergency

25
Q

what are the red flag symptoms of cauda equina syndrome

A

bilateral sciatics
saddle anaesthesia
urinary dysfucntion

26
Q

what is the investigation and management of cauda equina syndrome

A

urgent MRI

emergency lumbar discectomy

27
Q

what is degeneration

A

loss of normal spinal structure

seen in older patients

28
Q

what leads to degeneration of the spinal structures

A

product of:
disc prolapse
ligamentum hypertrophy
osteophyte formation

leads to myelopathy and radiculopathy

29
Q

what is cervical spondylosis

A

degenerative change in the cervical spine leading to spine and nerve root compression

30
Q

how can a patient present with cervical spondylosis

A

can present with myelopathy or radiculopathy

gradual speed of onset - months to years

31
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

32
Q

how does lumbar spinal stenosis present

A

pain down both legs - spinal claudication

worse on walking/standing - relieved by sitting or bending forward

33
Q

what is the management for lumbar spinal stenosis

A

lumbar laminectomy

34
Q

what are the three groups of spinal tumours

A 
extradural
intradural
intramedullary (in the spinal cord)
35
Q

give examples of extradural spinal tumours

A

mets - lung, breast, prostate

primary bone tumours - osteoblastoma

36
Q

give examples of intramural spinal tumours

A

meningioma
neurofibroma
lipoma

37
Q

what are intramedullary spinal tumours

A

intradural spinal tumors that arise from cells within the spinal cord, as opposed to adjacent structures such as the nerve roots or meninges

38
Q

give examples of intramedullary spinal tumours

A

astrocytoma
ependymoma
teratoma
haemangioblastoma

39
Q

how might a patient present with a malignant cord compression

A

pain, weakness, sphincter disturbance

40
Q

what are the investigations and management for malignant cord compression

A

MRI - urgently if bad pain develops

surgical decompression
radiotherapy

41
Q

what are the three spinal infections and where do they occur

A

osteomyelitis - infection within the vertebral body

discitis - infection of the intervertebral disc

epidural abscess - infection in the epidural space

42
Q

how might an epidural abscess present and what investigations must be done urgently

A

back pain
pyrexia
focal neurology

urgent MRI

43
Q

what are the risk factors for epidural abscess

A

IV drug abuse
diabetes
chronic renal failure
alcoholism

44
Q

what organisms cause epidural abscesses

A

staph aureus
streptococcus
e coli

45
Q

what is the management of epidural abscess

A

urgent surgical decompression

long term IV antibiotics

46
Q

what are the risk factors for osteomyelitis

A 
IV drug abuse
diabetes
chronic renal failure
alcoholism
**AIDS
47
Q

what is the management of osteomyelitis

A

antibiotics

surgery if evidence of neurology

48
Q

CASE 1: 37 year old lady

  • sudden onset pain in both legs
  • difficulty starting flow when she passes urine
  • normal power in her legs
  • reduced pin prick sensation around bottom

what is your Dx
what investigation
how would you manage

A

cauda equina syndrome

urgent MRI

emergency lumbar discectomy

49
Q

CASE 2: 69 year old patient

  • history of breast cancer
  • neck pain and pain radiating down her right arm
  • C6 dermatomal numbness
  • otherwise normal neurology

what is your Dx
what investigation

A

extradural metastasis from breast cancer
pressing at C6 level
causing radiculopathy

MRI

50
Q

CASE 3: 22 year old IVDU

  • 3 week history back pain and loss of power in his legs
  • cachectic (wasting)
  • 1000mls in his bladder before catheterization
  • pyrexial

what is your Dx
what investigation
how would you manage

A

epidural abscess

urgent MRI

urgent surgical decompression
long term IV antibiotics

NEURO (51 decks)

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