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ORTHOPAEDICS > Spinal and Nerve Root Disease > Flashcards

Spinal and Nerve Root Disease Flashcards

1
Q

DDx of spinal cord lesions:

Intrinsic:

  • Infection - 2
  • Inflammation - 3
  • Malignancy - 1
  • Happens in the brain - 1
  • Degenerative
  • A type of deficiency
A

EBV, syphilis

Transverse myelitis, MS, NMO

Primary tumour

Spinal stroke

Spino-cerebellar ataxia

B12 deficiency

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2
Q

DDx of spinal cord lesions:

Extrinsic:

  • Malignancy
  • Blood
  • Infection may cause what?
  • Obvious cause from an accident for example?
A

Tumour (either local or mets)

Haematoma

Abscess

Trauma

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3
Q

Spine and nerve root anatomy:

Grey matter:

  • What does it look like?
  • What type of nuclei does the dorsal horn and ventral horn contain?

White matter:

  • Where are ascending (sensory and afferent) tracts?
  • Where are descending (motor and efferent) tracts?
A

Butterfly shape

D - sensory nuclei
V - motor nuclei

Dorsal and external lateral cord

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4
Q

Route of a spine nerve:

What information does the dorsal and ventral root carry?

The 2 roots form a single spinal nerve. then split into the anterior rami and the posterior rami. What do these 2 supply?

A

D - sensory
V - motor

Anterior - most of the body
Posterior - the back

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5
Q

Injury levels:

Why do you make sure you scan a big portion of the spine, especially for lower presentations?

A

The lesion itself is often higher than the sensory level and is truer the lower down the lesion is.

This is because the nerve roots move down alongside the spine before exiting the spinal cord.

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6
Q

Injury levels:

Around what level is the phrenic nerve injured and what will that lead to?

Above what level do the intercostal muscles become effected?

What is the sympathetic trunk?

What range of levels does it exit in?

What may injury to it cause?

A

C3-5

Impaired ventilation - diaphragm

T8

A paired bundle of nerve fibres that run from the base of the skull to the coccyx. The sympathetic trunk lies just lateral to the vertebral bodies for the entire length of the vertebral column.

T1-L2

Autonomic dysfunction, including neurogenic shock

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7
Q

Spinal cord compression:

Define?

Causes:
- Non-neoplastic - 4

  • Neoplastic - list common origination of mets
A

Pressure on the spinal cord or the surrounding CSF or vascular system.

Trauma
Vertebral crush fracture due to osteoporosis
Slipped disc
Infection - discitis, epidural abscess, TB

Breasts 
Lung 
Prostate 
Myeloma 
Renal cell
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8
Q

Spinal cord compression:

S+S:

First symptom
What makes this worse? - 2

Second symptom - sensory loss:

  • Sym/assym
  • How many dermatomes are effected?
  • Is it on the same sensory level as the lesion?

Third symptom - motor loss:

  • Where?
  • Reflexes?
  • Tone?
  • What about sphincters?

What patient should this be a red flag in?

A

Back pain + worse on lying/coughing

Symmetrical sensory loss
1-2 dermatomes below lesions - remember they move down before exiting

Legs weakness
Hyperreflexia
Hypertonia

Sphincter dysfunction (hesitancy, frequency, and later painless retention)

CANCER PATIENTS!! - They present with worsening back pain or impaired mobility/sensation

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9
Q

Spinal cord compression:

Management:

  • Who needs to be contacted and for what?
  • What drug is given?
  • What scan is only useful in spinal trauma?
  • What scan will be used if there has been a history of trauma?
A

Neurosurgery

Dexamethasone (loading dose then daily)

MRI whole spine

Spine X-ray

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10
Q

Spinal stenosis:

What is it?

What part of the spine does this usually happen in?

What else is involved apart from the spinal cord?

A

Spinal degeneration (spondylosis), particularly of the facet joints, resulting in narrowing of the spinal canal.

Lumbar region

The nerve roots themselves, therefore, CORD+ROOTS

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11
Q

Spinal stenosis:

What type of leg pain do you get?

What else happens to the legs?

Where does the pain radiate to?

What position makes the symptoms better or worse?

A

Neurogenic intermittent claudication - exertional leg pain with aching and heaviness

Weakness and numbness

Relieved by flexion - sitting or lying down, walking uphill
Worsened by extension - standing up, arching back q

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12
Q

Spinal stenosis:

Management:

Non-surgical:

  • What can be worn to help?
  • What can be given for pain and inflammation?
  • What if the previous meds aren’t enough?
A

A brace - used to limit bending and twisting and assist in carrying some of the weight the discs normally withstand. Bracing for lumbar spinal stenosis aims to reduce pressure on and limit micro-motions in the lower spine, both of which can cause nerve root irritation and radicular pain.

NSAIDs

Epidural corticosteroids

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13
Q

Spinal stenosis:

Management:

Surgical:

  • One option!
  • Spinal surgery risk?
A

Decompression in those with debilitating symptoms

Nerve damage
Continued pain
Infection
CSF leak

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14
Q

Radiculopathy:

What is it?

A

Nerve ROOT compression

Disc degeneration and HERNIATION
Spondylosis (vertebral degeneration)
Trauma

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15
Q

Radiculopathy:

Sensory symptoms:

You get pain:
- How would patients describe the pain?

What other symptoms will they complain of?
Where would these symptoms be?

A

Sharp
Stabbing
Electrical
Hot

Numbness or paresthesia
Dermatomal distribution

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16
Q

Radiculopathy:

Motor symptoms - what will happen?

Are symptoms usually uni/bilateral?

What may happen if the cord is compressed at that level?

A

Weak in myotome

Unilateral

UMN signs below the lesion

17
Q

Radiculopathy:

What symptoms do you have with cervical radiculopathy?

What does lumbar radiculopathy cause 90% of?

A

Neck and upper limb symptoms

Sciatica (L4-S3)

18
Q

Radiculopathy - SCIATICA:

Where do you have pain? - 3 
Where is the pain worst? 
Uni/bi? 
Where does the pain radiate to? 
What reproduces the pain that is done in the spinal examination? 
What 2 other symptoms do they have? 
Reflexes? 
How may muscle weakness present?
A

Buttock and leg pain > back pain

Unilateral

Foot and toes

Straight leg raise

Numbness and paraesthesia

Hyporeflexia

Muscle weakness = foot drop

19
Q

Radiculopathy:

Management:

It is initially managed by mechanical back pain. What does this involve?

What is the next step if the pain is not improving?

A 
Same as mechanical back pain - no need for imaging:
> Continue ADLs 
> Patient education 
> Physiotherapy 
> Psychological support

Analgesia - paracetamol, NSAIDs, weak opioids or neuropathic (amitriptyline, gabapentin)

20
Q

Radiculopathy:

Management:

Was is done for refractory sciatica that is severe, acute and persists >1-2 wks?

What will surgery improve?

What should be done for someone with refractory cervical radiculopathy (>6 wks) or with objective neurological signs?

A

Epidural steroids or local anaesthetic injections

Refer for MRI
Possible epidural injections
Surgery

21
Q

CHECK RHEUMATOLOGY FOR MECHANICAL BACK PAIN

A

CHECK RHEUMATOLOGY FOR MECHANICAL BACK PAIN

ORTHOPAEDICS (31 decks)

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