Diseases of the Spinal Cord and Nerve Roots Flashcards
What are the five vertebral ligaments?
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Interspinal ligament
- Supraspinous ligament
What are the two parts to the vertebral disc?
Nucleus pulposus and anulus fibrosis
What are the boundaries of the spinal cord
C1-L2
Where does the spinal cord end?
At the conus medularis and become cauda equina (contain film terminale)
What myotome does C5 supply?
Elbow flexors
What myotome does C6 supply?
Wrist extensors
What myotome does C7 supply?
Elbow extensors
What myotome does C8 supply?
Finger extensors
What myotome does T1 supply?
Intrinsic hand muscles
What myotome does L2 supply?
Hip flexors
What myotome does L3 supply?
Knee extensors
What myotome does L4 supply?
Ankle dorsiflexors
What myotome does L5 supply?
Long toe extensors
What myotome does S1 supply?
Ankle plantar flexors
Describe the signs of an UMN lesion
- Weakness
- No atrophy
- Increased reflexes
- Increased tone
- No fasiculations
- Babinski sign present
Describe the signs of LMN lesion
- Weakness
- Atrophy present
- Decreased reflexes
- Decreased tone
- Fasiculations present
- No babinski sign
How to localise lesion?
Pain?
Sensory?
Weakness?
UMN vs LMN
Define myelopathy
Neurological deficit due to compression of spinal cord
What is the cause of: Weakness in elbow below Sensory level at C6 Increased tone in legs Brisk reflexes Babinski +ve
Myelopathy (UMN)
Define radiculopathy
Compression of nerve root leading to dermatomal and myotomal deficits
What is the cause of; Pain down ipsilateral leg Numbness in L4 dermatome Weakness in ankle dorsiflexion Reduced knee jerk
Radiculopathy
Name five causes of spine disease
- Degenerative
- Tumour
- Infection
- Trauma
- Congenital
What is a disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
What are two common parts of the spine for disc prolapse to occur?
Cervical and lumbar
What are the the effects of cervical disc prolapse?
Central –> cervical myelopathy
Lateral –> cervical radiculopathy
What are the effects of lumbar disc prolapse?
Central –> cauda equina syndome (CES)
Lateral –> lumbar radiculopathy
What are the symptoms of disc prolapse?
- Acute pain down leg/arm
* Numbness and weakness in distribution of nerve root involved
What is used to investigate disc prolapse?
MRI
What is the management of disc prolapse?
- Rehabilitation
- Nerve root inject
- Lumbar/cervical discectomy
What are red flags of cauda equina syndrome?
- Bilateral sciatica
- Saddle anaesthesia
- Urinary dysfunction
What is the investigation and management of CES?
- Medical emergency
- Clinico-radiological diagnosis
- Requires urgent MRI
- Emergency lumbar discectomy
What are degenerative spinal diseases?
Loss of normal spinal structure
What are causes of degenerative spinal disease?
- Disc prolapse
- Ligamentum hypertrophy
- Osteophyte formation
What are cervical spondylosis?
Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
Patient can present with either myelopathy or radiculopathy (or both)
Speed of onset is usually months to years
How do you manage cervical spondylosis?
- Conservative if no/mild myelopathy
- Surgery for progressive moderate to severe myelopathy
- Anterior and posterior approaches
What is the clinical presentation of lumbar spinal stenosis?
- Pain down both legs ‘spinal claudication’
* Worse on walking/standing and relieved by sitting or bending forward
What is the management of lumbar spinal stenosis?
Lumbar laminectomy
Name three intradural, extramedullary spinal tumours
- Meningioma
- Neurofibroma
- Lipoma
Name four intramedullary tumours
- Astrocytome
- Ependymoma
- Teratoma
- Haemangioblastoma
Name types of extradural tumours
- Metastases (lung, breast, prostate)
* Primary bone tumours (chrodomas, osteoblastomas, osteiud osteoma)
What is the clinical presentation of malignant cord compression?
Patient present with pain, weakness, sphincter disturbance
How should you investigate malignant cord compression?
If known cancer, should get urgent MRI if develops back pain
How do you manage malignant cord compression?
Surgical decompression and radiotherapy
Name three types of spinal infections
- Osteomyelitis
- Discitis
- Epidural abscess
What is osteomyelitis?
Infection within vertebral body
What is discitis?
Infection of intervertebral disc
What is epidural abscess?
Infection in the epidural space
What is the triad of symptoms of an epidural abscess?
- Back pain
- Pyrexia
- Focal neurology
What are the risk factors for epidural abscess?
IV drug abuse, diabetes, chronic renal failure, alcoholism
What are the causative organisms of epidural abscesses?
Staph aureus, streptococcus, E. coli
What is the investigation and management of epidural abscesses?
- Urgent MRI
* Managed with urgent surgical decompression and longterm IV antibiotic
What are risk factors for osteomyelitis?
IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS
What is the management of osteomyelitis?
- Antibiotics
* Surgery if evidence of neurology
