Spinal

Question 1

what layers are the intervertebral discs made up of

Answer 1

annulus fibrosis - fibrocartilage

nucleus pulposus - mostly water, collagen, proteoglycans

Question 2

most common causes low back pain

Answer 2

obesity
lack exercise
facet joint OA

Question 3

back pain red flags

Answer 3

age >55/<20
night pain
pain without improvement on rest 
trauma 
systemic upset 
weight loss 
urine retention or incontinence 
faecal incontinence 
saddle anaesthesia 
hx malignancy

Question 4

pathophysiology of lumbar disc herniation?

Answer 4

nucleus herniates through tear in annulus ring and compresses adjacent nerve roots

Question 5

most common spinal levels affected by lumbar disc herniation

Answer 5

L4/5

L5/S1

Question 6

what can a central disc herniation cause

Answer 6

spinal stenosis or cauda equina

Question 7

what can a paramedian disc herniation cause

Answer 7

compresses traversing nerve so if L4/5 it would affect L5

Question 8

what can a lateral disc herniation cause

Answer 8

affects the one exiting that level so if L4/5 it would affect L4

Question 9

general clinical features of disc prolapse

Answer 9

sciatic pain exacerbated by cough/sneeze
paraesthesia
weakness
SLR+ve - if leg <45 degree before eliciting sciatica

Question 10

S1 specific features of disc prolapse

Answer 10

pain on post thigh and radiates to heel
sensory loss lateral foot
reduced/absent ankle jerk
weak plantarflexion

Question 11

L5 specific features of disc prolapse

Answer 11

pain on posterior/posterolateral thigh, radiation to dorsal foot and great toe
weak dorsiflexion of toe or foot
paraesthesia and numbness of foot and great toe

Question 12

L4 specific features of sic prolapse

Answer 12

pain in ant thigh
wasting of quads
weak quads function and foot dorsiflexion
diminished ant thigh sensation, medial lower leg
reduced knee jerk

Question 13

indication for operative management of disc prolapse

Answer 13

failing conservative 
pain
central prolapse
tumour 
neuro deficit

Question 14

what is cauda equina syndrome and what are the causes

Answer 14

compression of cauda equina 
tumour 
infection 
haematoma 
trauma
disc prolapse - central L4/5

Question 15

clinical features cauda equina

Answer 15

urinary retention 
saddle paraesthesia 
incontinence 
low back pain 
bilateral sciatic back pain - radicular and partial/complete loss sensation/motor function

Question 16

investigation for CES

Answer 16

DRE

MRI

Question 17

what is spinal stenosis and what levels does it commonly occur at

Answer 17

narrowing of spinal canal compressing lower cord, neurogenic claudication
L3/4, L4/5

Question 18

cause of spinal stenosis

Answer 18

hypertrophy of facet joints and ligamentum flavum
protrusing intervertebral discs
spondylolisthesis

Question 19

features of spinal stenosis

Answer 19

progressive months/years
unilaterla/bilateral hip, buttock, lower extremity pain or burning
precipitated by back extension/standing and relief by sitting, lumbar flexion and walking uphill
preserved pulses

Question 20

diagnosis of spinal stenosis

Answer 20

clinical but can get MRI

Question 21

treatment of spinal stenosis

Answer 21

conservative with physio and painkillers

surgery if intolerable

Question 22

what is cervical spondylosis and pathophysiology

Answer 22

degenerative arthritis of c spine and intervertebral discs and zygapophyseal joints
cervical disc degeneration, stress on cartilage and osteophytic spurs on margins of end plates to grow posterior into spinal canal

Question 23

radiographic findings of cervical spondylosis

Answer 23

narrowing of disc space

osteophytes

Question 24

clinical features of cervical spondylosis

Answer 24

myelopathy

radiculopathy

Question 25

management of cervical spondylosis

Answer 25

surgical - laminectomy, discectomy, foraminotomy

Question 26

what is degenerative cervical myelopathy

Answer 26

spinal cord compression leading to UMN signs

Question 27

clinical features of degenerative cervical myelopathy

Answer 27

predominant in LL
imbalance and disturbed gait 
spasticity and decreased proprioception 
clumsy hands and tingling in fingers 
pain in non dermatomal distribution 
hyperreflexia 
\+ve babinski/hoffmans 
weakness

Question 28

investigation of degenerative cervical myelopathy

Answer 28

MRI C spin

Question 29

management of degenerative cervical myelopahty

Answer 29

decompressive surgery prevents further deterioration but doesnt improve symptoms really

Question 30

cause of acute spinal cord compression syndrome

Answer 30

haemorrage/collapse of tumour
infection
haemorrhage
trauma

Question 31

cause of chronic spinal cord compression syndromes

Answer 31

tumour
rheumatoid
degeneration

Question 32

what is anterior cord syndrome and features?

Answer 32

cord infarct of anterior spinal artery
paralysis
loss of pain and temp below level injury and preserved proprioception and vibration sensation

Question 33

how does complete cord transection present as?

Answer 33

spinal shock
then UMN signs
all motor and sensory affected below lesion

Question 34

how does brown sequard syndrome present?

Answer 34

ipsilateral loss of motor neuron and proprioception

contralateral loss pain and temp 1/2 segments below lesion

Question 35

causes of central cord syndrome?

Answer 35

acute extension to stenotic neck, syringomyelia

tumour

Question 36

features of central cord syndrome?

Answer 36

bilateral upper limb paralysis
cape like spinothalamic sensory loss
preserved DCML