spinal and neurological conditions Flashcards
Where is myelopathy found usually?
Cervical spine
What is myelopathy?
Compression on the spinal cord in the central canal
What can myelopathy be caused by?
central stenosis
central disc herniation
age related changes (bony spurs and/or osteophytes)
trauma and/or instability
spondylolisthesis
ligament thickening
postoperative problems
rarely - infections, tumours, cysts
What are some signs and symptoms of myelopathy?
Gait disturbances (ataxia, falls, clumsiness, balance)
fine motor skill and coordination changes
possibly neck pain and/or bilateral symptoms (pain, weakness P+N, paraesthesia or numbness)
Hyper-reflexia
possibly bladder and bowel disturbances
Name some risk factors for myelopathy
older age, degenerative changes, stenosis
Rheumatoid arthritis and ankylosing spondylitis (systemic autoimmune)
Trauma, upper cervical instability
How can myelopathy be managed?
conservative or surgical (fusion/stabilisation)
What is cauda equina syndrome?
compression on the collection of nerves at the bottom of the spinal cord (horses tail)
What are some of the causes of cauda equina syndrome?
herniation of a lumbar disc (most common cause)
stenosis
tumour
discitis
trauma
What will clinicians do if someone has CES?
MRI and bladder scanning
immediate surgery (spinal decompression) to try to prevent longstanding symptoms
post surgery - physiotherapy to gradually return to normal function
What are some signs and symptoms of CES?
retention of urine
loss of anal tone
saddle anaesthesia
bilateral leg pain and/or numbness
sexual dysfunction
What is radiculopathy?
a change in neurological function from nerve root compression, irritation or sensitivity
Name some signs and symptoms of radiculopathy
cervical - arm symptoms
lumbar-leg symptoms
pain in dermatomal distribution
sensory symptoms (paraesthesia, anaesthesia, allodynia) in dermatome
motor loss in the relevant nerve root
reflex changes
What is peripheral nerve entrapment/irritation?
an area in the peripheral nerves (not in the spine) in which the nerve can become irritated
can be located at an interface or area in which the nerve passes through a small anatomical space
Name some signs and symptoms of peripheral nerve irritation
may give pain and/or sensory symptoms at the interface and distal to the area the nerve supplies
depends what type of nerve it is - some are sensory, motor or both
How do we manage peripheral neuropathies?
physiotherapy/non invasive treatment first
education, activity modification, ROM, strength, function
splinting
CSI may provide short term relief
potentially surgery
What investigations would suspected myelopathy have?
full spine MRI
What investigations would potential radiculopathy have?
MRI of local region
What investigations would suspected peripheral nerve entrapment have?
EMG studies
Name the spinal red flags
Myelopathy (central/spinal cord compression)
cervical arterial dysfunction
Malignancy
systemic inflammatory disorders
infections
fractures
cauda equina syndrome
Name some specific low back pain conditions
ankylosing spondylitis
spinal stenosis (central and foraminal)
spondylosis
spondylolysis
spondylolisthesis
scoliosis
whiplash
radiculopathy
What is ankylosing spondylitis?
inflammatory arthritis
What is the main symptom of ankylosing spondylitis?
Back pain often starting in the SIJ
Where does ankylosing spondylitis mainly affect?
entheses, where ligaments, tendon and capsules are attached to bone
What changes will be seen on x-rays with ankylosing spondylitis?
osteophytes and possibly fusion
What changes will be seen on MRI for ankylosing spondylitis?
inflammation
Name some risk factors of ankylosing spondylitis
genetic (family history and HLA-B gene)
men
age (late adolescent)
Describe a typical presentation of ankylosing spondylitis
slow or gradual onset of back pain and stiffness over weeks or month, rather than hours or days
early morning stiffness and pain, wearing off or reducing during the day with exercise
persistence for more than 3 months
feeling better after exercise and worse after rest
weight loss
fatigue or tiredness
feeling feverish and experiencing night sweats
What is spinal stenosis?
canal narrowing
either central or foraminal
What causes spinal stenosis?
can be caused by a number of structures
osteophytes, disc herniation, thickening of ligament, tumours
