Spinal Cord and Root Compression

Question 1

What is the pain experienced in spinal cord/root compression?

Answer 1

1. Midline spinal pain - worse at night and lying down

2. Radicular - brachialgia, sciatica

Question 2

What is the difference between root and cord compression in motor signs demonstrated?

Answer 2

1. Root - radiculopathy, LMN signs

2. Cord - myelopathy, UMN signs

Question 3

What are the motor manifestations of root/cord compression?

Answer 3

1. Arms - clumsy hands, distal worse than proximal, extensors weaker than flexors
2. Legs - stiff, tripping, flexors weaker than extensors

Question 4

What are the autonomic manifestations of root/cord compression?

Answer 4

1. Painless urinary retention
2. Bowel - constipation, poor tone
3. Sexual dysfunction

Question 5

What is myelopathy and how does it present?

Answer 5

1. Pathological condition of injury to the spinal cord

2. UMN signs, hyperreflexia, upgoing plantars, sensory deficits, bowel/bladder symptoms, sexual dysfunction.

Question 6

What is radiculopathy and how does it present?

Answer 6

1. Dysfunction of a nerve root.

2. Pain in root distribution, dermatomal sensory disturbances, weakness of muscles, hyporeflexia.

Question 7

What are the indications for surgery in acute disc prolapse?

Answer 7

1. Severe unremitting pain despite conservative measures
2. Recurrent attacks of pain, causing time lost at work
3. Development of a neurological deficit

Question 8

What are the causes of cord compression?

Answer 8

1. Degenerative bone disease
2. Disc prolapse
3. Trauma, fractures, malignancy, abscess, haematoma.

Question 9

What disc is the most common to prolapse and how does it manifest clinically?

Answer 9

1. L4/L5

2. Weak hallux extension, reduced dorsum sensation.

Question 10

In which age group is disc prolapse more common and why?

Answer 10

1. 25-50 year olds

2. Nucleus becomes drier above this age

Question 11

What is the difference between the natural history of pain in disc prolapse and degenerative spinal narrowing?

Answer 11

1. Prolapse - pain gets better

2. Narrowing - pain gets worse requiring surgery

Question 12

What are the clinical manifestations of an L5/S1 disc prolapse?

Answer 12

Calf pain, weak plantarflexion, reduced S1 sensation, reduced ankle jerk.

Question 13

What is sciatica?

Answer 13

Pain along the course of the sciatic nerve, usually resulting from nerve root compromise (L4/L5).

Question 14

What are the symptoms of sciatica?

Answer 14

1. Back pain progressing to leg pain, radiating down buttocks.
2. Pain worse on coughing
3. Weakness
4. Numbness
5. Bladder problems

Question 15

What are the signs of sciatica?

Answer 15

1. Antalgic gait
2. Reduced straight leg raise
3. Motor/sensory disturbance

Question 16

How is suspected sciatica investigated?

Answer 16

MRI and nerve conduction studies

Question 17

What is the management for sciatica?

Answer 17

1. 70% improve within 4 weeks
2. Conservative management - analgesia, physiotherapy
3. Epidural steroids if pain is intolerable
4. Surgery if - non-resolving, severe pain, progressive motor deficit, cauda equina syndrome