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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

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
what are the red flag symptoms of cauda equina syndrome
bilateral sciatics saddle anaesthesia urinary dysfucntion
26
what is the investigation and management of cauda equina syndrome
urgent MRI emergency lumbar discectomy
27
what is degeneration
loss of normal spinal structure seen in older patients
28
what leads to degeneration of the spinal structures
product of: disc prolapse ligamentum hypertrophy osteophyte formation leads to myelopathy and radiculopathy
29
what is cervical spondylosis
degenerative change in the cervical spine leading to spine and nerve root compression
30
how can a patient present with cervical spondylosis
can present with myelopathy or radiculopathy gradual speed of onset - months to years
31
what is the management of cervical spondylosis
Conservative if no/mild myelopathy Surgery for progressive moderate to severe myelopathy - anterior and posterior approaches
32
how does lumbar spinal stenosis present
pain down both legs - spinal claudication worse on walking/standing - relieved by sitting or bending forward
33
what is the management for lumbar spinal stenosis
lumbar laminectomy
34
what are the three groups of spinal tumours
``` extradural intradural intramedullary (in the spinal cord) ```
35
give examples of extradural spinal tumours
mets - lung, breast, prostate primary bone tumours - osteoblastoma
36
give examples of intramural spinal tumours
meningioma neurofibroma lipoma
37
what are intramedullary spinal tumours
intradural spinal tumors that arise from cells within the spinal cord, as opposed to adjacent structures such as the nerve roots or meninges
38
give examples of intramedullary spinal tumours
astrocytoma ependymoma teratoma haemangioblastoma
39
how might a patient present with a malignant cord compression
pain, weakness, sphincter disturbance
40
what are the investigations and management for malignant cord compression
MRI - urgently if bad pain develops surgical decompression radiotherapy
41
what are the three spinal infections and where do they occur
osteomyelitis - infection within the vertebral body discitis - infection of the intervertebral disc epidural abscess - infection in the epidural space
42
how might an epidural abscess present and what investigations must be done urgently
back pain pyrexia focal neurology urgent MRI
43
what are the risk factors for epidural abscess
IV drug abuse diabetes chronic renal failure alcoholism
44
what organisms cause epidural abscesses
staph aureus streptococcus e coli
45
what is the management of epidural abscess
urgent surgical decompression | long term IV antibiotics
46
what are the risk factors for osteomyelitis
``` IV drug abuse diabetes chronic renal failure alcoholism **AIDS ```
47
what is the management of osteomyelitis
antibiotics | surgery if evidence of neurology
48
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
cauda equina syndrome urgent MRI emergency lumbar discectomy
49
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
extradural metastasis from breast cancer pressing at C6 level causing radiculopathy MRI
50
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
epidural abscess urgent MRI urgent surgical decompression long term IV antibiotics

NEURO (51 decks)

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