Diseases of the Spinal Cord and Nerve Roots (Surgical) Flashcards
where does the spinal cord extend from?
C1 - L2
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what happens with 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 happens with 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
shat is the management of disc prolapse?
rehab
nerve root inject
lumbar/cervical discectomy
what are the red flags for cauda equina syndrome?
–Bilateral sciatica
–Saddle anaesthesia
–Urinary dysfunction
what are the first things to do with cauda equina syndrome?
•Requires urgent MRI
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•Emergency lumbar discectomy
what is disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
who is likely to get disc prolapse?
younger patients
who is likely to get loss of normal spinal structure?
seen in older patients
what is loss of normal spinal structure a product of?
disc prolapse
ligamentum hypertrophy
osteophyte formation
what is cervical spondylosis?
•Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
how does a patient present with cervical spondylosis?
with either myelopathy or radiculopathy
what is the management of cervical spondylosis?
–Conservative if no/mild myelopathy
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–Surgery for progressive moderate to severe myelopathy
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–Anterior and posterior approaches
what is lumbar stenosis?
Pain down both legs ‘spinal claudication
how is lumbar spinal stenosis worsend or relieved?
•Worse on walking/standing and relieved by sitting or bending forward
what is the management of lumbar spinal stenosis?
lumbar laminectomy
what are the intradural spinal tumours?
meningioma
neurofribroma
lipoma
what are the intramedullary spinal tumours?
•Astrocytoma
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•Ependymoma
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•Teratoma
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•haemangioblastoma
how does a patient present with malignant cord progression?
patient presents with pain, weakness, sphincter disturbance
what are the different type 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 are the risk factors of epidural abscess?
IV drug abuse
diabetes
chronic renal failure
alcoholism
what are the organisms present in epidural abscesses?
staph aureus
streptococcus
e coli
what is the management of epidural abscess
urgent surgical decompression and long term IV antibiotics
what are the risk factors of osteomyelitis?
•IV drug abuse, diabetes, chronic renal failure, alcoholism, AIDS
what is the management of osteomyelitis?
antibiotics
surgery if evidence of neurology
