Spinal Disorders Flashcards
What are some causes of acute spinal cord compression?
Trauma
Tumours
Haemorrhage
Infection
What are some causes of chronic spinal cord compression?
Degenerative disease e.g. spondylosis
Tumours
Rheumatoid arthritis
What happens in complete spinal cord injury?
Complete loss of function from the affected level downwards
What will complete spinal cord injury cause initially?
What may appear later?
A flaccid, arreflexic paralysis known as spinal shock
UMN signs
Describe what pattern of deficits are seen in Brown Sequard syndrome?
Ipsilateral loss of motor function
Ipsilateral loss of light touch, vibration and proprioception sensation (dorsal columns)
Contralateral loss of pain and temperature sensation (spinothalamic)
In all spinal injuries which cause dysfunction of motor control - what pattern does this follow?
LMN weakness at the level of the lesion
UMN weakness below the level of the lesion
What is usually the cause of a central cord injury?
A hyperflexion or extension injury to an already stenotic neck
What happens in central cord syndrome?
Bilateral weeakness predominantly in the distal upper limbs
‘Cape like’ spinothalamic (pain and temperature) sensory loss
What is the classic cause of anterior cord injury?
What does this cause?
Vascular ischaemic stroke
Bilateral loss of pain and temperature sensation below the level of the lesion
Bilateral loss of motor function
What happens in posterior cord injuries?
Bilateral loss of light touch, proprioception and vibration sensation below the level of the lesion
Describe LMN weakness?
Describe UMN weakness?
‘Flaccid’ - reduced tone and reflexes
‘Spastic’ - increased tone and reflexes, clonus
What is the purpose of treatment for spinal cord compression?
What are the main steps of management?
To prevent further deterioration (does not usually improve things)
Immobilise
Investigation (x-ray/CT/MRI)
Decompress and stabilise surgically
? methyloprednisolone
What is spondylosis?
What is the most common type? What can this lead to?
A non-specific term for osteoarthritis or degenerative change affecting the spine
Cervical spondylosis - the most common cause of cervical myelopathy
Narrowing of the spinal canal above the level of L1 due to spondylosis causes what?
Narrowing of the spinal canal below the level of L1 due to spondylosis causes what?
Features of myelopathy and/or radiculopathy
Features of radiculopathy, or if the nerve roots responsible for bladder/bowel function are affected - cauda equina syndrome
What is radiculopathy?
What is the most common cause of this?
An abnormality which compresses or impinges on a spinal nerve root
A disc prolapse affecting either the lumbar or cervical spine
Describe the general presentation of radiculopathy?
LMN weakness affecting the specific myotome
Sensory loss in all modalities affecting the specific dermatome
Radiculopathy can cause pain in the area of skin/muscle supplied by that particular nerve root, how is this often described?
What can make it worse?
What is the typical pattern of pain in cervical radiculopathy?
What is the typical pattern of pain in lumbar radiculopathy?
Sharp, shooting, burning
Coughing, straining or movement
Neck pain which radiates down the arm
Lower back pain with associated sciatica
What is the primary investigation for most spinal problems and what is the purpose of this?
If that didn’t show anything, what would be the next line investigation?
MRI - to look for a compressive lesion
Nerve conduction studies
What are some treatment options for radiculopathy?
Physiotherapy and pain management (NSAIDs/neuropthic painkillers)
Surgery - only used last line, must weigh up risks and benefits
(Remember there is no difference in outcome after 1-2 years)
What is the most common cause of cervical myelopathy?
What is the onset like?
Does myelopathy cause unilateral or bilateral symptoms?
Why is this more severe than radiculopathy?
Cervical spondylosis
Slow and insidious
Bilateral
The symptoms are irreversible
Describe the general presentation of myelopathy?
What is a sign that is almost pathognomonic of cervical myelopathy?
LMN features at the level of the lesion
UMN features below the level of the lesion
Generalised hyper-reflexia, especially in the lower limbs
What are some pathological reflexes which may be seen in cervical myelopathy?
Babinski’s sign (upgoing plantars)
Hoffman’s sign (flick the middle finger causes flexion and adduction of the thumb)
Clonus
What is Lhermitte’s sign, which may be seen in cervical myelopathy but also other pathologies?
When does it occur?
An uncomfortable electrical sensation which runs down their back and into the limbs
On certain head movements
If a patient has a compressive lesion causing cervical myelopathy, what is the management and why?
Decompressive surgery - doesn’t make it better but will prevent it getting worse
Describe briefly the neurological presentation which is seen in cauda equina syndrome?
LMN pattern of weakness affecting the most distal muscles of the leg
Decreased sensation in all sensory modalities of areas supplied by sacral nerve roots - ‘saddle anaesthesia’
Bladder and bowel abnormalities (due to disruption of sacral autonomic fibres)
What is the management of cauda equina syndrome?
Urgent MRI and decompressive surgery as soon as possible, ideally within 24 hours
What is lumbar spinal stenosis?
Who is it generally seen in?
What can it lead to?
Narrowing of the central spinal canal
People aged > 50
Spinal claudication
What is failed back syndrome?
What are some risk factors for this?
People who still complain of neck or back pain following spinal surgery
Diabetes, smoking, high BMI, depression/anxiety
What is syringomyelia?
When does this present?
In which segment of the spinal cord is it most common?
What are some clinical risk factors for this?
What are some treatment options?
A rare condition in which a cyst forms in the spinal cord
Often in the 30s, but can range from childhood-seventies
Cervical
Traumatic paraplagia (spinal trauma) or Chiari malformations
Surgery or shunting, depending on the cause
What are the main neurological clinical features of syringomyelia?
LMN features at the level of the lesion (often most pronounced distally)
Loss of pain and temperature sensation in the arms
UMN signs below the level of the lesion
Excessive sweating
