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Neurology > Spinal Diseases > Flashcards

Spinal Diseases Flashcards

1
Q

What are some causes of Lower back pain.

A
  • Mechanical back pain
  • Lumbar disc herniation
  • Cauda equina
  • Lumbar stenosis
  • Malignancy
  • Trauma
  • Infection (e.g. TB)
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2
Q

What is the most common cause of back pain?

A

Mechanical back pain.

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3
Q

What causes Mechanical Back pain?

A

Lots of factors:
- Obesity
- Lack of Exercise
- Strain on paraspinal muscles
- Facet joint OA

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4
Q

What age do people typically get mechanical back pain?

A

Between 20 and 55 years old.

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5
Q

What things may a patient complain with if they have mechanical back pain?

A

Morning stiffness which resolves with movement.
Pain which is made worse by prolonged sitting or when rising from seated.

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6
Q

What kind of pain can patients get if the facet joints get hypertrophied?

A

Referred pain from the nerve supplying the facet joint.
- Mimics Sciatica
- However, doesn’t radiate below the knee.

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7
Q

What are some red flags for low back pain?

A

Age >60 or <20 yrs.
Pain not improved by rest.
Pain waking patient in the night.
Urinary retention/incontinence and faecal incontinence.
Saddle Anaesthesia.
Malignant Hx.
Unexplained Wt loss.
Fever, Immunosuppression or IV drug Abuse.

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8
Q

What does a Lumbar disc herniation describe?

A

When the nucleus herniates through a tear in the annulus ring and compresses the adjacent nerve roots.

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9
Q

What levels are the most common for lumbar disc herniation?

A

L4/5 and L5/S1

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10
Q

What is the likely mechanisms of injury for Lumbar disc herniation in old vs young patients?

A

Young: Strain on the spine e.g. carrying heavy loads.

Old: Due to Degeneration of the vertebrae or spondylosis.

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11
Q

What is Radiculopathy?

A

Dysfunction of a nerve root causing a dermatomal sensory deficit with weakness of the muscle groups supplied by that nerve.

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12
Q

What is Sciatica?

A

Pain along the sciatic nerve usually due to compression of its nerve roots (L4-S3).

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13
Q

What is the pain pattern in sciatica?

A

Shooting pain radiating from the buttocks down to the posterior knee/leg.
Pain can be exaggerated by coughing or sneezing.

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14
Q

What is a positive Straight leg raise in Sciatica?

A
  • Patient lying on their back.
  • Lift patients leg with knee straight.
  • If angle to which the leg can be raised before eliciting the patients sciatic pain is <45 then the test is said to be positive.
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15
Q

L5/S1 prolapsed intervertebral disc (root involved is S1).
What are the signs seen clinically?

A
  • Pain along the posterior thigh with radiation to the heel.
  • Weakness of plantar flexion (on occasion)
  • sensory loss in the lateral foot.
  • Reduced or absent ankle jerk.
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16
Q

L4/5 prolapsed intervertebral disc (root involved is L4).
What are the clinical signs seen?

A
  • Pain along the posterior or posterolateral thigh with radiation to the dorsum of the foot and great toe.
  • Weakness of dorsiflexion of the toe or foot.
  • Parasthesia and numbness of the dorsum of the foot and great toe.
  • Reflex changes unlikely.
17
Q

L3/4 prolapsed intervertebral disc (root involved is L4)
What are the signs seen clinically?

A
  • Pain in anterior thigh
  • Wasting of Quadraceps muscle.
  • Weakness of the Quadraceps function and dorsiflexion of the foot.
  • Diminished sensation over the anterior thigh, knee and medial aspect of lower leg.
  • Reduced knee jerk.
18
Q

What are the Indications for surgery in a Lumbar disc prolapse (discectomy)?

A
  • Failure of conservative Tx (physiotherapy and analgesia) - First line management.
  • Central disc prolapse (Bilateral sciatica or sphincter disturbance, diminished perineal sensation)
  • Tumour
  • Neurological deficits.
19
Q

How is Cauda-equina usually diagnosed?

