Diseases of the Spinal Cord and Nerve Roots (Surgical)

Question 1

Which tissues do you penetrate during a lumbar puncture?

Answer 1

Supraspoinous ligament

Interspinal ligament

Ligamentum flavum

Posterior longitudinal ligament

Question 2

Where does spinal cord compression stop?

Answer 2

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

Question 3

Where on the body is dermatomes

C5

C6

C7

C8

L3

L4

L5

S1?

Answer 3

L4 - knee and medial malleolus

Question 4

What spinal level are elbow flexors?

Answer 4

C5

Question 5

What level are Elbow extensors?

Answer 5

C7

Question 6

What level are wrist extensors?

Answer 6

C5

Question 7

What level are Finger extensors?

Answer 7

C8

Question 8

What level are intrinsic muscles of the hand?

Answer 8

T1

Question 9

What level are ankle dorsiflexors / plantarflexors?

Answer 9

Dorsiflexors - L4

Plantar flexors - S1

Question 10

What level are hip flexors?

Answer 10

L2

Question 11

What level are knee extensors?

Answer 11

L3

Question 12

What level are long toe extensors?

Answer 12

L5

Question 13

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

Answer 13

Biceps - C5/C6

Supinator - C6

Triceps - C7

Question 14

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

Answer 14

Knee - L3/L4

Ankle - S1

Question 15

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

Answer 15

Question 16

What are the features of a C6 spinal cord lesion?

Answer 16

Weakness in the elbow below sensory level at C6

Increased tone in legs

Brisk reflexes

Babinski positive

Question 17

What is myelopathy?

Answer 17

Neurological defecit due to compression of spinal cord

Myelopathy is UMNL

Question 18

What is the definition of clonus?

Answer 18

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

Question 19

What are the features of L4 nerve root lesion?

Answer 19

Pain down ipsilateral leg

Numbness in L4 dermatome

Weakness in ankle dorsiflexion

Reduced knee jerk

Question 20

What is meant by radiculopathy?

Answer 20

Compression of nerve root leading to dermatomal and myotomal defecits

Question 21

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

Answer 21

Degenerative

Tumour

Infection

Trauma

Congenital

Differentiated by history examination and investigations

Question 22

What is disc prolapse?

Answer 22

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

Question 23

Who is normally affected by disc prolapse?

Answer 23

Younger patients

Question 24

Describe the onset of pain in disc prolapse?

Answer 24

Tends to be acute onset pain

Question 25

What is central cervical disc prolapse konwn as?

Answer 25

Cervical myelopathy

Question 26

What is lateral cervical disc prolapse known as?

Answer 26

Cervical radiculopathy

Question 27

What is central lumbar disk prolapse known as?

Answer 27

Cauda equina syndrome

Question 28

What is lateral disk prolapse known as?

Answer 28

Lumbar radiculopathy

Question 29

Describe the pain in sciatica?

Answer 29

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

Question 30

What are the symptoms of disc prolapse?

Answer 30

Acute pain down leg / arm Numbness and weakness in distribution of nerve root involved

Question 31

What is the investigation for disc prolapse?

Answer 31

MRi

Question 32

What is the management of disc prolapse?

Answer 32

Rehabilitation Nerve root inject - injection of steroids around nerve root, lasts a week or two Lumbar / cervical discectomy

Question 33

What are the red flag symptoms for cauda equina syndrome?

Answer 33

Bilateral sciatica Saddle anaesthesia Urinary dysfunction - incontinence, altered retention, altered sensation

Question 34

How is the diagnosis of cauda equina syndrome achieved?

Answer 34

Clinico - radiological diagnosis MEDICAL EMERGENCY - REQUIRES URGENT MRI REQUIRES EMERGENCY LUMBAR DISCECTOMY

Question 35

What causes degenerative loss of normal spinal structure?

Answer 35

Disc prolapse Ligamentum hypertrophy Osteophyte formation

Question 36

What is meant by cervical spondylosis?

Answer 36

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

Question 37

What is the speed of onset for cervical spondylosis?

Answer 37

Months to years

Question 38

What is the management of cervical spondylosis?

Answer 38

–Conservative if no/mild myelopathy –Surgery for progressive moderate to severe myelopathy –Anterior and posterior approaches

Question 39

What are the features of lumbar spinal stenosis?

Answer 39

Pain down both legs 'spinal claudication' Worse on walking / standing and releived by sitting or bending forward

Question 40

What is the management of lumbar spinal stenosis?

Answer 40

Lumbar laminectomy

Question 41

What are the names of extradural spinal tumours?

Answer 41

Metastases Primary bone tumours (chrodomas, osteoblastomas, osteiud osteoma)

Question 42

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

Answer 42

Lung, prostate and breast

Question 43

What are the intradural tumours?

Answer 43

Meningioma Neurofibroma Lipoma

Question 44

What are the intramedullary tumours?

Answer 44

Astrocytoma Ependymoma Teratoma Haemangioblastoma

Question 45

What are the features of malignant cord compression?

Answer 45

Patient presents with pain, weakness and sphincter disturbance

Question 46

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

Answer 46

Urgent MRI

Question 47

What is the management of malignant cord compression?

Answer 47

Surgical decompression and radiotherapy

Question 48

What are the common spinal infections?

Answer 48

Osteomyelitis Discitis Epidural abscess

Question 49

What is osteomyelitis?

Answer 49

Infection within vertebral body

Question 50

What is discitis?

Answer 50

Infection of the intervertebral disc

Question 51

What is epidural abscess?

Answer 51

Infection of the epidural space

Question 52

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

Answer 52

Back pain Pyrexia Focal neurology (Treatment for epidural abscess is laminectomy and long term IV antibiotics)

Question 53

What are risk factors for epidural abscess?

Answer 53

IV drug abuse Diabetes Chronic renal failure Alcoholism

Question 54

What organisms are responsible for epidural abscess?

Answer 54

•staph aureus, streptococcus, e coli

Question 55

What are the risk factors for oseomyelitis?

Answer 55

IV drug abuse Diabetes Chronic renal failure ALcoholism AIDS

Question 56

What is management of osteomyelitits?

Answer 56

Antibiotics Surgery if evidence of neurology