Spinal cord & root compression Flashcards by E Thomas

How many vertebrae are there in the spine?

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How many spinal nerves are there? Divide them into sections

There are 30

C1 - C8
T1 - T12
L1- L5
S1 - S5

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Where are the ‘enlargements’ of the spine?

Cervical enlargement

Lumbrosacral enlargement

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Describe the features of spinal cord from top to bottom?

Starts at bottom of brainstem

Cervical enlargement

Lumbrosacral enlargement

Conus medullaris: the end of the spinal cord

Cauda equina: projections out of the conus medullaris

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Describe the structure of a vertebra bone?

Vertebral body

Vertebral foramen posterior to this

Transverse processes go out either side of the foramen

Spinous process goes out the back

The lamina links the transverse and spinous processes together

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What is the name of C1?

Atlas, carries the weight of the head

Like in mythology, atlas carrying the world

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What is the name of C2?

Axis

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What is sciatica?

Shooting pain from the lower back, through the buttocks and the leg that goes into the sole of the foot

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What causes sciatica?

Compression of any of the 5 nerve roots that contribute to the sciatic nerves

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Which spinal nerve roots contribute to the sciatic nerve?

L4
L5
S1
S2
S3

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Which spinal nerve roots supply the femoral nerve?

L2 - L4

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What parts of the body does the sciatic nerve contribute to?

Posterior compartment of thigh

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What is the structure of the vertebral discs?

Annulus fibrosis, hard-ish capsule on outside of disc

Nucleus pulposus: soft, fills centre of disc?

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What causes disc prolapse?

Degeneration due to age

Strenuous physical activity

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Describe what happens when a disc prolapses?

A weakness in the annulus fibrosis, means that the disc starts to protrude towards the spinal roots

The nucleus pulposus can leak out too

This can put pressure on the spinal cord or spinal roots causing symptoms

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Which discs of the spinal cord are more prone to prolapse?

Lumbar

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What is a disc herniation?

The same as a disc prolapse

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Clinical features or disc prolapse?

Back pain

Buttock, leg pain

Altered sensation

Motor weakness

Altered reflexes

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What causes the altered sensation and motor weakness in a disc prolapse?

The prolapsed disc is pressing on the spinal nerve roots?

Causing problems with motor and sensory nerve conduction

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What causes back pain in disc prolapse?

Pressing of herniated disc on the longitudinal ligament of the dura mater

A patient presents with pain from the buttocks down to the foot on his right side, he says the pain is worse on the lateral side of his foot.

On examination you find calf weakness and altered ankle reflexes.

Where is the disc prolapse?

The disc between L5 and S1 has prolapsed

The right S1 nerve root is being compressed

A patient presents with pain that radiates to his ankle and top of his foot on his left side

He has loss of sensation of the lateral side of his left leg, as well as the top of his left big toe.

Where is the disc prolapse?

The disc between L4 and L5 has prolapsed

The left L5 nerve root is being compressed

What is the sciatic stretch test?

A test that checks for damage affecting the sciatic nerve

Get the patient lying down
Lift the leg, keeping the knee straight
Move the ankle into a dorsiflexed position (so toes point back towards patient’s head) to lengthen the nerve further

If there is sciatic damage the patient will feel shooting pain, tingling, tight restricted feeling

Diagnosis of disc prolapse?

Clinical signs

Sciatic stretch test

Most cases of disc prolapse will require treatment to resolve them. True or false?

False 90% of cases resolve on their own

How does a disc prolapse resolve without intervention?

The herniated material becomes dehydrated, and can be reabsorbed

Management of disc prolapse?

Advise rest, analgesics and NAIDs If more severe provide physiotherapy Local steroid injections are sometimes indicated Advise them to come back if not resolved in 12 weeks If not resolved: MRI to look at herniation Microdiscectomy

When does a disc prolapse become an emergency?

If it results in cauda equina syndrome If there is compression on the spinal cord which results in progressive neurological deficits

What does spondylolisthesis mean?

Slippage of one vertebra out of position, either forward or back or laterally

What does spondylosis mean?

Degenerative disc disease

What does myelopathy mean?

Spinal cord disease

What does radiculopathy mean?

Spinal nerve root disease

Myelopathy VS radiculopathy?

Myelopathy = disease of spinal cord Radiculopathy = disease of spinal nerve root

What is cauda equina syndrome?

A medical emergency! A massive disc herniation where many nerves of the cauda equina are compressed

Does cauda equina syndrome occur acutely or chronically?

Acutely

Clinical features of cauda equina syndrome?

Impaired sphincter responses: - problems with micturition - post voidal incontinence Saddle anaesthesia: - numbness in saddle area - decreased anal tone Lower motor neuron signs in lower limbs: - paralysis - reduced reflexes

Where is the saddle area?

Perineal area If you were riding a horse, all the areas that would touch the saddle

Diagnosis of cauda equina syndrome?

MRI or CT (MRI preferred) Clinical signs and examination

Management of cauda equina syndrome?

Surgery ASAP, time is nerve function Surgical decompression, remove part of disc that has herniated and is putting pressure on cauda equina

What is the difference between simple disc prolapse and spinal cord compression?

Disc prolapse = radiculopathy, compression on spinal nerve roots Spinal cord compression = myelopathy, the compression is on the spinal cord

What are the causes of spinal cord compression?

Vertebral # caused by: Vertebral bone tumour (myeloma) or mets Osteoporosis (Spinal tuberculosis)

Clinical features of spinal cord compression?

Progressive weakness of legs Upper motor neuron pattern Anything below where the compression is affected by motor and sensory deficit Urinary incontinence

Why does myelopathy show an upper motor neuron pattern?

Damage is on spinal cord, which is the upper motor neuron

Why does radiculopathy show a lower motor neuron pattern?

Because the spinal nerve roots are lower motor neurons

Investigations of spinal cord compression?

Clinical signs MRI X-ray may show up any cancer

Management of spinal cord compression?

Emergency surgery to decompress spine Delay can lead to irreversible paraplegia Radiotherapy if not suitable for surgery (and malignant cause) Dexamethosone will reduce oedema around the lesion and can improve outcome

When should you call a neurosurgeon when you see a patient with possible disc prolapse or spinal cord compression?

If there are signs of cauda equina syndrome If there are progressive neurological defects After conservative management of a disc prolapse has failed

What is a microdiscectomy?

Removal of the herniated part of the disc to reduce the pressure on the spinal cord or spinal nerve roots