Spinal disorders Flashcards
What is myelopathy?
Damage to the spinal cord
What is myelitis?
Inflammation of the sPINAL CORD
What are the general signs that indicate spinal cord lesion?
Mixed UMN and LMN signs
Sensory signs
Sphincter involvement
Autonomic dysfunction
Bilateral, asymmetrical signs
What are the red flags for back pain?
Focal neurological deficit
History of trauma
Osteoporosis
Pain at night
Unexplained weight loss
History of malignancy
Fever
Thoracic pain
What are the signs of UMN lesion?
Weakness
Spastic paresis
Disuse atrophy
No fasciculations
Hyperreflexia
Hypertonia
Extensor plantar response (Babinski sign)
Upper limb: strong flexors, weak extensors
Lower limb: strong extensors, weak flexors
What are the signs of LMN lesion?
Weakness
Flaccid paresis
Wasting atrophy
Fasciculations
Hyporeflexia
Hypotonia
Flexor plantar response
What are the sensory signs of spinal cord pathology?
Ipsilateral: loss of touch, vibration and joint position sense
Contralateral: loss of pain and temperature sensation
What are some causes of myelopathy?
Tumour
Degenerative disease
Trauma
Vascular abnormalities
Demyelination
Autoimmune
Infection
B12 deficiency
Malignancy
Idiopathic
What is the presentation of B12 deficient myelopathy?
Hands and feet paraesthesia
Areflexia
First UMN signs- extensor plantars
Degeneration of:
- Corticospinal tracts → paraplegia
- Dorsal columns → sensory ataxia
Painless retention of urine
What is the classification of spinal disorders?
Congenital
Infection
Tumour
Emergency
Injury (trauma)
What are the types of spinal congenital anomalies?
Spina bifida
Tethered cord syndrome
What is spina bifida?
Birth defect in which there is incomplete closure of the spine
What is the clinical embryology of spina bifida?
Anterior neuropore failure to close at 24 days= anencephaly
Posterior neuropore failure to close at 26 days = spina bifida
What blood tests i done during pregnancy to identify open neural tube defects?
Alpha fetoprotein obtained from amniocentesis at 16 weeks of pregnancy
What are the risk factors for spina bifida?
- Low levels of folic acid during early pregnancy
- FH
- Diabetes
- Obesity
- Anti-seizure drugs
What is the classification of spina bifida?
Spina bifida occulta- closed
Spina bifida aperta- open
- Meningocele
- Myelomeningocele
What are the features of meningocele?
Lumbosacral
Sac covering is normal skin
Sac contains CSF
Translucent
No neurological deficit
Intact sphincters
Uncommon associated hydrocephalus
What are the features of myelomeningocele?
Lumbosacral
Sac covering is membranous
CSF and neural tissue
Transopaque
Neurological deficit
Double incontinence
Associated hydrocephalus
What is the clinical presentation of spina bifida?
Abnormal tuft of hair
Back swelling
Lower limb deficits- paraplegia
Sensory deficits- hypoesthesia
Sphincter distubrnace- incontinence
Back deformities- scloiosis
Lower limb deformities- clubbed feet
What is the treatment of myelomeningocele?
Surgical closure within 24hrs
Treat hydrocephalus
Treat bladder/bowel incontinence
Physiotherapy
What is tethered cord syndrome?
Inelastic anchoring of caudal spinal cord by an abnormally thick or fatty filum terminale
What are the types of spinal infections?
- Pyogenic vertebral osteomyelitis and discitis
- Granulomatous infections
- Epidural infections
- Postop infections
What is pyogenic vertebral osteomyelitis and discitis?
Infection of bone and IV disc
Most common in thoracic region
What are the causative organisms of pyogenic vertebral osteomyelitis and discitis?
Staph aureus.
Strep
What are the features of pyogenic vertebral osteomyelitis and discitis?
Axial pain
Fever
Radicular numbness, muscle weakness
Elevated CRP
What is the management of pyogenic vertebral osteomyelitis and discitis?
Blood cultures - causative pathogen
Urinalysis and culture- rule out UTI
Broad spectrum antibiotics
Surgery- debridement of infected tissue, decompression of neural structures and stabilization of spine
What are the types of spinal tumours?
Intradural
- Intramedullary: ependymoma, astrocytoma, hemangioblastoma
- Extramedullary
Extradural
- Metastases
- Bone cancers
What are the types of spinal emergencies?
Spinal epidural compression (haematoma, abscess)
Cauda equina syndrome
Conus medullaris syndrome
What are the features of spinal haematoma?
Collection of blood that compresses the spinal cord and nerve roots
Epidural/subdural- knife like pain
Subarachnoid- meningism
Motor weakness
Sensory deficits
Reflex deficits
Bowel/bladder dysfunction
What are the features of cauda equina syndrome?
Gradual, unilateral presentation
Ankle and knee jerks affected
More severe radicular pain
Saddle anaesthesia
Asymmetric, areflexia, paraplegia
Late presentation of urinary retention
What are the features of conus medullaris syndrome?
Sudden, bilateral presentation
Only ankle jerks affected
Less severe radicular pain
Saddle anaesthesia
Symmetric, hyperreflexia, distal paresis of lower limbs
Urinary and faecal incontinence
What is the aetiology of cauda equina syndrome?
Trauma- spinal fracture
Haemorrhage- epidural haematoma
Inflammatory disease
Infection- epidural abscess
Degenerative disease
Spinal tumours
What are the 2 types of cauda equina syndrome?
Incomplete- no incontinence or retention
Completer- urinary and bowel incontinence
What part of the spine is most commonly affected in spinal cord injury?
Cervical spine
What is primary spinal cord injury?
Direct damage to cell bodies
Direct damage to axons
What is secondary spinal cord injury?
Inflammation
Ischaemia
Demyelination
Scar formation
What is spinal shock?
Result of severe spinal cord injury
Transient loss of all neurological function below the lesion
What reflex is used to check the status of spinal shock?
Bulbocavernosus reflex
What is the bulbocavernosus reflex?
Compression of glans penis or clitoris results in external anal sphincter contraction via the pudendal nerve
What are the types of spinal cord injury?
Complete- complete loss of all motor and sensory function
Incomplete- residual motor and sensory function
What are the types of incomplete spinal cord injury?
Central cord syndrome
anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome
What are the features of central cord syndrome?
Most common
Also called syringomyelia
Associated with cervical fracture and cervical disc herniation
Due to development of fluid filled cyst around spinal canal
UL weakness >LL
Loss of pain and temperature sensation
Which tracts are damaged in central cord syndrome?
Corticospinal
Spinothalamic
What are the features of anterior cord syndrome?
Cord infarction in area supplied by anterior spinal artery
Bilateral loss of pain and temperature sensation
Bilateral spastic paresis
Fine touch, proprioception and vibration sense preserved
What tracts are damaged in anteriro cord syndrome?
Corticospinal
Spinothalamic
What are the features of posterior cord syndrome?
Posterior spinal artery
Bilateral damage to dorsal columns- bilateral loss of fine touch, proprioception and vibration sense
Spinothalamic tracts spared
What tracts are damaged in posterior cord syndrome?
Corticospinal maybe
Dorsal columns
What are the features of Brown-Sequard syndrome?
Hemi cord syndrome
Ipsilateral loss of fine touch, proprioception and vibration sense
Ipsilateral spastic paresis
Contralateral loss of pain and temperature
What tracts are damaged in Brown-Sequard syndrome?
Corticospinal
Spinothalamic
Dorsal columns
