Evaluation of the spine

Question 1

Lhermitte’s Sign

Answer 1

Neck extension results in “electric shock” sensation down the back and into the arms

Attributed to posterior column disease, often secondary to MS, disc herniation, B12 deficiency

Question 2

Lasegu’s Sign

Answer 2

Straight leg raise test - Flex patient’s leg and dorsiflex the foot; sharp, shooting pain is a positive sign

Tests L5/S1 (Sciatic) nerve roots for impingement

Question 3

At what vertebral level is the conus medullaris found?

Answer 3

L1/L2

Question 4

Biceps reflex - which nerve roots?

Answer 4

C5, C6

Question 5

Brachioradialis reflex - which nerve roots?

Answer 5

C6

Question 6

Triceps reflex - which nerve roots?

Answer 6

C6, C7

Question 7

Patellar reflex - which nerve roots?

Answer 7

L2, L3, L4

Question 8

Achilles reflex - which nerve roots?

Answer 8

S1

Question 9

Nerve root L4 testing - motor, sensory, reflex

Answer 9

Motor - Psoas, Quads

Sensory - Knee, medial leg

Reflex - Patellar

Question 10

L5 nerve root testing - motor, sensory, reflex

Answer 10

Motor - foot dorsiflexion, big toe extension, foot eversion/inversion

Sensory - Dorsum of foot, great toe

Question 11

S1 nerve root testing - motor, sensory, reflex

Answer 11

Motor - foot plantarflexion

Sensory - lateral foot, small toe, sole of foot

Reflex - Achilles

Question 12

Nerve root C5 testing - motor, sensory, reflex

Answer 12

Motor - deltoid, infraspinatus, biceps

Sensory - shoulder, upper lateral arm

Reflex - biceps

Question 13

Nerve root C6 testing - motor, sensory, reflex

Answer 13

Motor - wrist extensors, biceps

Sensory - 1st and 2nd digits of hand

Reflex - biceps, brachioradialis

Question 14

Nerve root C7 testing - motor, sensory, reflex

Answer 14

Most common radiculopathy of the UE (40-50%); usually involves herniation of the C6-C7 IVD

Motor - triceps

Sensory - 3rd digit

Reflex - Triceps

Question 15

Abdominal reflex

Answer 15

Elicited by drawing a line away from the umbilicus along the diagonals of the 4 abdominal quadrants; a normal reflex draws the umbilicus toward the direction of the line that is drawn

Upper reflex evaluates T8, T9, T10

Lower reflex evaluates T10, T11, T12

Question 16

Upper motor neuron signs

Answer 16

Spasticity
Hyperreflexia
Extensor Plantar Reflex (Babinski’s Sign)

Question 17

Lower motor neuron signs

Answer 17

Atrophy
Fasciculations 
Flaccidity
Decreased DTRs
Flexor Plantar Response

Question 18

Spinal Shock

Answer 18

Occurs with acute, complete spinal cord transection

Acutely, exam shows flaccid weakness, absent tone, absent DTRs, and absent autonomic function (bladder function, sweat)

By 3-4 months, exam shows UMN spasticity, hyperactive DTRs, Babinski sign

Question 19

Cervical Stenosis

Answer 19

Congenital or acquired narrowing of central cervical spinal canal

Can result in UMN signs in legs +/- bladder dysfunction

Question 20

Complete Cord Transection

Answer 20

Affects all ascending sensory and descending motor/autonomic tracts

Deficit: sensory and motor below the lesion; root sign at site

Question 21

Central Lesions

Answer 21

Ex: Syringomyelia, ependymoma, cord contusion

Tracts: Crossing ST

Deficit: Pain/temperature loss at level of lesion; sparing of position sensation

Question 22

Posterior Column Syndrome

Answer 22

Ex: Tabes Dorsalis (neurosyphilis)

Tracts: Posterior Column

Bilateral loss of position and vibration sense

Question 23

Combined anterior horn cell / pyramidal tract sydnrome

Answer 23

Ex: ALS

Tracts: Corticospinal, LMN cells in cord

Deficit: Loss of bilateral strength, fasciculations, atrophy

Question 24

Brown-Sequard Syndrome

Answer 24

Ex: Compression by herniated discs

Tracts: Crossed spinothalamic, uncrossed posterior column, crossed corticospinal

Below lesion, loss of contralateral pain/temperature, ipsilateral position and strength

Question 25

Posterolateral Column Syndrome

Answer 25

Ex: B12 deficiency (subacute combined degeneration)

Tracts: Posterior Column, Corticospinal

Deficit: Bilateral los sof position, vibration, and strength

Question 26

Anterior Horn Cell Syndrome

Answer 26

Ex: Polio

Deficits: Bilateral loss of strength, fasciculations, flaccidity, decreased DTRs

Question 27

Anterior Spinal Artery Occlusion

Answer 27

Tracts: Corticospinal + Spinothalamic

Deficit: B/L loss of strength, pain, temperature; sparing of position sense

Question 28

Pyramidal Tract Syndrome

Answer 28

Ex: Primary lateral sclerosis

Tracts: Corticospinal

Deficit: Bilateral UMN weakness with spastic gait, hyperreflexia; sparing of sensory tracts

Question 29

Myelopathy with Radiculopathy

Answer 29

Ex: Cervical spinal stenosis

Deficit: Bilateral UMN syndrome with spastic gait, hyperreflexia, ipsilateral/contralateral root signs, possible bladder dysfunction

Question 30

Conus Medullaris

Answer 30

Dysfunction of the cord tip (S2-S5)

Early bladder, bowel, and sexual dysfunction
Late pain in thighs and buttocks

Question 31

Cauda equina syndrome

Answer 31

Dysfunction of spinal roots L1-S5

Early root pain radiating to legs
Late bladder, bowel, and sexual dysfunction
Leg weakness and decreased DTRs (LMN)

Question 32

Where does parasympathetic control of the bladder come from?

Answer 32

Pre-ganglionic parasympathetic cells in the S2, S3, and S4 levels of the spinal cord; these pre-ganglionic parasympathetics send axons out the ventral roots S2, S3, and S4 to synapse on post-ganglionic parasympathetic cells in ganglia near the bladder

Question 33

Hoffmann’s sign

Answer 33

Heightened finger flexor reflex

Suggests an UMN lesion affecting the hands