Diseases of the Spinal Cord and Nerve Roots (Surgical) Flashcards
What are the 2 parts of the vertebral disc?
Nucleus pulposus – softer part in middle and this is the bit that sticks out when a disc protrudes
Anulus fibrosus - the tough circular exterior of the intervertebral disc that surrounds the soft inner core
What are the vertebral ligaments?
Where do UMN become LMN?
In ventral horn
In the anterior horn cell
Where does the spinal cord extend from?
Extends from C1 – L2
a
b
c
d
e
f
The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out
What is involved with localising a lesion?
What are the myotomes for different muscle gorup?
What would be seen in a C5 spinal cord lesion?
Weakness in shoulder and below
Sensory level at C5
Increased tone in legs
Brisk reflexes
Babinski +ve
Myelopathy (UMN) - Neurological deficit due to compression of spinal cord
What is a Myelopathy (UMN)?
Myelopathy (UMN) - Neurological deficit due to compression of spinal cord
What would be seen in a L4 nerve root lesion?
Pain down ipsilateral leg
Numbness in L4 dermatome
Weakness in ankle dorsiflexion
Reduced knee jerk
Radiculopathy (LMN) - Compression of nerve root leading to dermatomal and myotomal deficits
What is a Radiculopathy (LMN)?
Radiculopathy (LMN) - Compression of nerve root leading to dermatomal and myotomal deficits
What are different things that may be the cause of problems in the spine?
How do you deal with problems in the spine?
History (pain, speed of onset, PMH)
Examination
Investigations (bloods, xrays, CT, MRI)
What is disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
What age are disc prolapses more common and what is the onset like?
- Younger patients
- Tends be acute onset pain
What is the difference between if the disc prolapse happened centrally or off to one side?
If centre myelopathy
Radiculopathy if popped out to the side and you get symptoms on that side
(CES = cauda equina syndrome)
What are the symptoms of a disc prolapse and what investigation would be done?
Acute pain down leg/arm
Numbness and weakness in distribution of nerve root involved
Investigation with MRI
What is the management of a disc prolapse?
- Rehabilitation
- Nerve root inject
- Lumbar/cervical discectomy (the surgical removal of abnormal disc material that presses on a nerve root or the spinal cord)
What is cauda equina syndrome?
Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged
Medical emergency
How is cauda equina syndrome diagnosed?
Clinico-radiological diagnosis
What are the red flag signs of cauda equina syndrome? and what happens if there are present?
Red flags:
- Bilateral sciatica - pain in both legs
- Saddle anaesthesia - loss of sensation (anesthesia) restricted to the area of the buttocks, perineum and inner surfaces of the thighs
- Urinary dysfunction
Requires urgent MRI
What is the treatment of cauda equina syndrome?
Emergency lumbar discectomy
What are degenerative spine problems?
Loss of normal spinal structure
Seen in older patients
Results in:
- Disc prolapse
- Ligamentum hypertrophy
- Osteophyte formation
All of the above can cause myelopathy or rediculopathy depending on the location
What is 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
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 symptoms of lumbar spinal stenosis and what is the management?
- Pain down both legs ‘spinal claudication’
- Worse on walking/standing and relieved by sitting or bending forward
- Management with lumbar laminectomy (surgery that creates space by removing the lamina)
What are the locations of spinal tumours?
What are examples of intramedullary spinal tumours?
What are examples of intradural spinal tumours?
What are examples of extradural spinal tumours?
What location is the most common for spinal tumours?
extradural
What symptoms are experinced in malignant cord compression?
Patient present with pain, weakness, sphincter disturbance
What investigation would you do if ther eis a known cancer causing malignant cord compression?
If known cancer, should get urgent MRI if develops back pain
What is the management of malignant cord compression?
Management involves surgical decompression and radiotherapy
Spinal infection - what is Osteomyelitis?
infection within vertebral body
Spinal infection - what is discitis?
infection of intervertebral disc
Spinal infection - what is an Epidural abscess?
infection in the epidural space
An epidural abscess is a collection of pus (infected material) and germs between the outer covering of the brain and spinal cord and the bones of the skull or spine
What is important when dealing with spinal infections?
try to find the causative organis,
In an epidural abscess, any patient presenting with the following triad needs an urgent _____
- ____ pain
- _______
- ____________
MRI
- Back pain
- Pyrexia
- Focal neurology
What are the risk factors of an epidural abscess?
IV drug abuse, diabetes, chronic renal failure, alcoholism
What are the organisms that can an epidura abscess?
staph aureus, streptococcus, e coli
How is an epidural abscess managed
Managed with urgent surgical decompression and long-term IV antibiotics
What are the risk factors for osteomyelitis?
IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS
What is the management of osteomyelitis?
Management is with antibiotics
Surgery if evidence of neurology
37 year old lady presented with sudden onset pain in both legs. She has also noticed that she has difficulty starting flow when she passes urine. She has normal power in her legs but reduced pin prick sensation around bottom
What are you worried about?
What investigation do you want?
Cauda equine – bilateral, bladder dysfunction, saddle anaesthesia (a loss of sensation (anesthesia) restricted to the area of the buttocks, perineum and inner surfaces of the thighs)
MRI
69 year old patient with a history of breast cancer. She sees her GP with neck pain and pain radiating down her right arm. C6 dermatomal numbness but otherwise normal neurology
What are you most concerned about?
What investigation do you want?
What does this show?
How would you manage it?
Worried about metastases
Radiculopathy – pain down one side, one area of sensory loss and otherwise normal neurology
MRI
Squashed at many area
Multi level degenerative disease
Cant just decompress every level so try work out what level is the worse
22 year old IVDU who presented with 3 week history back pain and loss of power in his legs. He was cachectic and had 1000mls in his bladder before catheterization and was pyrexial
What are you worried about?
What investigation do you want?
How would you manage it?
Epidural abscess
MRI
Do blood culutre to try find causitive organism
Try decompress it
