Diseases of the Spinal Cord COPY Flashcards
What are the different parts of the spinal column?
How many vertebrae are there for each part of the spinal column?
Where does the spinal cord terminate in adults and children?
Adults - L2
Children - L3
Compare and contrast the following signs for UMN lesions and LMN lesions:
- weakness
- atrophy
- reflexes
- tone
- fasciculations
- babinki
What are fasciculations?
Involuntary muscle contraction and relaxation which may be visible under the skin
How do you localise a lesion?
How are dermatomes distributed?
What is a myotome?
Group of muscles that a single spinal nerve innervates
What is the myotome of C5, C6, C7, C8 and T1?
What is the myotome of L2, L3, L4, L5 and S1?
What is the clinical presentation of a C5 spinal cord lesion?
- Weakness in shoulder and below
- Sensory level at C5
- Increased tone in legs
- Brisk reflexes
- Babinski (one of the normal reflexes in infants, firmly stroke sole of foot and big toe moves upwards and other toes fan out) positive, should not happen in people over 2
This is myelopathy (UMN), which is a neurological deficit due to compression of the spinal cord
What is the clinical presentation of L4 nerve root lesion?
Signs and symptoms:
- Pain down ipsilateral leg
- Numbness in L4 dermatome
- Weakness in ankle dorsiflexion
- Reduced knee jerk
This is radiculopathy (LMN), which is compression of nerve root leading to dermatomal and myotomal deficits
What is radioculopathy?
Compression of nerve root leading to dermatomal and myotomal deficits
What is myelopathy?
Neurological deficit due to compression of the spinal cord
Is myelopathy UMN or LMN?
UMN
Is radioculopathy UMN or LMN?
LMN
What are the different types of spinal diseases?
What is a disc prolapse?
Acute herniation of intervertebral disc causing compression of spinal roots or spinal cord
If a disc prolapse occurs centrally does it cause myelopathy or radiculopathy?
Myelopathy
If a disc prolapse occurs lateral does it cause myelopathy or radiculopathy?
Radiculopathy
What is the clinical presentation of disc prolapse?
- Acute pain down leg/arm
- Numbness and weakness in distribution of nerve root involved
What investigation is done for disc prolapse?
MRI
What is the management of a disc prolapse?
- Rehabilitation
- Nerve root injection
- Lumbar/cervical discectomy
What red-flages for cauda equina syndrome?
- Bilateral sciatica (pain in buttocks or legs caused by sciatic nerve becoming compressed)
- Saddle anaesthesia (loss of sensation restricted to the area of the buttocks)
- Urinary dysfunction
What is bilateral sciatica?
Pain in buttocks or legs caused by sciatic nerve becoming compressed
What is saddle anaesthesia?
Loss of sensation restricted to the area of the buttocks
What is the investigation for cauda equina syndrome?
Urgent MRI
What is the treatment of cauda equina syndrome?
Treatment is emergency lumbar discectomy (surgery to remove herniated or degenerative disk in lower spine)
What is cauda equina syndrome?
Condition that occurs when the nerves that form the cauda equina are damaged
Is disc herniation seen in older or younger patients?
Younger patients
Are degenerative spinal disorders seen in older or younger patients?
Older patients
What are degenerative spinal conditions the result of?
- Disc prolapse
- Ligamentum hypertrophy (thickening of ligamentum flavum)
- Osteophyte formation (newly formed fibrocartilage and bone)
What can degenerative spinal conditions lead to?
Myelopathy or radiculopathy
What is cervical spondylosis?
Umbrella term for degenerative change in cervical spine leading to spine and nerve root compression
What is the clinical presentation of cervical spondylosis?
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 is lumbar spinal stenosis?
Is the narrowing of the spinal canal, compassing the nerves travelling through the lower back into the legs
What is the clinical presentation of lumbar spinal stenosis?
- Pain down both legs ‘spinal claudication’
- Worse on walking/standing and relieved by sitting or bending forwards
What is the management of lumbar spinal stenosis?
Lumbar laminectomy
What is a lumbar laminectomy?
Surgery that creates space by removing the lamina
What are the different classes of spinal tumours?
Extradural
Intradural
Intramedullary
What are examples of intradural spinal tumours?
Meningioma
Neurofibroma
Lipoma
What are examples of intramedullary spinal tumours?
Astrocytoma
Ependymoma
Teratoma
Haemangioblastoma
What are examples of extradural spinal tumours?
Metastases (lung, breast, prostate)
Primary bone tumours (chrodomas, osteoblastomas, ostelud osteoma)
What cancers commonly metastasis to the spinal cord and become extradural spinal tumours?
Lung
Breast
Prostate
Patients with malignant cord compression present with what?
- Pain
- Weakness
- Sphincter disturbance
What is the mangement of patients with malignant cord compression?
Management involves surgical decompression and radiotherapy
What are examples of spinal infections?
Osteomyelitis
Discitis
Epidural abscess
What is osteomyelitis?
Infections within vertebral body
What are risk factors for osteomyelitis?
- IV drug abuse
- Diabetes
- Chronic renal failure
- Alcoholism
- AIDS
What is the management of osteomyelitis?
- With antibiotics
- Surgery if evidence of neurology
What is discitis?
- Infection of intervertebral disc
What is an epidural abscess?
- Infection in epidural space
What do patients with an epidural abscess present with?
- Presents with the following triad
- Back pain
- Pyrexia
- Focal neurology (impairments of nerve, spinal cord or brain function that affects a specific region of the body)
What is focal neuropathy?
Impairments of nerve, spinal cord or brain function that affects a specific region of the body
What investigation should be done for epidural abscess?
Urgent MRI
What are risk factors for epidural abscess?
- IV drug abuse
- Diabetes
- Chronic renal failure
- Alcoholism
What organisms typically cause epidural abscess?
- Staph Aureus
- Streptococcus
- E-coli
What is the mangement of epidural abscess?
- Urgent surgical decompression and long-term IV antibiotics
