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Neuro > Spinal Disorders > Flashcards

Spinal Disorders Flashcards

1
Q

Describe the atlas

A

C1 - ring shaped
Has anterior and posterior arch fusing to lateral masses
No body or spinous process
Foramen transversarium has vertebral arteries in

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2
Q

Describe the axis

A

Has body and odontoid process that projects anteriorly

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3
Q

What are some features of cervical vertebrae?

A

Uncinate processes - bony process of superolateral aspects of C3-7 which resist lateral flexion
Uncovertebral joint - uncinate process and superior vertebrae
Spinous process

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4
Q

What are features of thoracic spine?

A

Heart shaped body, small spinal canal, ribs articulate with transverse process and ribs makes the thoracic spine stiffer

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5
Q

What are features of lumbar spine?

A

Kidney shaped bodies, transmits body weight to sacrum, no costal facets and width increases inferiorly

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6
Q

What are the features of the sacral vertebrae?

A

Fuse and progressively become smaller forming the triangular shape
Transmits weight to pelvis
Divided into 3 zones - lateral, intermediate and medial zones

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7
Q

What are some spinal ligaments?

A

Anterior and posterior atlanto-occipital membrane, transverse ligament, cruciate, apical, alar, anterior longitudinal, posterior longitudinal, ligamentum flavum and supraspinous ligament

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8
Q

Describe the atlanto-occipital and atlanto-axial joints?

A

First one allows flexion, extension and some lateral flexion
Atlanto-axial is median pivot joint

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9
Q

Describe the intervertebral discs

A

Located C2-3 and L5-S1
Has nucleus pulposus, annulus fibrosus and end plates - diffusion of nutrients to bone

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10
Q

What is the three column theory?

A

Anterior - anterior longitudinal ligament, anterior of annulus fibrosis and vertebral body
Middle - posterior longitudinal, posterior annulus fibrosis and vertebral body
Posterior - osseous and ligamentous structures posterior
Stability depends on 2 of these being intact

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10
Q

How many spinal nerves are there?

A

31 pairs
8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

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11
Q

What are the main reflexes of the body?

A

Bicep, supinator, triceps, abdominal, cremasteric, knee, ankle, anal cutaneous and bulbocavernous

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12
Q

When can loss of bulbocavernous reflex be seen?

A

In spinal shock, conus medullaris and cauda equina lesions

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13
Q

What tracts control sensation?

A

Dorsal column - fine touch, joint position, vibration and proprioception
Lateral spinothalamic tract - pain + temp.
Anterior spinothalamic tract - light crude touch

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14
Q

Describe the notochord in embryology

A

Neural plate formed from ectoderm then neural groove to neural fold
This closes to form neural tube - takes 28 days
Tube gives rise to brain and spinal cord
Notochord - mesoderm forms bones of spine

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15
Q

Describe the anterior neuropore

A

Closes at 24 days
Failure to close results in anencephaly which is most common brain defect

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16
Q

Describe the posterior neuropore

A

Closes at 26-28 days
Failure to close results in spinal bifida

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17
Q

What can identify neural tube defects in high risk mothers?

A

Alpha fetoprotein and acetylcholinesterase from amniocentesis

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18
Q

What is spinal bifida?

A

Birth defect where there is incomplete closure of spine and membrane surrounding spinal cord

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19
Q

What are the risk factors of spinal bifida?

A

Low levels of folic acid before and after early pregnancy
FH
Diabetes and obesity
Anti-seizure drugs - sodium valproate

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20
Q

What are the types of spinal bifida?

A

Spinal bifida aperta - includes meningocele and myelomeningocele
Spinal bifida occulta - closed
Mainly in lumbar region but can be cervical

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21
Q

What is the clinical picture of spinal bifida?

A

Back swelling, low back motor deficit, sensory deficit, sphincter disturbance and associated back + lower limb deformities

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22
Q

What are the differences between meningocele and myelomeningocele?

A

Meningocele - covered by normal skin and contains CSF, is translucent, no neurological deficit
Myelomeningocele - sac is usually membranous, contains CSF and neural tissue, trans opaque, neurological deficit and sphincter deficit. Also associated to HCP

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23
Q

What is the treatment for spinal bifida?

