Diseases of the Spinal Cords and Nerve Roots

Question 1

What is myelopathy?

Answer 1

Non-specific description of a deficit in the spinal cord

Question 2

What is myelitis?

Answer 2

Inflammation of the spinal cord

Question 3

What is radiculopathy?

Answer 3

Pathology in the nerve root

Question 4

What is radiculitis?

Answer 4

Inflammation in the nerve root

Question 5

Causes of spinal cord compression

Answer 5

Trauma 
Tumours 
Prolapsed intervertebral disc 
Disc herniation 
Epidural/subdural haematoma 
Inflammatory disease 
Infection 
Cervical spondylitic myelopathy 
Spinal manipulation

Question 6

Cervical degenerative disc disease develops when

Answer 6

one or more of the cushioning discs in the cervical spine start to break down

Question 7

Function of the 6 gel-like cervical discs

Answer 7

Absorb shock

Prevent vertebral bones from rubbing against each other while the neck moves

Question 8

Cervical discs are composed of

Answer 8

Tough, flexible outer layer of woven cartilage strands called the annulus fibrosis

Question 9

What is contained inside the annulus fibrosis?

Answer 9

Nucleus pulposis - mucoprotein gel which gives the disc its shock-absorption property

Question 10

What happens to the cervical discs with age?

Answer 10

Naturally begin to lose hydration

Question 11

What happens if the cervical discs lose hydration quicker than normal?

Answer 11

Less cushioning results in disc becoming more prone to cracks and tears

Question 12

Why are the cervical discs not able to repair themselves?

Answer 12

They don’t have a direct blood supply

Question 13

What are the possible outcomes of a tear in the cervical disc?

Answer 13

will not heal or will develop weaker scar tissue that has the potential to break again

Question 14

Common symptoms of cervical disc damage

Answer 14

Neck pain and stiffness

Pain, numbness or weakness in shoulder, arm and hand

Question 15

Type of pain typically experienced by those with lumbar degenerative disc disease

Answer 15

Low-grade continuous but tolerable pain

Question 16

A compromised disc in the lumbar spine results in pain in what region?

Answer 16

Lower back

Question 17

Compromised disc in the lumbar spine is most commonly due to

Answer 17

low energy injury to the disc that progresses with time

Question 18

At what age is some level of degeneration expected?

Answer 18

Over 60s

Question 19

Cause of lumbar disc degeneration

Answer 19

Inflammation

Question 20

Common symptoms of lumbar disc degeneration

Answer 20

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

Question 21

Sinister features of PMH associated with back pain

Answer 21

PMH of malignancy 
Age < 16 or > 50 with new onset pain 
Unexplained weight loss 
Previous longstanding steroid use 
Recent serious illness 
Recent significant infection

Question 22

Signs which are sinister when associated with back pain

Answer 22

Saddle anaesthesia 
Reduced anal tone 
Hip or knee weakness 
Generalised neurological deficit 
Progressive spinal deformity 
Urinary retention

Question 23

Symptoms which are sinister when associated with back pain

Answer 23

Non-mechanical pain (i.e. worse at rest) 
Thoracic pain 
Fevers/rigors 
General malaise 
Urinary retention

Question 24

Cauda equina syndrome describes

Answer 24

extreme pressure and swelling of the nerves at the end of the spinal cord

Question 25

Possible adverse affects of cauda equina syndrome if not treated quickly

Answer 25

Paralysis
Impaired bladder/bowel control
Difficult walking
Other physical and neurological problems

Question 26

Presentation of acute onset of cauda equina syndrome

Answer 26

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

Question 27

Presentation of gradual onset of cauda equina syndrome

Answer 27

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

Question 28

Neurological symptoms of cauda equina syndrome in the lower body

Answer 28

Weakness, tingling, numbness in legs/feet on one or both sides of the body

Question 29

Treatment of cauda equina syndrome

Answer 29

Surgery to relieve pressure on the nerves