MSK- Neuro Cons

Question 1

What is Myelopathy?

Answer 1

Compression on the spinal cord in the central canal.

Often occurs in the cervical spine and can be caused by central stenosis.

Question 2

What are the management options for Myelopathy?

Answer 2

Conservative or surgical (fusion/stabilization).

Surgical intervention may be necessary depending on severity.

Question 3

What is Cauda Equina Syndrome (CES)?

Answer 3

Compression on the collection of nerves at the bottom of the spinal cord (horses tail).

It is a rare but serious condition, occurring in 1-3/100,000 cases.

Question 4

What is the most common cause of Cauda Equina Syndrome?

Answer 4

Herniation of a lumbar disc (45%).

Other causes include stenosis, tumor, discitis, and trauma.

Question 5

What are the urgent medical actions required for Cauda Equina Syndrome?

Answer 5

MRI and bladder scanning within 48 hours.

Immediate surgery may be necessary to prevent longstanding symptoms.

Question 6

What are the risk factors for Myelopathy?

Answer 6

• Older age
• Degenerative changes
• Stenosis
• Rheumatoid arthritis
• Ankylosing spondylitis
• Trauma
• Upper cervical instability

Systemic autoimmune conditions can contribute to risk.

Question 7

What are common signs and symptoms of Myelopathy?

Answer 7

• Gait disturbances
• Fine motor skill changes
• Neck pain
• Bilateral symptoms (pain, weakness, P+N’s)
• Hyperreflexia
• Bladder and bowel disturbances

P+N’s refers to pins and needles sensation.

Question 8

What are the spinal red flags associated with Myelopathy?

Answer 8

• Cervical arterial dysfunction (CAD)
• Malignancy
• Systemic inflammatory disorders
• Infections
• Fractures
• Cauda equina syndrome (CES)

These conditions require immediate attention.

Question 9

What causes Myelopathy?

Answer 9

• Central disc herniation
• Age-related changes
• Trauma
• Spondylolisthesis
• Ligament thickening
• Postoperative problems
• Rarely, infections, tumors, cysts

Age-related changes can include bony spurs or osteophytes.

Question 10

What are the signs and symptoms of Cauda Equina Syndrome?

Answer 10

• Retention of urine
• Loss of anal tone
• Saddle anaesthesia
• Bilateral leg pain/numbness
• Sexual dysfunction

These symptoms indicate severe nerve compression.

Question 11

What are the signs and symptoms of Radiculopathy?

Answer 11

• Arm symptoms (cervical)
• Leg symptoms (lumbar)
• Pain in dermatomal distribution
• Sensory symptoms (paraesthesia, anaesthesia)
• Motor loss in the relevant nerve root
• Reflex changes (hyporeflexia)

Radiculopathy can occur rarely in the thoracic region.

Question 12

What investigations are typically done for Myelopathy?

Answer 12

Full spine MRI.

MRI is essential for diagnosing the extent of spinal cord compression.

Question 13

What is the management approach for peripheral neuropathies?

Answer 13

• Physiotherapy
• Education
• Activity modification
• ROM exercises
• Strength training
• Function improvement

Surgery may be considered if conservative management fails.

Question 14

What is Peripheral Nerve Entrapment?

Answer 14

An area in the peripheral nerves where the nerve can become irritated.

This typically occurs at anatomical interfaces where nerves pass through small spaces.

Question 15

Fill in the blank: The most common cause of Cauda Equina Syndrome is _______.

Answer 15

herniation of a lumbar disc.

Question 16

True or False: Myelopathy can only occur in the lumbar spine.

Answer 16

False.

Myelopathy usually occurs in the cervical spine.