A

Myelomeningocele - primary surgical closure
Intra uterine myelomeningocele repair (IUMR)

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24
Q

What is tethered cord syndrome?

A

Inelastic anchoring of the caudal spinal cord by abnormally thick or fatty filum terminale
Results in lumbosacral spinal cord being stretched and elongated
Presents with neurological, urological and orthopaedic signs

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25
Q

What could cause a spinal infection?

A

Pyogenic vertebral osteomyelitis and discitis
Granulomatous infections
Epidural infections
Postoperative infections

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26
Q

Describe pyogenic vertebral osteomyelitis and discitis

A

Discitis arises from hematogenous spread
Involve mainly the lumbar spine then thoracic then cervical being less
Most common - Staph aureus and streptococcus

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27
Q

What are the clinical symptoms and signs of pyogenic vertebral osteomyelitis and discitis?

A

Axial pain is most common and fever
Neurological changes in some patients - radicular numbness and muscle weakness

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28
Q

What are the investigations for pyogenic vertebral osteomyelitis?

A

WCC may increase, ESR, CRP is elevated, blood cultures, and urinalysis
Neuroimaging - X ray, CT and MRI

29
Q

What is the treatment for pyogenic vertebral osteomyelitis?

A

Fist line - broad spectrum IV antibiotics for 6-8 weeks
Immobilization for reducing pain and stabilises spine
Surgery needed if meds fail, neurological deterioration and spinal instability

30
Q

What are the risk factors for postoperative infections?

A

Increased age, obesity, diabetes, tobacco use, poor nutrition, prolonged surgical time and placement of instrument

31
Q

What is post operative infections associated with?

A

Longer hospital stays
Higher complication rates
Increased mortality

32
Q

How is post operative infections prevented?

A

Prophylactic antibiotics
If significant blood loss or gross contamination then intraoperative antibiotics

33
Q

What is the treatment for postoperative infections?

A

Open irrigation and debridement
IV antibiotics for 6 weeks and oral after

34
Q

What are the types of spinal cord tumours?

A

Extradural
Intradural extramedullary
Intramedullary

35
Q

What is the imaging used for spinal cord tumours?

A

Pain X ray and CT
MRI is gold standard

36
Q

What is the treatment of spinal cord tumours?

A

Surgical excision, biopsy and RT + chemo

37
Q

What are spinal emergencies?

A

Spinal epidural compression
Cauda equina and conus syndromes

38
Q

What are the causes of spinal hematomas?

A

Usually no factor identified
Anticoagulant therapy and vascular malformations
Trauma

39
Q

Describe spinal hematomas

A

Subdural, epidural, subarachnoid (can extend the whole length), intramedullary haemorrhage
Typically localised dorsally to spinal cord

40
Q

What are the clinical signs and symptoms of spinal hematomas?

A

Depends on location and extent of haemorrhage - motor weakness, sensory and reflex deficits and acute bladder/bowel dysfunction
Epidural and subdural - knife like pain
Meningitis like symptoms for subarachnoid

41
Q

What is the imaging and treatment for spinal hematomas?

A

MRI is gold standard
Coagulopathy and surgical decompression
Laminectomy

42
Q

What is cauda equina syndrome?

A

Surgical emergency that results from compressive, ischaemic and or inflammatory neuropathy of multiple lumbar and sacral nerve roots in lumbar spinal canal

43
Q

What is he aetiology of cauda equina syndrome?

A

Trauma, haemorrhage, inflammatory disease, infection, degenerative spine disease and spine tumours

44
Q

How does cauda equina syndrome present?

A

Leg pain, weakness, anaesthesia, saddle anaesthesia, bladder/bowel/ sexual dysfunction, decreased anal tone and absence of ankle reflex

45
Q

What are the types of cauda equina syndrome?

A

Incomplete - loss of urgency and decreased urinary sensation without incontinence of retention
Complete - urinary and bowel retention or incontinence

46
Q

What is the imaging and treatment for cauda equina syndrome?

A

MRI is gold standard
Treatment - surgical decompression within 24 hrs

47
Q

What is a primary spinal cord injury?

A

Trauma results in immediate death of local cells
1 - direct damage to cell bodies and/or neuronal processes
2 - damage to spinal axons

48
Q

What is secondary spinal cord injury?

