Diseases of the Spinal Cords and Nerve Roots Flashcards
What is myelopathy?
Non-specific description of a deficit in the spinal cord
What is myelitis?
Inflammation of the spinal cord
What is radiculopathy?
Pathology in the nerve root
What is radiculitis?
Inflammation in the nerve root
Causes of spinal cord compression
Trauma Tumours Prolapsed intervertebral disc Disc herniation Epidural/subdural haematoma Inflammatory disease Infection Cervical spondylitic myelopathy Spinal manipulation
Cervical degenerative disc disease develops when
one or more of the cushioning discs in the cervical spine start to break down
Function of the 6 gel-like cervical discs
Absorb shock
Prevent vertebral bones from rubbing against each other while the neck moves
Cervical discs are composed of
Tough, flexible outer layer of woven cartilage strands called the annulus fibrosis
What is contained inside the annulus fibrosis?
Nucleus pulposis - mucoprotein gel which gives the disc its shock-absorption property
What happens to the cervical discs with age?
Naturally begin to lose hydration
What happens if the cervical discs lose hydration quicker than normal?
Less cushioning results in disc becoming more prone to cracks and tears
Why are the cervical discs not able to repair themselves?
They don’t have a direct blood supply
What are the possible outcomes of a tear in the cervical disc?
will not heal or will develop weaker scar tissue that has the potential to break again
Common symptoms of cervical disc damage
Neck pain and stiffness
Pain, numbness or weakness in shoulder, arm and hand
Type of pain typically experienced by those with lumbar degenerative disc disease
Low-grade continuous but tolerable pain
A compromised disc in the lumbar spine results in pain in what region?
Lower back
Compromised disc in the lumbar spine is most commonly due to
low energy injury to the disc that progresses with time
At what age is some level of degeneration expected?
Over 60s
Cause of lumbar disc degeneration
Inflammation
Common symptoms of lumbar disc degeneration
Pain centred on lower back, may radiate to hips and legs
Continuous lower back pain that has lasted more than 6 weeks
Painful ache which is worse when sitting
Sinister features of PMH associated with back pain
PMH of malignancy Age < 16 or > 50 with new onset pain Unexplained weight loss Previous longstanding steroid use Recent serious illness Recent significant infection
Signs which are sinister when associated with back pain
Saddle anaesthesia Reduced anal tone Hip or knee weakness Generalised neurological deficit Progressive spinal deformity Urinary retention
Symptoms which are sinister when associated with back pain
Non-mechanical pain (i.e. worse at rest) Thoracic pain Fevers/rigors General malaise Urinary retention
Cauda equina syndrome describes
extreme pressure and swelling of the nerves at the end of the spinal cord
Possible adverse affects of cauda equina syndrome if not treated quickly
Paralysis
Impaired bladder/bowel control
Difficult walking
Other physical and neurological problems
Presentation of acute onset of cauda equina syndrome
Rapid development of symptoms
Severe lower back pain
Significant loss of bladder and bowel function
Sensory and motor deficits in lower body within 24 hours
Presentation of gradual onset of cauda equina syndrome
Develops progressively
Symptoms may come and go over several weeks/months
Partial or intermittent loss of bowel and bladder function
Recurring lower back pain in combination with muscle weakness and numbness
Bladder/bowel incontinence/dysfunction
Neurological symptoms of cauda equina syndrome in the lower body
Weakness, tingling, numbness in legs/feet on one or both sides of the body
Treatment of cauda equina syndrome
Surgery to relieve pressure on the nerves
