Disorders of the Spine Flashcards
inner fibres and outer fibres of the white matter of the spinal cord in each section are responsible for functioning where ( motor and sensory )
inner : Cervical functioning
middle : thoracic then lumber
outer : sacral
What are the 2 subsystems of the sensory pathway
1- Dorsal column system
2- spinothalamic tract
Where are the 3 neurons systems in the dorsal column system and spinothalamic tracts ( Explain pathways in detail )
Neurons transfer info from peripheral organ ( skin ) to cortex
1st neuron - located in dorsal root ganglion , travels up SC
2nd-
Dorsal system : 1st neurone reaches second neurone in medulla and 2nd neurone projects axon to cross over contralaterally then go towards thalamus
Spinothalamic : axon of 1st neuron enter posterior horn of grey matter where second neurone is , will crossover immediately in SC then travel to thalamus
3rd- located in thalamus contralateraly to dorsal root ganglion and axon goes to Cortex
What is the dorsal column system responsible for
Fine touch and proprioception of body
What is spinothalamic tract responsible for
pain and temperature sensation
What the divergence between the dorsal column system and spinothalamic tract
Dorsal column : 2nd neuron is in the medulla and cross over happens there
Spinothalamic : 2nd neuron is in the posterior horn of grey matter and cross over will happen there in the SC
What if a something is inactivating half of the SC ( hemisection of cord ) , on presentation what will be missing on the side of the lesion and what will be missing on the opposite Side
Side of lesion : missing fine touch and proprioception because dorsal column system doesn’t cross over till medulla
Opposite side : missing pain and temperature because spinothalamic tract in that lesion is responsible for other side
What are the 2 motor pathway systems
1- Pyramidal : starting from cortex and crosses over at the pyramidal decussation before the spinal cord
2- extrapyramidal : start from midbrain and crosses over at the midbrain
What is the function of the rubrospinal tract ? what happens if it is missing ?
To suppress the second motor neuron it meets in the spinal cord.
If missing then suppressing role won’t be there and spinal tone will be increased
Why does UMN lesion give you increased muscular tone
If there is a lesion to the rubrospinal tract that stops it’s suppressing role and thus muscle tone goes up
What is the difference between motor function in UMN lesion or LMN lesion
UMN : reduced power / missing power
LMN : reduced power/ missing power
What is another name for UMN
Central MN and first MN
What is another name for LMN
Peripheral MN , second MN
What is the difference between abnormalities in deep tendon reflexes in UMN lesion or LMN lesion
UMN : exaggerated , brisk , increased reflexogenic zone , polyclonal answers
LMN : weak / missing
What is the difference between pathological reflexes in UMN lesion or LMN lesion
UMN : Hoffman and Babinski present
LMN : missing
What is the difference between muscular tone in UMN lesion or LMN lesion
UMN : increased/spastic
LMN : decreased/missing
What creates the muscular tone and what suppresses it
Created by : 2 motor neurone / LMN
Suppressed by : rubrospinal tract / UMN / 1st neurone
What is typical for Parkinson’s increased muscle tone
Rigidity
What is Spastic increased muscle tone
” Clasp knife “
Resistance at first and then with continued pressure , suddenly resistance will drop and there will be sudden flop of limb
What is increased reflexogenic zone
In UMN lesion when there is reflex not exactly at the tendon
What is Polyclonal reflex
in UMN lesion when you get multiple reflexes after taping the tendon
What is Hoffman’s pathological sign
Present in UMN lesion , for upper limb.
holding and Flicking middle finger will result in grasping movement of rest of fingers
What is Babinski’s reflex
Present in UMN lesion, for lower limb.
