Diseases of the Spinal Cord and Nerve Roots (surgical) Flashcards
How many vertebrae are there of each spinal division? (cervical / thoracic etc.)
- Cervical: 7
- Thoracic: 12
- Lumbar: 5
- Sacral: 5
- Coccyx: 4
Should probably take a look at ligaments and parts of vertebrae again
cba right now tho
Spinal level & myotomes the correspond to? (doubt you’ll have to know but decent to get an idea)
C5: Elbow flexors C6: Wrist extensors C7: Elbow extensors C8: Finger extensors T1: Intrinsic hand muscles L2: Hip flexors L3: Knee extensors L4: Ankle dorsiflexors L5: Long toe extensors S1: Ankle plantar flexors
What is a myelopathy?
- Neurological deficit due to compression of spinal cord
- UMN
What is a radiculopathy?
- Compression of nerve root leading to dermatomal and myotomal deficits
- LMN
What is the effect of a C5 spinal cord lesion? Signs?
- Weakness in shoulder and below
- Sensory level gone below C5
- Increased tone in legs
- Positive Babinski
What is the effect of a L4 nerve root lesion? Signs?
- Pain down ipsilateral leg
- Numbness in L4 dermatome
- Weakness in ankle dorsiflexion
- Reduced knee jerk
What is a disc prolapse?
- Acute herniation of the intervertebral disc causing compression of spinal roots or spinal cord
- Can cause myelopathy or radiculopathy depending on where herniation is
Signs of disc prolapse?
- Acute pain down leg / arm
- Numbness and weakness in distribution area of nerve involved
Investigations and management for disc prolapse?
- Investigate with MRI
Management:
- Rehabilitation
- Nerve root injection
- Lumbar / cervical discectomy
What is cauda equina syndrome?
- Compression of nerve roots at the cauda equina. Can disrupt motor and sensory function to the lower extremities and bladder
Signs of cauda equina syndrome?
- Bilateral sciatica
- Saddle anaesthesia (loss of feeling in saddle region)
- Urinary incontinence
Investigations and treatment of cauda equina syndrome?
- MRI to investigate
- Lumbar discectomy to treat
- Needs to be done as emergency, paralysis can result if not done quickly enough
What can degeneration of normal spinal structure in older patients result in?
- Disc prolapse
- Ligamentum hypertrophy (of ligamentum flavum)
- Osteophyte (bony process where cartilage has degenerated) formation
All can lead to radiculopathy / myelopathy
What is cervical spondylosis?
- Umbrella term for degenerative changes in cervical spine leading to spinal cord and nerve root compression
- Speed of onset can be months to years
What is lumbar spinal stenosis?
- Lumbar spinal stenosis is a narrowing of the vertebral foramen, compressing the nerves traveling through the lower back into the legs
Signs, investigations and management of lumbar spinal stenosis?
- Pain down both legs, worsened by walking / standing
- MRI
- Lumbar laminectomy to treat (remove lamina of vertebra to make more space)
With respect to the meninges and SC itself, where do spinal tumours tend to occur?
- 5% intramedullary (within substance of SC itself)
- 40% intradural
- 55% extradural
Examples of intradural spinal tumours?
- Meningioma
- Neurofibroma
- Lipoma
Examples of extradural spinal tumours?
- Metastases (lung / breast / prostate)
- Primary bone tumours ( osteomas)
Examples of intramedullary spinal tumours?
- Astrocytoma
- Ependymoma
- Teratoma
- Haemangioblastoma
Two common causes of spinal cord / nerve root compression?
- Disc prolapse
- Spinal tumour
Presentation of malignant spinal cord compression? Investigations?
- Signs of SC compression: pain, weakness, urinary incontinence
- MRI
Management of spinal cord malignancy?
- Surgical decompression
- Radiotherapy
