extracranial path

Question 1

red flags for back pain

Answer 1

BACK PAIN
Bowel/bladder
Anasthesia - saddle
Constitutional Sx
Khronic disease
Parasthesias
Age >50 or under 20
IV drug use
Neuromotor defificts
Malignancy

Question 2

7 causes of extradural back pain

Answer 2

1. root compression
2. cervical disc syndrome
3. cervical stenosis
4. lumbar disc syndrome
5. cauda equina
6. lumbar stenosis
7. neurogenic claudication

Question 3

what is cervical disc syndrome

Answer 3

• nucleus pulp herniates through the annulus (C6-7)
• pain in arm follows nerve root dist.
• LMN signs and Sx

Question 4

Tx of cervical disc

Answer 4

conservative
- activity
surg
- anterior discectomy

Question 5

what is cervical stenosis

Answer 5

chroinc disc degen. and assoc. facet arthropathy

- mech. neck pain, myelopathy and radiculopathy

Question 6

Tx of cervical stenosis

Answer 6

1. decompression and stabilization
2. NAIDS, heat, ROM and strength
3. surgery if severe

Question 7

what is lumbar disc syndrome

Answer 7

herniated disc compressing nerve root BELOW level of disc

- initially back pain, then leg>back

Question 8

Tx of lumbar disc

Answer 8

conservative

surg. only for cauda equina

Question 9

what is cauda equina

Answer 9

compression or irritation of nerve roots below conus medullarus (L2)
- disc, fractures or tumors

Question 10

4 features of cauda equina

Answer 10

1. acute
2. LMN weakness/paras
3. autonomic
   - bowel/bladder
4. sensory
   - LBP
   - saddle anasthesia

Question 11

Tx of cauda

Answer 11

immed. surg. decompression

Question 12

what is lumbar spinal stenosis

Answer 12

congenital narrowing of spinal canal combined with degen. changes
- gradually progressive back and leg pain made better by sitting

Question 13

Tx of lumbar spinal stenois

Answer 13

• NSAID anal

- laminectomy if need be

Question 14

what is neurogenic claudication

Answer 14

ischemia of lumbosacral nerve roots secondary to vascular compromise
- dermatomal pain with increased activity

Question 15

what is main intradural intramedulary?

Answer 15

syringomelia (syrinx)

Question 16

what is a syrinx

Answer 16

cystic cavitation of the spinal cord

- varied presesntation of pain, loss of motor, and sense

Question 17

2 main cats of spinal cord lesion

Answer 17

1. complete
   - bilat loss of sense and motor at 4 levels below and UMN signs
2. incomplete
   - any residual function at 4 levels below

Question 18

4 main types of incomplete

Answer 18

1. brown-sequard (hemi)
   - ipsi motor and vib, contra pain
2. anterior cord
   - loss of motor and pain, no vib
3. central cord
   - loss of motor and that level of pain
4. posterior cord
   - loss of vib, others intact

Question 19

etiologies of peripheral nerve

Answer 19

• ischemia
• entrapment
• mechanical