Spinal Cord Flashcards
What are the cervical myotomes?
C5 - shoulder abduction and adduction, elbow flexion C6 - elbow flexion and wrist extension C7 - elbow extension, wrist flexion C8 - wrist flexion, finger flexion T1 - finger abduction
What myotomes are the biceps and brachioradialis reflexes?
C5 and C6
What myotome is the triceps reflex?
C7
What are the lumbosacral myotomes?
L2 - hip flexion and adduction
L3 - hyp adduction and knee extension
L4 - knee extension, foot inversion and dorsiflexion
L5 - hip extension and abduction, knee flexion, great toe dorsiflexion
S1 - knee flexion, foot plantarflexion and eversion
What are the myotomes for the lower limb reflexes?
Knee - L3/4
Great toe - L5
Ankle - S1
What is the common cause of spinal cord disease in 16-30 yo.?
Likely trauma of C4/5 or C5/6
What is the common cause of spinal cord disease in 30-50 yo.?
Likely disc disease of C5/6 or L4/5 or L5/S1
What is the common cause of spinal cord disease in 40+ yo.?
Likely malignancy
What are the potential causes of spinal cord problems?
Trauma Iatrogenic Osteoporosis Corticosteroid use Osteomalacia Osteomyelitis Tumour infiltration Disc herniation Infection
How do spinal cord problems present?
Back pain Numbness and paraesthesia Weakness and paralysis Bladder and bowel dysfunction Hyper-reflexia Spinal shock Neurogenic shoc
What happens in spinal shock?
Loss of reflexes, tone and motor function
What happens in neurogenic shock?
Following cervical or high thoracic injury
Bradycardia, hypotension, warm dry extremities, peripheral vasodilation, venous pooling, priapism, low cardiac output
When should a CT C Spine <1hr be considered?
GCS < 13 Intubated >65yo High impact injury Focal neurological deficit Paraesthesia of UL or LL
How is Spinal cord compression managed?
Immobilise C spine - collar and backboard
Intubate if above C5
Decompressive surgery
Supportive management - VTE prophylaxis, maintain vitals, nutrition, catheter, laxatives, pressure sore prevention
If malignancy - palliative
Abscess - IV Vancomycin, metronidazole and cefotaxime + surgery
How should patients with spinal cord disease be assessed?
History - injury method, symptoms (sensory, motor, autonomic, systemic), PMH, IV drugs? osteoporosis?
Imaging - AP and lateral views, CT and plain films, MRI if tumour or abscess suspected
How would a complete cord transection present?
Complete loss of all modalities below lesion
Spinal shock
Neurogenic shock - higher cervical
Horners syndrome - higher transection as sympathetics involved
Bowel and bladder involvement if lower transection
What can cause brown-sequard?
Trauma
Tumour
Herniation
MS
How would brown-sequard present?
Ipsilateral spastic paralysis
Ipsilateral loss of vibration and proprioception
Contralateral loss of pain and temperature
What can cause an anterior cord injury?
Flexion injury
Anterior spinal artery damage
How would an anterior spinal cord injury present?
Bilateral loss of motor function
Bilateral loss of pain and temperature
What can cause posterior cord injury?
Posterior spinal artery damage
Spinal stenosis
B12 deficiency
How would posterior cord injury present?
Bilateral loss of vibration and proprioception
What causes central cord injury?
Hyperextension injury
Spondylosis
Syringomyelia
How would central cord injury present?
Cape like distribution
Pain and temperature affected first
Motor affected more than sensory
What would cause cauda equina and how does it present?
Herniated lumbar disc or spinal canal stenosis
Saddle anaesthesia
Bladder retention - may be overflow incontinence
Leg weakness
What is cervical spondylosis?
Degeneration of annulus fibrosus + osteophyte formation leads to narrowing of the spinal canal and intervertebral foramina which can lead to a radiculopathy or myelopathy
How is the cord irritated in cervical spondylosis?
Osteophytes anteriorly
Thickened ligamentum flavum posteriorly
How does cervical spondylosis present?
Neck pain and stiffness Referred pain - headache and occipital Lhermitte's sign Cervical muscle spasm Limited range of movement
What is the difference between radiculopathy and myelopathy?
Radiculopathy - root compression
- pain and electrical sensations, numbness, dull reflexes, weakness, wasting of muscles
Myelopathy - cord compression
- Progressive symptoms, clumsy hands, gait disturbance, UMN leg and LMN arm signs, bladder and bowel features
What are the differentials for cervical spondylosis?
Acute hernia Spinal mets Multiple myeloma Fibromyalgia Ankylosing spondylitis Rheumatoid arthritis
How is cervical spondylosis managed?
Analgesia - NSAID’s
Gentle exercise - physio
Interlaminar cervical epidural injections
Surgical decompression
Radiculopathy - above + corticosteroids
Myelopathy - urgent referral, decompression or immobilisation if not fit for surgery
What investigation should be done for cervical spondylosis?
Cervical MRI if no improvement at 4-6 weeks
Immediately if red flag signs
Where can spondylosis also affect?
Lumbar - back pain, stiffness, leg claudication of buttocks and legs
Symptoms worse in morning
What is syringomyelia?
Collection of CSF within spinal cord
What causes syringomyelia?
Chiari malformation
Trauma
Tumours
Idiopathic
How does syringomyelia present?
Cape like loss of sensation to temperature
Preservation of light touch, proprioception and vibration
Classic example - pt burn hands without realising
What other signs and symptoms are associated with syringomyelia?
Spastic weakness Paraesthesia Neuropathic pain Upgoing plantars Bladder and bowel dysfunction
What complications are associated with syringomyelia?
Scoliosis
Horners
Syringobulbia is similar - fluid filled cavity within medulla of brainstem. Often extension of syringomyelia
How is syringomyelia investigated?
Full spine MRI with contrast - exclude tumour or tethered cord
Brain MRI - exclude chiari malformation
How is syringomyelia managed?
Treat underlying cause
Shunt can be placed into syrinx if persistent
