Spinal cord things-pathies

Question 1

What is vertebral pain syndrome
Symptoms
Signs
Causes

Answer 1

Aching pain - doesnt radiate, back stiffness, worse with movement but not neurological symptoms
[paravertebral muscle spasms and tenderness \/ ROM]

Usually wear and tear - rare causes: Tb, bacterial discitis/osteomyelitis, osteoporotic fractures, metastatic disease

Question 2

Red flags for back pain

Answer 2

Recent violent trauma (RTA), or minor trauma if osteoporotic
under 20 or over 50 (@new onset)
Hx of cancer, steroids, HIV/immunosuppression
Fever, chills, weight loss
Recent bacterial infection
neurological deficit in lower limbs
structural deformity
pain which is constant, severe, progressive, without relief with rest, morning stiffness

Question 3

myelopathy symptoms

Answer 3

pain in spine or radicular along dermatome
sensory disturbance along dermatome
weakness in lower limbs
bladder symptoms and incontinence

Question 4

Myelopathy - causes

Answer 4

pathology involving the spinal cord

disc-osteophyte cord compression
intervertebral disc prolapse
it is an injury to the spinal cord due to severe compression that may result from trauma, congenital stenosis, degenerative disease or disc herniation

Question 5

What is a radiculopathy and what are symptoms

Answer 5

Disease affecting nerve roots - usually from disc herniation or degenerative disease

• sensory changes - pins/needles, loss of sensation etc
• pain - may wake at night- neck, arm, dermatome of that nerve, sharp, radiating
• motor dysfunction (weakness)
• alteration in tendon reflexes
  in the distribution of a SINGLE specific nerve root
  Most commonly C6/7 upper / L5/S1 lower

usually unilateral - may be bilateral
usually gradual
may be exacerbated by coughing etc ^thoracic pressure

Question 6

Spinal claudication (neurogenic claudication)

Answer 6

bilateral radiating leg pain/paraesthesia which comes on with walking
need to rest or bend forwards to relieve it

symptom of lumbar spinal stenosis, ischaemia of the lumbar nerve roots (so a type of radiculopathy)

Question 7

Transverse myelitis

Answer 7

acute inflammatory disorder of spinal cord over days
usually after viral infection
(can be from SLE, sarcoidosis etc, infection, MS)

weakness/numbness of limbs, pins and needles feet up, bladder/bowel dysfunction

MRI
high dose steroids and antibiotics if infection

Question 8

Sub acute combined degeneration of the cord

Answer 8

peripheral+cord (combined) nerve damage

numbness/tingling of fingers/toes
distal sensory loss 
absent ankle jerks 
exaggerated knee jerks
upgoing plantar reflex

later - optic atrophy, retinal haemorrhage, sphincter disturbance, severe generalised weakness and dementia

Question 9

cauda equina syndrome symptoms

Answer 9

compresion of the cauda equina causing:
bladder/bowel dysfunction
saddle anaesthesia 
sexual dysfunction 
possible neurological deficit in lower limbs - asymmetrical (motor/sensory/reflex loss)
lower back pain 

sudden onset rapid progression

Question 10

At what level does the spinal cord end?

Answer 10

L1 - then the cauda equina is the nerves beyond this point

Question 11

cauda equina causes

Answer 11

lumbar disc herniation most common at L4/5 or L5/S1

also - tumours, trauma, infection, sarcoidosis etc etc

Question 12

cauda equina - what to do

Answer 12

emergency MRI

surgery to relieve pressure if stuff can be removed