spinal cord and nerve root compression

Question 1

anatomy

Answer 1

• Spinal cord
- spinal canal, C-C Jn to L1/2
(Conus), cauda equina
- cervical & lumbar expansion
• 8 cervical roots, 12
thoracic, 5 lumbar, 5
sacral, 1 coccygeal
- exit foramina, motor/sensory
components
• Brachial / lumbo-sacral
plexus
- root values, reflexes,
dermatomes, myotomes

Question 2

spinal cord compression

Answer 2

• Cervical / thoracic myelopathy
• Causes
- spondylosis, tumours, crush #
- usually older people
• Upper motor neurone signs
- hyper-reflexia, hypertonia, spasticity, clonus, Babinski
sign
- often power preserved, variable sensory changes
• MRI Scan

Question 3

babinski sign?

Answer 3

The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along a curve to the toes[4] (metatarsal pads). Many reflex hammers taper at the end of the handle to a point which was used for testing the plantar response in the past, however, due to the tightening of infection control regulation this is no longer recommended. Either a single use orange stick or the thumb nail should be used.

There are three responses possible:

Flexor: the toes curve down and inwards, and the foot everts; this is the response seen in healthy adults.
Indifferent: there is no response.

Extensor: the hallux dorsiflexes, and the other toes fan out; this is Babinski’s sign, which indicates damage to the central nervous system.
As the lesion responsible for the sign expands, so does the area from which the afferent Babinski response may be elicited. The Babinski response is also normal while asleep and after a long period of walking.

Question 4

Cervical Myelopathy?

Answer 4

• Middle age / elderly
• Chronic neck pain
• Spondylosis - anterior or posterior
• Numb, clumsy hands
• Stiff, heavy legs - spasticity
• Upper motor neurone signs
• MRI scan & surgical decompression
- ACD & F, laminectomy

Question 5

cervical root compression?

Answer 5

• Spondylosis, disc prolapse
• C5/6 & C6/7
• Symptoms
- Brachalgia, numbness, pins/needles, weakness
• Lower motor neurone signs
- reduced sensation, reduced/absent jerks, wasting,
weakness
• MRI Scan

Question 6

lumbo-sacral root compression?

Answer 6

• Spondylosis, disc prolapse
• L5/S1 & L4/5
• Symptoms
- Sciatica, numbness, pins/needles, weakness
• Lower motor neurone signs
- reduced sensation, reduced/absent jerks, wasting,
weakness
• MRI Scan

Question 7

cauda equina syndrome?

Answer 7

• Younger adults
• Acute disc prolapse
• Severe back / leg pain
• Acute sphincter disturbance
• Lower motor neurone signs
- perianal sensory changes, reduced anal tone
• Urgent MR & decompression

Question 8

lumbe canal stenosis

Answer 8

• Elderly
• Spondylosis, LBP
• Often very reduced canal diameter
• Leg symptoms
- pain, numbness, cramps, heaviness
• Worse on walking
- rest, lean forwards
• Rarely sphincter disturbance
• MRI & decompression - laminectomy

Question 9

brown sequard syndrome?

Answer 9

• Compression of one half of cord
- tumour, cysts, trauma
• Ipsilateral weakness
• Ipsilateral loss of vibration / proprioception
• Contralateral pain / temperature loss

Question 10

central cord syndrome?

Answer 10

• Post-traumatic – hyper-extension
• Elderly
• Quadraparesis
- Arms > legs
• Sensation preserved
• Can recover
• Timing of surgery controversial

Question 11

conus compression?

Answer 11

• L1/2
• Tumours, osteoporotic crush #,
spondylosis
• Bilateral symptoms
• Often asymmetrical
• Lower motor neurone signs