Spinal issues Flashcards
Who are spinal cord injuries seen in?
Males > females
20-29 years
What are the causes of spinal cord injuries?
Trauma Degenerative orthopaedic Tumours Spinal cord infarct Transverse myelitis Thoracoabdo aortic aneurysm
What are the most common traumatic causes pf spinal cord injury?
Falls
RTA
SPorts
What are the signs and symptoms of a complete spinal cord injury?
No motor or sensory function distal to lesion
No anal squeeze
No sacral sensation
ASIA grade A
What are the clinical features of an incomplete spinal cord injury?
Some function present below site of injury
ASIA grade B-D
What are the levels of the ASIA classification?
A= complete B= incomplete, sensory but no motor below lesion C= incomplete, motor function preserved grade <3 D= incomplete, motor function prserved grade >3 E= normal
What are the patterns of spinal cord injury?
Quadraplegia Paraplegia Central cord syndrome Anterior cord syndrome Brown- Sequard syndrome
What is quadriplegia?
Partial or total loss of use of all limbs and trunk
Spastic weakness
Rest failure if above C5
What is paraplegia?
Partial or total loss of use of lower limbs
Spastic weakness if injury above L1
Bladder and bowel involvement
Arms spared but trunk may be involved
Who is central cord syndrome seen in?
Older patients
What is central cord syndrome?
Hyperextension injury of neck where cervical tracts involved
Weakness of arms
Perianal and lower limbs preserved
What is anterior cord syndrome?
Hyperflexion injury causing anterior compression fracture and damaged anterior spinal artery
Profound weakness but vibratory sense, fine discrimination and proprioception spared
What is Brown-Sequard syndrome?
Hemisection of cord
Paralysis and loss of proprioception and fine touch of affected side below lesion and loss of pain and temperature sensation on opposite side
What is the most common cause of Brown Squared syndrome?
Penetrating injury
What causes neurogenic shock?
Injuries above T6
What does neurogenic shock cause?
Hypotension, bradycardia and hypotermia
Secondary to disruption of sympathetic outflow
What is spinal shock?
Transient depression of cord function below level of injury
Flaccid paralysis, areflexia
Lasts several hours to days
What is the emergent management of a spinal injury?
Airway
Breathing
Circulation- IV fluids
Disability- assess neurological function
What imaging is done for spinal injuries?
Xray and CT
MRI if neurological deficit or in children
What is the indication for surgical fixation in spinal injuries?
Unstable fracture
What is the long term management of spinal injuries?
Spinal cord injury unit Physio OT Psychological support Urological/sexual counselling
What causes radiculopathy?
Compressed nerve roots
What are the signs and symptoms of radiculopathy?
Limb pain worse than back pain
Root tension signs- using muscle exacerbates pain
Root compression signs- weakness and sensation changes
What is the treatment of radiculopathy?
Analgesia
Physio
Referral if no improvement after 12 weeks
What is disc prolapse?
Tearing of annual fibrosis, causing nucleus pulpous to protrude, compressing cord or nerve root
What are the types of disc prolapse?
Bulge
Protrusion
Extrusion
Sequestration
What is the most common type of disc prolapse?
Bulge
What is a disc protrusion?
Annulus weakened but still intact
What is a sequestrated disc?
Desiccated disc material free in canal
At what levels is disc prolapse most common?
C5/6
T11/12
L4/5
S1
What types of prolapse can happen in T vertebrae?
Cantral
Posteriolateral
Lateral
What is the most common type of disc hernuaion in lumbar vertebrae?
Posteriolateral
What are the signs and symptoms of a central disc prolapse?
UMN signs and symptoms
Back pain
What are the signs and symptoms of a lateral cord compression?
Compresses nerve roots
Limb pain is worse than back pain
Root tension signs- using muscle exacerbates pain
Root compression signs- weakness and sensation changes
What causes cauda equina syndrome?
Central lumbar disc prolapse Tumours Trauma or spinal stenosis Infection Iatrogenic
What are the clinical features of cauda equina?
Bilateral buttock and leg pain
varying dysaethesiae and weakness
Urinary retention +/- incontinence
What is the management of cauda equina syndrome?
Urgent MRI
Operation within 48 hours of onset
What does delay i operating in cauda equina syndrome cause?
Permanent dysfunction of bladder and anal sphincter
What is cervical and lumbar spondolysis?
Essentially OA of spine
Degenerative change, can include facet joints, discs, ligaments…
What can severe cervical and lumbar spondolysis cause?
Myelopthy and UMN signs in limbs
What are the main causes of spinal stenosis?
Ageing Arthritis Congenital Trauma Tumour Cysts
What are the clinical features of spinal stenosis?
Usually bilateral Sensory dysaethesia Posible weakness Relived by bendingg over, rest, sitting, walking uphill Worse walking down hill
What is the treatment of lateral recess stenosis?
Nerve root injection
Epidural
Surgery
What is the treatment of central stenosis?
Epidural steroid injection
Surgery
What is the treatment of foraminal stenosis?
Nerve root injection
Epidural injection
Surgery