A
  • Lumbosacral MRI and Digital rectal exam to assess for lack of anal sphincter tone and perianal numbness.
20
Q

What are the common causes of Lumbar Spinal Stenosis?

A
  • Hypertrophy of facet joints and Ligamentum flavum.
  • Protruding intervertebral discs.
  • Spondylolisthesis.
21
Q

What are the symptoms caused in Lumbar Stenosis?

A

Neurogenic claudication.
- unilateral or bilateral hip, buttock or lower extremity pain or burning sensation.

Made worse with standing or back extension and relieved by sitting, lumbar flexion or walking uphill.

22
Q

What does Neurogenic Intermittent Claudication refer to in Spinal Stenosis?

A

Leg weakness, tingling and numbness which can be accompanied by paresthesia.

23
Q

What is Cervical Spondylosis?

A

A Degenerative arthritic process involving the cervical spina and affecting the intervertebral disc and zygapophyseal joints.

24
Q

Does a degenerative cervical myelopathy cause upper or lower motor signs?

A

Upper

25
Q

What occurs to the cervical disc with age in Cervical Spondylosis?

A

Reduction of water content and fragmentation of the nucleus pulposus causing a degenerative problem

26
Q

What are the clinical features of Cervical Spondylosis?

A
  • Radiculopathy - lateral compression of a nerve causes LMN signs in the upper and lower limbs.
  • Myelopathy
  • Radiculopathy and Myelopathy often present together.
27
Q

What is Degenerative Cervical Myelopathy?

A

Myelopathy that can result from spinal cord compression which causes Upper motor neurone signs with symptoms more prominent in the lower limbs.

28
Q

In which patients does Degenerative cervical myelopathy usually occur?

A

Older patients.
- causes a deterioration of the patients gait and thus, is an important cause of falls in elderly.

29
Q

What symptoms are seen in Degenerative cervical Myelopathy?

A

A progressive condition so early symptoms usually subtle.
- imbalance and disturbance of gait
- Clumsy hands (difficulty holding fork, buttoning shirt)
- Legs jump at night due to hyperreflexia.

30
Q

What is the Gold Standard investigation of Degenerative cervical myelopathy?

A

MRI of the cervical spine Gold standard.

31
Q

What is the treatment of Degenerative Cervical Myelopathy?

A

Early treatment offers best chance of full recovery (most present too late)
- Decompressive spinal surgery
- Aim of Tx prevent further deterioration rather than improving symptoms.

32
Q

How do spinal cord compression syndromes occur?

A
  • Mechanical compression
  • Secondary ischaemic damage.
33
Q

What are the two types of Spinal cord compression syndromes?

A

Acute - Trauma, tumours (haemorrhage or collapse), Infection or spontaneous bleed.
Chronic - Degeneration (spondylosis), Tumours, Rheumatoid Arthritis.

34
Q

What is Anterior cord syndrome?

A

Cord infarction by the area supplied by the anterior spinal artery.

35
Q

What clinical features would a patient complain of with anterior cord syndrome?

A

Paralysis and loss of pain and temperature below the level of injury.
Preserved proprioception and vibration sensation.

36
Q

What is Brown-Sequard Syndrome?

A

Cord Hemisection damage - can occur due to penetrating injury or other cause.

37
Q

What ipsilateral and contralateral symptoms with a patient with Brown-Sequard syndrome complain of?

A
  • Ipsilateral upper motor neuron paralysis and loss of proprioception below the lesion.
  • Contralateral loss of pain and temperature sensation beginning at 1 or 2 segments below the lesion.
38
Q

What is central cord syndrome?

A

Caused by acute extension injury to already stenotic neck or syringomyelia or tumour,, causes a “Cape-like” Spinothalamic sensory loss (pain and temperature).

39
Q

Where does weakness predominate in Central Cord syndrome?

A

Predominantly bilateral upper limb weakness > Lower limb (the fibres supplying the upper limbs in the lateral corticospinal tracts are more medial to the fibres supplying the lower limbs, hence a lesion in the central cord is more likely to damage the upper limb fibres)
- Dorsal columns preserved.

Neurology (13 decks)

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