Neck, Back, Disc, and Root Disorders Flashcards
Mobility in the vertebral column
-Occurs mostly in cervical and lumbo-sacral areas
=Degenerative change/ mechanical problems
Symptoms and signs of degenerative change in the vertebral column
-Symptomless
-Pain
-Stiffness & Limitation of movement
-Crepitus (grating sensation)
-Generally inconsistent correlation between radiological signs of degenerative change & symptoms / Symptom severity
Pathophysiology leading to symptoms in degenerative changes in vertebral column
-Disc disease
-Facet joint disease
General Anatomy and corresponding neurological problems
-Affecting central canal: spinal cord or cauda equina
-Affecting Root foramina laterally: Radiculopathies (disease of roots)
-Cervical: Spinal Cord or Arm Roots
-Lumbo-Sacral: Cauda Equina or Leg Roots
Lumbo-sacral region neurological problems
-Central Disc Prolapse: CES (causa equina syndrome)
-Disc Prolapse/other degeneration affecting Root foramen: Lumbar Radiculopathy
Cervical region neurological problems
-Degenerative change affecting central canal: Cervical Spondylotic Myelopathy
-Disc Prolapse/other degeneration affecting Root foramen: Cervical Radiculopathy
-Most Often: L5, C5, C6, C7
Important pathology of mechanical spine problems
-PID (prolapsed intervertebral disc)
-Facet Joint disease
Imaging degenerative changes in vertebral column
-X-Ray: no real role, unless specific indications (acute trauma)
-MRI: modality of choice in neurological aspects (cord, cauda equina, root), not necessary for diagnosis in typical PID with radiculopathy
Neurological problem management
-Neck/Back Pain, PID with Radiculopathy
=Supportive whilst recovery takes place
=Exercises, Physiotherapy
=Surgery
-Cervical Spondylotic Myelopathy: Surgery possible
-CES: URGENT Diagnosis & Surgery
Presentation of spinal cord compression
-Insidious progression
-Neurological symptoms= gait disturbance, clumsy or weak hands, loss of sexual, bladder, or bowel function
-UMN signs in lower limbs= Babinski/ going up plantar reflex, hyperreflexia, clonus, spasticity
-LMN in upper limbs= atrophy, hyporeflexia
-Sensory changes= loss of vibration and joint position evident in hands compared to feet
-Pain= worsened by coughing or straining, localised or in root distribution
Diagnosis and management of spinal cord compression
-Investigation: MRI whole spine- trauma, prolapsed intervertebral disc, myeloma
-Management: surgery, corticosteroids
Presentation of metastatic cord compression
-Back pain= worse when lying down or coughing, severe and unremitting, localised spinal tenderness, nocturnal spinal pain
-Lower limb weakness, sensory loss and numbness, neurological signs (lesions above L1: upper MN in legs, below L1: lower MN legs and perianal numbness, tendon reflexes tend to be increased below level of lesion and absent at level of lesion)
-Bladder and bowel dysfunction, erectile dysfunction.
-More common in breast, lung, and prostate cancer.
Investigation and management of metastatic cord compression
-Investigation: urgent MRI whole spine within 24 hrs
-Management: high-dose oral dexamethasone, bisphosphonates, analgesia, urgent oncological assessment for consideration of radiotherapy or surgery
Presentation of transverse myelitis
-Recent infectious illness and vaccination
-10-19 or 30-39 yrs
-Motor weakness
-Paraesthesia
-Sensory loss= ascending tingling and/or numbness
-Bladder symptoms= urinary frequency, urgency, incontinence, or retention
-Bowel= incontinence or constipation
-Paroxysmal tonic spasms
-UMN lesions= hyper-reflexia, positive Babinski’s sign, limb spasticity
-Sensory loss/ sensory level
-McArdle’s sign (neck flexion)
-Back or neck pain
Investigation of transverse myelitis
-MRI spinal cord= exclude compressive myelopathy, intrinsic cord lesion) and brain
-MS presentation
-CSF= cellular pleocytosis
