Spinal injuries

Question 1

When would you get a central cord injury?
Which limbs are affected most?
Prognosis?

Answer 1

Typically hyperextension injury
Arms worse than legs
Prognosis variable but generally good

Question 2

Brown-Sequard injury?

Answer 2

Paralysis on ipsilateral side
Hypaesthesia on contralateral side
Best prognosis

Question 3

Anterior cord injury:

Usual cause?

Answer 3

Motor  loss
Loss  of  pain  and  temperature  sense
Deep  touch, position  and  vibration  preserved
May have  traumatic  or  vascular  cause
Prognosis  poor

Question 4

Treatment for children with unstable spine and ligament reduction?

Answer 4

Postural reduction

Question 5

Ankylosing spondylitis, how would you NOT treat?

Answer 5

DO NOT GIVE COLLAR!! Immobilise in natural postition

If you are suspicious of injury –> CT is MANDATORY

Question 6

Injury classically lifting heavy object

Pain worse on coughing

Answer 6

Disc tear

Question 7

Treatment for acute disc tear

Answer 7

is characteristically worse on coughing (which increases disc pressure).

Symptoms usually resolve but can take 2‐3 months to settle.

Analgesia and physiotherapy are the mainstay of treatment.

Question 8

L4, L5 and S1 form what?

Answer 8

Sciatic nerve

Question 9

Treatment for sciatica/lumar radiculopathy

Answer 9

First line treatment is with analgesia, maintaining mobility and physiotherapy.

Occasionally drugs for neuropathic pain (eg Gabapentin) can be used if leg pain is particularly severe. The majority of cases are dealt with in primary care with around 80‐90% of disc prolapses recovering spontaneously by 3 months.

Very occasionally surgery (discectomy) is indicated when pain is not resolving despite physiotherapy and there are localising signs suggesting a specific nerve root involvement and positive MRI evidence of nerve root compression. Again evidence of secondary gain (compensation claim, disability benefit) or psychological dysfunction is usually a predictor of poor outcome of surgery and a contra‐indication. Discectomy has a small risk of permanent neurologic injury (less than 1%)

Question 10

Treatment for bony nerve root entrapment?

Answer 10

Surgical decompression, with trimming of the impinging osteophytes, may be performed in suitable candidates.

Question 11

Spodylolysis

Answer 11

Defect in the pars interarticularis (like where one vertebrae articulates with the other)

Question 12

Spondylolisthesis

Answer 12

The forward slipping of one vertebrae over another

May co-exist with spondylolysis

Question 13

When can you give surgery for spondylolysis/spondylolisthesis?

Answer 13

When conservative treatment has failed
Adolescent with > 50% slip
Progressive neurological deficit
Postural deformity