Spinal conditions Flashcards
What red flags are associated with lower back pain?
Pain wakes the patient up at night
Saddle anaesthesia
Urinary retention or incontinence
PMH of malignancy
Weight loss or fever
Lumbar spinal stenosis describes narrowing of the spinal canal which compresses the lower spinal cord. What are some of the causes of this condition?
Hypertrophy of facet joints and the ligamentum flavum
Protruding intervertebral discs
Spondylolisthesis
What are some of the clinical features of lumbar spinal stenosis?
Relieved by sitting, lumbar flexion or walking uphill
Anthropoid posture (exaggerated flexion at the waist)
Weakness, tingling and paraesthesia
Hip/ buttock/ lower extremity pain
What is the surgical option for lumbar spinal stenosis?
Lumbar laminectomy
Describe the differences between neurogenic and vascular claudication in terms of; distribution and type of pain
NEUROGENIC
Dermatomal distribution
Burning pain
VASCULAR
Sclerotomal distribution
Cramping pain
Both neurogenic and vascular claudication are exacerbated by exercise and relieved by rest. What are some of the other relieving factors for neurogenic pain?
Relieved by resting
Walking up hill
Waist flexion
Sitting
What are some of the features of cervical spondylosis?
UMN signs or LMN signs
Narrowing of the disc space on imaging
Osteophyte formation
What are the surgery options for cervical spondylosis?
Decompressive cervical laminectomy
Anterior cervical discectomy
Posterior cervical foraminotomy
What happens to tone in UMN Vs LMN disease?
UMN = tone increased
LMN = tone decreased
Fasciculations are associated with UMN or LMN?
LMN
What happens to reflexes in UMN disease Vs LMN disease?
UMN = reflexes brisk
LMN = decreased/absent
What happens to planters in UMN disease Vs LMN disease?
UMN = upgoing plantars
LMN = downing plantars
Is clonus present with UMN disease or LMN disease?
UMN
Which type of disc herniation compresses the exiting nerve and which compresses the transversing nerve?
Posterolateral herniation compresses the transversing nerve
E.g a herniation at L4/5 damages L5
Far lateral (extraforaminal) herniation compresses the exiting nerve E.g a herniation at L4/5 damages L4
What might be some of the clinical features of an L5/ S1 prolapsed intervertebral disc?
Reduced/ absent ankle jerk reflex
Weakness of plantar flexion
Pain and sensory loss
What might be some of the clinical features of an L4/5 prolapsed intervertebral disc?
Weakness of dorsiflexion of the toe or foot
Pain and sensory loss
What might be some of the clinical features of an L3/4 prolapsed intervertebral disc?
Reduced knee jerk
Pain and sensory loss
What level of disc prolapse is usually the cause of cauda equina syndrome?
L4/5
What are some of the clinical features of caudal equina syndrome?
Bilateral leg pain
Saddle paraesthesia
Erectile dysfunction
Urinary retention and incontinence
How might degenerative cervical myelopathy present? (disc prolapse in the cervical spine)
Clumsy hands with fingertip paraesthesia
Difficulty with fine motor tasks
Hyperreflexia
What is meant by the term ‘Syrinx’?
Build up of fluid in the spinal cord
What is usually the investigation of choice for spinal problems?
MRI
What are the general treatment options for spinal problems?
Physiotherapy and analgesia
Surgery
What are some of the possible causes of acute and chronic spinal cord compression?
ACUTE
Truama
Collapse/ haemorrhage from a tumour
Infection
CHRONIC
Tumours
RA
Spondylosis (OA)
Describe the presentation of cord transection (complete spinal cord lesions)
Complete lesion
All motor and sensory modalities are affected below the level of the lesion
Contralateral loss of pain and temp sensation begins 1-2 segments below the lesion
Describe the presentation of Brown-Sequard syndrome/
Half of the spinal cord is injured
Ipsilateral motor paralysis below the level of the lesion
Contralateral loss of pain and temp sensation begins 1-2 segments below the lesion
Describe the presentation of central cord syndrome
Distal bilateral upper limb weakness
‘Cape-like’ spinothalamic sensory loss
What are some of the causes of central cord syndrome?
Syringomyelia
Narrowing of the spinal canal with age - pinches off blood supply - inner part of the spinal cord is the most sensitive to damage
Hyperflexion or extension injuries to an already stenotic neck
Describe the presentation of anterior cord syndrome
Paralysis and loss of pain and temperature sensation below the level of the injury with preserved proprioception and vibration sensation