A

Inflammation
Vascular events
Chronic phase of injury - demyelination and scar formation

49
Q

What are the vascular events which happen in spinal cord injury?

A

Damage to endothelial cells of local blood vessels so impaired blood flow - ischaemia
Impaired autoregulation and vasospasm at site - ischaemia
Neurogenic shock, bradycardia and hypotension
Influx of inflammatory cells so more inflammation and secondary tissue damage

50
Q

What is the definition of spinal shock?

A

Transient loss of neurological function below level of injury - flaccid paralysis and areflexia
Hypotension - shock
Duration is 72 hours but persists

51
Q

What are the multiple factors causing spinal shock?

A

Interruption of sympathetic
Loss of vascular tone - bradycardia
Relative hypovolemia - skeletal muscle paralysis
True hypovolemia - blood loss

52
Q

What is resolution of spinal shock first recognised by?

A

Return of the bulbocavernous reflex

53
Q

Describe a complete spinal cord injury

A

Complete loss of motor and sensory function below the level of injury in absence of spinal shock
Poor prognosis

54
Q

Describe incomplete spinal cord injury

A

Any residual motor or sensory function below level of injury
Sacral sparing, voluntary anal sphincter contraction or voluntary toe flexion

55
Q

Describe central cord injury

A

Incomplete - most common
Usually results from hyperextension injury in older patients with pre-existing stenosis
Can result in cord contusion
Associated with cervical fracture/ dislocation and traumatic cervical disc herniation

56
Q

What is the clinical symptoms of central cord syndrome?

A

Motor - weakness in UL more than LL
Sensory - loss below level of injury
Urine retention
Recovery is usually incomplete - LL first

57
Q

What is anterior cord syndrome?

A

Cord infarction in the territory supplied by anterior spinal artery
Can result from occlusion of anterior spinal artery or cord compression

58
Q

What is the presentation of anterior cord syndrome?

A

Paraplegia or quadriplegia
Dissociated sensory loss below lesion - loss of pain and temp. with preservation of 2 point discrimination, joint position and deep pressure

59
Q

What does Brown Sequard Syndrome manifest with?

A

Ipsilateral loss of joint position, vibration loss and discrimination, also spastic paresis below level of injury
Contralateral loss of pain and temp. one level below lesion

60
Q

What is primary and secondary assessment?

A

Primary - ATLS, airway, breathing, circulation and immobilisation
Secondary - GCS, identify axial skeleton fractures, pelvis fractures and appendicular skeleton

61
Q

What imaging is used for spinal cord injury?

A

X ray
CT
MRI

62
Q

What are indications for early decompression?

A

Incomplete spinal cord injury
Patients with progressive neurological deterioration

63
Q

Describe occipital condyle fracture

A

Rare and usually stable
Due to direct blow to head
Presents with loss of consciousness, cranio-cervical pain and rarely lower cranial nerve deficits

64
Q

Describe atlanto-occipital dislocation

A

Is common in children
Mechanism - hyperextension, distraction and rotation
Typically instant fatal injury and most have neurological deficits

65
Q

Describe fracture of the atlas

A

Can be of posterior/ anterior arch, both with intact or disrupted ligament, and lateral mass fractures
Usually neurologically intact

66
Q

Describe a fracture of the axis

A

Can be of the odontoid process, traumatic spondylolisthesis of axis and fractures of body

67
Q

Describe subaxial cervical spine fractures

A

Ligamentous or osseous
Can be unilateral (displacement less than 25%), bilateral (more than 50%), tear drop (have neurological deficit) and burst fractures

68
Q

Describe thorco-lumbar spine injuries

A

Thorco-lumbar junction is most frequently affected segment then lumbar and thoracic segments
Can be compression, burst, seat belt and fracture dislocations

69
Q

Describe sacral spinal injuries

A

Zone 1 - neurological injuries, L5 or sciatic nerve damage
2 - higher incidence of neurological deficit but no sphincter involvement
3 - highest rate of neurological damage as nearer central canal

70
Q

What surgical management of spine fractures?

A

Occipital condyle avulsion fractures, altanto-occipital dislocation, more than 5mm C1-2 displacement, neurological deficits, biomechanical instability and non union after 12 weeks

Neuro (40 decks)

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