stimulation of plantar side of foot causes Big toe to move upwards and back and rest of toes go down
What could go wrong with the spine ( types of problems, non specific )
1- congenital 2- developmental 3- inflammatory / infection 4- degenerative 5- traumatic 6- neoplastic 7- metabolic / endocrine
Where is the cervical enlargement
C5-8
Where are the lumber enlargement
L1-5
Why are the cervical and lumber enlargements important
Cervical : where 2nd neurone for arms is located
Lumber : where 2nd neurone for legs is located
What second neurone is at the thoracic segments
Thoracic intercostal muscle neurons
For leg movement where does the 1st neurone need to travel to to meet the 2nd neurone that projects to legs
L1-L5
For arm movement where does the 1st neurone need to travel to to meet the 2nd neurone that projects to arms
C5-C8
Signs of Complete high C1-C4 cervical injury ( what’s happening with patient )
aka. Complete severing of spinal cord
1- Quadriplegia : no movement in arms or legs ( 2nd neuron isn’t being stimulated )
2- Spastic : rubrospinal is being suppressed
3- Sensory loss : correspond with level of injury, C4 dermatome is at clavicle. from clavicle down everything will be numb ( anesthesia )
4- Bowel and bladder function : central type impairment
5- Breathing problems : intercostal muscles impaired and diaphragm is partially working
Causes of high C1-C4 cervical injury
1- Trauma / fracture / compression
2- herniated disk
3- tumour
4- Infection
What is central type impairment of bowel and bladder function and what could it lead to
Bladder: retention of urine ( catheterization )
Bowel : severe constipation
= recurrent UTI ‘s , can kill them
How is the diaphragm innervated
Neurones located in brainstem and partially neurones in the first cervical segments
Signs of Complete Low C5 to T1 injury ( what’s happening with patient )
Where the 2nd neurone for the arms so they will be injured too
1- Flaccid paralysis of arms: since 2nd neurone in C5-8 will also be injured then will muscle won’t be spastic will be flaccid ( NO INCREASED TONE IN ARMS )
2- Spastic paralysis in lower limbs ( INCREASED TONE )
3- Breathing problems : intercostal muscles not working but Diaphragm is working ( shouldn’t need help )
4- Bowel and bladder function : centrally impaired
5- Sensory loss: correspond with level of injury. lateral Dermatomes of arm are spared but not medial or rest of body.
6- Horner’s syndrome : Contracted pupil , drooping eyelid , no sweating of face
Signs of Complete thoracic T2 to T12 injury ( what’s happening with patient )
Below Cervical enlargement so arms are sparred ( lower spastic paraplegia )
1- Intact arm movement due to Preserved 1st and 2nd neurone for arm
2- Spastic paralysis of lower limbs : injury above lumber enlargement
3- Breathing problems: intercostal muscles not working but Diaphragm is working
4- Sensory loss : correspond with level of injury. Anesthesia from chest down, arms sparred
5- Bowel and bladder function : centrally impaired
Signs of Complete Lumbar L1 to L3 injury ( what’s happening with patient )
At lumber enlargement so 2nd neurones for lower limbs are damaged too
1- Arms are fully intact
2- Normal breathing : intercostal and diaphragm working
2- Flaccid paraplegia of lower limbs : 2nd neurones are impaired too
3- Bowel and bladder function : centrally impaired
4- Sensory loss: Correspond with level of injury. anesthesia from waist ( inguinal folds) down
Signs of Complete Conus S2 injury ( what’s happening with patient )
Impaired conus medlars / cauda equina
1- Intact movement of all limbs
2- Bowel and Bladder function : peripheral impairment( incontinence) , leaving urine and faeces
3- Anal reflex impairment
4- Sensory loss : saddle type anesthesia : back buttocks and upper inner thigh
5- Peripheral type paralysis : flaccid, weakness of legs
What is peripheral impairment of bowel and bladder
Incontinence : urine and faeces leaking
Signs of Cauda Equine syndrome ( S2 )
1- Loss of anal tone 2- loss of perineal sensation 3- faecal and urinary incontinence 4- maybe sciatic type symptoms 5- leg weakness: flaccid type paralysis
Acute cauda equine compression is a ….
neuroseurigal emergenecy
What is a acute condition common neurosurgical emergency
Acute Cauda Equine compression ( incomplete cauda equine )
What is Brown Sequard Syndrome ( Left side, T11 ) and what are the symptoms
Lesion only affecting left side of cord ( at T11 )
1- Only one leg is affected , usually left side same side s injury. Weakness with spasticity : central spastic paralysis
2- Priorproception and deep sensation anesthesia on left side and pain and temperature anesthesia on right side of waist down
Where is the conus medularis
L1
Where is the cauda equina
L2
If there is a C7 vertebral fracture where is the lesion
T1
If there is a C4 vertebral fracture where is the lesion
C5
