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NEURO > Diseases of the Spinal Cord and Nerve Roots (surgical) > Flashcards

Diseases of the Spinal Cord and Nerve Roots (surgical) Flashcards

1
Q

How many vertebrae are there of each spinal division? (cervical / thoracic etc.)

A
  • Cervical: 7
  • Thoracic: 12
  • Lumbar: 5
  • Sacral: 5
  • Coccyx: 4
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2
Q

Should probably take a look at ligaments and parts of vertebrae again

A

cba right now tho

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3
Q

Spinal level & myotomes the correspond to? (doubt you’ll have to know but decent to get an idea)

A 
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
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4
Q

What is a myelopathy?

A
  • Neurological deficit due to compression of spinal cord

- UMN

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5
Q

What is a radiculopathy?

A
  • Compression of nerve root leading to dermatomal and myotomal deficits
  • LMN
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6
Q

What is the effect of a C5 spinal cord lesion? Signs?

A
  • Weakness in shoulder and below
  • Sensory level gone below C5
  • Increased tone in legs
  • Positive Babinski
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7
Q

What is the effect of a L4 nerve root lesion? Signs?

A
  • Pain down ipsilateral leg
  • Numbness in L4 dermatome
  • Weakness in ankle dorsiflexion
  • Reduced knee jerk
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8
Q

What is a disc prolapse?

A
  • Acute herniation of the intervertebral disc causing compression of spinal roots or spinal cord
  • Can cause myelopathy or radiculopathy depending on where herniation is
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9
Q

Signs of disc prolapse?

A
  • Acute pain down leg / arm

- Numbness and weakness in distribution area of nerve involved

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10
Q

Investigations and management for disc prolapse?

A
  • Investigate with MRI

Management:

  • Rehabilitation
  • Nerve root injection
  • Lumbar / cervical discectomy
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11
Q

What is cauda equina syndrome?

A
  • Compression of nerve roots at the cauda equina. Can disrupt motor and sensory function to the lower extremities and bladder
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12
Q

Signs of cauda equina syndrome?

A
  • Bilateral sciatica
  • Saddle anaesthesia (loss of feeling in saddle region)
  • Urinary incontinence
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13
Q

Investigations and treatment of cauda equina syndrome?

A
  • MRI to investigate
  • Lumbar discectomy to treat
  • Needs to be done as emergency, paralysis can result if not done quickly enough
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14
Q

What can degeneration of normal spinal structure in older patients result in?

A
  • Disc prolapse
  • Ligamentum hypertrophy (of ligamentum flavum)
  • Osteophyte (bony process where cartilage has degenerated) formation

All can lead to radiculopathy / myelopathy

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15
Q

What is cervical spondylosis?

A
  • Umbrella term for degenerative changes in cervical spine leading to spinal cord and nerve root compression
  • Speed of onset can be months to years
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16
Q

What is lumbar spinal stenosis?

A
  • Lumbar spinal stenosis is a narrowing of the vertebral foramen, compressing the nerves traveling through the lower back into the legs
17
Q

Signs, investigations and management of lumbar spinal stenosis?

A
  • Pain down both legs, worsened by walking / standing
  • MRI
  • Lumbar laminectomy to treat (remove lamina of vertebra to make more space)
18
Q

With respect to the meninges and SC itself, where do spinal tumours tend to occur?

A
  • 5% intramedullary (within substance of SC itself)
  • 40% intradural
  • 55% extradural
19
Q

Examples of intradural spinal tumours?

A
  • Meningioma
  • Neurofibroma
  • Lipoma
20
Q

Examples of extradural spinal tumours?

A
  • Metastases (lung / breast / prostate)

- Primary bone tumours ( osteomas)

21
Q

Examples of intramedullary spinal tumours?

A
  • Astrocytoma
  • Ependymoma
  • Teratoma
  • Haemangioblastoma
22
Q

Two common causes of spinal cord / nerve root compression?

A
  • Disc prolapse

- Spinal tumour

23
Q

Presentation of malignant spinal cord compression? Investigations?

A
  • Signs of SC compression: pain, weakness, urinary incontinence
  • MRI
24
Q

Management of spinal cord malignancy?

A
  • Surgical decompression

- Radiotherapy

25
Q

Types of spinal infection?

A
  • Osteomyelitis: infection within vertebral body
  • Discitis: infection of intervertebral disc
  • Epidural abscess: infection in the epidural space (between dura and vertebral wall)
26
Q

What is an epidural abscess? Risk factors?

A
  • Inflammation with pus in the epidural space

- IV drugs, diabetes, chronic renal failure, alcoholism

27
Q

Organisms causing epidural abscess?

A
  • Staph Aureus
  • Streptococcus
  • E Coli
28
Q

Presentation (red flags) for an epidural abscess?

A
  • Back pain
  • Pyrexia
  • Focal neurological deficits
29
Q

Management of epidural abscess?

A
  • Urgent surgical decompression

- Long term IV antibiotics

30
Q

What is osteomyelitis? risk factors?

Management of spinal osteomyelitis?

A

Infection of the bone

  • IV drugs, diabetes, chronic renal failure, alcoholism, AIDS
  • IV antibiotics, surgery if neurological deficits present

NEURO (52 decks)

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